Abstract The diabetic complications involve blood vessels, eye, kidney and foot, and cause high disability and mortality, which severely endanger human health and quality of life. Epidemiological data have shown that the mortality of diabetes appears a tendency towards a rise in China, which results in a high burden of disease, and early screening and interventions are urgently needed to reduce the risk of mortality. Based on the publications of mortality due to diabetes in China from 2010 to 2021, this review summarizes the epidemiological characteristics of diabetes mortality and the main causes of deaths due to diabetes in China, so as to provide insights into management of diabetes epidemics and reduction in risk of diabetes mortality.

Objective To evaluate the diagnosis and surgical treatment of primary hyperthyroidism with concurrent thyroid carcinoma. Methods The clinical data of 43 hyperthyroidism cases complicating thyroid carcinoma, confirmed by pathology at our hospital from January 1999 to September 2010 were retrospectively analyzed. Results Preoperatively 40 patients were examined by ultrasound,29 cases were diagnosed with carcinoma, the diagnostic accuracy of ultrasound was 72. 5%. Thyroidectomy was performed in all the 43 patients, including subtotal thyroidectomy (5 patients), homolateral total thyroidectomy and contralateral subtotal thyroidectomy with neck dissection (25 patients ), total thyroidectomy with neck dissection or radical neck dissection (11 patients ) and lobectomy plus isthmus resection (2 patients ).Postoperative pathology identified papillary carcinoma in 38 cases, and follicular carcinoma in 5 cases.Postoperative temporary hypocalcemia developed in 3 cases and one suffered from irritating when drinking.No hoarseness or blooding. 39 patients were followed-up from 2 to 110 months averaging 45 months, there was no tumor recurrence. Conclusions Preoperative routine ultrasonography helps to identify thyroid carcinoma that coexists with primary hyperthyroidism. The postoperative prognosis of thyroid papillary carcinoma concurrent with hyperthyroidism is satisfactory.

Objective: To estimate the burden of disease (BOD) attributable to main risk factors of chronic diseases in Zhejiang Province in 2017, so as to provide the evidence for formulating the control strategy for chronic diseases and reducing BOD. Methods: The results of the Global Burden of Disease Study 2017 ( GBD 2017 ) were extracted to evaluate years of life lost due to premature mortality ( YLL ), years lived with disability ( YLD ) and disability-adjusted life years ( DALY ). The gender- and age-specific BOD attributable to main risk factors of chronic diseases, including the environment, metabolism and behaviors, in Zhejiang Province in 2017 was estimated and compared with those in 1990. Results: High DALY rates of chronic diseases were estimated attributable to tobacco use ( 2 807.08/105 ), unreasonable diet ( 2 724.72/105 ) and hypertension ( 1 878.69/105 ) in Zhejiang Province in 2017, and high DALY rates of chronic diseases were estimated in men attributable to tobacco use ( 4 764.77/105 ), unreasonable diet ( 3 297.00/105 ) and hypertension ( 2 076.92/105 ), while high DALY rates of chronic diseases were estimated in women attributable to unreasonable diet ( 2 117.16/105 ), hypertension ( 1 668.24/105 ) and hyperglycemia ( 1 100.53/105 ), respectively. Among individuals at ages of 15 to 49 years, high DALY rates of chronic diseases were estimated attributable to unreasonable diet ( 759.29/105 ), drug abuse ( 611.71/105 ) and tobacco use ( 605.37/105 ); among individuals at ages of 50 to 69 years, high DALY rates of chronic diseases were estimated attributable to tobacco use ( 5 528.37/105 ), unreasonable diet ( 4 628.18/105 ) and hypertension ( 2 757.78/105 ); and among individuals at ages of 70 years and older, high DALY rates of chronic diseases were estimated attributable to unreasonable diet ( 16 370.09/105 ), tobacco use ( 15 551.40/105 ) and hypertension ( 14 408.63/105 ). As compared to those in 1990, the DALY rates of chronic diseases attributable to high body mass index, alcohol use, hyperglycemia, high low-density lipoprotein cholesterol and drug abuse increased by 108.23%, 48.59%, 23.17%, 17.64% and 6.06%, and the DALY rates of chronic diseases attributable to air pollution, occupational risks, unreasonable diet and impaired renal function reduced by 51.11%, 44.81%, 22.49% and 19.83%, and no significant alterations were detected in DALY rates of chronic diseases attributable to tobacco use or hypertension in 2017. Conclusions There was a high BOD of chronic diseases attributable to tobacco use, unreasonable diet and hypertension in Zhejiang Province in 2017, and the BOD of chronic diseases attributable to high body mass index, alcohol use and hyperglycemia appeared a tendency towards a rise in Zhejiang Province in 2017 relative to in 1990.

Objective To understand the pattern of and influencing factors on leisure time physical exercises among adults in Zhejiang. Method Totally 17 437 residents aged 18 years and over selected by stratified cluster random sampling in Zhejiang in 2010 were investigated. Result Overall 21.82%(95%CI:17.12%-27.38%) of adults took part in leisure time physical exercises in 2010. The proportion was higher in urban (29.04%,95%CI:23.46%-35.33%) than in rural (18.81%,95%CI:12.89%-26.61%) (χ2=222.06, P<0.05) areas, and also higher in females (22.91%,95%CI:17.66%-29.15%) than in males (20.56%,95%CI:16.39%-25.48%) (χ2=13.94, P<0.05). Adults aged 18-24 and 55-74 years were more likely to take apart in physical exercises (χ2=266.73, P<0.05), and the lowest proportion was found among farmers (5.33%,95%CI:3.99%-7.11%) (χ2=2 078.40, P<0.05). These proportions both increased along with education level and family income increase (χ2=444.87, P<0.05;χ2=332.20, P<0.05). Overall 83.04%and 90.08%of physical exercisers took part in exercises at least 3 times per week and 30 minutes per time, only 30.67% of those reached moderate or vigorous intensity, and overall 5.38% (95%CI: 3.85%-7.48%) of adults took part in regular leisure time physical exercises in 2010. Multiple logistic regression showed that age, education level, occupation and chronic disease history have influence on regular physical exercises. Conclusion The leisure time physical exercises level was generally low among adults in Zhejiang. Young and middle-aged adults with less education and low income especially farmers should be put on emphasis.

Objective To study the epidemiological characteristics of diabetes,and to provide effective prevention and intervention strategies for diabetes in Zhejiang Province.Methods Descriptive epidemiological method was used to analyze the surveillance data of diabetes from 2007 to 2012.Results 272 534 cases of new on-set diabetes were reported through the noncommunicable disease surveillance system in Zhejiang Province from 2007 to 2012,and the annual incidence was 277.08/100 000.According to different types of diabetes,the proportions of type 1,type 2,gestational,and other types diabetes were 0.69％,96.04％,2.23％,and 1.03％,respectively.The incidence was higher in urban and female population.The diabetes incidence was increased with 20.18％ per year and the growing speed of incidence in rural area and males were faster than those in urban area and females,respectively.The incidence in 70-year group was the highest and the growth speed in 20-year group was the fastest one.11.89％ of diabetes patients were diagnosed with complications simultaneously and the proportion of diabetic neuropathy,vasculopathy,and nephropathy was accounted for 82.81％.The incidence of diabetic complications was increased at first and then decreased from 2007 to 2012.Conclusion With the aging trends in Zhejiang province,the incidence will be increased rapidly,and the rural,male,and adolescence populations should be the focus objectives for the diabetes prevention and control in the future.Although the trend of diabetic complications incidence was tended to decline,the result should be confirmed by further researches.

Objective To explore the association of sedentary behavior and time with risk of metabolic syndrome (MS).Methods A total of 10 149 subjects were recruited from local residents aged ≥40 years old in Jiashan County by cluster-random sampling method.The data including physical activity,job,sedentary time,and sleep,etc.were collected.Height and body weight,waist circumference,blood pressure,blood glucose,blood lipid,etc.were determined.Logistic regression was used for correlation analysis.Results The prevalence of MS was 28.64％ in local residents over 40 years old in Jiashan.The rate of sedentary behavior in all subjects was 67.57％,with 3 h sedentary time on average.Compared with non-MS group,the rates of sedentary behavior and sedentary time were significantly higher in MS group (P＜0.01).Multivariate logistic regression analysis showed that sedentary behavior was independently associated with an increased risk of MS after adjustment for age,sex,body mass index (BMI),smoking,drinking,and sedentary time(OR=1.16,95％ CI 1.03-1.30,P=0.017).Increased sedentary time was associated with higher risks of hypertension,type 2 diabetes mellitus,and dyslipidemia (P ＜ 0.05 or P ＜ 0.01).Sedentary time ≥ 5 h/d independently increased the risk of MS (OR =1.15,95％ CI 1.01-1.31,P =0.034).Conclusions There is a high prevalence of MS in adults over 40 years old living in the eastern coastal rural area.MS and its related diseases are closely associated with sedentary behavior and its duration.

Objective: To understand the epidemiological characteristics of nonfatal injury and its influencing factors among middle school students in Zhejiang Province,and to provide evidence for prevention and control of nonfatal injury of adolescents. Methods: Using multi-stage stratified cluster sampling method,24 157 middle school students from 442 schools in 30 counties（cities,districts）of Zhejiang Province were selected to investigate socio-demographic characteristics,the occurrence of nonfatal injury and injury-related behaviors from April to May of 2017. Logistic regression model was used to analyze influencing factors for nonfatal injury among middle school students. Results: The incidence of nonfatal injuries in 23 462 secondary school students in the past 12 months was 20.86%. The incidence of nonfatal injury was 24.15% in boys,which was higher than 17.33% in girls（P<0.05）. The incidence of nonfatal injury was 20.17% in urban students and 21.19% in rural students,and the difference between them was not statistically significant（P>0.05）. The incidence of nonfatal injury was 22.17% in junior high school students,19.42% in senior high school students and 19.51% in vocational high school students,and there was statistically significant difference between them（P<0.05）. The results of the multivariate logistic regression analysis showed that boys（girls：OR=0.805,95%CI：0.728-0.890）,poor academic performance（OR=1.149,95%CI：1.018-1.298）,smoking（OR=1.260,95%CI：1.083-1.466）,drinking（OR=1.410,95%CI：1.279-1.553）,more physical activity（OR：1.244- 1.527,95%CI：1.098-1.767）,loneliness（OR：1.336-1.500,95%CI：1.219-1.682）,sadness（OR=1.308,95%CI：1.186-1.441）,absenteeism（OR=1.390,95%CI：1.182-1.634）,running away from home（OR=1.242,95%CI：1.076- 1.435）,fighting（OR=1.771,95%CI：1.594-1.967）and being bullied（OR=2.071,95%CI：1.869-2.294）were risk factors for nonfatal injury in middle school students. Conclusion The incidence of nonfatal injuries among secondary school students was 20.86%. Male students were the high risk group. The incidence of nonfatal injury was related to gender,smoking,drinking,negative emotions and violence.

Objective: To investigate thestatus and control of blood lipid level among patients with type 2 diabetes mellitus（T2DM）in rural communities of Zhejiang Province，and to provide evidence for blood lipid control for T2DM. Methods: A sample of 10 343 patients with T2DM managed by communities from Jiashan，Suichang and Yongkang in 2016 were recruited. Through the diabetes registry system，physical examination and laboratory tests，data of demographic features，blood pressure，body mass index（BMI），waist circumstance（WC），glycated hemoglobin（HbA1c），total cholesterol（TC），triglyceride（TG），low-density lipoprotein cholesterol（LDL-C）and high-density lipoprotein cholesterol（HDL-C）were collected to learn the status of blood lipid control. Logistic regression analysis was conducted to explore the influencing factors for blood lipid control. Results: The control rate of TC，TG，LDL-C and HDL-C in patients with T2DM was 29.84%，58.72%，48.25% and 61.27%，respectively. About 11.76% of patients had all the four indicators in control，while 9.22% of patients failed in all. The higher control rates of all of the four indicators were seen in males than females，in older age，in lower BMI and in normal people than in central obese people（all P<0.05）. The results of multivariate logistic regression analysis showed that sex（OR=3.556，95%CI：3.070-4.119），age（OR=1.130，95%CI：1.060-1.204），WC（OR=0.989，95%CI：0.980-0.998）， BMI（OR=0.768，95%CI：0.688-0.857），systolic blood pressure（OR=0.991，95%CI：0.984-0.999），HbA1c level（OR=0.914，95%CI：0.876- 0.953），smoking（OR=0.768，95%CI：0.639-0.924）and drinking（OR=0.688，95%CI：0.536-0.884）were associated with the control of TC，TG，LDL-C and HDL-C in patients with T2DM. Conclusion The control rate of blood lipid is low in patients with T2DM in rural communities of Zhejiang Province，surveillance and interventions should be focused on sex，overweight/obesity，smoking，alcohol intake，blood glucose and blood pressure.

Objective: To investigate the degree and influencing factors of glycosylated hemoglobin ( HbA1c ) control among patients with type 2 diabetes ( T2DM ) living in rural communities of Zhejiang Province, so as to provide the reference for optimizing the management of diabetes patients in rural communities. Methods: Permanent adult patients with T2DM that were registered and received standardized management in all communities of Jiashan County and Suichang County, and 6 communities of Yongkang City, Zhejiang Province in 2016 were recruited, and their demographic characteristics were captured from the health record system and chronic disease management system. The height, body weight, waist circumstance and blood pressure were measured, and HbA1c and blood lipid parameters were detected. The degree of HbA1c control ( <7% ) was analyzed, and its influencing factors were identified using a multivariable logistic regression model. Results: A total of 10 339 patients with T2DM were enrolled, including 4 520 men ( 43.72% ) and 5 819 women ( 56.28% ), with a mean age of ( 63.54±9.78 ) years and the mean course of diabetes of ( 6.36±4.73 ) years. The rate of HbA1c control was 47.89%. Multivariable logistic regression analysis showed that males ( OR=1.123, 95%CI: 1.024-1.233 ), region ( Suichang, OR=2.413, 95%CI: 2.106-2.765; Yongkang, OR=2.460, 95%CI: 2.188-2.767 ), course of disease ( 5-9 years, OR=1.724, 95%CI: 1.504-1.977; 10 years and longer, OR=2.881, 95%CI: 2.477-3.351 ), use of hypoglycemic drugs ( OR=1.203, 95%CI: 1.089-1.329 ), development of chronic complications ( OR=1.190, 95%CI: 1.027-1.379 ), uncontrolled blood pressure ( OR=1.140, 95%CI: 1.030-1.261 ), uncontrolled blood lipid ( OR=1.258, 95%CI: 1.104-1.433 ), and smoking ( OR=1.318, 95%CI: 1.165-1.491 ) were statistically associated with HbA1c control among T2DM patients. Conclusion The rate of HbA1c control was 47.89% among T2DM patients in rural communities of Zhejiang Province. HbA1c control should be given a high priority among men living in low-economic-level regions with long course of disease, use of hypoglycemic drugs, chronic complications, smoking, uncontrolled blood pressure and lipid.

Objective: To understand the underreporting rate of death among residents in Zhejiang Province from 2016 to 2018, so as to provide a basis for improvement of death surveillance measures. Methods: Multi-stage random cluster sampling was used to select residents in 30 public health surveillance areas of Zhejiang Province and all the residents were investigated the general information and death conditions that occurred during the period 2016-2018 by door to door visit. The underreporting rate of death was calculated and descriptive methods were used to analyze the causes of underreporting deaths. Results: A total of 358 992 residents were investigated in 30 public health surveillance areas of Zhejiang Province. There were 63 underreporting deaths among 5 896 deaths, with an underreporting rate of 1.07%. The underreporting rate in men was 1.30%, which was higher than 0.75% in women ( P<0.05 ). The underreporting rate of residents aged 20 to <40 years was 6.74%, the highest among all the age groups ( P<0.05 ). The underreporting rate was 4.46% on the way to the hospital, the highest among all the places of death ( P<0.05 ). The underreporting rate in Wuxing District of Huzhou was 5.80%, the highest among all the surveillance areas. There were 25 cases of "late report or untimely review", accounting for 39.68%; 38 cases of "not report", accounting for 60.32%, of which 14 cases were caused by doctors forgetting to report, accounting for 22.22%. Conclusion The underreporting rate of death in Zhejiang Province from 2016 to 2018 is generally low. In response to underreporting deaths, multi-departmental collaboration should be promoted to effectively strengthen the reporting and management of routine death surveillance.