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 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.

Objective:To evaluate the correlation of community management index of essential hypertension and type 2 diabetes with the probability of premature mortality of major chronic diseases.Methods:From 2016 to 2018, the management of essential hypertension and type 2 diabetes were obtained from annual report of comprehensive prevention and control of chronic diseases in communities of Zhejiang province. The death data of chronic diseases were obtained from Information Management System of Chronic Diseases of Zhejiang province and annual population data were obtained from Public Security Bureau of Zhejiang Province. The management of essential hypertension and type 2 diabetes in communities of Zhejiang Province from 2016 to 2018 was described. The death status of major chronic diseases, including cardiovascular diseases, malignant tumors, diabetes and chronic respiratory diseases, in the same period was also described. Spearman correlation analysis and linear regression model were used to explore the correlation of community management of essential hypertension and type 2 diabetes with the probability of premature mortality of major chronic diseases.Results:The number of essential hypertension patients under standardized management, blood pressure control and regular medication increased from 3.127 3, 2.811 5 and 3.569 7 million in 2016 to 3.355 9, 3.151 8 and 4.010 6 million in 2018, respectively. The number of type 2 diabetes patients with standardized management, blood glucose control and regular medication increased from 0.805 5, 0.687 5 and 0.913 4 million in 2016 to 0.912 6, 0.798 7 and 1.064 8 million in 2018, respectively. The standardized mortality rate of chronic diseases decreased from 403.07/100 000 in 2016 to 380.07/100 000 in 2018. The proportion of premature deaths of chronic diseases decreased from 28.39% in 2016 to 26.90% in 2018. The proportion of deaths from major chronic diseases in all chronic diseases decreased from 90.96% in 2016 to 90.69% in 2018.The probability of premature mortality decreased from 10.68% in 2016 to 9.67% in 2018. The spearman correlation analysis showed that the blood pressure control and regular drug use were negatively correlated with the probability of premature death of major chronic diseases ( r values were -0.367 and -0.392; P values were 0.035 and 0.024). According to the linear regression model analysis, with increase of 100 000 of essential hypertension control cases or regular medication use cases of type 2 diabetes, the probability of premature death of major chronic diseases decreased by 0.47% (95% CI: 0.39%, 0.54%) or 1.31% (95% CI: 1.12%, 1.50%), respectively. Conclusion:From 2016 to 2018, the community management of essential hypertension and type 2 diabetes was negatively correlated with probability of premature death of major chronic diseases in Zhejiang province.

Objective:To evaluate the correlation of community management index of essential hypertension and type 2 diabetes with the probability of premature mortality of major chronic diseases.Methods:From 2016 to 2018, the management of essential hypertension and type 2 diabetes were obtained from annual report of comprehensive prevention and control of chronic diseases in communities of Zhejiang province. The death data of chronic diseases were obtained from Information Management System of Chronic Diseases of Zhejiang province and annual population data were obtained from Public Security Bureau of Zhejiang Province. The management of essential hypertension and type 2 diabetes in communities of Zhejiang Province from 2016 to 2018 was described. The death status of major chronic diseases, including cardiovascular diseases, malignant tumors, diabetes and chronic respiratory diseases, in the same period was also described. Spearman correlation analysis and linear regression model were used to explore the correlation of community management of essential hypertension and type 2 diabetes with the probability of premature mortality of major chronic diseases.Results:The number of essential hypertension patients under standardized management, blood pressure control and regular medication increased from 3.127 3, 2.811 5 and 3.569 7 million in 2016 to 3.355 9, 3.151 8 and 4.010 6 million in 2018, respectively. The number of type 2 diabetes patients with standardized management, blood glucose control and regular medication increased from 0.805 5, 0.687 5 and 0.913 4 million in 2016 to 0.912 6, 0.798 7 and 1.064 8 million in 2018, respectively. The standardized mortality rate of chronic diseases decreased from 403.07/100 000 in 2016 to 380.07/100 000 in 2018. The proportion of premature deaths of chronic diseases decreased from 28.39% in 2016 to 26.90% in 2018. The proportion of deaths from major chronic diseases in all chronic diseases decreased from 90.96% in 2016 to 90.69% in 2018.The probability of premature mortality decreased from 10.68% in 2016 to 9.67% in 2018. The spearman correlation analysis showed that the blood pressure control and regular drug use were negatively correlated with the probability of premature death of major chronic diseases ( r values were -0.367 and -0.392; P values were 0.035 and 0.024). According to the linear regression model analysis, with increase of 100 000 of essential hypertension control cases or regular medication use cases of type 2 diabetes, the probability of premature death of major chronic diseases decreased by 0.47% (95% CI: 0.39%, 0.54%) or 1.31% (95% CI: 1.12%, 1.50%), respectively. Conclusion:From 2016 to 2018, the community management of essential hypertension and type 2 diabetes was negatively correlated with probability of premature death of major chronic diseases in Zhejiang province.

Objective: To learn the current status of injury among community residents in Zhejiang Province,and to provide reference for injury prevention strategy. Methods: A total of 38 005 residents were recuited from 11 counties or districts in Zhejiang Province by multi-stage cluster random sampling. A retrospective questionnaire survey was conducted to collect their injury occurrence from June 1st of 2017 to May 31st of 2018,then analyzed the incidence,mortality and types of injury. Results: Among 38 005 respondents,2 186 injuries occurred,the incidence rate of injury was 5.75%. The incidence rate of injury in males and females were 5.67% and 5.84%,respectively. The incidence rate of injury in rural respondents（6.97%）was higher than that（4.79%）in urban respondents（P<0.05）. Seven respondents died of injury and the mortality rate was 18.42/100 000. The top five types of injury were falls（2.27%）,traffic accidents（1.53%）,animal bites（0.69%）,sharp articles（0.50%）and blunt articles（0.41%）. The lowest incidence rate of injury lay in 15 to 24 years old,and the highest lay in 65 to 74 years old. The incidence rate of injury increased with age（P<0.05）. The first type of injury in respondents aged 15 to 44 years old was traffic accidents,while others was falls. Conclusion The incidence of injury is higher in rural residents than in urban residents in Zhejiang Province,which increase with age. Falls and traffic accidents are the main threats to residents in Zhejiang Province.

Objective To evaluate the impact of diabetes prevalence and mortality on health life expectancy (HLE).Methods A cause-excluded health adjusted life expectancy method was used to quantitatively analyze the impact of diabetes on HLE and the composition of health life losses (HLL),using the integrated data on population mortality,self-assessed health status and diabetes prevalence.Results The HLE for people aged 15 was 55.80 in Zhejiang,in 2013.After removing the diabetes morbidity and mortality,the HLE for men aged 15 increased by 0.86 and 1.13,respectively,with an increase of 1.04 and 0.66 for urban and rural residents.Substantial increase of HLE was observed in women and urban residents than those for men and rural residents.HLL caused by diabetes mortality and morbidity appeared as 0.10 and 0.79,with a ratio of 7.92.Conclusion HLL caused by diabetes mortality was much greater than those caused by diabetes mortality,suggesting the most effective measure in reducing the diabetes-related HLL is to promote the healthy lifestyle in urban areas and especially for women.

OBJECTIVETo estimate the disease burden of type 2 diabetes in population in Zhejiang in 2013.

METHODSAccording to the method in global burden of disease study (GBD) 2010, the related disability adjusted life years (DALYs), years of life lost (YLL) and years lived with disability (YLD) were calculated by using the incidence, prevalence and mortality data of type 2 diabetes in population in Zhejiang and DISMODⅡ.

RESULTSThe overall DALYs of type 2 diabetes was 5.36 per 1000 population, which was higher in women (5.49 per 1000) than in men (5.24 per 1000), The population in urban area had higher DALYs (5.47 per 1000) than those in rural area (5.42 per 1000). The DALYs in old population was high, which peaked in age group 80-84 years (32.63 per 1000) with YLL/YLD of 0.62. The disease burden of type 2 diabetes was mainly caused by disability.

CONCLUSIONThe YLL of type 2 diabetes in Zhejiang was higher than the national average level.

China ; epidemiology ; Diabetes Mellitus, Type 2 ; epidemiology ; Disabled Persons ; Female ; Humans ; Incidence ; Male ; Prevalence ; Quality-Adjusted Life Years ; Rural Population ; Urban Population

[Summary] Thyroid cancer is the complicated result of both environmental and genetic factors. Recently with the emergence of genome-wide association study ( GWAS) , the researches on genetic predisposition of thyroid cancer have entered a new phase and revealed a lot of new susceptibility genes or regions. Up to now, there are 11 regions with 16 single nucleotidepolymorphisms in total have been found with GWAS, which provide new ideas for the cause of thyroid cancer and its prevention.

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 survey the incidence of acute coronary events (nonfatal acute myocardial infarction and death from coronary heart disease),and analyze the trend and distribution characteristics in permanent residents aged 25 years and more across 30 surveillance regions of Zhejiang province from 2010 to 2012.Methods Through databases matching and duplicate checking,this study incorporated the register module of coronary disease and the cause of death register module in Zhejiang provincial information system for chronic non-communicable diseases surveillance and management.The distribution of incidence was calculated across gender,age groups,regions and times.Results A total of 31 872 person-time acute coronary events were identified.The gender-and age-standardized mean annual incidence was 81156 per 100 000 people in overall population,with 94.33 in males and 68.27 in females.Age-standardized incidence was 87.90 and 77.36 per 100 000 people in urban and rural area,respectively.Urban area had higher incidence rate than rural in each of the three years,and had obvious trend of increasing (P ＜0.001) compared with rural area (P =0.331).Incidence rate also increased significantly with age (P ＜ 0.001).In addition,compared with women,men had higher incidence in each age group (all P ＜ 0.001).The incidence rate increased rapidly in population older than 75 years old.The highest incidence was observed in age group ≥85 years old,with 2 371.67 and 1 873.92 per 100 000 in males and females,respectively.Apparent seasonal trend was observed for acute coronary events,which was low in summer and high in winter.Conclusions Quantity and incidence for acute coronary events in residents aged 25 years and more of Zhejiang surveillance regions increased during 2010 to 2012.Male had higher incidence than female,and the incidence in urban areas was higher compared with rural areas.Residents older than 75 years old were high risk population of events,and winter was the high-occurrence season.