Mortality pattern trends and disparities among Chinese from 2004 to 2016

Evolving trends, regional differences, determinants, and disease sources of provincial-level health inequalities in china 1990-2019: a temporal convergence and novel triple decomposition analysis

BACKGROUND

Promoting health equity has been a worldwide goal, but serious challenges remain globally and within China. Multiple decomposition of the sources and determinants of health inequalities has significant implications for narrowing health inequalities and improve health equity.

METHODS

Life expectancy (LE), healthy life expectancy (HALE), age-standardized mortality rate (ASMR), and age-standardized disability-adjusted life-year (DALY) rates in 31 provinces of mainland China were selected as health status indicators, obtained from the Global Burden of Disease (GBD) database. Temporal convergence analysis was used to test the evolving trends of health status. Dagum's Gini coefficient decomposition was used to decompose the overall Gini coefficient based on intraregional and interregional differences. Oaxaca-Blinder decomposition was used to calculate contributions of determinants to interregional differences. The factor-decomposed Gini coefficient was used to analyze the absolute and marginal contribution of each component to overall Gini coefficients.

RESULTS

From 1990-2019, China witnessed notable improvements in health status measured by LE, HALE, ASMR and age-standardized DALY rates.Nevertheless, the three regions (East, Central and West) exhibited significant inter-regional differences in health status, with the differences between the East and West being the largest. The adjusted short-term conditional β-convergence model indicated that the inter-provincial differences in LE, HALE, ASMR, and age-standardized DALY rates significantly converged at annual rates of 0.31%, 0.35%, 0.19%, and 0.28% over 30 years. The overall Gini coefficients of LE, HALE, and age-standardized DALY rates decreased, while the ASMR exhibited an opposite trend. Inter-regional and intra-regional differences accounted for >70% and <30% of overall Gini coefficients, respectively. Attribution analysis showed that socioeconomic determinants explained 85.77% to 91.93% of the eastern-western differences between 2010-2019, followed by health system determinants explaining 7.79% to 11.61%. The source-analysis of Gini coefficients of ASMR and age-standardized DALY rates revealed that noncommunicable diseases (NCDs) made the largest and increasing absolute contribution, while communicable, maternal, neonatal, and nutritional diseases (CMNNDs) had a diminishing and lower impact. However, NCDs exerted a negative marginal effect on the Gini coefficient, whereas CMNNDs exhibited a positive marginal effect, indicating that controlling CMNNDs may be more effective in reducing health inequities.

CONCLUSIONS

Regional differences are a major source of health inequities in China. Prioritizing prevention and control of CMNNDs, rather than NCDs, may yield more pronounced impacts on reducing health inequalities from the perspective of marginal effect, although NCDs remain the largest absolute contributor to health inequalities.

A Continuous Non-Invasive Blood Pressure Prediction Method Based on Deep Sparse Residual U-Net Combined with Improved Squeeze and Excitation Skip Connections

Arterial blood pressure (ABP) serves as a pivotal clinical metric in cardiovascular health assessments, with the precise forecasting of continuous blood pressure assuming a critical role in both preventing and treating cardiovascular diseases. This study proposes a novel continuous non-invasive blood pressure prediction model, DSRUnet, based on deep sparse residual U-net combined with improved SE skip connections, which aim to enhance the accuracy of using photoplethysmography (PPG) signals for continuous blood pressure prediction. The model first introduces a sparse residual connection approach for path contraction and expansion, facilitating richer information fusion and feature expansion to better capture subtle variations in the original PPG signals, thereby enhancing the network's representational capacity and predictive performance and mitigating potential degradation in the network performance. Furthermore, an enhanced SE-GRU module was embedded in the skip connections to model and weight global information using an attention mechanism, capturing the temporal features of the PPG pulse signals through GRU layers to improve the quality of the transferred feature information and reduce redundant feature learning. Finally, a deep supervision mechanism was incorporated into the decoder module to guide the lower-level network to learn effective feature representations, alleviating the problem of gradient vanishing and facilitating effective training of the network. The proposed DSRUnet model was trained and tested on the publicly available UCI-BP dataset, with the average absolute errors for predicting systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean blood pressure (MBP) being 3.36 ± 6.61 mmHg, 2.35 ± 4.54 mmHg, and 2.21 ± 4.36 mmHg, respectively, meeting the standards set by the Association for the Advancement of Medical Instrumentation (AAMI), and achieving Grade A according to the British Hypertension Society (BHS) Standard for SBP and DBP predictions. Through ablation experiments and comparisons with other state-of-the-art methods, the effectiveness of DSRUnet in blood pressure prediction tasks, particularly for SBP, which generally yields poor prediction results, was significantly higher. The experimental results demonstrate that the DSRUnet model can accurately utilize PPG signals for real-time continuous blood pressure prediction and obtain high-quality and high-precision blood pressure prediction waveforms. Due to its non-invasiveness, continuity, and clinical relevance, the model may have significant implications for clinical applications in hospitals and research on wearable devices in daily life.

Clinical analysis of twenty-one cases of acute ischemic stroke related to Trousseau syndrome

BACKGROUND

Trousseau syndrome (TS) is relatively rare and easily overlooked by clinicians, causing misdiagnosis and affecting subsequent treatment.

OBJECTIVE

In this study, clinical features, laboratory examination, imaging features, treatment, and prognosis of patients with TS were discussed.

METHODS AND MATERIAL

From February 2018 to April 2022, cases of 21 patients with malignant tumors complicated by acute ischemic stroke (AIS) were admitted to the Neurology Department of the hospital, and were retrospectively analyzed and discussed based on the literature.

RESULTS

Twenty-one cases were included in the study. Of these, 95.23% (20/21) developed AIS 6-21 months after the onset of malignant tumors, 9.52% (2/21) had ischemic stroke as the first symptom, 4.76% (1/21) had recurrent ischemic stroke, and 14.29% (3/21) subsequently experienced venous and arterial thrombosis events; 80.95% (17/21) were pathologically confirmed to have adenocarcinoma; and 90.47% (19/21) of infarction cases involved multiple blood vessel feeding sites. MRI showed multiregional, multifocal patchy infarcts. D-dimer concentration was higher than normal in all patients. In addition, 61.90% (13/21) of the patients had poor outcomes according to mRS.

CONCLUSION

TS is a rare clinical type. It is often associated with adenocarcinoma, and the treatment is different from that of conventional cerebral infarction and the prognosis is very poor. In clinical practice, for AIS of unknown cause, if MRI shows multiple small lesions accompanied by a significant increase in D-dimer, routine screening for latent malignant tumors is recommended.

Health benefits of vehicle electrification through air pollution in Shanghai, China

Vehicle electrification has been recognized for its potential to reduce emissions of air pollutants and greenhouse gases in China. Several studies have estimated how national-level policies of electric vehicle (EV) adoption might bring very large environmental and public health benefits from improved air quality to China. However, large-scale adoption is very costly, some regions derive more benefits from large-scale EV adoption than others, and the benefits of replacing internal combustion engines in specific cities are less known. Therefore, it is important for policymakers to design incentives based on regional characteristics - especially for megacities like Shanghai - which typically suffer from worse air quality and where a larger population is exposed to emissions from vehicles. Over the past five years, Shanghai has offered substantial personal subsidies for passenger EVs to accelerate its electrification efforts. Still, it remains uncertain whether EV benefits justify the strength of incentives. The purpose of our study is to evaluate the health and climate benefits of replacing light-duty gasoline vehicles (ICEVs) with battery EVs in the city of Shanghai. We assess health impacts due to ICEV emissions of primary fine particulate matter, NOx, and volatile organic compounds, and to powerplant emissions of NOx and SO2 due to EV charging. We incorporate climate benefits from reduced greenhouse gas emissions based on existing research. We find that the benefit of replacing the average ICEV with an EV in Shanghai is US$6400 (2400-14,700), with health impacts of EVs about 20 times lower than the average ICEV. Larger benefits ensue if older ICEVs are replaced, but replacing newer China ICEVs also achieves positive health benefits. As Shanghai plans to stop providing personal subsidies for EV purchases in 2024, our results show that EVs achieve public health and climate benefits and can help inform policymaking strategies in Shanghai and other megacities.

Health benefits from the reduction of PM2.5 concentrations under carbon tax and emission trading scheme: a case study in China

Climate policies could improve air quality, thereby generating health benefits and thus increasing labour input for economic growth. Nevertheless, health benefits are usually overlooked in evaluation frameworks of climate policies. In this paper, a dynamic recursive computable general equilibrium (CGE) model is adopted to define how climate policies are related to air pollution, namely [Formula: see text] concentrations. Health benefits of climate policies are divided into reduction of [Formula: see text]-related morbidity and mortality. The CGE model results show that both carbon tax and emission trading scheme (ETS) decrease morbidity and mortality; therefore, under climate policies, [Formula: see text]-related labour loss decreases, and thus increasing labour input triggers an economic boom. Carbon tax generates more health benefits in short term, while health benefits of ETS policy will gradually increase in long term. Hence, we conclude that regarding health benefits, a long-term ETS policy is preferable to a long-term carbon tax. This finding implies that the recently established nationwide ETS market in China is meaningful, as it will generate more health benefits in future. Nevertheless, the quantified health benefits in this paper still cannot compensate GDP loss induced by climate policy implementations, implying that it is a challenging task to unbiasedly model health benefits of climate policies. Hence, we have recommended that the scopes and contents of health benefits should be expanded in evaluations of climate policies.

Incidence and Predictors of Mortality among Community-Dwelling Older Adults in Malaysia: A 5 Years Longitudinal Study

With older adults accounting for 10.7% of the Malaysian population, determining the predictors of mortality has now become crucial. Thus, this community-based longitudinal study aimed to investigate the predictors for mortality among community-dwelling older adults using a wide range of factors, including clinical or subclinical. A total of 2322 older adults were interviewed and assessed by trained fieldworkers using validated structured questionnaires. The questionnaire consisted of information on socio-demographic characteristics, health status, neuropsychological and psychosocial functions, lifestyle, dietary intake and biophysical measures. The incidence rate of mortality was 2.9 per 100 person-years. Cox regression analysis indicated that advancing age (Adjusted Hazard Ratio, Adj HR = 1.044, 95% CI: 1.024–1.064), male (Adj HR = 1.937, 95% CI: 1.402–2.675), non-married status (Adj HR = 1.410, 95% CI: 1.078–1.843), smoking (Adj HR = 1.314, 95% CI: 1.004–1.721), a higher fasting blood sugar (Adj HR = 1.075, 95% CI: 1.029–1.166), a lower serum albumin (Adj HR = 0.947, 95% CI: 0.905–0.990), a longer time to complete the TUG test (Adj HR = 1.059, 95% CI: 1.022–1.098), and a lower intake of total dietary fibre (Adj HR = 0.911, 95% CI: 0.873–0.980) were the predictors of mortality in this study. These findings provide an estimated rate of multiethnic mortality in middle-income countries and diet is one of the predictors. These predictors of mortality could be a reference in identifying new public health strategies to ensure longer healthier life spans with lower disability rate among community-dwelling older adults in Malaysia.

Urban-rural lifespan disparities and cause-deleted analysis: evidence from China

OBJECTIVES

To examine the length and dispersion level of lifespan for the subnational populations in China, identify the urban-rural gap and sex differences, and analyse the contribution made by causes of death.

SETTING

Cause-specific mortality data extracted from the Chinese Disease Surveillance Points system, grouped by sex and urban/rural residence.

PRIMARY OUTCOME MEASURES

Life expectancy and lifespan disparity are used to measure the length and dispersion level of lifespan, respectively. Cause-specific contributions are obtained by contrasting cause-deleted life expectancy and lifespan disparities with observed values.

PARTICIPANTS

Aggregated national data gathered from over 605 surveillance points across China, covering over 264 million people by 2016 (about 19.14% of the total Chinese population).

RESULTS

In the decade under observation, all subpopulations in China, by area and sex, experienced increases in life expectancy and decreases in lifespan disparity, while causes of deaths contributed differently. For example, based on the 2016 data, if cardiovascular diseases were deleted, there would be an increase in life expectancy that ranges from 5.59 years for urban males to 6.69 years for rural females. However, also lifespan disparity would increase, ranging from 0.81 years for urban females to 1.37 years for rural males.

CONCLUSIONS

In China, the urban-rural gaps in both life expectancy and lifespan disparity are shrinking as the rural residents are catching up fast, while the gender gaps remain large, and even widening. Causes of death with different age distribution patterns contribute differently to the level and direction of the urban-rural and sex differentials in life expectancy and lifespan disparity. Sex differentials were observed in cardiovascular diseases, respiratory diseases, lung and liver cancers, and external causes, while urban-rural differences were found in lung and breast cancers, and external causes.

Gender Disparities of Heart Disease and the Association with Smoking and Drinking Behavior among Middle-Aged and Older Adults, a Cross-Sectional Study of Data from the US Health and Retirement Study and the China Health and Retirement Longitudinal Study

Heart disease remains the leading cause of death globally by gender and region. Smoking and alcohol drinking are known modifiable health behaviors of heart disease. Utilizing data from the US Health and Retirement Study and the China Health and Retirement Longitudinal Study, this study examines heart disease disparities and the association with smoking and drinking behavior among men and women in the US and China. Smoking and drinking behavior were combined to neither, smoke-only, drink-only, and both. In the US, the prevalence was higher in men (24.5%, 95% CI: 22.5-26.6%) than in women (20.6%, 95% CI: 19.3-22.1%) and a higher prevalence was found in the smoke-only group for both genders. In contrast, women in China had higher prevalence (22.9%, 95% CI: 21.7-24.1%) than men (16.1%, 95% CI: 15.1-17.2%), and the prevalence for women who smoked or engaged in both behaviors were ~1.5 times (95% CI: 1.3-1.8, p < 0.001) those who did not smoke or drink, but no statistical difference were found in men. The findings might be due to differences in smoking and drinking patterns and cultures by gender in the two countries and gender inequality among older adults in China. Culturally tailored health promotion strategies will help reduce the burden of heart disease.

Provision of physical activity advice for patients with chronic diseases in Shenzhen, China

BACKGROUND

Physical activity (PA) may best be promoted to patients during clinical consultations. Few studies investigated the practice of PA advice given by physicians, especially in China. This study aimed to investigate the prevalence and contents of PA advice given by physicians in China and its association with patients' characteristics.

METHODS

Face-to-face questionnaire asking the prevalence and contents of PA advice given by physicians was administered to adult patients in three major hospitals in Shenzhen, China. Attitude of compliance, stature, PA level, and socio-demographic information were also collected. Data was analyzed via descriptive statistics and binary logistic regression.

RESULTS

Of the 454 eligible patients (Age: 47.0 ± 14.4 years), only 19.2% (n = 87) reported receiving PA advice, whereas 21.8%, 23.0%, 32.2%, and 55.2% of patients received advices on PA frequency, duration, intensity, and type, respectively. Male patients were more likely to receive PA advice from physicians [odds ratio (OR): 1.81; 95% confidence interval (CI): 1.08-3.05], whereas patients who were unemployed (OR: 0.16; 95% CI: 0.04-0.67), and who already achieved adequate amount of PA (OR: 0.29; 95% CI: 0.12-0.71) were less likely to receive PA advice.

CONCLUSIONS

Prevalence of physicians providing physical activity advice to patients is low, there is a pressing need to take intervention measures to educate healthcare providers.

More to Explore: Further Definition of Risk Factors for COPD - Differential Gender Difference, Modest Elevation in PM2.5, and e-Cigarette Use

Chronic obstructive pulmonary disease (COPD) is a severe respiratory disease with high morbidity and mortality, representing the third leading cause of death worldwide. Traditional risk factors for COPD include aging, genetic predisposition, cigarette smoking, exposure to environmental pollutes, occupational exposure, and individual or parental respiratory disease history. In addition, latest studies have revealed novel and emerging risk factors. In this review, differential gender difference as a factor for COPD development at different territories is discussed for the first time. First, women seem to have more COPD, while more women die of COPD or have more severe COPD, in Western societies. This seems different from the impression that COPD dominants in men, which is true in Eastern societies. It might be related to higher rate of cigarette smoking in women in developed countries (i.e., 12.0% of women in United States smoke vs. 2.2% in China). Nonetheless, women in Eastern societies are exposed to more biomass usage. Second, modest elevation in PM2.5 levels at >∼21.4-32.7 μg/m3, previously considered "cleaner air," is associated with incidence of COPD, indicating that more stringent goals should be set for the reduction of PM2.5 levels to prevent COPD development. Last but not least, e-cigarette use, which has become an epidemic especially among adolescents as officially declared by the United States government, has severe adverse effects that may cause development of COPD early in life. Built upon an overview of the established risk factors for COPD primarily focusing on cigarette smoking and environmental pollutions, the present review further discusses novel concepts, mechanisms, and solutions evolved around the emerging risk factors for COPD discussed above, understanding of which would likely enable better intervention of this devastating disease.

Trend of the mortality of major liver diseases and its impact on life expectancy in China from 2006 to 2017

BACKGROUND

Liver diseases are the serious cause of death in China. We aim to describe the trends and disparities of major liver disease mortality rates and the loss of life expectancy (LLE) in China.

METHODS

Annual percentage change (APC) and average APC (AAPC) were calculated using the Joinpoint regression model. LLE was calculated using cause eliminated life table.

RESULTS

From 2006 to 2017, the overall age-standardized mortality rate (ASMR) of liver cirrhosis lightly declined (AAPC: -2.97%), whereas the ASMR of viral hepatitis and liver cancer remained stable. Viral hepatitis (AAPC: -4.36%) and liver cirrhosis (AAPC: -4.35%) ASMRs both declined for females. The highest ASMRs of viral hepatitis and liver cirrhosis were in the west region, while that of liver cancer was in the middle region. The ASMRs of liver cirrhosis in the middle region and liver cancer in the east region significantly decreased. The means of LLE on viral hepatitis, liver cirrhosis and liver cancer were 0.05, 0.1 and 0.46 years, respectively.

CONCLUSIONS

The burden of liver diseases is still severe and there are disparities between genders and different regions in China. Accurate early diagnostic approaches for high-risk populations should be established to eliminate the burden of liver diseases.

Cross-sectional study of the prevalence and risk factors of metabolic syndrome in a rural population of the Qianjiang area

The prevalence of the metabolic syndrome (MS) is increasing in China, but there are disparities between urban and rural populations, and across different regions.To examine the prevalence and risk factors of MS in the rural area of Qianjiang (Southwest China).From March 2016 to June 2018, 6 townships in the Qianjiang District of Chongqing Municipality were selected for a cross-sectional study of the residents in rural areas. Demographics and medical history were collected using a questionnaire. Anthropometry and blood pressure were obtained by physical examination. Blood lipids, fasting plasma glucose, and 2-h postprandial glucose were measured.A total of 2949 (1067 males and 1882 females) were included. The mean age was 63.8 ± 10.7 years. The prevalence of MS in the study population was 16.8% (496/2949). The prevalence of MS was 7.4% in men, 22.2% in women, 15.7% in Han, 18.1% in Tujia, and 14.8% in Miao. According to age, the prevalence of MS was 10.6%, 17.0%, and 18.3% in the 30-50, 50-69, and ≥ 70 years groups. The multivariable analysis showed that female sex (OR = 33.36, 95%CI: 17.0-65.53), dyslipidemia (OR = 4.71, 95%CI: 1.73-12.82), kidney diseases (OR = 2.32, 95%CI: 1.37-3.94), waistline (OR = 1.39, 95%CI: 1.33-1.46), high-density lipoprotein cholesterol (OR = 0.12, 95%CI: 0.06-0.23), triglycerides (OR = 1.52, 95%CI: 1.31-1.76), alanine aminotransferase (OR = 0.98, 95%CI: 0.97-1.00), γ-glutamyltransferase (OR = 1.00, 95%CI: 1.00-1.01), and glycated hemoglobin (OR = 1.31, 95%CI: 1.08-1.59) were independently associated with MS.The prevalence of MS was 16.8% in Qianjiang. Female sex, kidney diseases, alanine aminotransferase, and γ-glutamyltransferase were independent risk factors for MS.