Objective:To investigate the annual growth rate of obesity prevalence of residents aged 18 and above in China and prevention keypoints for target populations from 2013 to 2018.Methods:This was a cross-sectional study. Subjects from China Chronic Disease and Risk Factor Surveillance project in 2013 and 2018 were included. The prevalence of obesity and growth rate in 31 provinces (autonomous regions and municipalities) in China were collected through survey questionnaires and on-site measurements. Other demographic data such as the proportion of obesity control measures, diet, exercise and drug use was also analyzed. Obesity among adults was defined as body mass index≥28.0 kg/m2.Results:A total of 174 736 residents, aged (51.5±14.2) years, which included 74 704 (42.8%) males were recruited in 2013, and 179 125 residents, aged (55.1±13.8) years, which included 79 337 (44.3%) males were included in 2018. The average annual increase rate of adult obesity prevalence in China from 2013 to 2018 was 3.2% (uncertainty interval ( UI) 2.7%-3.6%), and the average increase rate of obesity prevalence among men (5.2% ( UI 4.6%-5.9%)) was higher than that of women (0.9% ( UI 0.5%-1.3%)). For subgroups analysis, the average increase rate of obesity prevalence among residents aged 18 to 29 (7.4% ( UI 6.9%-7.9%)), education level beyond college degree (6.3% ( UI 5.5%-7.1%)), and unmarried population (11.2% ( UI 10.2%-12.1%)) were higher than that of other subgroups between 2013 and 2018. The residents in Hainan province showed the highest average annual growth rate of obesity. With the exception of Shanxi, Hunan, Gansu and Ningxia province, the annual growth rate of obesity prevalence among adults increased in all other provinces (autonomous regions and municipalities) from 2013 to 2018. For the obese population, the proportion of people who took weight control measures increased from 22.6% in 2013 to 32.7% in 2018. Conclusions:The prevalence of obesity growth characteristics in subpopulations and regions in China are obviously different. Accordingly the focus points of obesity prevention and control in different regions should have their own emphasis.

Objective:To analyze the burden of cardiovascular disease (CVD) attributed to low physical activity (LPA) and its changing trends in China from 1990 to 2019.Methods:On the basis of the province results of the Study of Global Burden of Disease 2019 in China, we described the distribution of CVD death and disability-adjusted life year (DALY) attributed to LPA by sex, age and province. Joinpoint 4.9.1.0 was used to calculate the average annual percentage change.Results:In 2019, the number of CVD deaths and DALY attributed to LPA in people aged ≥25 years were 0.127 million and 1.863 million person-years in China, respectively, The age-standardized mortality rate (ASMR) and standardized DALY rate of CVD attributed to LPA were slightly higher in men than in women, and much higher in ischemic heart disease patients than in ischemic stroke patients. The ASMR (8.85/100 000) and the standardized DALY rate (112.34/100 000) of CVD attributed to LPA in China in 2019 showed no obvious change compared with 1990, while decreased in the last decade. The largest increases in the mortality rate and DALY rate were observed in people aged ≥75 years from 1990 to 2019 (26.89%, 15.61%), but the mortality rate and DALY rate in people aged 60-74 years showed a decreasing trend. The mortality rate and DALY rate in men aged 25- 44 years showed the largest increases (37.50%, 35.49%), while women aged ≥75 years had the largest increases (31.00%, 18.02%). In 2019, the highest ASMR and standardized DALY rate of CVD attributed to LPA were found in Jilin, Inner Mongolia and Hebei. The largest increases were found in Qinghai (182.41%, 154.70%), Gansu (181.29%, 152.77%), and Chongqing (132.01%, 102.79%) and the largest decreases were found in Beijing (59.11%, 62.09%), Macau (41.89%, 39.37%) and Guangdong (36.93%, 40.72%) from 1990 to 2019.Conclusion:The disease burden of CVD attributed to LPA in China was quite high and showed gender, age and area specific differences.

Objective:To examine the burden and trends of acute viral hepatitis in Guangdong Province from 1990 to 2019, and provide reference evidences for hepatitis prevention and control in the province.Methods:Data on acute viral hepatitis (hepatitis A, B, C, and E) in Guangdong from 1990 to 2019 were extracted from the Global Burden of Disease Study 2019 database. The incidence, prevalence, mortality, and disability-adjusted life years (DALY) data were analyzed by age and gender, and the estimated annual percentage change (EAPC) was calculated to describe the changing trends in disease burden.Results:From 1999 to 2019, the standardized incidence, prevalence, mortality, and DALY of acute viral hepatitis in Guangdong were higher than the national averages. In 2019, 51.43% (2 245 087/4 365 221) of acute viral hepatitis cases in Guangdong Province were mainly attributed to hepatitis B, and 77.18% (106/138) of deaths were due to acute hepatitis B. In different age groups, except for acute hepatitis B, which was more common in adults, the incidence rates of other types of viral hepatitis such as hepatitis A, B, and E showed an overall decreasing trend with age. The mortality rates of different types of acute viral hepatitis, except for the <5 age group, increased with age. The overall incidence and mortality rates of acute viral hepatitis were higher in men than in women.Conclusions:The overall burden of acute viral hepatitis in Guangdong declined in 2019, but remained higher than the national level. Further efforts are needed to strengthen hepatitis prevention and screening in different population in Guangdong Province, especially in children and the elderly.

Background::Spinal injuries are an urgent public health priority; nevertheless, no China-wide studies of these injuries exist. This study measured the incidence, prevalence, causes, regional distribution, and annual trends of spinal injuries in China from 1990 to 2019.Methods::We used data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2019 to estimate the incidence and prevalence of spinal injuries in China. The data of 33 provincial-level administrative regions (excluding Taiwan, China) provided by the National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention (CDC) were use to systematically analyze the provincial etiology, geographical distribution, and annual trends of spinal injuries. The Bayesian meta-regression tool DisMod-MR 2.1 was used to ensure the consistency among incidence, prevalence, and mortality rates in each case.Results::From 1990 to 2019, the number of living patients with spinal injuries in China increased by 138.32%, from 2.14 million to 5.10 million, while the corresponding age-standardized prevalence increased from 0.20% (95% uncertainty interval [UI]: 0.18-0.21%) to 0.27% (95% UI: 0.26-0.29%). The incidence of spinal injuries in China increased by 89.91% (95% UI: 72.39-107.66%), and the prevalence increased by 98.20% (95% UI: 89.56-106.82%), both the most significant increases among the G20 countries; 71.00% of the increase could be explained by age-specific prevalence. In 2019, the incidence was 16.47 (95% UI: 12.08-22.00, per 100,000 population), and the prevalence was 358.30 (95% UI: 333.96-386.62, per 100,000 population). Based on the data of 33 provincial-level administrative regions provided by CDC, age-standardized incidence and prevalence were both highest in developed provinces in Eastern China. The primary causes were falls and road injuries; however, the prevalence and specific causes differed across provinces.Conclusions::In China, the overall disease burden of spinal injuries increased significantly during the past three decades but varied considerably according to geographical location. The primary causes were falls and road injuries; however, the prevalence and specific causes differed across provinces.

Background::Studies that comprehensively address the characteristics of centenarian deaths are rare. The present study aimed to depict the characteristics of centenarian deaths in China and their changing trends.Methods::Data on centenarian deaths between 2013 and 2020 were obtained from the national mortality surveillance system of China, including date, place of death (PoD), and underlying cause of death (CoD). Descriptive analyses were performed to understand the epidemiological characteristics, and a joinpoint regression model was adopted to examine the changing trends in the proportions of different PoDs, CoDs among centenarians, and centenarian deaths accounting for all deaths and deaths among people aged 65 years and older.Results::There were 46,938 registered centenarian deaths between 2013 and 2020 that included 34,311 females (73.10%) and 12,627 males (26.90%). January (12.05%), February (9.99%), and December (9.74%) were the top three months with the highest number of deaths. The proportions of deaths that occurred in homes, hospitals, and nursing homes were 81.71%, 13.63%, and 2.68%, respectively. The proportion of deaths in nursing homes increased by 9.60% (95% confidence intervals [CIs], 6.4-12.9%) from 2014 to 2020. Heart disease (35.72%) was the leading cause of death, followed by respiratory diseases (17.63%), cerebrovascular disease (15.60%), and old age (11.22%). The proportion of respiratory diseases decreased by 4.8% (95% CI, -8.8 to -0.7%), and the proportion of deaths from old age decreased by 2.3 % (95% CI, -4.4 to -0.1%) per year. Shanghai had the highest proportions of deaths in hospitals (39.38%) and nursing homes (14.68%). Sichuan had the highest proportion of deaths attributed to respiratory diseases (32.30%), while Jiangsu (26.58%) and Zhejiang (23.61%) had the highest proportions of deaths from old age.Conclusion::Unlike other countries, centenarian deaths in China are characterized by a higher proportion of home and heart disease deaths, and this death pattern differs across provinces.

Background::Evaluating the impact of digestive system diseases is vital for devising effective prevention strategies. However, comprehensive reports on the burden of digestive system diseases in China are lacking. Our study aimed to provide an overview of the burden and trends of digestive system diseases from 1990 to 2019 in China and its provinces.Methods::This cross-sectional study utilized the Global Disease Burden Study 2019 to estimate the incidence, mortality rate, disability-adjusted life years (DALYs), years of life disability, years of life lost, and changes in the burden of digestive diseases across Chinese provinces from 1990 to 2019. The analysis of disease burden primarily examines the characteristics of sub-disease distribution, time trends, age distribution, and sex distribution. Additionally, we compared provincial age-standardized DALYs for digestive diseases with the expected rates based on the socio-demographic index (SDI).Results::In 2019, there were 499.2 million cases of digestive system diseases in China, resulting in 1,557,310 deaths. Stomach cancer, colon and rectal cancer, and esophageal cancer are the top three diseases associated with mortality and DALY related to digestive system diseases. Meanwhile, cirrhosis and other chronic liver diseases, gastroesophageal reflux disease, and gallbladder and biliary diseases are the top three kinds of diseases with the highest prevalence among digestive system diseases. The risk of gastric cancer sharply increases among men after the age of 40 years, leading to a significant disparity in burden between men and women. As the SDI increased, the DALYs associated with digestive system diseases in China and its provinces showed a downward trend.Conclusion::Our study highlights the inverse correlation between DALYs associated with digestive system diseases and the SDI.

Background::Non-communicable diseases (NCDs) are the primary causes of disability and death. The aim of this study is to analyze the disease burden of NCDs in China from 1990 to 2021.Methods::This study used data on NCDs in China and its provinces from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021. The study analyzed the disease burden of NCDs in 2021 and its changes from 1990 to 2021 using indicators including deaths and disability-adjusted life years (DALYs).Results::Between 1990 and 2021, the NCD burden in China exhibited an upward trend. In 2021, China had 10.6 (95% uncertainty interval [UI]: 9.0–12.2) million deaths and 349.3 (95% UI: 301.5–401.2) million DALYs due to NCDs, accounting for 91.0% (95% UI: 90.4–91.7%) of all deaths and 86.7% (95% UI: 86.0–87.4%) of all DALYs. NCDs caused a lower disease burden in females than in males. Cardiovascular diseases and neoplasms were the main NCD level 2 causes of deaths and DALYs, resulting in 5.1 (95% UI: 4.3–5.9) and 2.8 (95% UI: 2.3–3.4) million deaths and 100.2 (95% UI: 84.6–116.6) million and 71.2 (95% UI: 59.3–85.2) million DALYs in 2021, respectively. Chronic respiratory diseases were the third leading cause of NCD deaths, while musculoskeletal disorders were the third leading cause of NCD DALYs. Qinghai, Xizang, and Heilongjiang had the highest age-standardized mortality rates and age-standardized DALY rates (per 100,000) for NCDs, while Hong Kong Special Administration Region (SAR), Macao SAR, and Shanghai recorded the lowest age-standardized mortality rates and age-standardized DALY rates.Conclusions::NCDs caused a high disease burden in China and exhibited heterogeneity across sexes and provinces. China needs to focus on addressing key NCDs and implement intervention measures tailored to the disease distribution characteristics to reduce the NCD burden.

Background Air pollution is a major public health concern. Air Quality Health Index (AQHI) is a very important air quality risk communication tool. However, AQHI is usually constructed by single-pollutant model, which has obvious disadvantages. Objective To construct an AQHI based on the joint effects of multiple air pollutants (J-AQHI), and to provide a scientific tool for health risk warning and risk communication of air pollution. Methods Data on non-accidental deaths in Yunnan, Guangdong, Hunan, Zhejiang, and Jilin provinces from January 1, 2013 to December 31, 2018 were obtained from the corresponding provincial disease surveillance points systems (DSPS), including date of death, age, gender, and cause of death. Daily meteorological (temperature and relative humidity) and air pollution data (SO₂, NO₂, CO, PM_2.5, PM₁₀, and maximum 8 h O₃ concentrations) at the same period were respectively derived from China Meteorological Data Sharing Service System and National Urban Air Quality Real-time Publishing Platform. Lasso regression was first applied to select air pollutants, then a time-stratified case-crossover design was applied. Each case was matched to 3 or 4 control days which were selected on the same days of the week in the same calendar month. Then a distributed lag nonlinear model (DLNM) was used to estimate the exposure-response relationship between selected air pollutants and mortality, which was used to construct the AQHI. Finally, AQHI was classified into four levels according to the air pollutant guidance limit values from World Health Organization Global Air Quality Guidelines (AQG 2021), and the excess risks (ERs) were calculated to compare the AQHI based on single-pollutant model and the J-AQHI based on multi-pollutant model. Results PM_2.5, NO₂, SO₂, and O₃ were selected by Lasso regression to establish DLNM model. The ERs for an interquartile range (IQR) increase and 95% confidence intervals (CI) for PM_2.5, NO₂, SO₂ and O₃ were 0.71% (0.34%–1.09%), 2.46% (1.78%–3.15%), 1.25% (0.9%–1.6%), and 0.27% (−0.11%–0.65%) respectively. The distribution of J-AQHI was right-skewed, and it was divided into four levels, with ranges of 0-1 for low risk, 2-3 for moderate risk, 4-5 for high health risk, and ≥6 for severe risk, and the corresponding proportions were 11.25%, 64.61%, 19.33%, and 4.81%, respectively. The ER (95%CI) of mortality risk increased by 3.61% (2.93–4.29) for each IQR increase of the multi-pollutant based J-AQHI , while it was 3.39% (2.68–4.11) for the single-pollutant based AQHI . Conclusion The J-AQHI generated by multi-pollutant model demonstrates the actual exposure health risk of air pollution in the population and provides new ideas for further improvement of AQHI calculation methods.

BACKGROUND: Epilepsy accounts for a significant portion of the global disease burden. However, little is known about the disease burden of epilepsy in China and its provinces. METHODS: We assessed the burden of epilepsy in China and its provinces, municipalities, and autonomous regions from 1990 to 2019. Burden was measured as incidence, prevalence, deaths, years lived with disability, years of life lost, and disability-adjusted life years (DALYs), by age, sex, year, and province. We used the Socio-Demographic Index (SDI) to determine the association between the provincial development level and age-standardized DALY rates of epilepsy from 1990 to 2019. RESULTS: In 2019, epilepsy caused 1367.51 thousand (95% uncertainty interval [UI]: 979.92-1837.61 thousand) DALYs, and the age-standardized DALY rate was 99.77 (95% UI: 71.33-133.52)/100,000. The age-standardized incidence and prevalence rates for epilepsy in China were 24.65/100,000 and 219.69/100,000, increased by 45.00% (95% UI: 8.03-98.74%) and 35.72% (95% UI: 0.47-86.19%) compared with that in 1990, respectively. From 1990 to 2019, the proportion of DALY caused by epilepsy in the age group under 25 years steadily decreased. The proportion of DALYs caused by epilepsy in people aged 50 years and over increased from 9.45% and 10.22% in 1990 to 29.01% and 32.72% for male and female individuals in 2019, respectively. The highest age-standardized mortality rates were seen in Tibet (4.26 [95% UI: 1.43-5.66]/100,000), Qinghai (1.80 [95% UI: 1.15-2.36]/100,000), and Yunnan (1.30 [95% UI: 0.88-1.62]/100,000), and the lowest mortality rates were in Guangdong (0.48 [95% UI: 0.39-0.64]/100,000), Zhejiang (0.56 [95% UI: 0.44-0.70]/100,000), and Shanghai (0.57 [95% UI: 0.41-0.73]/100,000). The age-standardized DALY rates across the country and in provinces, municipalities, and autonomous regions generally decreased as their SDI increased. CONCLUSIONS The disease burden of epilepsy is still heavy in China, especially in the western provinces. The incidence and prevalence of epilepsy increased between 1990 and 2019, and the burden of epilepsy in the elderly increases gradually. This study provides evidence on epilepsy prevention and care of different regions in China.
Aged ; Humans ; Male ; Female ; Middle Aged ; Adult ; Global Burden of Disease ; China/epidemiology* ; Quality-Adjusted Life Years ; Cost of Illness ; Epilepsy/epidemiology* ; Prevalence

Objective:To analyze the burden of asthma disease and its trends among children and adolescents aged 1 to 19 years in China during 1990-2019 and to provide a basis for optimizing the health management strategy of asthma in children and adolescents.Methods:Data based on the 2019 Global Burden of Disease Study for China were used to compare the incidence, prevalence, death, and disability adjusted life year (DALY) of children and adolescents with asthma in 1990 and 2019 and to describe the distribution of the disease burden of asthma in children and adolescents by provincial administrative regions in China from 1990 to 2019.Results:In 2019, the number of incidence, prevalence, and death were 2 154 100 [95% uncertainty interval ( UI): 1 378 000- 3 197 600], 8 690 700 (95% UI: 5 798 300-13 126 500), and 78 (95% UI: 63-106), respectively. The incidence, prevalence, and mortality were 718.23/100 000 (95% UI: 459.47/100 000-1 066.17/100 000), 2 897.73/100 000 (95% UI: 1 933.33/100 000-4 376.75/100 000), and 0.03/100 000 (95% UI: 0.02/100 000-0.04/100 000), respectively. The incidence and prevalence increased [change rate: 3.28% (95% UI: -0.66%-7.27%) and 0.58% (95% UI: -3.33%-4.18%)], respectively, and the mortality decreased [change rate: -92.17% (95% UI: -94.97%--85.78%)] compared with 1990. The age-standardized DALY rate decreased by 17.91% from 1990 to 2019. On the whole, the rate of decline showed less in the eastern and more in the western areas. The three provinces with the most significant decreases were Yunnan Province (-53.15%), Guizhou Province (-45.46%), and Tibet Autonomous Region (-35.61%). Hong Kong Special Administrative Region (0.65%) was the only region showing an increase in disease burden. The age-standardized DALY rate for asthma in children and adolescents ranged from 103.26/100 000 to 144.35/100 000 by the province in 2019. The province with the highest age-standardized DALY rate was Hong Kong Special Administrative Region (144.35/100 000), and the lowest was Heilongjiang Province (103.26/100 000). The asthma disease burden was higher in male children and adolescents than in females. Conclusions:Incidence and prevalence of asthma increased, and mortality decreased in children and adolescents in China from 1990-2019. The age-standardized DALY rate also decreased, but there were regional disparities in the rate of decline. The disease burden was more significant in males than in females. Research and prevention efforts for asthma in children and adolescents should be continued.