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Lin JJ, Dai PY, Zhang J, Guan YQ, Gong WW, Yu M, Fang L, Hu RY, He QF, Li N, Wang LX, Liang MB, Zhong JM. Association between metabolic syndrome severity score and cardiovascular disease: results from a longitudinal cohort study on Chinese adults. Front Endocrinol (Lausanne) 2024; 15:1341546. [PMID: 38654930 PMCID: PMC11036864 DOI: 10.3389/fendo.2024.1341546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 03/25/2024] [Indexed: 04/26/2024] Open
Abstract
Objective This study aimed to quantify the severity of metabolic syndrome(MetS) and investigate its association with cardiovascular disease(CVD) risk on Chinese adults. Methods 13,500 participants from the Zhejiang Adult Chronic Disease Study were followed up between 2010 and 2021. A continuous MetS severity score derived from the five components of MetS was used to quantify MetS severity, and the association between MetS severity and the risk of incident CVD was assessed using Cox proportional hazard and restricted cubic spline regression. Results Both the presence and severity of MetS were strongly associated with CVD risk. MetS was related to an increased risk of CVD (hazard ratio(HR):1.700, 95% confidence interval(CI): 1.380-2.094). Compared with the hazard ratio for CVD in the lowest quartile of the MetS severity score, that in the second, third, and highest quartiles were 1.812 (1.329-2.470), 1.746 (1.265-2.410), and 2.817 (2.015-3.938), respectively. A linear and positive dose-response relationship was observed between the MetS severity and CVD risk (P for non-linearity = 0.437). Similar results were found in various sensitivity analyses. Conclusion The MetS severity score was significantly associated with CVD risk. Assessing MetS severity and further ensuring intervention measures according to the different severities of MetS may be more useful in preventing CVD.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Jie-ming Zhong
- Department of Chronic and Non-communicable Disease Prevention and Control, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
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2
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He D, Qin K, Li J, Li Y, Chen Z, Xu J, Zhu Y. Increased incidence risks of cardiovascular disease among cancer patients: Evidence from a population-based cohort study in China. Int J Cardiol 2024; 396:131362. [PMID: 37722455 DOI: 10.1016/j.ijcard.2023.131362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 08/20/2023] [Accepted: 09/15/2023] [Indexed: 09/20/2023]
Abstract
BACKGROUND Cardiovascular disease (CVD) is becoming a major concern among cancer patients, leading to the development of a new field named cardio-oncology. However, previous studies were mainly based on the western population and focused on CVD mortality. Evidence from the Chinese population is limited. Furthermore, few studies investigated the incidence risks of CVD among cancer patients. METHODS 85,787 eligible cancer patients were included from Hangzhou city, China. Age-standardized standard incidence ratio (SIR) was used to reflect the incidence risks of CVD among cancer patients as compared with the standard population, which was defined as all residents in Hangzhou city during the same period. RESULTS After three years of follow-up, cancer patients showed elevated incidence risks of CVD (SIR = 1.41, 95%CI: 1.35-1.47) as compared with the standard population. The elevated risks of CVD were highest in the first year after cancer diagnosis (SIR = 1.68, 95%CI: 1.58-1.78), then followed by the second (SIR = 1.21, 95%CI: 1.11-1.31) and the third (SIR = 1.18, 95%CI: 1.07-1.29) year. These results were consistent in males and females. Furthermore, different risks of CVD were observed among different cancer sites. Patients with pancreatic cancer showed the highest risks of CVD, then followed by liver cancer, lung cancer, kidney cancer, gastric cancer, bladder cancer, prostate cancer, and colorectal cancer. CONCLUSIONS Cancer patients have increased incidence risks of CVD, especially in the first year after cancer diagnosis. The increased risks of CVD vary by different cancer sites. Our findings highlight the importance of paying close attention to the CVD risks among cancer patients.
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Affiliation(s)
- Di He
- Department of Epidemiology & Biostatistics, School of Public Health, and Department of Respiratory Disease, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Kang Qin
- Hangzhou Center for Disease Control and Prevention, 568 Mingshi Road, Shangcheng District, Hangzhou, Zhejiang, China
| | - Jun Li
- Department of Epidemiology & Biostatistics, School of Public Health, and Department of Respiratory Disease, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Yuhao Li
- Department of Epidemiology & Biostatistics, School of Public Health, and Department of Respiratory Disease, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Zhaohui Chen
- Department of Epidemiology & Biostatistics, School of Public Health, and Department of Respiratory Disease, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Jue Xu
- Hangzhou Center for Disease Control and Prevention, 568 Mingshi Road, Shangcheng District, Hangzhou, Zhejiang, China.
| | - Yimin Zhu
- Department of Epidemiology & Biostatistics, School of Public Health, and Department of Respiratory Disease, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China; Cancer Center, Zhejiang University, Hangzhou, Zhejiang, China.
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3
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Xie P, Li X, Guo F, Zhang D, Zhang H. Direct medical costs of ischemic heart disease in urban Southern China: a 5-year retrospective analysis of an all-payer health claims database in Guangzhou City. Front Public Health 2023; 11:1146914. [PMID: 37228711 PMCID: PMC10203198 DOI: 10.3389/fpubh.2023.1146914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 04/11/2023] [Indexed: 05/27/2023] Open
Abstract
Introduction This study aimed to estimate the direct medical costs and out-of-pocket (OOP) expenses associated with inpatient and outpatient care for IHD, based on types of health insurance. Additionally, we sought to identify time trends and factors associated with these costs using an all-payer health claims database among urban patients with IHD in Guangzhou City, Southern China. Methods Data were collected from the Urban Employee-based Basic Medical Insurance (UEBMI) and the Urban Resident-based Basic Medical Insurance (URBMI) administrative claims databases in Guangzhou City from 2008 to 2012. Direct medical costs were estimated in the entire sample and by types of insurance separately. Extended Estimating Equations models were employed to identify the potential factors associated with the direct medical costs including inpatient and outpatient care and OOP expenses. Results The total sample included 58,357 patients with IHD. The average direct medical costs per patient were Chinese Yuan (CNY) 27,136.4 [US dollar (USD) 4,298.8] in 2012. The treatment and surgery fees were the largest contributor to direct medical costs (52.0%). The average direct medical costs of IHD patients insured by UEBMI were significantly higher than those insured by the URBMI [CNY 27,749.0 (USD 4,395.9) vs. CNY 21,057.7(USD 3,335.9), P < 0.05]. The direct medical costs and OOP expenses for all patients increased from 2008 to 2009, and then decreased during the period of 2009-2012. The time trends of direct medical costs between the UEBMI and URBMI patients were different during the period of 2008-2012. The regression analysis indicated that the UEBMI enrollees had higher direct medical costs (P < 0.001) but had lower OOP expenses (P < 0.001) than the URBMI enrollees. Male patients, patients having percutaneous coronary intervention operation and intensive care unit admission, patients treated in secondary hospitals and tertiary hospitals, patients with the LOS of 15-30 days, 30 days and longer had significantly higher direct medical costs and OOP expenses (all P < 0.001). Conclusions The direct medical costs and OOP expenses for patients with IHD in China were found to be high and varied between two medical insurance schemes. The type of insurance was significantly associated with direct medical costs and OOP expenses of IHD.
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Affiliation(s)
- Peixuan Xie
- Department of Health Policy and Management, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Xuezhu Li
- Department of Health Policy and Management, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Feifan Guo
- Department of Health Policy and Management, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Donglan Zhang
- Division of Health Services Research, New York University Long Island School of Medicine, Mineola, NY, United States
| | - Hui Zhang
- Department of Health Policy and Management, School of Public Health, Sun Yat-sen University, Guangzhou, China
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Zhao Y, Hua X, Ren X, Ouyang M, Chen C, Li Y, Yin X, Song P, Chen X, Wu S, Song L, Anderson CS. Increasing burden of stroke in China: A systematic review and meta-analysis of prevalence, incidence, mortality, and case fatality. Int J Stroke 2023; 18:259-267. [PMID: 36274585 DOI: 10.1177/17474930221135983] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The epidemiology of stroke is evolving in China as the population undergoes demographic, lifestyle, and economic transitions. An updated review is pertinent to providing feedback on current, and in planning future, prevention and management strategies. AIMS To identify high-quality epidemiological studies for quantifying the prevalence, incidence, mortality, and case fatality for stroke in China. METHODS A search was undertaken across a range of bibliographic databases on 30 November 2021 without time limitation. Assessments were made of the risk of bias of the included studies. The outcomes were synthesized using a random-effects model. Subgroup analysis and meta-regression models were used to define the source of heterogeneity. RESULTS Of 9407 identified records, 26 population-based studies were included. Due to significant heterogeneity across the studies, the original range for crude rates of indices was wide. The pooled annual prevalence was 1329.5/100,000 (95% confidence interval (CI) 713.6-2131.9, p < 0.001), incidence 442.1/100,000 (327.6-573.8, p < 0.001), mortality 154.1/100,000 (52.6-308.8, I2 = 100%, p < 0.001), and case fatality 35.8% (26.1% to 46.1%, I2 = 97%, p < 0.001). The prevalence and incidence of stroke have increased, but stroke-related case fatality has declined in China over recent decades. There are significant regional and rural-urban differences in incidence rates. CONCLUSION Despite improved public health policies and healthcare delivery, the burden of stroke remains high in China. Further coordinated efforts are required in prevention and community care to offset the likelihood of further expansion in the absolute number of stroke cases in this large population.
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Affiliation(s)
- Yang Zhao
- The George Institute for Global Health China, Beijing, China.,The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Xing Hua
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Xinwen Ren
- The George Institute for Global Health China, Beijing, China
| | - Menglu Ouyang
- The George Institute for Global Health China, Beijing, China.,The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Chen Chen
- The George Institute for Global Health China, Beijing, China.,The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia.,Neurology Department, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Yunke Li
- The George Institute for Global Health China, Beijing, China
| | - Xiaoya Yin
- The George Institute for Global Health China, Beijing, China.,Shanghai Municipal Center for Disease Control & Prevention, Shanghai, China
| | - Peige Song
- School of Public Health and Women's Hospital, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, China
| | - Xiaoying Chen
- The George Institute for Global Health China, Beijing, China.,The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Simiao Wu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Lili Song
- The George Institute for Global Health China, Beijing, China.,The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Craig S Anderson
- The George Institute for Global Health China, Beijing, China.,The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia.,Department of Neurology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
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5
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Yu S, Guo X, Li G, Yang H, Zheng L, Sun Y. Low educational status correlates with a high incidence of mortality among hypertensive subjects from Northeast Rural China. Front Public Health 2022; 10:951930. [PMID: 36091501 PMCID: PMC9453591 DOI: 10.3389/fpubh.2022.951930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 08/08/2022] [Indexed: 01/24/2023] Open
Abstract
Objective Cumulative evidence indicates that education plays a major role in predicting cardiovascular risk factors. In this study, we intend to examine the possible relationship between education status and mortality in a large general subject from rural China. Methods Adult hypertensive subjects (n = 5,227, age = 57.22 ± 10.18 years; 49.1% men) were recruited from general population surveys (Northeast China Rural Cardiovascular Health Study). Their educational status was categorized into two groups as follows: (1) Low education (illiterate or lower than primary school) and (2) medium-high education (higher than primary school). Cardiometabolic comorbidities, related cardiovascular risk factors, and echocardiographic measurements were analyzed in both groups. Results Less educated hypertensive subjects had significantly higher prevalence of obesity, diabetes, dyslipidemia, and left ventricular hypertrophy than medium-high educated hypertensive subjects. In the medium-high educated subjects, a significant increase in left ventricular ejection fraction and lower rate of antihypertensive medication was found. Cox proportional hazards analysis indicated that medium-high education was independently associated with all-cause mortality (hazard ratio = 0.76; 95% confidence interval, 0.58, 0.99; P = 0.043) and cardiovascular mortality (hazard ratio = 0.65; 95% confidence interval, 0.44, 0.96; P = 0.028). Conclusion Education may act as the best predictor of all-cause and cardiovascular mortality in rural hypertensive subjects. This finding suggests that in rural areas, education is likely to represent a cardiovascular specific risk factor and should be evaluated in the strategies of hypertension.
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Affiliation(s)
- Shasha Yu
- Department of Cardiology, First Hospital of China Medical University, Shenyang, China
| | - Xiaofan Guo
- Department of Cardiology, First Hospital of China Medical University, Shenyang, China
| | - GuangXiao Li
- Department of Clinical Epidemiology, Institute of Cardiovascular Diseases, First Hospital of China Medical University, Shenyang, China
| | - Hongmei Yang
- Department of Cardiology, First Hospital of China Medical University, Shenyang, China
| | - Liqiang Zheng
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yingxian Sun
- Department of Cardiology, First Hospital of China Medical University, Shenyang, China,*Correspondence: Yingxian Sun
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Bipolar Disorder and Cardiovascular Risk in Rural versus Urban Populations in Colombia: A Comparative Clinical and Epidemiological Evaluation. Ann Glob Health 2021; 87:112. [PMID: 34824993 PMCID: PMC8603855 DOI: 10.5334/aogh.3479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Various multifactorial elements may contribute toward the urban and rural disparities in cardiovascular disease (CVD) risk, particularly among patients with psychiatric diseases. Objective: To investigate whether rural patients diagnosed and treated for Bipolar Disorder (BD) have different risk profiles and outcomes of CVD compared to urban (BD) patients. Methods: We conducted a case-control study that included 125 BD patients (cases) from rural Filadelfia, Colombia and 250 BD patients (controls) treated in Bogotá, Colombia. Cases and controls were 2:1, matched by age and sex. We applied the Framingham Heart Study (FHS) risk calculator to assess risk. Differences by rural/urban status (i.e., case-control status) were assessed by chi-square, paired t-tests, and logistic regression. Findings: Rural BD patients were found to have lower education (p = 1.0 × 10–4), alcohol consumption (p = 3.0 × 10–4), smoking (p = 0.015), psychiatric (p = 1.0 × 10–4) and CV family history (p = 0.0042) compared to urban BD patients. Rural BD patients were 81% more likely to have a more favorable CVD risk profile (OR: 0.19, 95% CI [0.06–0.62]) than urban BD patients, despite rural BD patients having increased CVD morbidity (p = 1.0 × 10–2). Conclusion: Based on increase in morbidity but lower predictive risk in the rural population, our study suggests that the FHS-CVD calculator may not be optimal to assess CVD risk in this population.
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Wei X, Zhang Z, Chong MKC, Hicks JP, Gong W, Zou G, Zhong J, Walley JD, Upshur REG, Yu M. Evaluation of a package of risk-based pharmaceutical and lifestyle interventions in patients with hypertension and/or diabetes in rural China: A pragmatic cluster randomised controlled trial. PLoS Med 2021; 18:e1003694. [PMID: 34197452 PMCID: PMC8284676 DOI: 10.1371/journal.pmed.1003694] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 07/16/2021] [Accepted: 06/13/2021] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Primary prevention of cardiovascular disease (CVD) requires adequate control of hypertension and diabetes. We designed and implemented pharmaceutical and healthy lifestyle interventions for patients with diabetes and/or hypertension in rural primary care, and assessed their effectiveness at reducing severe CVD events. METHODS AND FINDINGS We used a pragmatic, parallel group, 2-arm, controlled, superiority, cluster trial design. We randomised 67 township hospitals in Zhejiang Province, China, to intervention (34) or control (33). A total of 31,326 participants were recruited, with 15,380 in the intervention arm and 15,946 in the control arm. Participants had no known CVD and were either patients with hypertension and a 10-year CVD risk of 20% or higher, or patients with type 2 diabetes regardless of their CVD risk. The intervention included prescription of a standardised package of medicines, individual advice on lifestyle change, and adherence support. Control was usual hypertension and diabetes care. In both arms, as usual in China, most outpatient drug costs were out of pocket. The primary outcome was severe CVD events, including coronary heart disease and stroke, during 36 months of follow-up, as recorded by the CVD surveillance system. The study was implemented between December 2013 and May 2017. A total of 13,385 (87%) and 14,745 (92%) participated in the intervention and control arms, respectively. Their mean age was 64 years, 51% were women, and 90% were farmers. Of all participants, 64% were diagnosed with hypertension with or without diabetes, and 36% were diagnosed with diabetes only. All township hospitals and participants completed the 36-month follow-up. At 36 months, there were 762 and 874 severe CVD events in the intervention and control arms, respectively, yielding a non-significant effect on CVD incidence rate (1.92 and 2.01 per 100 person-years, respectively; crude incidence rate ratio = 0.90 [95% CI: 0.74, 1.08; P = 0.259]). We observed significant, but small, differences in the change from baseline to follow-up for systolic blood pressure (-1.44 mm Hg [95% CI: -2.26, -0.62; P < 0.001]) and diastolic blood pressure (-1.29 mm Hg [95% CI: -1.77, -0.80; P < 0.001]) in the intervention arm compared to the control arm. Self-reported adherence to recommended medicines was significantly higher in the intervention arm compared with the control arm at 36 months. No safety concerns were identified. Main study limitations include all participants being informed about their high CVD risk at baseline, non-blinding of participants, and the relatively short follow-up period available for judging potential changes in rates of CVD events. CONCLUSIONS The comprehensive package of pharmaceutical and healthy lifestyle interventions did not reduce severe CVD events over 36 months. Improving health system factors such as universal coverage for the cost of essential medicines is required for successful risk-based CVD prevention programmes. TRIAL REGISTRATION ISRCTN registry ISRCTN58988083.
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Affiliation(s)
- Xiaolin Wei
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Zhitong Zhang
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Marc K. C. Chong
- School of Public Health and Primary Care, Chinese University of Hong Kong, Hong Kong, China
| | - Joseph P. Hicks
- Nuffield Centre for International Health and Development, University of Leeds, Leeds, United Kingdom
| | - Weiwei Gong
- Zhejiang Provincial Centre for Disease Control and Prevention, Hangzhou, China
| | - Guanyang Zou
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jieming Zhong
- Zhejiang Provincial Centre for Disease Control and Prevention, Hangzhou, China
| | - John D. Walley
- Nuffield Centre for International Health and Development, University of Leeds, Leeds, United Kingdom
| | - Ross E. G. Upshur
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Min Yu
- Zhejiang Provincial Centre for Disease Control and Prevention, Hangzhou, China
- * E-mail:
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8
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Tessua KK, Munseri P, Matuja SS. Outcomes within a year following first ever stroke in Tanzania. PLoS One 2021; 16:e0246492. [PMID: 33571298 PMCID: PMC7877648 DOI: 10.1371/journal.pone.0246492] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 01/19/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Stroke contributes to a significant proportion of deaths and disability worldwide, with a high fatality rate within 30 days following a first ever stroke. We describe the outcomes within one year among patients who succumbed a first ever stroke and survived the first 30 days. METHODS Participants were patients who survived after 30 days from succumbing a first ever stroke admitted at the Muhimbili University of Health and Allied Sciences Academic Medical Center. Stroke survivors or their next of kin were contacted at one year after succumbing a first stroke to determine the outcomes. We assessed participants' vital status and level of disability using the modified Rankin scale. Assessment on utilization of stroke secondary preventive measures among survivors was done by an interviewer-based questionnaire that assessed the number of times participants attended follow up clinics, medication refill and adherence. Participants were examined for waist-hip ratio, body mass index and blood pressure. Cholesterol levels were assessed at one year post first stroke for survivors. Outcomes were summarized as proportions, survival at one year was estimated by using the Kaplan Meier analysis and Cox regression analysis was performed to determine for predictors of mortality. RESULTS We recruited 130 first stroke survivors. Mortality within one year was 53/130 (40.8%) and disability rate measured by Modified Rankin Scale with scores of 3-5 was 29/77 (37.7%) among survivors. Factors associated with mortality were residual disability HR = 8.60, {95% CI (1.16-63.96)}, severe stroke, HR = 2.67 {95% CI (1.44-4.95)} and residing in Dar-es-Salaam HR = 2.15 {95% (CI 1.06-4.36)}. Non-adherence rates to antihypertensives, antiplatelets and statins was 11/73 (15.1%), 9/23 (39.1%) and 18/22 (81.8%) respectively. Attendance rates of follow-up clinics among all survivors and physiotherapy among survivors with disability are 45/77 (58.4%) and 16/29 (55.2%) respectively. CONCLUSIONS The mortality and disability rates within a year following a first ever stroke among 30 days stroke survivors is high. Secondary stroke preventive measures should be enhanced to mitigate stroke adverse outcomes. Community outreach programs could be useful interventions in preventing the adverse outcomes of stroke.
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Affiliation(s)
- Kezia Kodawa Tessua
- Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Patricia Munseri
- Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Sarah Shali Matuja
- Department of Internal Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
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Process Evaluation of a Clustered Randomized Control Trial of a Comprehensive Intervention to Reduce the Risk of Cardiovascular Events in Primary Health Care in Rural China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17114156. [PMID: 32532144 PMCID: PMC7312738 DOI: 10.3390/ijerph17114156] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 05/26/2020] [Accepted: 06/08/2020] [Indexed: 12/13/2022]
Abstract
Background: Cardiovascular disease (CVD) is a major public health challenge in China. This study aims to understand the processes of implementing a comprehensive intervention to reduce CVD events in areas of drug therapy, lifestyle changes, and adherence support in a clustered randomized controlled trial (cRCT). This trial consisted of 67 clusters spanning over 3 years in Zhejiang Province, China. Method: A qualitative process evaluation was nested within the cRCT conducted in 9 township hospitals with 27 healthcare providers, 18 semi-structured interviews, and 23 observational studies of clinical practices within the intervention arm. Results: Effective and repeated trainings using an interactive approach were crucial to improve the prescribing behaviour of family doctors and their patient communication skills. However, the awareness of patients remained limited, thus compromising their use of CVD preventive drugs and adoption of healthy lifestyles. Health system factors further constrained providers’ and patients’ responses to the intervention. Financial barrier was a major concern because of the low coverage of health insurance. Other barriers included limited doctor–patient trust and suboptimal staff motivation. Conclusion: Our study suggests the feasibility of implementing a comprehensive CVD risk reduction strategy in China’s rural primary care facilities. However, health system barriers need to be addressed to ensure the success and sustainability of the intervention.
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10
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Liu S, Li Y, Zeng X, Wang H, Yin P, Wang L, Liu Y, Liu J, Qi J, Ran S, Yang S, Zhou M. Burden of Cardiovascular Diseases in China, 1990-2016: Findings From the 2016 Global Burden of Disease Study. JAMA Cardiol 2020; 4:342-352. [PMID: 30865215 DOI: 10.1001/jamacardio.2019.0295] [Citation(s) in RCA: 386] [Impact Index Per Article: 96.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Importance Cardiovascular disease (CVD) remains the top cause of death in China. To our knowledge, no consistent and comparable assessments of CVD burden have been produced at subnational levels, and little is understood about the spatial patterns and temporal trends of CVD in China. Objective To determine the national and province-level burden of CVD from 1990 to 2016 in China. Design, Setting, and Participants Following the methodology framework and analytical strategies used in the 2016 Global Burden of Disease study, the mortality, prevalence, and disability-adjusted life-years (DALYs) of CVD in the Chinese population were examined by age, sex, and year and according to 10 subcategories. Estimates were produced for all province-level administrative units of mainland China, Hong Kong, and Macao. Exposures Residence in China. Main Outcomes and Measures Mortality, prevalence, and DALYs of CVD. Results The annual number of deaths owing to CVD increased from 2.51 million to 3.97 million between 1990 and 2016; the age-standardized mortality rate fell by 28.7%, from 431.6 per 100 000 persons in 1990 to 307.9 per 100 000 in 2016. Prevalent cases of CVD doubled since 1990, reaching nearly 94 million in 2016. The age-standardized prevalence rate of CVD overall increased significantly from 1990 to 2016 by 14.7%, as did rates for ischemic heart disease (19.1%), ischemic stroke (36.6%), cardiomyopathy and myocarditis (23.1%), and endocarditis (26.7%). Substantial reduction in the CVD burden, as measured by age-standardized DALY rate, was observed from 1990 to 2016 nationally, with a greater reduction in women (43.7%) than men (24.7%). There were marked differences in the spatial patterns of mortality, prevalence, and DALYs of CVD overall as well as its main subcategories, including ischemic heart disease, hemorrhagic stroke, and ischemic stroke. The CVD burden appeared to be lower in coastal provinces with higher economic development. The between-province gap in relative burden of CVD increased from 1990 to 2016, with faster decline in economically developed provinces. Conclusions and Relevance Substantial discrepancies in the total CVD burden and burdens of CVD subcategories have persisted between provinces in China despite a relative decrease in the CVD burden. Geographically targeted considerations are needed to tailor future strategies to enhance CVD health throughout China and in specific provinces.
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Affiliation(s)
- Shiwei Liu
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yichong Li
- Fuwai Hospital Chinese Academy of Medical Sciences, Shenzhen, Shenzhen, China
| | - Xinying Zeng
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Haidong Wang
- Institute of Health Metrics and Evaluation, University of Washington, Seattle
| | - Peng Yin
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Lijun Wang
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yunning Liu
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jiangmei Liu
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jinlei Qi
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Sha Ran
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.,Youyang County Center for Disease Control and Prevention, Chongqing, China
| | - Shiya Yang
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.,Dianjiang County Center for Disease Control and Prevention, Chongqing, China
| | - Maigeng Zhou
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
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Abstract
Background The pattern of stroke in rural population differs from that in urban ones. Although there are many studies on this condition in sub-Saharan Africa, few studies about stroke pattern in a Kenyan rural area exist.. This study therefore aims at describing the characteristics of stroke in a rural Kenyan hospital. Patients and Methods The study was conducted on 227 consecutive patients admitted with a World Health Organization (WHO) diagnosis of stroke in Kangundo Hospital, a level IV facility in Machakos, Eastern Kenya, between April 2015 and September 2016. The sub-type and anatomical distribution of stroke as well as the age, gender of the patients were recorded prospectively. Diagnosis was made through physical neurological examination and confirmed by Computerized Tomography (CT) scan imaging. Only those with complete bio-data, past medical and social history, clinical and physical findings of the patients and imaging results were included. The data were entered into a pre-formatted questionnaire, analysed for means, standard deviations and frequencies, and are presented in tables and bar charts. Results Out of 3200 medical admissions, 227 (7.09%) had a confirmed diagnosis of stroke. Ischaemic stroke was more common (67.4%) than haemorrhagic stroke (32.6%). It affected mainly the anterior circulation, especially the middle cerebral artery (39%). The mean age of patients was 68.8 years, (Range 32–96). It was more common in females (62%) than in males (38%). Hypertension was the most common (74%) risk factor followed by alcohol abuse (63%), tobacco smoking (48%) and diabetes mellitus (42%). Conclusion Ischaemic stroke was the more common major cause of morbidity in the rural hospital studied in Kenya. It occurred most commonly among elderly females, with the most frequent comorbidities being hypertension. In addition, modifiable lifestyle factors like alcohol abuse and cigarette smoking contributed to the prevalence; hence we recommend the control of blood pressure and glucose as well as lifestyle modification to reduce the scourge in our studied population.
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12
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Peng Y, Wang Z, Dong B, Cao S, Hu J, Adegbija O. Life's Simple 7 and ischemic heart disease in the general Australian population. PLoS One 2017; 12:e0187020. [PMID: 29073220 PMCID: PMC5658112 DOI: 10.1371/journal.pone.0187020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Accepted: 10/11/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The American Heart Association released 7 modifiable factors, Life's Simple 7, that are expected to improve cardiovascular health (CVH), but their contributions to ischemic heart disease (IHD) in the general Australians are not well clarified. METHODS We performed a cross-sectional study based on 7499 adults (≥18 years) who have tested for total cholesterol and fasting plasma glucose as part of 2011-12 Australian Health Survey. Poisson regression analyses were used to estimate the incidence rate ratios and population attributable fractions of those factors to IHD prevalence. Participants were classified into three CVH groups based on the number of ideal metrics: inadequate (0-2), average (3-4), and optimal (5-7). Logistic regression analyses were performed to elucidate the relationship between overall CVH and IHD prevalence. RESULTS 357 participants were self-reported having IHD condition, with a weighted prevalence of 3.3%. Physical inactivity, elevated body mass index (BMI) and total cholesterol (TC) were independently associated with IHD. Compared to the inadequate category, participants in the optimal and average categories have a 78% [adjusted odds ratio (OR), 0.22; 95% confidence interval (CI), 0.03-1.96] and a 45% (adjusted OR, 0.55; 95% CI, 0.39-0.77) lower IHD risk. One more optimal metric was associated with an 18% lower IHD risk (adjusted OR, 0.82; 95% CI, 0.71-0.93). CONCLUSIONS Our findings indicate that physical inactivity, raised BMI and elevated TC were independent modifiable risk factors of IHD in the general Australian population. The improvement of overall CVH may also reduce IHD risk among the general Australian adults.
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Affiliation(s)
- Yang Peng
- Centre for Chronic Disease, Centre for Clinical Research, The University of Queensland, Herston, Australia
- * E-mail:
| | - Zhiqiang Wang
- Centre for Chronic Disease, Centre for Clinical Research, The University of Queensland, Herston, Australia
| | - Bin Dong
- Centre for Chronic Disease, Centre for Clinical Research, The University of Queensland, Herston, Australia
- Institute of Child and Adolescent Health, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Sifan Cao
- Centre for Longitudinal and Life Course Research, School of Public Health, The University of Queensland, Herston, Australia
| | - Jie Hu
- Centre for Chronic Disease, Centre for Clinical Research, The University of Queensland, Herston, Australia
| | - Odewumi Adegbija
- Centre for Chronic Disease, Centre for Clinical Research, The University of Queensland, Herston, Australia
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