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2022 Vol. 38, No. 5

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2022, 38(5)
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2022, 38(5): 0-1.
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Special Report –
Changing trend in disease burden of lung cancer and its risk factors among Chinese residents, 1990 – 2019
LU You-hua, WANG Bing-xiang, WANG Jia-lin,
2022, 38(5): 513-517. doi: 10.11847/zgggws1137000
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  Objective  To examine changing trend in disease burden of lung cancer and related risk factors among residents in China from 1990 to 2019 for developing targeted strategies on lung cancer prevention and treatment.   Methods  The open access data relevant to disease burden of lung cancer and its associates among Chinese residents in 1990, 2005 and 2019 were extracted from the Global Burden of Disease (GBD) Study 2019. We used years lived with disability (YLDs), years of life lost (YLLs), and disability adjusted life years (DALYs) to describe changes of lung cancer burden and population-attributable faction (PAF) to analyze the disease burden attributable to risk factors and epidemiological transition among the residents of various age groups from 1990 to 2019.   Results  In 2019 among Chinese male residents, the rates (1/100 000) of YLDs, YLLs, and DALYs of lung cancer were 19.10, 1 632.03, and 1 651.13 and all the rates were higher than those of 8.73, 731.14, and 739.87 among Chinese female residents; the three rates increased with age, with the highest rates of 76.17, 5 243.52, and 5 319.70 in the residents aged 70 years and over. Compared to those in 1990, the rates of YLDs, YLLs, and DALYs increased by 3.61%, 2.49%, and 2.50%, respectively in 2019. Among the 16 known risk factors of lung cancer, the top five with highest contributions to DALYs (million person years), DALYs rate (1/10 000) and PAF were smoking (10.75, 755.91 and 62.06%), environmental particulate pollution (3.86, 271.20 and 22.47%), second-hand smoke (1.35, 94.81 and 7.86%), high fasting plasma glucose (1.11, 77.87 and 6.47%) and home air pollution due to solid fuel use (0.85, 59.72 and 4.94%). Of the PAF for the 16 known risk factors during the period of 1990 – 2019, the PAFs of 8 factors increased, with the highest increase of 110.12% for environmental particulate pollution and other 8 factors′ PAF decreased, with the lowest decrease of 77.74% for home air pollution due to solid fuel use.   Conclusion  During 1990 – 2019 among residents in China, the disease burden of lung cancer was heavy and the YLDs, YLLs and DALYs rate of lung cancer increased; smoking is still a main risk factor for disease burden of lung cancer.
Changing trend in disease burden of mental illness and its risk factors in China, 1990 – 2019
LI Juan-juan, ZHAO Shu-yong, DU Yuan-ze,
2022, 38(5): 518-522. doi: 10.11847/zgggws1136676
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  Objective  To explore changing trend in disease burden of mental illness and its risk factors in Chinese popula-tion from 1990 to 2019 for providing evidences to prevention and treatment of mental illness.   Methods  The open data of the Global Burden of Disease Study (GBD) were used in the study. Age-sex-specific prevalence rate, years lived with disability (YLDs) and disability-adjusted life years (DALYs) for 1990, 2000, 2010 and 2019 were adopted to describe the burden of mental illness and combined with population attributable fraction (PAF) to assess the changing trend in the burden.   Results  Among Chinese residents in 2019, the rate (1/100 000) for mental illness prevalence, YLDs and DALYs were 12 055.47, 1 426.78 and 1 426.62; the rates increased with the increment of age among the residents of various age groups, with the highest rates in the residents aged 50 – 69 years; compared to those in female residents, the rates were lower in male residents (prevalence: 10 886.21 vs. 11 649.28, YLDs: 1 294.39 vs. 1564.03, DALYs: 1 294.51 vs. 1 564.22). The DALYs (million person years) attributed to child sexual abuse and intimate partner violence increased from 1.063 and 3.094 in 1990 to 1.404 and 3.801 in 2019, with the increases of 32.04% and 22.87%. The DALYs attributed to bullying victimization, child sexual abuse and bullying, lead exposure and other environmental risks declined, with the highest decrease of 39.58% for both DALYs attributed to lead exposure and other environmental hazards. In comparison to that in 1990, the PAF of DALYs attributed to child sexual abuse increased by 1.73% in 2019; however, the PAF of DALYs attributed to bullying, child sexual abuse and bullying, intimate partner violence, lead exposure, and other environmental hazards decreased by 49.17%, 40.09%, 5.39%, 53.47%, and 53.47%, respectively. The DALYs due to intimate partner violence rose but that due to bullying declined during 2010 – 2019.   Conclusion   The disease burden of mental illness gradually increased from 1990 to 2019 among residents in China and disability was a main contributor to the burden. Psychological education and counseling should be promoted among the residents, especially among the elderly women at a higher risk of mental illness.
Disease burden of Alzheimer′s disease and other dementias in Chinese residents between 1990 and 2019: an age-period-cohort analysis and prediction
ZHANG Jing-ya, LU Yong-bo, LI Hao-ran,
2022, 38(5): 523-528. doi: 10.11847/zgggws1138308
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  Objective  To examine changing trend in disease burden of Alzheimer′s disease and other dementias in China for providing suggestions to prevention and treatment of senile dementia.   Methods  The data on the incidence, mortality, years of life lost (YLL), years lived with disability (YLD), and disability adjusted life years (DALY) of Alzheimer′s disease and other dementias in Chinese population aged 55 years and above during 1990 – 2019 were extracted from the Global Burden of Disease Study 2019 (GBD 2019). The effects of age, period and cohort on the disease burden due to senile dementia were assessed with an age-period-cohort (APC) model. The incidence rate of senile dementia in next 30 years in China were also predicted based on the estimated changing trend in senile dementia morbidity and population profile.   Results  The analyses revealed following changing trends for senile dementia during the 30-year period in China: increasing in standardized incidence rate, standardized YLD rate and standardized DALY rate but decreasing in standardized mortality rate and standardized YLL rate. The results of APC model analysis showed that the risk of senile dementia increased with age and time series but decreased with year of birth during the period. The prediction results showed that the incidence rate of senile dementia would continue to rise in the next 30 years in China according to predictive analysis using Bayesian APC model. The estimated incidence rate of senile dementia in 2049 among Chinese population aged 55 – 94 years is 9.651‰ and the estimated incidence rate is 11.419‰ and 7.302‰ for female and male elderly population.   Conclusion  The disease burden of senile dementia increased in China during 1990 – 2019 and the increase in senile dementia risk was dominantly influenced by age effect and period effect. A continuous increase in the incidence rate of the disease, especially among elderly female population, is predicted. The results suggest that targeted health education and specific intervention program should be promoted for the control of the disease in the elderly population.
Changing trend in disease burden of skin and subcutaneous diseases among Chinese residents, 1990 – 2019
CHEN Dong-yu, YANG Xiao-yu, WANG Hong-xin,
2022, 38(5): 529-533. doi: 10.11847/zgggws1137391
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  Objective  To analyze changing trend in the burden of skin and subcutaneous diseases among Chinese residents during 1990 – 2019 for providing evidences to the development of health policy.   Methods  Data on incidence and prevalence of skin and subcutaneous diseases among Chinese residents in 1990, 2000, 2010, and 2019 were collected from the Global Burden of Disease Study 2019 (GBD 2019). Indicators including incidence and prevalence number, crude and standardized incidence and prevalence, disability-adjusted life years (DALY) and estimated annual percentage change (EAPC) of the indicators were adopted to assess changing trend in disease burden of skin and subcutaneous diseases.   Results  Compared to that in 1990, an upward trend in the burden of skin and subcutaneous diseases was observed among Chinese residents in 2019, with the increases of 29.33% for incidence number, 27.20% for age-standardized incidence rate, 27.23% for prevalence number, 5.52% for age-standardized prevalence rate, and 14.75% for DALY, respectively; but the age-standardized DALY rate decreased by 0.29%. During the period, the age-standardized prevalence rate and DALY rate of skin and subcutaneous diseases in female residents were higher than those in the male residents; while the age-standardized incidence rate for female residents was lower than that for male residents. In terms of different skin and subcutaneous diseases in Chinese residents during the 30-year period, decubitus ulcer showed the highest increase in age-standardized incidence rate (with an EAPC of 1.078, 95% uncertainty interval [95% UI]: 0.826 – 1.317) and in DALY rate (EAPC = 2.202, 95% UI: 0.905 – 3.451); in contrast, cellulitis manifested the highest decrease in age-standardized incidence rate (EAPC = – 1.210, 95% UI: – 1.416 – – 1.019) and in DALY rate (EAPC = – 7.304, 95% UI: – 8.081 – – 7.087); the increase of age-standardized prevalence rate was the highest for acne vulgaris (EAPC = 1.087, 95% UI = 1.052 – 1.110) but the decrease was the highest for cellulitis (EAPC = – 1.097, 95% UI: – 1.289 – – 0.917).   Conclusion  Among Chinese residents during 1990 – 2019, the burden of skin and subcutaneous diseases was under control but still remained at a high level due to increased incidence rate and prevalence rate of the diseases; special concern should be paid to decubitus ulcer to attenuate the burden of skin and subcutaneous diseases.
Disease burden of cervical cancer and breast cancer in Chinese women in 1990 and 2019
YU Xi-he, ZHANG Jing-ru, JIANG Hai-rui,
2022, 38(5): 534-538. doi: 10.11847/zgggws1136776
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  Objective  To analyze levels and changes of morbidity, mortality and disease burden of breast and cervical cancer among Chinese women in 1990 and 2019 and to provide a reference for developing effective strategies on breast and cervical cancer prevention and control and reducing relevant disease burden in the population.   Methods  The data of 1990 and 2019 on morbidity and mortality of breast and cervical cancer for global and Chinese women were extracted from the dataset of the Global Burden of Diseases (GBD). Disability-adjusted life years (DALY), years of life lost (YLL), and years lived with disability (YLD) were calculated to assess disease burden of breast and cervical cancer among the women.   Results  In 2019 in China, the number of morbidity and mortality were 368 400 and 93 500 for female breast cancer, with the increases of 354.25% and 125.85% compared to those in 1990; while for cervical cancer, the number of morbidity and mortality were 109 800 and 53 400, with the increases of 169.78% and 102.27%, respectively. The morbidity, mortality, DALY, YLL, YLD and their standardization rates for female breast cancer and cervical cancers increased with age, reaching higher levels after the age of 55 in both 1990 and 2019. The DALY for female breast cancer and cervical cancer were 2 877 200 person-years and 1 622 200 person-years in 2019, with the increases of 102.12% and 89.64% compared to those in 1990.   Conclusion  The disease burden of breast and cervical cancer among women in China increased significantly in 2019, suggesting that the prevention and control of the cancer should be further strengthened.
Trend in disease burden of leukemia in China, 1990 – 2019
DAI Meng-na, XI Yan, YIN Wen-qiang,
2022, 38(5): 539-546. doi: 10.11847/zgggws1135530
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  Objective   To examine the disease burden of leukemia and its changing trend in China during 1990 – 2019 for providing a reference to strategy development of intervention and treatment of leukemia in China.   Methods   The data on leukemia incidence, mortality, and disability adjusted life year (DALY) in China were extracted from the database of the Global Burden of Disease Study 2019. Standardization was conducted for the incidence, mortality, and disability rate and Joinpoint regression model was adopted to analyze chronological trends in the standardized rates and to find meaningful turning points of the changing rates.   Results   The mortality, incidence rate and DALY of leukemia in China have been decreasing form 1990 to 2019. During the period for the standardized rates of leukemia, the mortality decreased averagely per year by 1.8% (1.5% for males and 2.2% for females), the incidence by 2.4 (2.1% for males and 2.2% for females), and the DALY by 1.8% (0.4% for males and 1.0% for females), respectively. The differences in the decreases of leukemia incidence, mortality and DALY rate were all statistically significant among general, male and female populations.   Conclusion   The disease burden of leukemia in China has decreased during 1990 – 2019, but the incidence rate has started to rebound. Under the influence of urbanization, industrialization and aging in China, the disease burden of leukemia may continue to increase, and it is necessary to strengthen researches on pathogenesis and risk factors of leukemia for developing effective intervention measures in high risk populations to slow down the increase in disease burden the disease.
Disease burden of gastric cancer in Chinese population: a comparison between 1990 and 2017
GUO Jia, HE Yuan, WANG Xue-mei,
2022, 38(5): 547-552. doi: 10.11847/zgggws1134352
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  Objective   To compare the disease burden of gastric cancer among Chinese residents in 1990 and 2017 for providing references to decision making on gastric cancer prevention and health management.   Methods   Using the data of 1990 and 2017 from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017, we analyzed the changes in years of life lost (YLL), years living with disability (YLD) and disability-adjusted life years (DALY) due to gastric cancer in Chinese population between 1990 and 2017.   Results   In contrast with those in 1990, higher gastric cancer-related YLL (7 648 000 person-years [PYs] vs. 7 340 000 PYs), YLD ( 167 000 PYs vs. 74 000 PYs), standardized YLD rate (8.5/100 000 vs. 8.4/100 000) and DALY (7 815 000 PYs vs. 7 415000 PYs) were observed in 2017 in Chinese population, with the increasing percentage of 4.2%, 125.7%, 1.2%, and 5.4%; but the standardized YLL rate declined from 779/100 000 to 383.2/100 000 and the standardized DALY rate declined from 787.3/100 000 to 391.7/100 000. There were gender, age, and region differences in the changes between 1990 and 2017 for disease burden due to gastric cancer in the population; in the males, the YLD increased by 152.1%, higher than 76.9% in the females; while the standardized YLL and DALY rate decreased by 46.4% and 45.8% in the males, both lower than in female population (58.5% and 58.0%); the YLL, standardized YLD rate, and DALY of the males increased by 13.7%, 11.6%, and 15.1% but those of the females decreased by 12.7%, 19.0%, and 11.9%, respectively; the DALY decreased in people aged < 50 and 55 – 59 years but increased in the people of other age groups, with the highest increase of 133.5% in the people ≥ 80 years; the standardized DALY rate decreased among all age groups and the decrease percentage (75.7%) was the highest for the people aged 20 – 24 years; the highest increase of DALY (86.2%) was observed in the population of Shaanxi province whereas the greatest decrease of DALY (25.1%) was in the population of Tibet Autonomous Region; the standardized DALY rate decreased in all 33 provincial-level administrative divisions, with the greatest decrease (66.7%) in Beijing and the least decrease (14.7%) in Shaanxi province.   Conclusion   The disease burden of gastric cancer in Chinese population decreased in 2017 compared to that in 1990 but the decrease differed by gender and region and the disease burden is still at a relatively high level.
Disease burden associated with road injury in 1999 and 2019: a comparison between China and the world
YU Xi-he, SHANG Pan-pan, JIANG Hai-rui,
2022, 38(5): 553-556. doi: 10.11847/zgggws1135173
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  Objective  To examine the disease burden due to road injuries in China and the world in 1999 and 2019, and to provide references for the prevention and control of road injuries in China.   Methods  The data of 1999 and 2019 on road injury-related disease burden in population of China and the world were extracted from the Global Burden of Disease (GBD 2019) Study. Years of life lost (YLL), years lived with disability (YLD), and disability adjusted life years (DALY) attributed to road injury for China population and world population were analyzed and compared.   Results   For the years of 1999 and 2019, the mortality rate (1/100 000) of road injury in China population were 20.48 and 17.58, which were higher than those (19.69 and 15.49) in world population; the YLL rate (1/100 000) attributed to road injury in China population were 1 065.77 and 724.09, which were also higher than those (1 042.40 and 723.92) in world population; whereas, compared to those in world population, lower YLD rate (101.65/100 000 vs. 191.80/100 000), DALY (208.02/100 000 vs. 218.27/100 000), and DALY rate (1 171.41/100 000 vs. 1 234.20/100 000) were observed in China population. Among all road injuries in China population for the years of 1999 and 2019, the highest mortality rate (11.56/100 000 and 9.91/100 000), YLL rate (594.38/100 000 and 389.66/100 000), YLD rate (33.98/100 000 and 67.02/100000), and DALY rate (628.37/100 000 and 456.68/100 000) were attributed to pedestrian injury; and the all rates for the year of 2019 were higher than those in world population (mortality rate: 5.82/100 000, YLL rate: 50.86/100 000, YLD rate: 53.42/100 000, and DALY rate: 3.04.28/100 000). For the years of 1999 and 2019 in China population and consistent with the situations in world population, the disease burden of road injury was higher in males than in females; the age-specific road injury-related YLD rate was the highest in the elderly aged ≥ 70 years and the DALY rate was the highest in the people aged 15 – 49 and 50 – 69 years; the age-specific YLL rate was the highest in the people aged 15 – 49 years. For the year of 1999 in China population, the DALY rate of road injury caused by industrial injury and alcohol drinking in China was higher than those in world population; while the DALY rate of road injury correlated to low bone density, smoking and high body temperature were lower than those in world population. For the year of 2019 in China population, the DALY rate of road injury associated with low bone density and alcohol consumption were higher than those in world population; while the DALY rate of road injury caused by work-related injuries, high body temperature and smoking were lower than those in world population.   Conclusion   For China population in years of 1999 and 2019, the disease burden due to road injuries was relatively heavier and the mortality rate and YLL rate of road injuries were higher than those in world population. The study results suggest that males, middle-aged and elderly people, the people with low bone density or alcohol consumption are key populations in road injury prevention in China.
Burden of cardiovascular disease attributable to dietary lead exposure among adults in China, 2017
LI Yi-ling, YAN Yi-zhong, LIU Jia-lin,
2022, 38(5): 557-562. doi: 10.11847/zgggws1137343
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  Objective  To analyze the burden of cardiovascular disease (CVD) attributable to dietary lead among Chinese adults aged 18 years and over in 2017, and to provide a reference for assessing health hazards caused by exposure to lead in diet.   Methods  The data on disease burden of CVD among residents in China were extracted from the Global Burden of Disease Study 2017 (GBD 2017). The information relevant to blood lead (BLL), bioavailability of lead ingestion through digestive tract and respiratory tract for Chinese adults and lead concentrations in food, air, and drinking water were retrieved form literatures published from January 2000 to July 2020 via searching PubMed, Web of Science, China National Knowledge Infrastructure (CNKI), WanFang Database, and China Biology Medicine Database (CBMdisc). Population attribution fraction (PAF) was calculated using comparative risk assessment to estimate the burden of cardiovascular disease due to lead exposure. Based on the principle of integrated exposure uptake biokinetic (IEUBK) model, the contribution rate of dietary lead exposure to BLL was evaluated.   Results  The pooled mean BLL for Chinese adults was 5.23 μg/dL (5.96 μg/dL for males and 4.90 μg/dL for females). In 2017, the total disability-adjusted life years (DALYs) of cardiovascular disease attributable to lead exposure in Chinese adults was 3.2396 million years and the standardized attributable DALY rate was high for the adults in Sichuan, Yunnan, and Hunan province, resulting in the loss of 635.00, 633.62, and 547.36 healthy life years per 100 000 people, respectively. The dietary lead was a major contributor to the adults′ lead exposure, accounting for 57.01% and 58.60% of total lead exposure in male and female adults. The DALYs of cardiovascular disease attributed to dietary lead exposure was 1.8634 million, including 602.3 thousand DALYs of ischemic heart disease, 997.0 thousand DALYs of stroke, and 193.7 thousand DALYs of hypertensive heart disease.   Conclusion   For Chinese adults in 2017, lead exposure contributes to a significant ratio of burden of cardiovascular disease, and diet is a primary source of lead exposure.
Epidemiological Research
Public health safety literacy and its influencing factors among residents in four provinces of China
NING Yan, HOU Xiao-hui, WANG Xiao-yan,
2022, 38(5): 563-569. doi: 10.11847/zgggws1137705
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  Objective  To explore the status and influencing factors of public health safety literacy (PHSL) among residents in four provinces of China for providing references to the development of appropriate intervention strategies.   Methods  We recruited 2 809 urban and rural residents aged 15 – 69 years in three provinces (Hubei, Guangdong and Sichuan) and Beijing municipality using stratified multistage cluster sampling and conducted an on-site self-administered electronic questionnaire survey among the residents during April – June, 2021. A scale with three domains (each with a maximum score of 40) was designed to assess the PHSL of the residents. T-test, one-way analysis of variance (ANOVA), and χ2 test were adopted in univariate analysis and logistic regression in multivariate analysis.   Results   For all the participants, the mean overall PHSL score was 81.61 ± 13.71 and the mean domain scores were 29.21 ± 5.89 for PHS perception, 25.10 ± 5.10 for PHS knowledge, and 27.30 ± 4.87 for PHS skills. There were 80.85% of the participants being assessed with basic PHSL (with the overall scale score of ≥ 72) and there were 86.69%, 61.05%, and 78.96% of the participants being assessed with basic PHS perception, knowledge, and skills (with the domain scores of ≥ 24); also based on the scale of overall score of ≥ 96 and domain scores of ≥ 32, the proportion of the participants with good PHSL was 15.70% and the proportions of participants with good PHS perception, knowledge and skills were 35.32%, 14.03% and 20.15%, respectively. Multivariate logistic regression analysis showed that PHSL was associated with residential region, sex, education and household income. The participants residing in Hubei, Sichuan, and Guangdong province were less likely to have basic/good PHSL, with the odds ratios (OR) of 0.485/0.422, 0.488/0.699, and 0.389/0.566 in contrast to those residing in Beijing municipality. The participants being female (versus male: OR = 1.336/1.283), with the education of higher than primary school education or below (junior high school: OR = 1.786/1.205; senior high or vocational or technical secondary school: OR = 2.204/2.013; college and above: OR = 2.932/3.710), with the annual household income of more than 30 000 RMB yuan (30 000 – 60 000: OR = 1.660/1.648; ≥ 120 000: OR = 1.865/2.145) were more likely to have basic/good PHSL.   Conclusion  For 15 – 69 years old residents in four provincial administrative regions of China, the PHSL still needs to be improved and the residents′ PHSL is influenced mainly by gender, education, annual household income and residential region.
Changing trend in eating away from home and its impact on obesity among Chinese adults aged 18 and over: 2002 – 2015
WEI Xiao-qi, JU La-hong, YU Dong-mei,
2022, 38(5): 570-576. doi: 10.11847/zgggws1137746
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  Objective  To analyze the trend of eating away from home (EAFH) and its influence on obesity among Chinese adults from 2002 to 2015.   Methods  The data on 44394, 37703 and 77944 residents aged 18 years and above were extracted from three waves of China National Nutrition and Health Survey (CNNHS) conducted during 2002, 2010 – 2012 and 2015 across the country. The proportion and trend of EAFH among the adults by demographic and social-economic factors were analyzed with Chi-square and Cochran-Armitage trend test. Multivariate logistic regression analysis was used to explore influencing factors of EAFH and the influence of EAFH on obesity.   Results  Among all the participants surveyed in 2002, 2010 – 2012, and 2015, the proportions of reporting EAFH in past week were 7.2%, 16.5%, and 20.2%, with a significant increasing trend (P < 0.0001); for the male and female participants, the proportions were 9.8%, 20.0%, and 25.1% and 5.0%, 13.8%, and 15.8%, respectively, both with a significant increasing trend (P < 0.0001). The results of multiple logistic regression showed that the participants with following characteristics were more likely to have EAFH: being male, at ages of 18 – 44 years, unmarried, with the annual household income of ≥ 20 000 yuan RMB per capita, having the education of college and above, and being on-the-job workers of other than agriculture, forestry, animal husbandry, fisheries and water conservancy industry; the results also revealed that the male participants reporting EAFH were at an increased risk of obesity (odds ratio [OR] = 1. 166, ( 95% confidence interval [95% CI]: 1.101 – 1.235; P = 0.002), but the females with EAFH were at a decreased risk of obesity (OR = 0.922, 95% CI: 0.861 – 0.986, P = 0.001).   Conclusion  During 2002 – 2015 among Chinese adults aged 18 and above, the proportion of EAFH showed an increasing trend; the proportion was higher and the increasing trend was more obvious among the 18 – 44 years old unmarried adults with higher education and income. Frequent EAFH could increase obesity risk in the population. The results suggest that health education relevant to EAFH should be promoted among adult population in China.
Allocations of school doctors and clinics in public primary and secondary schools across Chinese mainland, 2019 – a general survey
TANG Xiao-zhe, LIU Yao, LIU Dong-shan,
2022, 38(5): 577-581. doi: 10.11847/zgggws1138263
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  Objective   To examine the status of doctors and clinics allocation in public primary and secondary schools across the mainland of China for providing a reference to the formulation of school health strategies.   Methods  With Epidemiological Dynamic Data Collection Platform (EDDC) of the Chinese Center for Disease Control and Prevention, we conducted a general survey on school doctors and clinics allocation among primary and secondary schools across 30 provincial-level administrative divisions in the mainland of China from October 2019 to February 2020.   Results  Among the 193 492 public primary and secondary schools surveyed, 33 407 (17.27%) had school doctors and there were 44 881 school doctors providing healthcare services to 155 143 857 students in 2019, with a student-school doctor ratio of 3457 : 1. Of the 66 682 surveyed schools with the total student number of 600 and above, only 1 296 (1.94%) met the national standard (≤ 600 : 1) for the student-school doctor ratio. School clinics were set up in 15.41% (n = 29 809) of all schools surveyed. There were statistical disparities in allocations of part/full time school doctors and school clinics, student-school doctor ratio, proportions of the school doctors taking professional training programs/refresher courses among the schools in different regions and the schools of various types (primary/secondary/vacation school and boarding/non-boarding) (all P < 0.01).   Conclusion  There were significant deficits in allocations of school doctors and clinics among primary and secondary schools across China and region- and school type-specific measures should be taken to improve the situation.
Working status of primary health care workers during the epidemic period: a cross-sectional survey
HUANG Lei, MIAO Yan-qing
2022, 38(5): 582-584. doi: 10.11847/zgggws1137318
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  Objective  To examine working duty and load and changes in salary among primary health care workers (HCWs) during the epidemic period for improving professional capability construction of medical staff in China.   Methods  Using multistage cluster sampling, we recruited 3030 HCWs from 191 community/township health care centers in 6 provincial level regions (Zhejiang, Hubei, Henan, Yunnan, and Sichuan province and Tianjin municipality) across China. A survey with a self-designed questionnaire among the primary HCWs were conducted during January, 2021.   Results  Valid information were collected from 98.05% (2 971) of the workers. Reported by the respondents, the main involvements during the epidemic period included the dissemination of epidemic prevention and control knowledge, population screening, epidemiological investigation, and home isolation observation. Of the 811 clinicians surveyed, 37.99% (310) reported part-time participation in basic public health services, with the health management for the elderly or major chronic disease patients being the highest reported service item. Decrease in overall income during the epidemic period was reported by 50.82%(1 510) of the respondents; more respondents being clinicians of traditional Chinese medicine reported the decrease and the proportion of reporting the decrease was higher among the respondents in eastern regions.   Conclusion  During epidemic control in China, primary health care workers undertook tasks according their responsibilities and played an important role as health gatekeepers. Talent incentive policies and integration of treatment and prevention should be implemented to promote professional capability of the health care workers.
Experimental Study
Antagonistic effect of andrographolide on cigarette smoke-induced lung injury in mice
LIU Jia-li, DING Gan-ling, WANG Jia-qi,
2022, 38(5): 585-588. doi: 10.11847/zgggws1136848
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Abstract:
  Objective  To explore protective effect of andrographolide on lung injury in mice exposed to cigarette smoke, and to provide evidences for the prevention and treatment of chronic obstructive pulmonary disease (COPD).   Methods  Forty mice were randomly divided into a control group (A), cigarette smoke exposure group (B), normal saline group (C), and andrographolide group (D). All the mice were exposed to cigarette smoke (300 mg/m3) for one hour, twice a day, five days in a week for 12 weeks, except for those of group A. The mice of group D were treated with an intraperitoneal injection of andrographolide at dose of 20 mg/kg body weight once a week after last cigarette smoke exposure during the week and the mice of group C were treated simultaneously but with 200 μL saline. By the completion of all the treatments, lung tissue and blood samples of the mice were collected for determinations of alveolus mean lining interval (MLI), mean alveolar area (MAA), interleukin-6 (IL-6)/interleukin-8 (IL-8)/matrix metalloproteinase-9 (MMP-9) in serum and bronchoalveolar lavage fluid (BALF). Correlations among IL-8, IL-9 and MMP-9 were analyzed.   Results  The MLI, MAA, IL-6, IL-8 and MMP-9 of the mice exposed to cigarette smoke were significantly higher than those of the control mice. Compared with those of the mice with cigarette smoke exposure, the MLI, MAA, IL-6, IL-8 and MMP-9 were significantly decreased in the mice of andrographolide group. In BALF, the concentration of IL-6 and IL-8 were significantly correlated with that of MMP-9.   Conclusion  Andrographolide could reduce BALF MMP-9, exerting an anti-inflammatory effect on lung injury induced by cigarette smoke exposure in mice.
Survey and Report
Construction of health effect-oriented comprehensive evaluation index system for essential national public health service
YOU Li-li, CHEN Xin-yue, YANG Ling-he,
2022, 38(5): 589-596. doi: 10.11847/zgggws1137292
Abstract(107) HTML (29) PDF 573KB(21)
Abstract:
  Objective   To construct an effect-oriented comprehensive evaluation index system for national basic public health services, and to provide methods and tools for innovating evaluation method of basic public health projects and promoting the transformation from process evaluation to health outcome evaluation.   Methods  Primary, secondary and tertiary indexes were constructed and selected with literature review, field interview of senior professionals, expert Delphi consulting and logical analysis; subjective and objective weights of the indexes were calculated through analytic hierarchy process and entropy weight method.   Results  Through literature analysis and interview consultation, an index pool consisting of 3 first-, 25 second- and 104 third-level indicators was preliminarily formed, including 47 third-level indicators reflecting health effects. For the first round of expert Delphi consultation on indicator screening, the positive coefficient of experts is 97.5%, the expert authority coefficient is 0.82, and the expert familiarity coefficient is 0.88. The final comprehensive evaluation index system consists of three first-level indexes of project investment, implementation and health effect, with the weights of 11.35%, 26.48% and 62.18%, along with 20 second- and 54 third-level indexes. Among the health effect indicators, the weight of awareness of and satisfaction to health services was the highest (16.39%), followed by the weight of health management in chronic disease patients (14.97%), children′s health management (12.42%), maternal health management (12.42%), and health education (5.43%). Among the three-level effect indexes, the weight of residents′ satisfaction to health service was the highest (7.25%), followed by the incidence of hypertension and diabetes complications in the managed population (5.35%) and the incidence of diabetes complications in the managed population (5.27%). Besides the health statistics from routine monitoring system in China, the electronic health records in residents′ information system can be used as a main data source for health effect indicators.   Conclusion  The comprehensive index system constructed in this study for the evaluation on essential national public health service is effect-oriented and can be used for regular and periodical evaluation on the basis of making full use of residents′ health records in the basic public health information system.
Effectiveness of NPIs and vaccine coverage in the prevention and control of COVID-19 epidemic – an ecological comparative study among Australia, Korea, Singapore, Israel and India
YAN Wen-xin, ZHU Zheng, WU Yun-xiao,
2022, 38(5): 597-603. doi: 10.11847/zgggws1138325
Abstract(352) HTML (126) PDF 915KB(63)
Abstract:
  Objective  To compare measures and effectiveness of case detection, transmission control, and vaccination for containment of coronavirus disease 2019 (COVID-19) epidemic in Australia, South Korea, Singapore, Israel, and India for providing evidences to the development of strategies on worldwide prevention and control of the epidemic.   Methods  The data on COVID-19 epidemic from January 1st 2020 through 2021 in the five countries were retrieved from the website of Our World in Data. Country-specific effects of non-pharmacological interventions (NPIs) and vaccinations on infectious source tracing, intercepting transmission, and protecting susceptible populations in the five countries were assessed by comparing correlations between the daily numbers of testing and incidence cases, the Oxford-stringency index and daily incidences, and the number of fully vaccinated persons per 100 population and daily mortalities.   Results  The severity of COVID-19 epidemic was controlled by increased daily number of detection in a certain extent and the daily number of confirmed incidence cases decreased after the day with the highest detection number. The Oxford-stringency index increased with the worsening of COVID-19 epidemic but decreased somewhat with the weakening of the epidemic and the decrease in the index could relate to a rebound of the epidemic. The case-fatality rate of COVID-19 decreased with the increase of fully vaccination rate.   Conclusion  Countries around the world should actively learn from international experience, follow the laws of epidemiology, start from controlling the source of infection, cutting off the transmission route and protecting susceptible people, adapt NPIs and promote booster vaccination universally, further research and development, for coping effectively with the global public health challenge.
Revenue of maternal and child health institutions in China – an analysis on monitoring data of 2020
MA Zhong-hua, HU Huan-qing, HUANG Ai-qun,
2022, 38(5): 604-609. doi: 10.11847/zgggws1137260
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Abstract:
  Objective  To examine revenue situation of maternal and child health (MCH) institutions at all administrative levels in China and to provide evidences for governmental decision-making.   Methods  The data on revenue of 3 094 MCH institutions in 31 provincial level administrative regions across the mainland of China in 2020 were collected through the national monitoring and direct reporting system for MCH institutions; other relevant information were also extracted from China Health Statistical Yearbook of 2020. The revenue and financial subsidy income of the MCH institutions in 2020 were analyzed and compared.   Results  The entire financial subsidy income of 63.09 billion yuan RMB accounted for 28.7% of the total revenue of MCH institutions in 2020 and the proportion was much lower than that for other public welfare institutions including the centers for disease control and prevention (73.6%) and health supervision institutes (91.5%). There were obvious differences in the median values (million yuan) of the revenue for the MCH institutions in various regions, at different administrative levels, and belong to different financial management categories, with significant higher medians for the MCH institutions in the eastern region (25.81), at provincial level (712.17) and under the combined financial management for public welfare of first- and second-category (70.33) compared to other MCH institutions.   Conclusion  At present, unreasonable composition, single source, and insufficient financial support are main problems for revenue of MCH institutions in China, suggesting that guarantee mechanism and policy flexibility relevant to revenue of MCH institutions need to be improved urgently.
Epidemiological characteristics of metabolic phenotypic heterogeneity in adults with obesity in Shaanxi province
JING Hui, TENG Yu-xin, Samuel Steven Chacha,
2022, 38(5): 610-613. doi: 10.11847/zgggws1136326
Abstract:
  Objective  To examine epidemic characteristics of obesity metabolic phenotype heterogeneity among urban adults in Shaanxi province, and to provide evidences for individualy stratified identification and classification management of obesity metabolic phenotype.   Methods  Data on 13 072 urban adults aged 20 – 89 years without major diseases were collected from Shaanxi Urban Cohort Baseline Survey of Natural Population Cohort Study in Northwest China conducted from 2017 to 2019. According to the status of obesity and metabolic abnormality, the adults were further divided into four subgroups of metabolic healthy non-obesity (MHNO), metabolic unhealthy non-obesity (MUNO), metabolic healthy obesity (MHO) and metabolic unhealthy obesity (MUO), and the heterogeneity and epidemiological characteristics of different obesity metabolic phenotype groups were analyzed.   Results  Of all the adults, the majority (66.55%, 8 700) were with MHNO, followed by those with MUNO (22.56%, 2 949), MHO (4.09%, 535) and MUO (6.79%, 888). For the male adults, the proportion of MHNO, MUNO, MHO and MUO population was 55.8%, 27.9%, 6.1% and 10.2%, respectively; the metabolic phenotype of obesity changed with age (χ2trend = 9.143, Ptrend = 0.002), with the proportion of MUNO increasing with the increase of age (χ2trend = 217.096, Ptrend < 0.001) and the proportions of NHNO and MHO decreasing with the increase of age (both Ptrend < 0.001). For the female adults, the proportion of MHNO, MUNO, MHO and MUO were 55.8%, 27.9%, 4.09% and 6.79%, and the proportion also changed with age (χ2trend = 486.235, Ptrend < 0.001); the proportion of MUNO, MHO and MUO increased with the increase of age (Ptrend < 0.05 all) but the proportion of MHNO decreased with the increase of age (χ2trend = 738.600, Ptrend < 0.001). When the obesity standard changed from body mass index (BMI) ≥ 28.0 to BMI ≥ 25.0, the proportion of MHO increased from 4.09% to 16.06%; when the metabolic abnormality criterion changed from ≥ 2 to ≥ 0, the proportion of MHO decreased from 4.09% to 1.02%.   Conclusion  The metabolic heterogeneity of obesity exists obviously among urban adults in Shaanxi province; the proportion of the adults with obesity but normal metabolism is low, while the metabolic abnormality is prominent in obese adults.
A school cluster outbreak of COVID-19 caused by SARS-CoV-2 Omicron variant
LI Ya-fei, FAN Wei, WANG Wen-hua, et.al,
2022, 38(5): 614-618. doi: 10.11847/zgggws1138512
Abstract(650) HTML (163) PDF 985KB(173)
Abstract:
  Objective  To analyze a cluster outbreak of coronavirus disease 2019 (COVID-19) caused by the Omicron variant of severe acute respiratory syndrome coronavirus virus 2 (SARS-CoV-2) in a boarding school for providing a reference to COVID-19 epidemic prevention and control.   Methods  From China Information System for Disease Control and Prevention, we extracted the information on all COVID-19 cases laboratory-confirmed during January 8 – 19, 2022 among the students and teachers in a boarding school at a county in Henan province. Incidence rate (proportion) and histogram were used to describe epidemiological characteristics of the outbreaks. Basic reproduction number (R0) and time-varying reproduction number (Rt) were calculated with R software.   Results  Totally 283 COVID-19 cases infected with SARS-CoV-2 Omicron BA.1 variant were diagnosed during the 12-day period and the attack rate was 6.8% for the 4 124 students and teachers of the school. The cases occurred in 23 classes (all for senior high school students and only one for junior high school students) and the class-specific attack rate ranged 1.6% – 76.8%. For the 269 student cases at a mean age of 17.0 ± 0.9 years, the male to female ratio was 1 : 1.09; while the mean age was 24.0 (25th percentile = 23.0, 75th percentile = 30.0) years for the 14 teacher cases. The estimated R0 was 5.46 (95% confidence interval: 3.11, 8.77); the estimated Rt increased first and then declined. Obvious symptoms were observed among 18.4% (52) of all cases and major clinical manifestations included fever, sore throat and cough, which occurred in 69.2%, 30.8% and 19.2% of the 52 sufferers. The confirmed cases were clinically classified as common or mild type patients.   Conclusion  The Omicron variant of SARS-CoV-2 identified among the cases of the school cluster outbreak of COVID-19 was highly contagious but induced relatively mild clinical symptoms. Follow up studies need to be conducted among the cases of the epidemic outbreak to assess long-term adverse effects of the viral infection in the infected people.
Epidemic characteristics and key measures of prevention and control in key places and units under regular COVID-19 prevention and control – a literature analysis
GAO Peng, LI Meng-yao, LI Qiao-sheng, Yawen Jia, Liangyu Kang, Jue Liu, Min Liu,
2022, 38(5): 619-623. doi: 10.11847/zgggws1138136
Abstract(168) HTML (74) PDF 561KB(30)
Abstract:
  Objective  To examine weaknesses in epidemic prevention and control in key places and units during regular coronavirus disease 2019 (COVID-19) containment for improving control measures on the epidemic in the future.   Methods  Totally 11 studies on COVID-19 epidemic and its control published up to January 20, 2022 were retrieved from China CDC Weekly. The information on key strategies for COVID-19 epidemic control was collected from relevant documents issued by government departments during the epidemic period.   Results  The places or units with more COVID-19 infections were characterized by frequent gathering of people, high pedestrian flow, and with relatively closed spaces. Most of the index cases were detected among examinees attending medical institutions for compulsory/voluntary/routine screening test and most of the epidemic outbreaks were related to imported cases or imported good with virus contamination. For the key places and units involved in epidemics without local cases, the implemented preventive measures included preparing anti-epidemic materials, keeping ventilation and cleaning of indoor environment, conducting routine disinfection, improving staff management, implementing monitoring on migrant people, and strengthening the publicity of epidemic prevention knowledge; additional measures implemented in the key places and units with local cases were carrying out immediate epidemiological investigations to identify risk areas and performing nucleic acid testing among populations in risk areas.   Conclusion  In prevention and control of COVID-19 epidemic, special concern should be paid to medical institutions and places and units correlated with overseas affairs or imported goods. In future, the measures to be strengthened for epidemic containment are the identification of high risk population, the quarantine of imported cargoes, , strict control of nosocomial infection, and epidemic prevention in holidays.
Emotional responses and behavioral coping mechanism to sufferers′ privacy leakage among Chinese internet users during public health emergencies
LIU Zhi-xin, LIU Jun-ping, SUN Ming-lei,
2022, 38(5): 624-628. doi: 10.11847/zgggws1136921
Abstract(131) HTML (31) PDF 830KB(19)
Abstract:
  Objective  To study emotional reactions to and behavior intentions about sufferers′ privacy leakage among internet users in China during public health emergencies (PHE) and to provide references for improving government supervision capability and risk communication strategy.   Methods  Totally 54 blogs and 6 946 comments relevant to two events of PHE sufferers′ privacy leakage were retrieved from Sina Weibo during March 2021 using Octoparse software. High-frequency words were extracted from the retrieved corpus with ROST Content Mining software and a grounded theory-based textual analysis was performed after open, spindle and selective coding with NVivo12.0.   Results  Finally 25 initial and 11 main categories were identified; a 'situation-perception-reaction' theoretical model was constructed; and a logical framework was formed for the internet users′ emotional response and coping behaviors to the incidents of PHE sufferers′ privacy leakage.   Conclusion   Influenced by personal characteristics, risk information and other factors, the self-perception on sufferers′ privacy leakage would occur among internet users in public health emergencies; based on the self-perception, the internet users may produce corresponding emotional reactions, and finally make behavioral response choices.
Dissemination of research findings in public health among science and technology professionals in China
LIU Jing, HU Yi-luan, YIN Xue-jun,
2022, 38(5): 629-633. doi: 10.11847/zgggws1138373
Abstract(142) HTML (75) PDF 583KB(12)
Abstract:
  Objective  To investigate the dissemination of research findings in public health and its influencing factors among science and technology professionals in China.   Methods  An online survey was conducted in January 2022 among 1 466 science and technology professionals recruited from Chinese Preventive Medicine Association, Chinese Nutrition Society, Chinese Antituberculosis Association, and Chinese Association of STD and AIDS Prevention and Control. The information on the professionals′ research experience, working years, academic papers published, ways of funding support to dissemination, training experience in dissemination and implementation (D&I) research, and work experience in research-related setting were collected and associations of the professionals′ characteristics with dissmination of research findings were analyzed.   Results  Valid responses were collected from 956 (65.2%) of the professionals recruited and of the valid respondents, 737 reported being engaged in researches. For all the 737 respondents conducting research works, 58.1 % stated ever having disseminated their research findings, while the proportions of ever conducting the dissemination were 64.3%, 64.4%, and 67.8% for the respondents spending most of working time in research practice, doing research work for more than 20 years, and having published more than 6 academic papers during past 3 years, respectively. The respondents with following characteristics were more likely to conduct the dissemination of research finding: receiving funds that support to the disseminations through various ways (odds ratio [OR] = 2.39, 95% confidence interval [95% CI]: 1.61 – 3.54), ever taking a part in D&I research-related training (OR = 2.05, 95 % CI: 1.36 – 3.09), and having work experience in a practice or policy setting (OR = 5.38, 95% CI: 3.75 – 7.73) according to the results of multivariate binary logistic regression analysis.   Conclusion  A lot of effort is required for promoting the dissemination of scientific research findings among Chinese science and technology professionals in public health.
Overview
Research progress in carcinogenicity of metalworking fluids
ZOU Li-hai, KANG Dian-min
2022, 38(5): 634-636. doi: 10.11847/zgggws1135442
Abstract(97) HTML (36) PDF 430KB(17)
Abstract:
Metalworking fluids (MWFs) is used in the machinery manufacturing industry in huge quantities and with a large number of exposed workers. MWFs can simply be divided into 2 categories: oil-based and water-based fluids, or by its nature into 4 categories: straight oils, soluble oils, synthetic fluids and semi-synthetic fluids. During machining and grinding operations, MWFs is sprayed directly onto the exposed skin of the operator′s hands or face, or is dispersed into the air of the workplace environment and inhaled by the operator, resulting in occupational health hazards due to mechanical splashing, rotating workpiece forces, atomisation and evaporation, burning or pyrolysis due to increased surface temperature of the metal cutting workpiece. The health hazards of MWFs to skin and respiratory system are well established, but the issue of its carcinogenicity is still debated. In this study, the carcinogenicity of MWFs is reviewed in terms of the relationship between exposure to MWFs and cancer, the relationship between MWFs types and cancer, and the carcinogenic factors of MWFs for providing a reference for further research on the health hazards of MWFs.
Public Health Forum
Establishment and application of a multisectoral coordination mechanism for containment of COVID-19 epidemic in Fujian province – a brief discussion
MAO Yi-meng, WU Sheng-gen, ZHENG Kui-cheng,
2022, 38(5): 637-640. doi: 10.11847/zgggws1138330
Abstract(573) HTML (67) PDF 507KB(64)
Abstract:
For effective containment of coronavirus disease 2019 (COVID-19) epidemic, a multisectoral coordination mechanism was established and applied in emergency responses to three local and two major imported epidemics in Fujian province. The multisectoral coordination mechanism is characterized by the involvement of three departments (public health, public security, and industry and information technology) and comprehensive utilization of big data from the three departments. The application of the multisectoral coordination mechanism improved the efficiency of routine control measures and played an important role in successful coping with the COVID-19 epidemics in the province by adopting more active procedures instead of passive managements.