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Objective: To investigate the association between hyperuricemia and the risk for stroke occurrence, as well as the mediating effect of hypertension on this association. Methods: In this study, the China Chronic Diseases and Nutrition Surveillance system in 2015 was used as baseline data. We identified hospital admissions for stroke using the electronic homepage of inpatient medical records from 2013-2020, and death data were obtained from the 2015-2020 National Mortality Surveillance System. A retrospective cohort was established after matching and linking the database. The Cox proportional hazard regression model was used to analyze the relationship between hyperuricemia and the risk of stroke and its subtypes. Restricted cubic spline analysis was conducted to examine the dose-response relationship between serum uric acid levels and the risk for stroke. Mediation analysis was performed to investigate the mediating effect of hypertension on the association between hyperuricemia and the risk for stroke and its subtypes. Subgroup analyses were conducted based on gender and age groups. Results: A total of 124 352 study subjects were included, with an accumulative follow-up time of 612 911.36 person-years. During the follow-up period, 4 638 cases of stroke were found, including 3 919 cases of ischemic stroke and 689 cases of hemorrhagic stroke. The incidence density of stroke was 756.72 per 100 000 person-years, 641.37 per 100 000 person-years for ischemic stroke, and 114.60 per 100 000 person-years for hemorrhagic stroke. Multivariable Cox proportional hazards regression models showed that after adjusting for covariates, compared to those without hyperuricemia, individuals with hyperuricemia had a 16% higher risk for stroke [hazard ratio ( HR )=1.16, 95% CI : 1.06-1.27], a 12% higher risk of ischemic stroke ( HR =1.12, 95% CI : 1.01-1.24), and a 39% higher risk of hemorrhagic stroke ( HR =1.39, 95% CI : 1.11-1.75). Mediation analysis showed that hypertension partially mediated the associations between hyperuricemia and the risk for stroke, ischemic stroke, and hemorrhagic stroke, with mediation proportions of 36.07%, 39.98%, and 25.34%, respectively. The mediating effect is pronounced in the male population and individuals below 65. Conclusion: Hyperuricemia is a risk factor for stroke, and hypertension partially mediates the effect of hyperuricemia on stroke.

Objective: To understand the prevalence of insufficient physical activity among adults aged ≥18 years in China and to explore the influencing factors. Methods: The China Chronic Disease and Risk Factor Surveillance was conducted in 298 counties/districts in China in 2018, covering 31 provinces (autonomous regions, municipalities). A multi-stage stratified cluster random sampling method was used to select permanent residents aged ≥18 years. A questionnaire including Global Physical Activity Questionnaire was used to collect information about the participants' demographic characteristics and physical activity through face-to-face interview. A total of 183 769 participants completed the survey. After complex data weighting, the prevalence of insufficient physical activity, occupation, transportation, and leisure-time physical activity time was analyzed. Multivariate logistic regression models were used to analyze the influencing factors related to insufficient physical activity. Results: The prevalence of insufficient physical activity among adults aged ≥18 years was 22.3% (95% CI : 20.9%-23.7%) in China in 2018, with males [24.4% (95% CI : 23.0%-25.8%)] significantly higher than females [20.2% (95% CI : 18.6%-21.8%)]. Adults aged 70 years and above [28.4% (95% CI : 26.9%-29.9%)] were significantly higher than adults in other age groups, followed by adults aged 18-29 years [26.4% (95% CI : 24.4%- 28.3%)] and 30-39 years [23.4% (95% CI : 21.5%-25.3%)], and tended to increase with increasing education and total sedentary behavior time ( P <0.001). The weekly occupation, transportation, and leisure-time physical activity time appeared 958.6 (95% CI : 911.4-1 005.8) minutes, 234.5 (95% CI : 224.7- 244.2) minutes, and 88.6 (95% CI : 83.5-93.7) minutes, respectively. Multivariate logistic regression analysis showed that males, adults living in rural areas or northern China, ≥70 years, with junior high school education, an annual household income per capita <6 000 yuan and institutional/clerical/ technical occupation and longer total sedentary behavior time were related to a higher prevalence of insufficient physical activity. Conclusions: In China, over one-fifth of the adults had lower physical activity levels. Adults who are male, young adults, more educated, institutional/clerical/technical occupation, and with more extended total sedentary behavior are the populations that need to be focused on to promote physical activity-related health.

Objective: To assess the cardiovascular health status of adults in China by using the "Life's Essential 8" score, and provide reference for the development and improvement of cardiovascular disease prevention and control policies and measures. Methods: Chronic Disease and Nutrition Surveillance was conducted in 298 counties/districts in 2015 in 31 provinces (autonomous regions, municipalities) across China, multi-stage stratified cluster random sampling was used to select 45 households in each village or neighborhood, and 20 households were further selected to conduct dietary surveys. In this study, a total of 70 093 adults aged ≥20 years who completed the dietary survey and had complete information were included, their cardiovascular health status were assessed by using the "Life's Essential 8" score, a cardiovascular health scoring standard released by the American Heart Association in 2022. All results were adjusted using complex design-based sampling weights to achieve a better estimate of the population. Results: In 2015, the overall cardiovascular health score of Chinese adults aged ≥20 years was 73.3±12.6, the score was significantly higher in women (77.9±11.6) than in men (68.7±11.8), and higher in urban area (74.5±12.8) than in rural area (71.9±12.2), the differences were significant ( P <0.001). It was estimated that about 0.25% (95% CI : 0.16%-0.33%) of adults in China had cardiovascular health score of 100, and 33.0% (95% CI : 31.6%-34.3%), 63.2% (95% CI : 62.1%-64.3%), and 3.9% (95% CI : 3.5%-4.2%) of adults had high, moderate and low cardiovascular health scores, respectively. The proportion of those with high cardiovascular health scores was relatively low in men, those with low education level, those with low income, those living in rural areas, and those living in southwest China ( P <0.001). Of the eight factors, diet had the lowest mean score (46.0, 95% CI : 44.7-47.3), followed by blood pressure (59.4, 95% CI : 58.2-60.6) and tobacco exposure (61.4, 95% CI : 60.6-62.2). Conclusions: The cardiovascular health status of two-thirds of adult population in China needs to be improved. Diet, tobacco exposure, and blood pressure are the factors affecting the cardiovascular health of Chinese population, to which close attention needs to be paid, and men, rural residents, and those with lower socioeconomic status are key groups in cardiovascular health promotion.

Objective: To understand the health examination rate and its changing trend in adults in China from 2010 to 2018, identify the main factors affecting the health examination rate and provide data support for decision making of health intervention. Methods: Data from China Chronic Disease and Risk Factor Surveillance in 2010, 2013, 2015 and 2018 were used. After complex weighting of the data, the rates of health examination, its changing trends and reasons for receiving health examination in adults were analyzed. Average annual percent change (AAPC) was used to describe the changing trend. Anderson model was used as the analysis framework. Multivariate logistic regression model was used to identify the influencing factors for the health examination rate. Results: From 2010 to 2018, the health examination rate in adults increased from 28.2% (95% CI : 24.8%-31.6%) to 41.0% (95% CI : 38.9%-43.1%, P for trend <0.001), the AAPC was 5.47%, the annual average increase was more obvious in those with lower education level and lower income level and in those living in rural area and in western China. In 2018, people received health examination mainly due to providing without charge by community (36.7%) and working unit (28.5%). The results of multivariate analysis showed that being women, age ≥45 years, education level of junior high school or above, living in urban areas, medical insurance, annual income ≥24 000 RMB, suffering from multiple chronic diseases, non-smoking, drinking, adequate physical activity were positive factors for receiving health examination. Conclusion: The rate of health examination in adults increased in China during 2010-2018, and the main reason for receiving health examination is free of charge.

Objective: To explore the associations of glycated hemoglobin (HbA1c) with FPG and oral glucose tolerance test 2-hour (OGTT-2 h) in areas at different altitude in China. Methods: Subjects who participated in 2018-2019 China Chronic Disease and Risk Factor Surveillance and had no prior type 2 diabetes diagnosis were included. Subsequently, they were categorized into three groups based on altitude of living area (<2 000, 2 000- and ≥3 000 m). With adjustment for intracluster correlation, multivariable linear regression analysis was performed to evaluate the associations of HbA1c with FPG and OGTT-2 h in the context of HbA1c was normal (<5.7%) or abnormal (≥5.7%). Furthermore, the shape of relationships between HbA1c and glucose indicators was examined using restricted cubic spline. Finally, receiver operating characteristic curve was used to evaluate the diagnostic performance of HbA1c for diabetes. Results: A total of 157 277 subjects were included in the analysis. While FPG and OGTT-2 h levels gradually decreased with increase of altitude, HbA1c level was similar among the three groups. When HbA1c was <5.7%, its association with FPG and OGTT-2 h was weak and no obvious difference was observed among the three groups. When HbA1c was ≥5.7%, the FPG and OGTT-2 h increased by 15.45% (95% CI :14.71%- 16.18%) and 24.54% (95% CI :23.18%-25.91%) respectively per one standard deviation increase in HbA1c in group in area at altitude <2 000 m. However, the FPG and OGTT-2 h increased by 13.08% (95% CI :10.46%-15.76%) and 21.72% (95% CI :16.39%-27.31%), respectively, in group in area at altitude 2 000- m, and increased by 11.41% (95% CI :9.32%-13.53%) and 20.03% (95% CI :15.38%- 24.86%), respectively, in group of altitude ≥3 000 m. The restricted cubic spline indicated that the curve showing the association of HbA1c with FPG and OGTT-2 h was flat when HbA1c was <5.7%, but showed a positive linear relationship when HbA1c was ≥5.7%. The area under curve for detecting diabetes was 0.808 (95% CI :0.803-0.812) in group of altitude <2 000 m and 0.728 (95% CI :0.660-0.796, P =0.022) in group of altitude ≥3 000 m. The relevant optimal cutoff value of HbA1c was 5.7%, with a sensitivity of 65.4% and a specificity of 83.0%, and 6.0%, with a sensitivity of 48.3% and a specificity of 93.7%, respectively. Conclusions: When HbA1c was ≥5.7%, the association between HbA1c and glucose indicators became weaker as the increase of altitude. In the area at altitude ≥3 000 m, it may not be appropriate to use HbA1c in the diagnosis of diabetes.

Objective: To analyze the blood pressure measurement of Chinese adult residents in 2018 and provide a scientific basis for early detection and intervention of hypertension. Methods: In 2018, China Chronic Disease and Risk Factor Surveillance were conducted in 298 counties (districts) of 31 provinces (autonomous regions, municipalities) across the country, using a multi-stage stratified cluster random sampling method to survey permanent residents aged 18 years and above. We selected 184 509 people and carried out a face-to-face questionnaire survey and body measurement method to collect demographic data, major chronic diseases, and blood pressure measurement information of the survey subjects. Blood glucose and blood lipid-related indicators were obtained by laboratory testing. There were 170 551 adult residents included in the study after excluding abnormal and missing data for key variables. After complex weighting, blood pressure detection rates and detection times in people with different blood pressure levels and other diseases were analyzed. SAS 9.4 software was used to perform the χ 2 -test and trend test. Results: Among adult residents in China, the proportions of those with normal blood pressure, commonly recognized 'high' blood pressure, and newly detected hypertension who had their blood pressure tested within three months were 44.4%, 50.4%, and 52.6%, respectively. The proportions all appeared higher in women than in men (all P <0.05), in urban than in rural areas (all P <0.05), and showed an increasing trend with age (all P <0.001); The proportion of these three populations who had never had their blood pressure measured was 27.6%, 24.2%, and 23.5% respectively. The proportion of people with diagnosed hypertension who had their blood pressure tested within seven days was 44.0%, 51.4% in urban areas, higher than 37.7% in rural areas ( P <0.001), and the proportion of people who had their blood pressure tested increased with education, per capita annual income and BMI (all P <0.001). Conclusions: The behavior of regular self-monitoring of blood pressure among adult residents in China still needs to be improved, especially among men and rural areas. Relevant health promotion and education should be strengthened. More targeted policies and measures should be developed to improve blood pressure measurement behavior in people with normal high blood pressure and other high-risk groups to control elevated blood pressure effectively.

Objective: To describe and compare blood glucose levels in adults aged 18 years old and above in China and explore the relationship between BMI and waist circumference with blood glucose. Methods: China Chronic Disease and Risk Factor Surveillance were conducted in 298 counties/districts in China in 2018, covering 31 provinces (autonomous regions, municipalities). A multi-stage stratified cluster random sampling method selected permanent residents aged 18 years and above. Information on demographics, behavior-related risk factors, BMI, waist circumference, and blood glucose were collected through a face-to-face questionnaire, physical measurement, and laboratory examination. After complex weighting of data, they described the blood glucose levels of people with different characteristics and explored the relationship of BMI and waist circumference with blood glucose by multiple linear regression model analysis. Results: A total of 177 816 adults were included in the study. The average fasting blood glucose and average glycosylated hemoglobin were (5.73±1.46) mmol/L and (5.37±0.83) %, with people aged 60 years old and above group highest than that of other, with males higher than females ( P <0.001); and urban was higher slightly than rural for the average of average glycosylated hemoglobin ( P <0.001). The average fasting blood glucose and average glycosylated hemoglobin increased with increased BMI and waist circumference ( P <0.001). Results from multiple linear regression model analysis showed that: 1) for each increase in BMI unit and waist circumference, the fasting glucose levels increased by 0.019 mmol/L and 0.008 mmol/L (all P <0.001) in those not diagnosed with diabetes, 2) by 0.021 mmol/L ( P =0.163) and 0.014 mmol/L ( P =0.004) in those newly detected as diabetes, and 3) by 0.028 mmol/L ( P =0.088) and 0.023 mmol/L ( P <0.001) in those self-reported as having been diagnosed as diabetes, respectively. However, glycosylated hemoglobin levels increased: 1) by 0.015% and 0.006% in those not diagnosed as diabetes (all P <0.001), 2) by 0.050% and 0.019% in those newly detected as diabetes (all P <0.001), and 3) by 0.033% and 0.019% in those self-reported as having been diagnosed as diabetes (all P <0.001), respectively. These associations with waist circumference were more robust than with BMI. Conclusions: Adults not diagnosed with diabetes with abnormal BMI or waist circumference are the key population for prevention and control. Measures improving the awareness rate of waist circumference should be taken to maintain average blood glucose in various groups.

Objective: To analyze the status of measuring the blood glucose among Chinese residents aged 18 years and above and to provide a scientific basis for evaluating the Healthy China Initiative. Methods: China Chronic Disease and Risk Factor Surveillance were conducted in 298 counties/districts in China in 2018, covering 31 provinces (autonomous regions, municipalities). A multi-stage stratified cluster random sampling method selected permanent residents aged 18 years and above. Questionnaires collected demographic characteristics, blood glucose measurements, and significant chronic disease prevalence. Body measurements were conducted to collect body height, weight, and waist circumference; Fasting venous blood was collected from participants to measure FPG before OGTT-2 h was obtained among participants without a self-reported history of diagnosed diabetes. The analysis included 177 904 residents aged 18 and above. After being weighed, the blood glucose measurement rates of adults in different groups were compared. Results: Among adults who had not been diagnosed with diabetes, The blood glucose measurement rates of regular, prediabetes, and newly detected elevated blood glucose within 12 months were 32.0% (95% CI : 30.5%-33.5%), 39.5% (95% CI : 37.4%-41.6%) and 43.8% (95% CI : 41.0%-46.4%), respectively. The measurement rates were higher in females than males; urban was higher than rural. The blood glucose rates increased with age, education, and BMI. These differences were significant ( P <0.05). Among the adults with diabetes, the blood glucose measurement rate within six months was 89.6% (95% CI : 88.4%-90.8%); the measurement rate was higher in females than in males and higher in the west than in east and central regions of China, with statistical significance ( P <0.05). Among adults in the study who did not have 1 or 2 or ≥3 major chronic diseases, the blood glucose measurement rates within six months were 19.6% (95% CI : 18.4%-20.7%), 41.8% (95% CI : 40.1%-43.5%), 58.9% (95% CI :57.0%-60.7%),71.9% (95% CI : 69.0%-74.9%), respectively. The blood glucose measurement rate was on the rise and increased with the number of comorbidities ( P <0.001). The blood glucose measurement rate of adults who did not have 1 or 2 major chronic diseases was higher in urban areas than in rural areas. The blood glucose rates increased with age, education, and BMI and the differences were significant ( P <0.05). The blood glucose measurement rate of adults with ≥3 major chronic diseases was higher in females than in males ( P <0.001), and there was no difference among other groups ( P >0.05). Conclusion: It is necessary to promote blood glucose measurement in residents aged 18 years and above in China. Relevant departments should strengthen the publicity and education to promote regular blood glucose measurement for high-risk populations to improve the efficiency of preventing and treating diabetes and its complications.

Objective: To understand the awareness of weight and waist circumference and their influencing factors among residents aged ≥18 years in China and provide a reference for the development of relevant prevention and treatment policies and evaluation of intervention effects. Methods: We selected 298 counties (districts) from the 31 provinces (autonomous regions and municipalities) which participated in the 2018 China Chronic Disease and Risk Factor Surveillance program and included 194 779 permanent residents aged ≥18 years. To obtain the demographic characteristics of the study population, we used a multi-stage stratified whole-group random sampling method, questionnaires, and physical measurements. In this study, 179 045 people who completed the survey and had complete information on weight and waist circumference awareness were used as the study subjects. The weight awareness rate and waist circumference awareness rate were calculated by gender stratification, age, urban-rural, and education level groups. A multi-factor logistic regression model was used to analyze the influencing factors related to weight and waist circumference awareness of residents aged ≥18 years. Results: The weight awareness rate of adult residents in China in 2018 was 45.4% (95% CI : 41.9%-48.9%), higher among men [46.2% (95% CI : 42.5%-49.8%)] than women [44.6% (95% CI : 41.1%-48.2%)], and in urban areas [54.3% (95% CI : 49.3%-59.3%)]. The highest weight awareness rate appeared in residents with low BMI grouping [49.9% (95% CI : 44.3%-55.6%)], and the weight awareness rate in residents with undiagnosed central obesity, hypertension, and diabetes was higher than that of residents with diagnosed diabetes, with statistically significant differences ( P <0.05). The waist circumference awareness rate of adult residents was 11.6% (95% CI : 9.7%-13.4%), higher in women [12.8% (95% CI : 10.8%-14.8%)] than in men [10.3% (95% CI : 8.6%-12.0%)], higher in urban [14.6% (95% CI : 11.7%-17.4%)] than in rural [8.3% (95% CI : 6.5%-10.2%)], and the waist circumference awareness rate was higher among residents with confirmed diabetes than those with undiagnosed diabetes, with statistically significant differences ( P =0.020). The difference was statistically significant ( P <0.001). The weight and waist circumference awareness rate increased with education level and annual per capita household income. Multi-factor logistic regression analysis suggested that urban, highly educated, high per capita annual household income and health check-up residents may have higher weight and waist circumference awareness rates among adult residents in China. Conclusion: Less than half of the adult residents in China know their weight status, and only about one-tenth know their waist circumference. Rural residents, those with low education levels and low annual per capita household income, and those who are obese need to be given prioritized attention. The relevant government departments should strengthen the popularization of the importance of weight and waist circumference on health and improve the awareness of our residents about their waist circumference and weight.

Objective: To understand the current status of community health management, treatment and control of hypertension in patients aged 35 years and above in China in 2015, and identify the influencing factors. Methods: Using the questionnaire survey results and physical measurement information collected by China Chronic Diseases and Nutrition Monitoring System in 2015, hypertension patients aged 35 years and above diagnosed at township health center level (community health service centers) or above were selected as the research subjects. The patients were complexly weighted to analyze their general characteristics, community health management, treatment and control status. Results: This study included 23 974 hypertension patients aged 35 years and above diagnosed by medical and health institutions at township level and above in 2015. After complex weighting, the community health management rate of hypertension patients aged 35 years and above was 54.10% (95% CI : 51.02%-57.17%), the standardized community management rate was 45.72% (95% CI : 42.93%-48.51%), the treatment rate was 88.16% (95% CI : 87.00%-89.31%), and the control rate was 22.67% (95% CI : 21.25%-24.09%), the treatment control rate was 27.76% (95% CI : 26.09%-29.42%). Multivariate analysis showed that patients in urban areas as well as in rural areas who were aged over 65 years old ( OR =1.40, 95% CI : 1.05-1.87; OR =3.11, 95% CI : 2.22-4.36), taking medicine as prescribed ( OR =2.15, 95% CI : 1.46-3.15; OR =1.35, 95% CI : 1.13-1.62), monitoring blood pressure ( OR =2.34, 95% CI : 1.88-2.90; OR =3.10, 95% CI : 2.72-3.53) were more willing to accept community health management of hypertension. Urban hypertension patients with high education level ( OR =0.51, 95% CI : 0.39-0.66), moderate alcohol consumption ( OR =0.69, 95% CI : 0.57-0.84) or excessive alcohol consumption ( OR =0.73, 95% CI : 0.58-0.92) had a poor acceptance of community hypertension management. Overweight ( OR =0.74, 95% CI : 0.61-0.91; OR =0.83, 95% CI : 0.71-0.98), obesity ( OR =0.54, 95% CI : 0.45-0.65; OR =0.67, 95% CI : 0.54-0.83) patients in urban areas as well as in rural areas with hypertension had poor blood pressure control, and patient taking medication as prescribed ( OR =4.58, 95% CI : 3.16-6.63; OR =2.84, 95% CI : 2.18-3.69) had better blood pressure control. Urban hypertension patients in central China ( OR =0.74, 95% CI : 0.61-0.89) or with excessive alcohol consumption ( OR =0.72, 95% CI : 0.54-0.97) had poor blood pressure control while urban hypertension patients with other chronic diseases ( OR =1.22, 95% CI : 1.04-1.44) and participating in standardized hypertension community management ( OR =1.29, 95% CI : 1.06-1.58) had better blood pressure control.Rural hypertension patients who located in central and western China ( OR =0.71, 95% CI : 0.58-0.87; OR =0.62, 95% CI : 0.47-0.80), with moderate alcohol consumption ( OR =0.81, 95% CI : 0.67-0.98), taking salt more than 6 g per day ( OR =0.80, 95% CI : 0.69-0.93) had poor blood pressure control, and the rural hypertension patients who underwent blood pressure monitoring ( OR =1.38, 95% CI : 1.18-1.61) had better blood pressure control. Conclusions: The community health management of hypertension in patients aged 35 years and above has been improved in China, but there is still a certain gap between the control of hypertension and related indicators. It is necessary to take multi standardized intervention measures for the better prevention and control of hypertension.

Objective: To describe and compare the prevalence, sick status awareness, treatment and control of hypertension in adults aged 18 years and above in China. Methods: National Chronic Disease and Risk Factor Surveillance was conducted in 298 counties/districts in China in 2018, which covered 31 provinces (autonomous regions, municipalities). A multi-stage stratified cluster random sampling method was used to select 194 779 permanent residents aged 18 years and above. Face to face questionnaire surveys were conducted to collect the information about their demographic characteristics, hypertension diagnosis and treatment as well as the blood pressures measurement. The systolic and diastolic blood pressure were measured using certified medical upper arm electronic sphygmomanometer for the adults. After excluding those with abnormal blood pressure, 179 873 adults were included in the final analyses. Gender, age and area or region specific mean blood pressure, the prevalence, sick status awareness, control and treatment rates of hypertension, and blood pressure measurement were evaluated for the adults surveyed. All the results were weighted according to complex sampling scheme and had post-stratification to represent the whole adult population in China. Results: The average systolic blood pressure was (127.7±18.8) mmHg (1 mmHg=0.133 kPa) and the average diastolic blood pressure was (76.8±11.2) mmHg in the adults aged 18 years and above in China in 2018. Among the adults without history of hypertension, 50.9%(95% CI :49.9%-51.9%) had prehypertension. The prevalence rate of hypertension in adults in China was 27.5% (95% CI : 26.6%-28.4%). In men, 30.8% (95% CI : 29.8%-31.9%) had hypertension, compared with 24.2% (95% CI : 23.3%-25.1%) in women. The rural adults had higher hypertension prevalence rate [29.4% (95% CI : 28.4%-30.3%)] compared with urban adults [25.7% (95% CI : 24.4%-27.1%), P <0.000 1]. The highest hypertension prevalence rate was observed in adults in northern China [33.3% (95% CI : 31.5%-35.2%)], followed by that in adults in northeastern China [32.7% (95% CI : 28.1%-37.4%)] compared with other regions in China, and with significant differences ( P <0.000 1). Among the adults with hypertension, 41.0% (95% CI : 39.7%-42.4%) were aware of their sick status, 34.9% (95% CI : 33.6%-36.1%) were taking antihypertensive medicines, and 11.0% (95% CI : 10.2%-11.8%) had their blood pressure controlled. In the hypertensive patients, women and urban residents were more likely to have higher rates of sick status awareness, treatment and control of hypertension compared with men and rural residents (all P <0.000 1). Among the adults without history of hypertension, 41.9%(95% CI : 40.7%-43.2%) had active or passive measurement of blood pressure in the past 3 months. Conclusions: Given the higher prevalence rate of hypertension and lower blood pressure measurement rate in Chinese adults, as well as unsatisfied status of awareness, treatment and control of hypertension in patients, more efforts should be made in hypertension prevention and control, such as improved risk factor intervention and case management, especially in rural areas.

To study and establish a set technology systems of sampling, investigation, quality control, and data analysis of complex sampling for chronic diseases and risk factor surveillance in China based on the requirements of the WHO and China's national conditions, and provide evidence for the policy making and prevention and control evaluation of chronic diseases and technical support for the research of chronic diseases. Through the study of complex sampling technique, adjustment of surveillance points and evaluation of their representatives, a national and provincial representative surveillance system and a complex weighted data analysis were established. According to the relevant plans, actions, and policies in China and other countries, the surveillance content and index system were studied and constructed, which was in line with China's national conditions, "1 + X" steps surveillance, covering the content of questionnaire , physical measurement, and laboratory testing. Based on modern information technology, a three-level platform of information collection and a multi-center laboratory quality control technology system were established, including sampling, information collection, biological sample management, quality control, and result display. Relying on the above research techniques, a national epidemiological investigation was conducted in China, which covered cerebrovascular disease, mental disorders, digestive system disease, and diabetes complications, to obtain the national representative data. This study reflected the innovation of "combination of medicine and prevention" and multi department cooperation in the fields of clinical medicine and public health and provided some big data for the health policy making and the evaluation of the effects of chronic disease prevention and control.

Objective: To understand the sleep status and related influencing factors among 18-59 years old employed floating population and to provide evidence for policy development. Methods: Data were gathered from the Chinese Floating Population Chronic Disease Surveillance (2012) program. Floating population were selected through multistage clustering sampling method and stratified by industries from China. Information on demographics, behavior-related risk factors, sleep duration and social pressure etc ., were collected through face-to-face interview on questionnaires. After complex weighting of data, multivariable logistic regression method was used to explore the sleep status and related influencing factors among these employed floating people. Results: A total of 43 521 subjects were included in the study. The average sleep duration per day was 7.77 h, with females (7.87 h) higher than males (7.69 h). The prevalence of insufficient sleep was 12.3% (95% CI : 11.8%-12.7%), with 45-59 years old group (21.2%) higher than that of the 18-year olds (11.2%). Results from the multivariable logistic regression analysis showed that factors as gender, age, marital status, education, occupation, inflowing area, behavior-related risk factors, BMI, social pressure, self-rated health status and self-reported chronic diseases were the main factors that affecting the rates of sleep deficiency in this population. The prevalence rate of insufficient sleep was 1.18 times higher (95% CI : 1.07-1.31) in males than that in females, and 1.22 (95% CI : 1.11-1.33) times higher in smokers than that in the non-smokers, 1.31(95% CI : 1.16-1.49) times higher in excessive drinkers than that of the normal population, 1.46 (95% CI : 1.29-1.65) times and 1.33 (95% CI : 1.18-1.50) times in those with heavier workload and stress than those without. Conclusion: The prevalence of insufficient sleep among the employed floating population was affected by multiple factors that called for more attention by different departments of the government.

Objective: To study the relationship between eating behavior and obesity among Chinese adults. Methods: Data were collected from 171 040 people who had been engaged in the 2013 China Chronic and Non-communicable Disease and Risk Factors Surveillance project. Rao-Scott χ (2) test and complex sampling design were used to compare the differences in the rates of eating behavior and obesity. A binary logistic regression model based on complex sampling design was used to investigate the relationship between eating behavior at three meals (breakfast, lunch and dinner) and obesity. Results: The proportion (3.3%) of skipping breakfast appeared the highest. Proportions of eating out for all the three meals were 16.4%, 21.4% and 11.7%, respectively. The prevalence rates of obesity among men who ate lunch at home, ate out or skipped the lunch were 13.2%, 16.1% and 15.9%, respectively. The prevalence rates of obesity among women who ate lunch at home, ate out or skipped lunch were 14.5%, 9.8%, 19.6%, respectively. Results from the multivariate logistic regression analysis showed that eating out for lunch and skipping lunch were both positively correlated with obesity in men (eating out for lunch: OR =1.10, 95% CI : 1.02-1.18; skipping lunch: OR =1.36, 95% CI : 1.02-1.80) while skipping lunch was positively associated with obesity ( OR =1.47, 95% CI :1.07-2.02) in women. No statistical association was noticed between eating out for lunch and obesity in women, with OR =0.86 (95% CI : 0.73-1.00). Both eating out for dinner and skipping dinner were positively correlated with obesity in men, with eating out for lunch as OR =1.19 (95% CI : 1.06-1.34) and skipping dinner as OR =1.89 (95% CI : 1.07-3.33). Avoid dinner was positively associated with obesity in women, with OR =1.64 (95% CI : 1.02-2.63). Women who ate out for dinner showed lower risk of obesity than those who ate at home with OR =0.74 (95% CI : 0.59-0.94). Conclusions: Different eating behaviors were seen in Chinese adults, with the highest proportion of eating out for lunch and the lowest proportion for dinner. Both eating out for lunch and dinner appeared risk factors of obesity in men while avoid lunch or dinner were both associated with obesity in both sex.

Objective: To study the correlation between hypertension label and self-rated health (SRH) in adults aged ≥18 years in China. Methods: Data were from 2013 Chronic Non-communicable Disease and Risk Factor Surveillance Project. The project collected the information through multi stage stratified cluster sampling, face-to-face questionnaire survey and on-site body measurement. The SRH status of the adults was inquired according to the recommendation of Behavioral Risk Factor Surveillance System (BRFSS) in the United States. Blood pressure measurement was performed by using OMRON HBP-1300 electronic sphygmomanometer. Surveymeans and surveyfreq processes were used to describe the general characteristics of the sample population. The cumulative odds logit model was implemented by the processes of surveylogistic to analyze the association between hypertension label and self-rated health in adults in China. Results: A total of 173 008 subjects were included in this study. Hypertension was associated with poorer SRH ( OR =1.29, 95 %CI : 1.22-1.35, P <0.001), but this association was eliminated by adjustment for hypertension label ( P =0.670). Hypertension label was associated with poorer SRH ( OR =2.09, 95 %CI : 1.96-2.23, P <0.001) and the association was still significant even after adjusting for actual hypertension status ( OR =2.08, 95 %CI : 1.94-2.23, P <0.001). In hypertension group, those with hypertension label had poorer SRH than those without hypertension label ( OR =2.18, 95 %CI : 2.02-2.36, P <0.001). In normal blood pressure group, those with hypertension label had poorer SRH than those without hypertension label ( OR =1.89, 95 %CI : 1.64-2.18, P <0.001). Men's SRH was more sensitive to hypertension label, especially in hypertension group ( OR =2.20, 95 %CI : 1.98-2.45, P <0.001). The results were all adjusted for demographic factors, smoking status, alcohol consumption, physical activity and chronic diseases. Conclusions: Hypertension label is associated with self-rated health independently in adults in China. The diagnosis of hypertension should strictly follow the latest guidelines.

Objective: To investigate the status of self-measurement of body weight in overweight and obese adults in China and identify the related factors. Methods: A total of 87 670 adults were enrolled in this study, who were selected through multi stage cluster random sampling from 177 099 residents aged ≥18 years in 302 surveillance areas in China where the fourth chronic non-communicable disease and related factor surveillance project was conducted in 2013. The information about their demographic characteristics and body weight measurement were collected by using questionnaire. Their body height, body weight, waist circumstance and blood pressure were measured respectively through physical examination. Fasting venous blood samples were obtained and assayed for FPG, TC, TG, LDL-C and HDL-C levels. Venous blood samples after 75 g glucose intake were obtained and assayed for OGTT-2h level. The proportion of self-body weight measurement were analyzed after complex sample weighting. Results: The proportion of overweight and obese adults who had self-body weight measurement within 1 week, 1 month and 1 year were 18.9 % , 23.0 % and 30.2 % , respectively. The proportion of those having self-body weight measurement within 1 week was higher in men than in women, and lowest in ≥60 years old group ( P <0.05). The proportion of overweight and obese adults who had never measured their body weight was 20.5 % , the proportion was higher in women than in men, and highest in ≥60 years old group ( P <0.05). Older age ( OR =0.73, 95 %CI : 0.64-0.82) was risk factor for self-body weight measurement; female ( OR =1.11, 95 %CI : 1.03-1.19), higher education level (junior college and above OR =3.79, 95 %CI : 2.89-4.97), high- income ( OR =1.61, 95 %CI : 1.31-1.98), dyslipidemia ( OR =1.13, 95 %CI : 1.04-1.23), diabetes ( OR =1.15, 95 %CI : 1.03-1.30) were the protective factors for self-body weight measurement. Conclusion: It is necessary to promote self-body weight measurement in overweight and obese adults in China. Targeted health education should be carried out for different groups to encourage regular self-body weight measurement to maintain healthy body weight.

Objective: To understand the control attempts of body weight and its related factors among overweight and obese adults in China. Methods: Data was from the 2013 Chinese Chronic Diseases and Risk Factors Surveillance Program, which covered 302 surveillance sites. 179 570 adults, selected through multistage stratified cluster sampling method, were interviewed. Demographic characteristics and weight-control attempts were collected via face-to-face interview. BMI, waist circumstance and blood pressure were individually measured under physical examination. Venous blood samples were obtained and tested for FPG, OGTT-2h, TC, TG, LDL-C and HDL-C. A total of 87 545 overweight and obese patients were included in this study, with the exclusion of 152 patients having the missed critical information. Rates on weight control and attempts were analyzed, using the complex weighting on samples to represent the overall overweight and obese adults in China. Results: The rate of weight-control attempts was 16.3% (95 %CI : 14.9%-17.7%). Among all the 12 133 patients who had undergone weight-control measures, the proportions of different attempts were as follows: diet (40.9%, 95 %CI : 38.4%-43.3%), combination of diet and physical activity (31.5%, 95 %CI : 28.9%-34.0%), physical activity (22.8%, 95 %CI : 21.0%-24.6%) and drug control (1.3%, 95 %CI : 1.0%-1.7%). Factors as: being female ( OR =1.26, 95 %CI : 1.15-1.38), at younger age (18-44 years old, OR =1.51, 95 %CI : 1.31-1.74), with high education levels (college degree or above, OR =4.52, 95 %CI : 3.76-5.43), having high annual income (≥24 000 Yuan, OR =1.94, 95 %CI : 1.63-2.30) etc ., appeared as favorable factors for taking the measures vs . rural residency ( OR =0.63, 95 %CI : 0.55- 0.72) as the unfavorable one. Conclusion: The rate of weight-control attempts appeared low among the overweight and obese adults who were affected by factors as age, education and income level. Personalized intervention measures should be carried out for people with different characteristics.

Objective: To estimate the prevalence of MS in elderly people aged ≥60 years and its related factors in China and provide scientific evidence for prevention and control of MS in the elderly. Methods: Data used in this study were obtained from the 2013 Chinese Chronic Diseases and Risk Factor Surveillance Program. A total of 50 497 people aged ≥60 years were selected and interviewed through multistage stratified cluster sampling at 298 surveillance sites in 31 provinces. According to the Chinese MS diagnostic criteria proposed by the Chinese Medical Association Diabetes Branch in 2017, the prevalence rates of different MS forms were compared, and the main related factors were analyzed. Results: The prevalence rate of MS was 36.9 % (95 %CI : 35.4-38.5). The prevalence rate was higher in urban area than in the rural area, higher in females than in males, higher in eastern area than in western area. The prevalence rate of MS in elderly people aged ≥70 years was lower than that in those aged 60-69 years. The rate in the elderly with higher education and income levels was higher than that in the elderly with lower socioeconomic level. The comparison of the prevalence of the five forms of MS in the elderly showed that hypertension had the highest prevalence rate (72.8 % ), followed by hyperglycemia (41.7 % ) and central obesity (37.6 % ). The prevalence rates of hypertriglyceridemia and low HDL-C were 25.8 % and 17.5 % . The risk for MS in women was 1.20 times higher than that in men. Age, gender, education level, living area and urban or rural residence were the main factors influencing the prevalence of MS. Smoking, drinking and physical activity levels were correlated with MS. Conclusions: The risk for MS was higher in women than in men in China's elderly population, and the risk was related to socioeconomic level and life behaviors. It is recommended to carry out lifestyle interventions, such as increasing exercise and having reasonable diet for the elderly patients with MS. Hypertension and diabetes patients also need to be treated with drugs to reduce the risk of cardiovascular disease morbidity and mortality.

Objective: To understand medical treatment seeking behaviors and its influencing factors in employed floating population in China and provide evidence for the development of health service policies for floating population. Methods: Data were from the national chronic disease and risk factor surveillance (floating population part) in 2012. Floating population were selected through multistage clustering sampling stratified by industries in 170 counties and districts from 31 provinces (autonomous regions, municipality directly under the central government) and Xinjiang Production and Construction Corps in the mainland of China. Information on demographic basic information, health status and health seeking behaviors six months before the investigation were collected through face-to-face questionnaire interview. The people aged 18-59 who had physical discomfort in the past six months was analyzed. After complex weighted analysis, multinomial logistic regression model was used to analyze the health seeking behavior and its influencing factors in the employed floating population. Results: A total of 11 134 suitable people aged 18-59 years were included in the study. The number and proportion of the people seeking medical treatment, having self-treatment and having no treatment were 4 950 (44.5 % ), 3 880 (34.8 % ) and 2 304 (20.7 % ), respectively. Multinomial logistic regression analysis showed that women were 1.275 times (95 %CI : 1.100-1.477) more likely to seek medical treatment compared with men. The medical treatment seeking rates of floating population in the eastern, central and western areas were 2.153 times (95 %CI : 1.669-2.777), 2.310 times (95 %CI :1.777-3.002), 2.177 times (95 %CI : 1.695-2.796) higher than that of floating population in northeastern area. In terms of seeking treatment, the proportion of the floating population with annual income of more than 25 000 yuan was 1.255 times (95 %CI : 1.088-1.448) higher than that of the floating population with annual income of 25 000 yuan or less than 25 000 yuan. The proportion of the floating population with severe physical discomfort within the past six months was 8.076 times (95 %CI : 6.091-10.707) higher than that of the floating population without severe physical discomfort and the proportion of the floating population who participated in medical insurance in both original living places and current living places was 1.566 times (95 %CI : 1.250-1.961) higher than that of the floating population who did not participate in medical insurance in two places. The incidence ratio of medical care seeking and self-treatment in new generation of floating population was 1.369 (95 %CI : 1.157-1.619) and 1.240 (95 %CI : 1.042-1.475) compared with old generation of floating population. Compared with the widowed/divorced/separated, the incidence ratio of medical treatment seeking and self-treatment for the married/cohabited was 1.590 (95 %CI : 1.057-2.391) and 1.815 (95 %CI : 1.209-2.725). The more severe physical discomfort, the higher level medical institutions they chose ( P <0.05). Conclusions: The treatment rate in medical institutions of employed floating population was low in China. Gender, generation of floating population, marital status, area, annual income, severity of physical discomfort in past six months and the way to participate in medical insurance were the main factors affecting the medical treatment seeking behaviors of employed floating population.

Objective: To understand the prevalence and disease burden of major chronic diseases in the elderly in China and provide scientific basis for the prevention and control of chronic diseases and for the rational allocation of health resources. Methods: We analyzed the prevalence of chronic diseases in residents aged ≥60 years in China by using national and provincial surveillance data of chronic diseases and related risk factors in China. We conducted the analysis on the burden of chronic diseases in the elderly in China by using the data of global burden of disease. Results: The prevalence rates of hypertension, diabetes and hypercholesterolemia were 58.3 % , 19.4 % and 10.5 % respectively in residents aged ≥60 years in China. Up to 75.8 % of the residents aged ≥60 years had at least one chronic disease. The prevalence rate was higher in women than in men, higher in urban area than in rural area. With the increase of age, the prevalence rate of chronic diseases also increased. The top three chronic diseases with heavy disease burden in residents aged ≥70 years were stroke, myocardial infarction, cancer and chronic obstructive pulmonary disease. Conclusion: The prevalence of major chronic diseases in the elderly is high with three quarters of the elderly suffering from at least one chronic disease, and the burden of chronic diseases is increasing.

Objective: To study the relationship between blood pressure level and major risk factors for cardiovascular diseases in adults in China. Methods: A total of 179 347 adults aged ≥18 years were recruited from 298 surveillance points in 31 provinces in China in 2013 through complex multistage stratified sampling. The survey included face to face interview and physical examination to collect information about risk factors, such as smoking, drinking, diet pattern, physical activity, overweight or obesity, and the prevalence of hypertension. The blood pressure was classified into 6 levels (ideal blood pressure, normal blood pressure, normal high blood pressure and hypertension phase Ⅰ, Ⅱ and Ⅲ). The relationship between the prevalence or co-prevalence of risk factors for cardiovascular disease and blood pressure was analyzed. Results: The adults with ideal blood pressure, normal blood pressure, normal high pressure, hypertension phase Ⅰ, Ⅱ and Ⅲ accounted for 36.14 % , 22.77 % , 16.22 % , 16.43 % , 5.97 % and 2.48 % , respectively. Among them, the blood pressure was higher in men, people in Han ethnic group and those married, and the blood pressure was higher in those with older age, lower income level and lower education level, the differences were all significant ( P <0.05). Whether taking antihypertensive drug or not, co-prevalence of risk factors influenced the blood pressure levels of both sexes ( P <0.05), and the blood pressure levels of those taking no antihypertensive drug was influenced more by the co-prevalence of risk factors. Finally, multiple logistic analysis showed that the risks for high blood pressure in adults with 1, 2 and ≥3 risk factors were 1.36, 1.79 and 2.38 times higher, respectively, than that of the adults without risk factor. Conclusion: The more the risk factors for cardiovascular disease in adults, the higher their blood pressure were. It is necessary to conduct comprehensive behavior intervention targeting ≥ 2 risk factors for the better control of blood pressure in general population.

Objective: To explore the relations between the prevalence of multiple chronic diseases and cigarette smoking behavior in the Chinese adults. Methods: Based on the results: from the 2013 Chronic Disease Risk Factor Surveillance (NCD Surveillance), 176 534 Chinese residents aged 18 years and above, covering 298 counties (districts) in 31 provinces, was randomly recruited, using the multi-stage stratified clustering sampling method. Information on demographics, cigarette smoking (status, quantity and period) was obtained through face-to-face interviews and questionnaires. Anthropometric data and blood samples were collected and properly stored for analysis. Results In total, 175 386 adults were included for statistical analyses, with 42.7% as males and 57.3% as females. The prevalence rates of hypertension, high total cholesterol and high triglycerides were 30.4%, 7.2% and 18.0% in male smokers, 35.6%, 14.0% , 10.3% and 15.9% in female smokers respectively, which were all higher than those in the respective non-smokers. Male smokers were found under lower risk on hypertension, but 19% higher on total glycerides when compared with non-smokers of the same sex( OR =1.19, 95% CI :1.10-1.30), when multiple risk factors were under control. Male current smokers with more than 20 cigarettes per day have 41% ( OR =1.41, 95% CI : 1.28-1.55) higher risk of high TG than non-smokers. Female smokers presented 40% ( OR =1.40, 95% CI : 1.15-1.70) higher risk in high glycerides than the non-smokers. Specifically, women smoking longer than 20 years have 60% ( OR =1.60, 95% CI : 1.31-1.95) higher risk of high TG than women smoking less than 20 years. Conclusions: Prevalence rates of certain chronic diseases were seen higher in smokers of both genders. People with longer history of smoking or being heavier smokers, appeared at advanced risk on developing chronic diseases.

Objective: To investigate the prevalence and co-prevalence of tobacco use, excessive alcohol use, insufficient intake of vegetable and fruit, physical inactivity, and overweight or obesity in floating population and influencing factors in China, 2012. Methods: Data from the 2012 China Chronic Disease Risk Factor Survey in Floating Population in China were used. In this survey, 48 704 people aged 18-59 years in floating population were selected through stratified multistage clustering sampling in 170 counties and districts from 31 province (autonomous regions and municipalities) and Xinjiang Production and Construction Corps. The gender specific prevalence and co-prevalence of five risk factors were estimated, and the rank sum test was used for result comparison. Results: Among the people surveyed, 27.4 % had one risk factor, 37.1 % had two risk factors, 28.5 % had ≥3 risk factors. The prevalence or co-prevalence of risk factors were positively correlated with age ( P <0.05), income level ( P <0.05) and migration time ( P <0.05), and negatively correlated with educational level ( P <0.05). People who were males, in Han ethnic group, engaged in construction and from other provinces were more likely to have more risk factors ( P <0.05). Conclusion: The prevalence and co-prevalence of tobacco use, excessive alcohol use, insufficient intake of vegetable and fruit, physical inactivity and overweight or obesity were high in floating population in China, suggesting that it is necessary to strengthen the comprehensive behavior intervention in floating population.

Objective: To understand the passive smoking exposure level and related risk awareness in adults in China in 2013. Methods: A face-to-face questionnaire survey was conducted in 179 570 adults selected through multistage cluster sampling from Chinese chronic disease and risk factors surveillance sample population (2013) in 302 surveillance sites. The effective sample size was 176 179 adults. After comprehensive weighting of the samples, the passive smoking exposure level and the awareness rate of related risks were analyzed. Results: The passive smoking exposure rate was 52.8 % (95 %CI : 51.2 % -54.4 % ) and the rate decreased with age ( χ (2)=515.8, P <0.000 1). The exposure rate was highest in persons engaged in commercial services (61.6 % , 95 %CI : 58.6 % -64.5 % ). The awareness rate of related risks was 67.9 % (95 %CI : 65.8 % -69.9 % ). The awareness rate was higher in urban area (77.0 % , 95 %CI : 75.0 % -79.1 % ) than in rural area (60.0 % , 95 %CI : 57.7 % -62.4 % ), in males (69.8 % , 95 %CI : 67.8 % -71.7 % ) than in females (65.9 % , 95 %CI : 63.7 % -68.1 % ). The awareness rate of three related diseases in urban residents (49.8 % , 95 %CI : 47.3 % -52.4 % ) were higher than that in rural residents (37.9 % , 95 %CI : 35.4 % -40.5 % ); the awareness rate of passive smoking related lung cancer was highest (88.5 % , 95 %CI : 87.5 % -89.5 % ), followed by lung disease in children (70.0 % , 95 %CI : 68.1 % -71.9 % ), the awareness rate of passive smoking related heart disease was lowest (46.8 % , 95 %CI : 44.6 % -49.1 % ). Conclusion: The passive smoking exposure level is relatively high in adults in China, and the awareness rate of passive smoking exposure risks, especially heart disease, is low.

Objective: To estimate the effect of daily diurnal temperature range (DTR) on mortality in different areas in China. Methods: A time series study using the data collected from 66 areas in China was conducted, and Meta-analysis was used to analyze the estimates of associations between DTR and daily mortality. Modifying effects of extremely low and high DTR-mortality relationship by season and socioeconomic status (SES) were also evaluated respectively. Cumulative excess risk ( CER ) was used as an index to evaluate the effects. Results: The information about 1 260 913 registered deaths were collected between 1 January 2006 and 31 December 2011, we found the relationship between extreme DTR and mortality was non-linear in all regions and the exposure-response curve was J-shaped. In central and south areas of China, the result indicated the obvious acute effect of extremely high DTR, and the mortality effect in central area ( CER =5.1%, 95 % CI : 2.4%-7.9%) was significant higher than that in south area ( CER =4.5%, 95 % CI : 1.7%-7.3%). Regarding to the modification of seasons, the cumulative mortality effect of DTR in cold season ( CER =5.8%, 95 %CI : 2.5%-9.2%) was higher than that in hot season ( CER =3.1%, 95 %CI : 1.1%-5.1%). Generally, deaths among the elderly (≥75 years) were associated more strongly with extremely high DTR. Conclusions: The mortality effects of extremely DTR in different areas and seasons showed different characteristics, that in central area and in cold season it was significantly stronger. After modified by season and SES, DTRs were the greatest threat to vulnerable population, especially to the elderly (≥75 years). Therefore, more attention should be paid to vulnerable groups and protection measures should be taken according to the local and seasonal conditions.

Objective: To investigate the community-based management of diabetes patients aged ≥35 years in China. Methods: The subjects from 2013-2014 Chronic Non-communicable Disease and Risk Factor Surveillance in China were used in this study, those who were aged ≥35 years and diagnosed by doctors in hospitals at community level or above were selected through clustering sampling. Questionnaire was used to collect the data of subjects' general information, health status, the treatment and the control of blood glucose. Blood samples were taken from the subjects to detect the fasting blood glucose level and blood glucose level at 2 hours after oral administration of glucosum anhydricum. The subjects were weighted according to complex sampling scheme to calculated the different rates and 95 %CI . The Rao - scott χ 2 test was performed to test the differences in rates between the subgroups. Results: The survey indicated that among the 10 056 diabetes patients aged ≥35 years and diagnosed with diabetes, 4 609 received management service in communities. After being weighted, the management rate of diabetes patients was 45.0% (95 % CI : 40.8%-49.2%). Females (46.9%, 95 % CI : 42.8%-51.0%) had higher management rate than males (43.0%, 95 % CI : 38.1%-47.9%). The management rate was higher in rural area (50.4%, 95 %CI : 46.3%-54.5%) than in urban area (41.6%, 95 %CI : 35.5%-47.6%). There was a significant age specific difference in the proportion of patients receiving management services ( χ 2 =21.0, P <0.01), the rate of management was highest in the patients aged ≥65 years (49.2%, 95 %CI : 43.6%-54.7%), but lowest in the patients aged 35-44 years (35.2%, 95 % CI : 27.9%-42.4%). The overall standardized management rate of diabetes patients in communities was 16.7% (95 % CI : 13.7%-19.7%). The proportion of urban patients receiving standardized management service (19.7%, 95 % CI : 15.3%-24.1%) was higher than that of rural patients (12.8%, 95 % CI : 9.8%-15.8%). The overall treatment rate of diabetes patients in communities was 95.8% (95 %CI : 94.8%-96.9%). The treatment rate was higher in females (97.0%, 95 %CI : 96.0%-98.0%) than that in males (94.5%, 95 %CI : 92.7%-96.4%). The control rate of blood glucose in diabetes patients receiving management in communities was 34.6% (95 %CI : 31.5%-37.6%), and the highest blood glucose control rate was in the patients aged ≥65 years (38.2%, 95 %CI : 33.4%-43.0%), while the lowest blood glucose control rate was in the patients aged 45-54 years (34.4%, 95 % CI : 26.7%-42.0%). Conclusions: Both the standardized management rate and blood glucose control rate were low in the diabetes patients aged ≥35 years in China. It is necessary to strengthen the allocation of medical resources in communities and standardized diabetes management.

Objective: To understand the effects of standardized community-based management of hypertension in urban and rural areas in China and related influencing factors., Methods: The study subjects were the hypertension patients aged ≥35 years who were recruited in 2011 from the participants of 2010 national chronic and non-communicable disease surveillance project. The hypertension patients were diagnosed in community health centers or higher level hospitals and included in community based hypertension management project. By face-to-face questionnaire survey and health examination, the information of the subjects' demographic characteristics, risk factors, complications, involvement in community-based management of hypertension, anti-hypertension treatment, blood pressure, body height, waistline and body weight were collected. In this study, Rao-Scott χ(2) test was used to compare the variations among sub-groups. Taylor series linearization method was used to estimate the prevalence rate. The complex sampling and unconditional multivariate logistics regression analysis was conducted to identify the influencing factors for the control of hypertension., Results: A total of 5 120 subjects were recruited in the analysis. The proportion of those receiving management for more than two years was 36.57%, and it was higher in urban area(44.56%)than in rural area(31.79%, P<0.05); In the past 12 months, 6.17% and 14.46% of the patients received no blood pressure measurement and drug therapy advice respectively, but there were no significant differences between urban group and rural group(P>0.05); In the past 12 months, the proportions of the patients receiving diet and physical activity advice were 84.25% and 84.90% respectively, and the proportions were higher in urban group than in rural group(P<0.05); In the past 12 months, the proportions of the subjects receiving tobacco and alcohol use advice were 78.41% and 77.80% respectively, and the proportions were higher in rural group than in urban group(P<0.05). In urban area, the subjects receiving standardized management had lower SBP(142.79±17.39)mmHg, lower DBP(84.26±9.49)mmHg and higher blood pressure control rate(49.77%)than those receiving no standardized management(P<0.05); while in rural area, no difference was found in BP control between the patients receiving and receiving no standardized management(P>0.05). In urban area, the influencing factors for BP control among the subjects receiving community based management were educational level, annual income, body weight, hypertension management mode, times of receiving BP measurement, times of receiving antihypertensive medicine advice and receiving physical activity advice; while in rural area, the influencing factors for BP control among the subjects receiving community based management were annual income, body weight, family history of hypertension, antihypertensive medicine awareness, times of receiving antihypertensive medicine advice and receiving diet advice., Conclusion: The effects of community-based standardized management of hypertension were better in urban area than in rural area, and the quality of the services of community-based hypertension management was lower in rural area than in urban area.

Objective: To estimate the 10-year risk for ischemic cardiovascular disease(ICVD)in adults aged ≥35 years., Methods: In 2010, we conducted a cross sectional survey among 98 712 adults aged ≥18 years selected through using multi-stage stratified cluster random sampling, and 67 214 adults without ICVD history and aged ≥35 years were recruited as study subjects. Their information on cardiovascular disease history and related behavior risk factors, including smoking, hypertension and diabetes diagnosis history were collected through face-to-face questionnaire interview, health examination and laboratory detection. The 10-year risk for ICVD in this group was evaluated according to the China 10-year risk for ICVD score tables., Results: The average score and 10-year risk for ICVD in the adults aged ≥35 years were 5.1(95% CI: 4.9-5.2)and 4.2%(95% CI: 4.0%-4.4%), respectively. A total of 8.5% of the adults aged ≥35 years had high 10-year risk for ICVD(95%CI: 7.8%-9.2%). This proportion was 12.1% for males(95%CI: 11.1%-13.0%)and 4.9% for females(95%CI: 4.4%-5.5%)(P<0.05), 8.8% for those living in rural areas(95%CI: 7.8%-9.7%)and 8.1% for those living in urban areas(95%CI: 7.2%-8.9%)(P<0.05). About 19.1% and 72.4% of adults had middle and low 10-year risk for ICVD, respectively(95%CI: 18.2%-20.0%, 95%CI: 70.9%-73.9%). The proportion of the adults with high and middle risk for ICVD in 10 years was higher among those with lower educational level or with lower income level(P<0.05)., Conclusion: About 8.5% of the adults aged ≥35 years in China have high 10-year risk for ICVD. Being male, living in rural area, with lower education or lower income levels were related with the higher 10-year risk for ICVD.

Objective: To explore the impact of health management programs on hypertension related to their cost of the hypertensive, so as to provide evidence for related policy-making., Methods: Data was from the 2011 China Non-communicable and Chronic Disease Survey Project which was developed in 161 counties (districts) and Xinjiang production and Construction Corps. Information regarding hypertensive patients were collected through a questionnaire. Two-part model was used to analyze the influence from health management scheme., Results: This study included 11 294 participants who were 35 years old or beyond, with 4 904 (43.42%) males and 6 390 (56.58%) females. The median cost from the outpatient was 100 (30-200) Yuan, and the cost of patients under management program were significantly lower than those without (P<0.05). Median pharmacy cost appeared as 30 (15-100) Yuan but there was no significant difference noticed between the cost from the managed or unmanaged patients (P>0.05). Regarding the calculation on the outpatient cost, results showed that the patients under the management program were more likely to practice 'outpatient-medical-behavior' (OR =2.50, 95% CI:2.26-2.76) with nearly three quarters of the cost from the unmanaged patients. Hypertensive patients from the urban areas were more likely to adopt 'medical behavior'(OR=1.31, 95% CI:1.18-1.45) which was 1.69 times of the costs from the rural patients. RESULTS of the pharmacy cost showed that the urban hypertension patients were more likely to purchase medicine (OR=1.10, 95% CI:1.01-1.20) and was 1.19 times the costs of the rural patients., Conclusion: Health management program on hypertension showed preliminary but promising results in reducing the out-patient cost in the treatment of hypertension,thus should be promoted and implemented.

Objective: To understand the trends and influential factors on infant mortality in Henan province from 2000 to 2010., Methods: Descriptive method, Cox-Stuart trend test and multiple linear regression were used to study the infant mortality trends and related influential factors in the regions with monitoring programs of Henan province, from 2000 to 2010., Results: The total urban and rural infant mortality rates dropped significantly, from 30.91 per thousand, 10.05 per thousand, 33.99 per thousand in 2000 to 7.12 per thousand, 5.51 per thousand, 8.03 per thousand in 2010, respectively. The average annual rates of decrease were 13.65 percent, 5.83 percent and 13.44 percent. The downward trends were statistically significant (P < 0.05). The infant mortality rates dropped more significantly in rural areas (25.96%) than in the urban areas (4.54%). Difference between urban and rural areas reduced from 23.49% to 2.52%. Rates on factors as setting up maternal record cards, carrying on postpartum visits, hospital delivery, or under help by new midwives and low birth weight rate etc. were remarkably influencing the rate on infant mortality (F = 229.738, P = 0.004). In order, the impact of strengths on those factors showed as: hospitalized delivery rate, low birth weight rate, the rate of 'clean' delivery, setting up record cards on postpartum visits., Conclusion: Total provincial, urban and rural infant mortality rates all showed downward trends. The infant mortality rates dropped more significantly in rural areas than in urban areas. Difference between urban and rural areas was gradually getting small. Rates on setting up maternal record cards, carrying on postpartum visit, hospital delivery and under help by new midwives rate were important factors that significantly impacting the infant mortality rate. Work on setting up record cards and hospital delivery should be further strengthened.

Objective: To identify the most common life events that occurred prior to suicide in elderly individuals and the relationship of these life events to depressive symptoms., Methods: A detailed study considering life events in the year prior to death, the presence of mental illness at the time of death and the level of depressive symptoms in the 2 weeks prior to death was undertaken with the family members and other associates of 304 persons at 55 years of age and older who died of suicide., Results: The three most common negative life events were acute or chronic physical illness or injury (59.2%), major changes in diet, sleeping or other daily routines (37.8%) and financial difficulties (34.5%). The severity of depressive symptoms was significantly greater among persons who had experienced these life events both for persons with or without definite mental illness., Conclusion: Most elderly persons who died of suicide events had experienced multiple negative life events in the year prior to death and these life events were closely related to the severity of depressive symptoms at the time of death.

Objective: To understand the specific patterns of suicide in Chinese population and its trend., Methods: The mortality level and trend of suicide in Chinese population by sex, age and areas were reviewed and the geographic distribution of suicide mortality was described using National Disease Surveillance Data in 1991 - 2000., Results: During 1991 - 2000, the mortality rate of suicide was stable. Suicide was still one of the main health problems in Chinese population, especially in rural areas. The pattern of suicide in rural areas remained the same as reported before. The death rate of suicide attempts in female was higher than in male. There was a peak of death rate among rural people aged 15 - 34. However the death rate among rural women aged 15 - 34 was falling, which did not significantly affect the current suicide pattern., Conclusions: There was high death rate of suicide in eastern and central rural areas, especially in boundaries among provinces, which could have been related to traditional culture, economic situation etc. Using pesticide as a tool of suicide was also an important factor with high death rate of suicide. These findings suggested that the specific pattern would last for another 20 years along with the social development and reform.

Objective: The mortality and trend of injury in 1991 - 2000, the distribution of causes of injuries by areas as well as disease burden in Chinese population were discussed., Methods: Data on mortality level and causes of injuries provided by National Disease Surveillance Program in 1991 - 2000, adjusted by under-reporting rate together with years of potential life lost (YPLL) and WPYLL of injuries and proportion of YPLL and WPYLL of total death, were calculated., Results: The mortality of injury was kept at a stable level from 1991 to 2000. The adjusted average death rates were 66.56/100,000 with 81.41/100,000 in males, 51.17/100,000 in females, and 38.68/100,000, 74.63/100,000 in urban and rural populations respectively. Death rates of injury in the east, central and west rural areas were 1:1.14:1.21 respectively. Injury was the main cause of death among children and youths. Traffic accident, suicide, drowning, poisoning and fall were main causes of injury accounting for 70 percent of all the injury mortality. Since 1990's, the death rate of traffic accident had been obviously increasing, YPLL and WPYLL in injury 2132 years/10,000 and 1587 years/10,000, respectively. The YPLL and WPYLL were 24.56% and 26.51% of total deaths., Conclusion: The disease burden of injury was heavy and the death of injury caused more social and economic losses owing to premature death. The increasing death rate of traffic accident called for more attention. Different effective control strategies should be formulated based on different death causes of injury and different target populations.

Objective: To evaluate the accuracy of reports of suicide in the national death registry systems and to estimate a more accurate suicide rate., Methods: Twenty-three sites from the Disease Surveillance Points Network-one of the national death registry systems-were selected and 1 932 of the deaths that occurred at these sites from August 1995 through August 2000 in which the official cause was classified as "accidental" or "mental illness" were selected for detailed household surveys focusing on reassessing the cause of death. Valid interviews were completed in 1 653 of these cases. The original cause of death recorded on the death certificate was compared with the finding of the detailed household survey and the result was used to adjust the suicide rate., Results: After detailed investigation, 16 of the 857 (1.87%) deaths reported on the death certificate as suicide were considered accidental deaths, 39 of the 721 (5.41%) accidental deaths were considered suicide, 17 of the 35 (48.57%) cases reported as undetermined accidents were considered suicide, and 6 of the 40 (15.00%) cases in which mental illness was the recorded cause of death were considered suicide. After adjustments for errors in the reported cause of death and for missing deaths, the reported crude suicide rate of 13.65/100 000 in China was adjusted to 22.99/100 000 (95% CI: 21.78/100 000 - 24.25/100 000)., Conclusion: After adjustments the actual suicide rate for China was higher than the reported rate indicating that suicide was an increasingly important public health problem for China.

In this paper, epidemiological distribution and trend on injuries of Chinese population are described, and at the same time, characters and proportion of injuries to the total deaths are analyzed according to data in National Disease Surveillance Point system (DSP). Some important injuries and variance in population by different sexes, age groups and places are analyzed in detail. The death rate on suicide of Chinese population is high, reaching 19.58/10(5). The rate of suicide among females is higher than males, especially in female population of 20-34 age group, proportion is 46.70% to female total suicide. Rate of suicide of old people is also very high, population of over 60 years olds. It counts 29.72% to the total. The death rate due to transportation is going up, from 9.82/10(5) in 1991 to 14.32/10(5) in 1995, with an annual average incseasing ratio 7.84%. Drowning is the major cause of injuries for children of 0-14 years old, proportion of their death is 56.56% to the total death of drowning, 46.48% among them is children of 1-4 years old.

The leading health problems in the Chinese population are analyzed with indices as standard death rate, YPLL and DALY, using data from The Chinese Diseases Surveillance Points System (DSP). Disease pattern in China is different from that in the 1950's owing to demographic transition (aging of the population), decrease of both morbidity and mortality of communicable disease etc. That made chronic disease relatively more important the increase of some risk factors, directly cause the rising of mortality and morbidity of some chronic diseases and injuries related to lung cancer and transportation. At present the character of the disease pattern is as follows: there is still a long way to go to control communicable diseases, although the incidence rates and proportion have decreased. Meanwhile, chronic diseases and injuries are becoming major health issues. Hence, China is facing double challenges.