Association between urbanisation and the risk of hyperuricaemia among Chinese adults: a cross-sectional study from the China Health and Nutrition Survey (CHNS)

Prevalence and related factors of hyperuricaemia in Chinese children and adolescents: a pooled analysis of 11 population-based studies

BACKGROUND AND AIMS

Hyperuricaemia can lead to gout and is associated with an increased risk of cardiometabolic disease. We aimed to investigate the prevalence of hyperuricaemia and its related factors in Chinese children and adolescents.

METHODS

We pooled data from 11 population-based studies comprising 54,580 participants aged 3-19 years. The sex- and age-standardized prevalence of hyperuricaemia was estimated overall and by sex, age, weight status, geographic region and survey year.

RESULTS

Serum uric acid (SUA) increased gradually from 3 to 11 years with no significant sex difference, and then increased dramatically during 11-15 years. The estimated overall prevalence of hyperuricaemia was 23.3% (26.6% in boys and 19.8% in girls, p < .001). The prevalence increased with growing age (3.7, 9.8, 15.8, 35.5 and 31.7% among children aged 3-5, 6-8, 9-11, 12-15 and 16-19 years, respectively, p for trend < .001) and with increasing weight status (18.2, 37.6, 50.6 and 64.5% among children with non-overweight, overweight, obesity and extreme obesity, respectively, p for trend < .001). The prevalence was higher in North than in South (24.2 vs. 19.7%, p < .001), and increased markedly from 16.7% during 2009-2015 to 24.8% during 2016-2019. In multivariable regression analyses, sex, age, obesity, region and survey year were independently associated with odds of hyperuricaemia.

CONCLUSIONS

The prevalence of hyperuricaemia in Chinese children and adolescents is unexpectedly high. The findings suggest an urgent need to implement effective interventions to reduce risk of hyperuricaemia in Chinese youths.KEY MESSAGESQuestion: What is the prevalence of hyperuricaemia in Chinese children and adolescents?Findings: In this large pooled cross-sectional study comprising >50,000 children and adolescents aged 3-19 years, we found that the prevalence of hyperuricaemia was high in overall population and subgroups of sex, age, obesity, region and survey year.Meaning: Our findings indicate that hyperuricaemia is an important health problem in Chinese children and adolescents, and effective intervention strategies are needed to reduce its burden.

Adherence to DASH Dietary Pattern and Its Association with Incident Hyperuricemia Risk: A Prospective Study in Chinese Community Residents

Hyperuricemia represents a great burden on global public health, and it is important to provide effective guidance at the level of dietary patterns. We evaluated the association between the Dietary Approaches to Stop Hypertension (DASH) diet and the risk of hyperuricemia in a large-scale, community-based cohort in East China. In total, 45,853 participants that did not have either hyperuricemia nor gout were included and assigned a DASH dietary score based on their baseline dietary intake. They were then divided into five quintiles (Q1−Q5) according to their score, followed by cross-linkages with local health information systems and in-person surveys. Cox proportional hazards models were adopted to calculate hazard ratio (HR) and 95% confidence intervals (CIs). During a median follow-up of 4.54 years, 2079 newly diagnosed hyperuricemia cases were documented. Compared to the DASH Q1 group, the risk of incident hyperuricemia for the Q5 group was significantly reduced by 16% (HR: 0.84; 95% CIs: 0.72−0.97) in the adjusted model. The associations of DASH diet with hyperuricemia appeared stronger (P for interaction <0.001) among participants with 3−4 cardiometabolic diseases at baseline, compared with their counterparts. Our results suggest that the DASH diet could be taken into account in the recognition of risk population and the prevention of hyperuricemia.

The Effect of Urbanization on Health Care Expenditure: Evidence From China

This paper investigates the impact and non-linear effects of urbanization on health care expenditure in China. The results indicate that urbanization in both Eastern and Central regions can significantly increase health care expenditure. But the impact of urbanization is not significant, which is related to the backward economic development level and low urbanization rate in the Western region. Taking population aging into consideration, the results of the panel threshold regression model imply that the positive relationship between urbanization and health care expenditure becomes greater when the level of population aging exceeds 10.72% in the Eastern region and 7.00% in the Western region. Therefore, in the urbanization process, the government should pay attention to the positive effect of urbanization on health care expenditure, provide more financial support for the construction of medical facilities, and expand the coverage of medical services and security for residents, especially for elderly people.

Medical Students' Perspective and Knowledge of Asymptomatic Hyperuricemia and Gout Management: A Cross-Sectional Study

The prevalence and incidence of gout doubled from 1990 to 2017. Therefore, we can expect that a number of doctors have come across a patient with gout in their daily practice. Hence, we wanted to investigate how familiar our medical students, as future medical professionals, are with gout. This cross-sectional survey included Medical Studies students from the two largest universities in Croatia: the University of Split School of Medicine, and the University of Zagreb School of Medicine, and included a total of 221 fifth or sixth year medical students. Most students gave correct answers to questions about treatment approach and non-pharmacological interventions in asymptomatic hyperuricemia (>80%). Less than 3% of all students agreed they knew enough about care for patients with asymptomatic hyperuricemia, whereas almost 15% thought they were well familiar with care for gout patients. Less than 8% of students considered their school education adequate on both topics, and less than 2% were aware of the existence of EULAR guidelines. Physicians lacking in the latest knowledge on the pathophysiology of gout, the influence of lifestyle, and genetic factors limits their ability to properly manage gout. With increasing prevalence, gout should be more represented in medical students’ education.

Hypertension Prevalence Rates Among Urban and Rural Older Adults of China, 1991-2015: A Standardization and Decomposition Analysis

Objectives: The prevalence of hypertension (HTN) among older adults is becoming an important issue in public health in China as it is now stepping into the super-aged society with high pressure of a chronic disease burden. With urban–rural differences in population composition and health facilities, this study aimed to assess the gaps in the prevalence trends of HTN among older adults by considering demographic factors such as age, gender, education level, and regional differences during 1991–2015 in China.

Methods: We adopted the consistent sampling design and measure of HTN of the cross-longitudinal surveys of the China Health and Nutrition survey, and we compared the HTN prevalence rates between urban and rural older adults by taking each wave of the survey as a cross-sectional sample of the Chinese population by the following and supplementary samples. The classic standardization and decomposition analysis method was utilized with four factor-specific rates, and contributions were calculated, i.e., age, gender, education, and region, which reflects the aspect of demographic and social development differences between urban and rural areas of China.

Results: The prevalence rates of HTN of the whole of older adults were increasing in 1991–2015. However, the gaps of prevalence rates of HTN between urban and rural areas show different trends accompanied by the health policies launched by the government. Namely, the gap was narrowed during 1993–1997 and then enlarged during 1997–2011 and narrowing again. Those trends reflect the policy effects with the health resource allocation and utilization of health services for urban and rural older adults.

Conclusions: With the four factors of decomposition analysis, the differences reflect the results of health policy effects, considering the urban–rural discrepancy on older adults with different demographic characteristics. Hence, the differentiated policies should be considered with the urban–rural population, such as HTN prevention and the population health promotion.