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Objective To provide a comprehensive overview of poisoning mortality patterns in China. Methods Using mortality data from the Chinese national disease surveillance points system, we examined trends in poisoning mortality by intent and substance from 2006 to 2016. Differences overtime between urban and rural residents among different age groups and across external causes of poisoning were quantified using negative binomial models for males and females separately. Results In 2016, there were 4936 poisoning deaths in a sample of 84060559 people (5.9 per 100000 people; 95% confidence interval; 5.6-6.2). Age-adjusted poisoning mortality dropped from 9.2 to 5.4 per 100000 people between 2006 and 2016. Males, rural residents and older adults consistently had higher poisoning mortality than females, urban residents and children or young adults. Most pesticide-related deaths (34 996 out of 39 813) were suicides among persons older than 15 years, although such suicides decreased between 2006 and 2016 (from 6.1 per 100000 people to 3.6 for males and from 5.8 to 3.0 for females). In 2016, alcohol caused 29.3% (600/2050) of unintentional poisoning deaths in men aged 25-64 years. During the study period, unintentional fatal drug poisoning by narcotics and psychodysleptics in individuals aged 25-44 years increased from 0.4 per 100 000 people to 0.7 for males and from 0.05 to 0.13 for females. Conclusion Despite substantial decreases in mortality, poisoning is still a public health threat in China. This warrants further research to explore causative factors and to develop and implement interventions targeting at-risk populations. Objectif Offrir un apercu detaille des schemas de mortalite par empoisonnement en Chine. Methodes A partir de donnees sur la mortalite provenant du systeme national chinois a points pour la surveillance des maladies, nous avons examine les tendances de la mortalite par empoisonnement, suivant les intentions et les substances, de 2006 a 2016. Les differences au fil du temps entre residents urbains et ruraux, de differentes tranches d'age et pour differentes causes externes d'empoisonnement, ont ete quantifiees a l'aide de modeles binomiaux negatifs, en separant les hommes et les femmes. Resultats En 2016, on a compte 4936 empoisonnements mortels sur un echantillon de 84 060 559 personnes (5,9 pour 100 000 habitants; interval le de confiance de 95%: 5,6-6,2). La mortalite par empoisonnement ajustee en fonction de l'age est passee de 9,2 a 5,4 pour 100 000 habitants entre 2006 et 2016. Les hommes, les residents ruraux et les adultes les plus ages affichaient systematiquement une mortalite par empoisonnement superieure a celle des femmes, des residents urbains et des enfants ou jeunes adultes. La plupart des deces dus a des pesticides (34 996 sur 39 813) etaient des suicides de personnes de plus de 15 ans, bien que ce type de suicides ait diminue entre 2006 et 2016 (passant de 6,1 a 3,6 pour 100 000 habitants chez les hommes et de 5,8 a 3,0 chez les femmes). En 2016, l'alcool a cause 29,3% (600/2050) des empoisonnements mortels involontaires chez les hommes de 25 a 64 ans. Durant la periode etudiee, les empoisonnements mortels involontaires dus a des narcotiques et des psychodysleptiques chez les personnes agees de 25 a 44 ans sont passes de 0,4 a 0,7 pour 100 000 habitants chez les hommes et de 0,05 a 0,13 chez les femmes. Conclusion En depit de fortes baisses de la mortalite, les empoisonnements restent une menace pour la sante publique en Chine. Cela justifie de mener des recherches plus poussees afin detudier les facteurs qui en sont a l'origine et d'elaborer puis de deployer des interventions axees sur les populations a risque. Objetivo Ofrecer una vision general integradora de los patrones de mortalidad por intoxicacion en China. Metodos Utilizando datos de mortalidad del sistema nacional chino de puntos de vigilancia de enfermedades, examinamos las tendencias en la mortalidad por intoxicacion con intencion y fundamento de 2006 a 2016. Se cuantificaron las diferencias en el tiempo entre los residentes urbanos y rurales para diferentes grupos por edades y considerando causas externas de intoxicacion, utilizando modelos binomiales negativos para hombres y mujeres de forma independiente. Resultados En 2016, hubo 4936 muertes por intoxicacion en una muestra de 84060559 personas (5,9 por cada 100000 personas; intervalo de confianza del 95%; 5,6-6,2). La mortalidad por intoxicacion ajustada por edades disminuyo de 9,2 a 5,4 por cada 100 000 personas entre 2006 y 2016. Los hombres, los habitantes de zonas rurales y los adultos mayores tuvieron una mortalidad superior por intoxicacion comparado con las mujeres, los habitantes de zonas urbanas y los ninos o adultos jovenes. La mayoria de las muertes relacionadas con pesticidas (34996 de 39 813) fueron suicidios entre personas mayores de 15 anos, aunque estos suicidios disminuyeron entre 2006y 2016 (de 6,1 por cada 100 000 personas a 3,6 en los hombres y de 5,8 a 3,0 en las mujeres). En 2016, el alcohol provoco el 29,3% (600/2050) de las muertes por intoxicacion no intencionadas en hombres entre las edades de 25 y 64 anos. Durante el periodo de estudio, la intoxicacion fatal con farmacos no Intencionada por narcoticos y psicodislepticos en individuos entre las edades de 25 y 44 anos aumento de 0,4 por cada 100 000 personas a 0,7 en los hombres y de 0,05 a 0,13 en las mujeres. Conclusion A pesar de la disminucion sustancial en la mortalidad, la intoxicacion sigue siendo una amenaza para la salud publica en China. Esto justifica mas investigaciones para explorar factores causales y desarrollar e implementar intervenciones orientadas a las poblaciones en riesgo., [phrase omitted] Introduction According to the Global Burden of Disease 2015 update, approximately 86 353 people died from unintentional poisonings worldwide in 2015, with 78 054 (90%) deaths occurring in [...]

In China, sample-based mortality surveillance systems, such as the Chinese Center for Disease Control and Prevention's disease surveillance points system and the Ministry of Health's vital registration system, have been used for decades to provide nationally representative data on health status for health-care decision-making and performance evaluation. However, neither system provided representative mortality and cause-of-death data at the provincial level to Inform regional health service needs and policy priorities. Moreover, the systems overlapped to a considerable extent, thereby entailing a duplication of effort. In 2013, the Chinese Government combined these two systems into an integrated national mortality surveillance system to provide a provincially representative picture of total and cause-specific mortality and to accelerate the development of a comprehensive vital registration and mortality surveillance system for the whole country. This new system increased the surveillance population from 6 to 24% of the Chinese population. The number of surveillance points, each of which covered a district or county, increased from 161 to 605. To ensure representativeness at the provincial level, the 605 surveillance points were selected to cover China's 31 provinces using an iterative method involving multistage stratification that took into account the socibdemographic characteristics of the population. This paper describes the development and operation of the new national mortality surveillance system, which is expected to yield representative provincial estimates of mortality in China for the first time. En Chine, des systemes de surveillance de la mortalite fondes sur des echantillons (comme le systeme a points de surveillance des maladies du Centre chinois pour le controle et la prevention des maladies et le systeme d'enreglstrement des donnees d'etat civil du ministere de la Sante) sont utilises depuis plusieurs dizaines d'annees pour obtenir des donnees representatives a l'echelle nationale de la situation sanitaire, en vue d'eclairer les processus decisionnels en matiere de sante et d'evaluer les resultats. Or, aucun de ces systemes traditionnellement utilises ne proposait de donnees representatives sur la mortalite et les causes de deces a l'echelle provlnciale, pourtant necessaires pour correctement definir les priorites et tes besoins regionaux en matiere de politiques de sante. Parailleurs, ces systemes etaient largement redondants entre eux, ce qui impliquait done une duplication inutile des efforts. En 2013, le gouvernement chinois a fusionne ces deux systemes dans un systeme national integre de surveillance de la mortalite afin d'obtenir une image representative a l'echelle provinciate de la mortalite totale et de la mortalite par cause et d'accelerer la creation d'un systeme exhaustif d'enregistrement des donnees d'etat civil et de surveillance de la mortalite pour tout le pays. Ce nouveau systeme a permis d'augmenter la couverture de la surveillance (de 6% de la population chinoise couverte auparavant a 24%). Le nombre de points de surveillance (chacun couvrant un district ou un comte) est passe de 161 a 605. Pour garantir une bonne representative a l'echelle provinciate, tes 605 points de surveillance ont ete selectlonnes de maniere a couvrir tes 31 provinces chinoises a l'aide d'une methode iterative impliquant une stratification a plusieurs degres qui a tenu compte des caracteristiques sociodemographiques de la population. Cet article decrit l'elaboration et te fonctionnement de ce nouveau systeme national de surveillance de la mortalite, qui devrait permettre d'obtenir pour la premiere fois des estimations representatives a l'echelle provinciate de la mortalite en Chine. En China, los sistemas de vigilancia de la mortalidad basados en muestras, tales como el sistema de puntos de vigilancia de las enfermedades del Centro de Prevencion y Control de Enfermedades de China y el sistema de registro civil del Ministerio de Salud, se han utilizado durante decadas para proporcionar datos nacionalmente representativos del estado de salud para tomar decisiones medicas y evaluaciones de rendimiento. Sin embargo, ningun sistema ofrecia datos representativos en cuanto a defunciones y las causas de las defunciones a un nivel provincial con el objetivo de informar de las necesidades de servicios sanitarios regionales y las prioridades de la politica. Asimismo, los sistemas se solapaban hasta un punto considerable, lo que suponia una duplicacion de los esfuerzos. En 2013, el gobierno chino combino estos dos sistemas en un sistema nacional integrado de vigilancia de la mortalidad para proporcionar una imagen provincialmente representativa de la mortalidad total y de la mortalidad por causas especificas y para acelerar el desarrollo de un registro civil completo y un sistema de vigilancia de la mortalidad para todo el pais. Este nuevo sistema aumento la poblacion de vigilancia de un 6 a un 24% de la poblacion china. El numero de puntos de vigilancia, donde cada uno cubria un distrito o condado, subio de 161 a 605. Con el objetivo de garantizar una representacion a nivel provincial, los 605 puntos de vigilancia se seleccionaron para cubrir las 31 provincias de China mediante la utilizacion de un metodo iterativo que consistia en una estratificacion de etapas multiples que tenia en cuenta las caracteristicas sociodemograficas de la poblacion. Este articulo describe el desarrollo y funcionamiento del nuevo sistema nacional de vigilancia de la mortalidad, el cual se espera que aumente las estimaciones provinciales representativas de mortalidad en China por primera vez., Introduction Reliable and timely information on cause-specific mortality is fundamental for informing the development, implementation and evaluation of health policy. (1,2) China has yet to establish a complete vital registration [...]

To examine the trends of nasopharyngeal carcinoma (NPC) mortality and years of life lost (YLL) in China and its provinces from 2005 to 2020, our study used data from China National Mortality Surveillance System (NMSS) to estimate the number and rate of mortality and YLL of NPC by age and sex. We calculated average annual percent change (AAPC) to describe the trend of NPC mortality and YLL over time. We also analyzed the proportion of NPC deaths in all cancer deaths and explored the drivers of change in NPC deaths by decomposition analysis. The age‐standardized mortality rate (ASMR) of NPC in China had a significant downward trend from 2.0/100 000 in 2005 to 1.4/100 000 in 2020 (AAPC = −2.4, P <.05). Age‐standardized YLL rate also showed the similar trends (AAPC = −2.8, P <.05). Southern provinces including Guangdong (163.9/100 000), Guangxi (130.5/100 000), and Hainan (105.6/100 000) had the highest YLL rate in 2020. The mortality and YLL rate increased with age and males were higher than females. From 2005 to 2020, the proportion of NPC deaths in all cancer deaths remained stable at around 1.0% in China. The total number of deaths of NPC increased by 7.3%, of which age‐specific mortality, population growth, and population aging accounted for −46.2%, 8.5% and 45.0%, respectively. NPC remains a significant public health issue in China southern provinces and tailored prevention and control strategies should be strengthened to reduce the burden of premature mortality of NPC in high risk areas. [ABSTRACT FROM AUTHOR]

Objectives. To analyze diabetes mellitus (DM) mortality and years of life lost (YLL) in different years and different subgroups at the national and regional levels in China from 2005 to 2020. Methods. We estimated mortality and YLL of DM and its subcategories for 31 provinces in China during 2005–2020 using multisource data from the National Mortality Surveillance System (NMSS). Results. The age standardized mortality rate (ASMR) of DM increased from 12.18 per 100,000 in 2005 to 13.62 per 100,000 in 2020, which was an increase of 11.86%. The ASMR of type 2 diabetes mellitus (T2DM) was much higher than that of type 1 diabetes mellitus (T1DM). The ASMR of T1DM remained stable, but the rate of T2DM increased, and the increase in male patients was higher than that in their female counterparts. At the same time, the burden of premature death was highest in the group ≥ 80 years old, and ASMR increased from 236.02 per 100,000 in 2005 to 358.86 per 100,000 in 2020. In 2005, the eastern region had the highest ASMR of DM, but the western region's ASMR grew faster and eventually became the highest in 2020. In addition, the YLL rate in the eastern region showed a downward trend; however, in the middle and western regions the YLL rate continued to rise, with that of the western region rapidly increasing. Conclusion. A dramatically upward trend in DM deaths can be seen in China from 2005 to 2020. DM remains a chronic disease in urgent need of prevention and control, especially in the elderly and people in less-affluent provinces. We must put forward more targeted policies to effectively allocate medical resources and focus on high-risk groups to reduce the premature-mortality burden of DM and its subcategories. [ABSTRACT FROM AUTHOR]

Background Traumatic brain injury (TBI) is a significant global public health problem, but has received minimal attention from researchers and policy-makers in low- and middle-income countries (LMICs). Epidemiological evidence of TBI morbidity and mortality is absent at the national level for most LMICs, including China. Using data from China's Disease Surveillance Points (DSPs) system, we conducted a population-based longitudinal analysis to examine TBI mortality, and mortality differences by sex, age group, location (urban/rural), and external cause of injury, from 1 January 2006 to 31 December 2013 in China. Method and findings Mortality data came from the national DSPs system of China, which has coded deaths using the International Classification of Diseases-10th Revision (ICD-10) since 2004. Crude and age-standardized mortality with 95% CIs were estimated using the census population in 2010 as a reference population. The Cochran-Armitage trend test was used to examine the significance of trends in mortality from 2006 to 2013. Negative binomial models were used to examine the associations of TBI mortality with location, sex, and age group. Subgroup analysis was performed by external cause of TBI. We found the following: (1) Age-adjusted TBI mortality increased from 13.23 per 100,000 population in 2006 to 17.06 per 100,000 population in 2008 and then began to fall slightly. In 2013, age-adjusted TBI mortality was 12.99 per 100,000 population (SE = 0.13). (2) Compared to females and urban residents, males and rural residents had higher TBI mortality risk, with adjusted mortality rate ratios of 2.57 and 1.71, respectively. TBI mortality increased substantially with older age. (3) Motor vehicle crashes and falls were the 2 leading causes of TBI mortality between 2006 and 2013. TBI deaths from motor vehicle crashes in children aged 0-14 years and adults aged 65 years and older were most often in pedestrians, and motorcyclists were the first or second leading category of road user for the other age groups. (4) TBI mortality attributed to motor vehicle crashes increased for pedestrians and motorcyclists in all 7 age groups from 2006 to 2013. Our analysis was limited by the availability and quality of data in the DSPs dataset, including lack of injury-related socio-economic factors, policy factors, and individual and behavioral factors. The dataset also may be incomplete in TBI death recording or contain misclassification of mortality data. Conclusions TBI constitutes a serious public health threat in China. Further studies should explore the reasons for the particularly high risk of TBI mortality among particular populations, as well as the reasons for recent increases in certain subgroups, and should develop solutions to address these challenges. Interventions proven to work in other cultures should be introduced and implemented nationwide. Examples of these in the domain of motor vehicle crashes include policy change and enforcement of laws concerning helmet use for motorcyclists and bicyclists, car seat and booster seat use for child motor vehicle passengers, speed limit and drunk driving laws, and alcohol ignition interlock use. Examples to prevent falls, especially among elderly individuals, include exercise programs, home modification to reduce fall risk, and multifaceted interventions to prevent falls in all age groups., Author(s): Peixia Cheng 1, Peng Yin 2, Peishan Ning 1, Lijun Wang 2, Xunjie Cheng 1, Yunning Liu 2, David C. Schwebel 3, Jiangmei Liu 2, Jinlei Qi 2, Guoqing [...]

Background: Schizophrenia is an important public health problem in China. This study aims to assess the long-term trends in the incidence and disability-adjusted life years (DALYs) rate of schizophrenia in China between 1990 and 2019. Methods: The incidence and DALYs data were drawn from the Global Burden of Disease Study 2019, and an age–period–cohort model was used in the analysis. Results: The age-standardized incidence rate (ASIR) and age-standardized DALYs rate (ASDR) of schizophrenia increased by 0.3 and 3.7% for both sexes between 1990 and 2019. For males, the local drift for incidence was higher than 0 (P < 0.05) in those aged 10 to 29 years (local drifts, 0.01 to 0.26%) and lower than 0 (P < 0.05) in those aged 35 to 74 years (local drifts, −1.01 to −0.06%). For females, the local drift was higher than 0 (P < 0.05) in those aged 10 to 34 years (local drifts, 0.05 to 0.26%) and lower than 0 (P < 0.05) in those aged 40 to 74 years (local drifts, −0.86 to −0.11%). The local drift for DALYs rate was higher than 0 (P < 0.05) in the age group from 10 to 69 years (local drifts, 0.06 to 0.26% for males and 0.06 to 0.28% for females). The estimated period and cohort relative risks (RR) for DALYs rate of schizophrenia were found in monotonic upward patterns, and the cohort RR for the incidence increased as the birth cohort moved forward starting with those born in 1972. Conclusion: Although the crude incidence of schizophrenia has decreased in China, the ASIR, ASDR, and crude DALYs rate all showed a general increasing trend over the last three decades. The DALYs rate continue to increase as the birth cohort moved forward, and the increasing trend of incidence was also found in individuals born after 1972. More efforts are needed to promote mental health in China. [ABSTRACT FROM AUTHOR]

Cardiovascular disease (CVD) is leading cause of death in China. We aimed to provide national and subnational estimates and its change of premature mortality burden of CVD during 2005–2020. Data from multi-source on the basis of national mortality surveillance system (NMSS) was used to estimate mortality and years of life lost (YLL) of total CVD and its subcategories in Chinese population across 31 provinces during 2005–2020. Estimated CVD deaths increased from 3.09 million in 2005 to 4.58 million in 2020; the age-standardized mortality rate (ASMR) decreased from 286.85 per 100,000 in 2005 to 245.39 per 100,000 in 2020. A substantial reduction of 19.27% of CVD premature mortality burden, as measured by age-standardized YLL rate, was observed. Ischemic heart disease (IHD), hemorrhagic stroke (HS) and ischemic stroke (IS) were leading 3 causes of CVD death. Marked differences were observed in geographical patterns for total CVD and its subcategories, and it appeared to be lower in areas with higher economic development. Population ageing was dominant driver contributed to CVD deaths increase, followed by population growth. And, age-specific mortality shifts contributed largely to CVD deaths decline in most provinces. Substantial discrepancies were demonstrated in CVD premature mortality burden across China. Targeted considerations were needed to integrate primary care with clinical care through intensifying further strategies for reducing CVD mortality among specific subcategories, high risk population and regions with inadequate healthcare resources. • CVD premature mortality burden in China remained high during 2005 to 2020. • Ischemic heart disease and stroke were leading 2 causes of CVD premature mortality burden. • Marked heterogeneity was observed in sex-age-specific characteristics and geographical patterns for CVD mortality at subnational level. • Substantial reduction of CVD mortality occurred among youngsters aged 0–14 years. • Population ageing is the dominant driver of increase for total CVD deaths. [ABSTRACT FROM AUTHOR]

Background: Coarse particulate matter with aerodynamic diameter between 2.5 and 10 [micro]m ([PM.sub.2.5-10]) air pollution is a severe environmental problem in developing countries, but its challenges to public health were rarely evaluated. Objective: We aimed to investigate the associations between day-to-day changes in [PM.sub.2.5-10] and cause-specific mortality in China. Methods: We conducted a nationwide daily time-series analysis in 272 main Chinese cities from 2013 to 2015. The associations between [PM.sub.2.5-10] concentrations and mortality were analyzed in each city using overdispersed generalized additive models. Two-stage Bayesian hierarchical models were used to estimate national and regional average associations, and random-effect models were used to pool city- specific concentration-response curves. Two-pollutant models were adjusted for fine particles with aerodynamic diameter [less than or equal to]2.5 [micro]m ([PM.sub.2.5]) or gaseous pollutants. Results: Overall, we observed positive and approximately linear concentration-response associations between [PM.sub.2.5- 10] and daily mortality. A 10-[micro]g/[m.sup.3] increase in [PM.sub.2.5-10] was associated with higher mortality due to nonaccidental causes [0.23%; 95% posterior interval (PI): 0.13, 0.33], cardiovascular diseases (CVDs; 0.25%; 95% PI: 0.13, 0.37), coronary heart disease (CHD; 0.21%; 95% PI: 0.05, 0.36), stroke (0.21%; 95% PI: 0.08, 0.35), respiratory diseases (0.26%; 95% PI: 0.07, 0.46), and chronic obstructive pulmonary disease (COPD; 0.34%; 95% PI: 0.12, 0.57). Associations were stronger for cities in southern vs. northern China, with significant differences for total and cardiovascular mortality. Associations with [PM.sub.2.5-10] were of similar magnitude to those for [PM.sub.2.5] in both single- and two-pollutant models with mutual adjustment. Associations were robust to adjustment for gaseous pollutants other than nitrogen dioxide and sulfur dioxide. Meta-regression indicated that a larger positive correlation between [PM.sub.2.5-10] and [PM.sub.2.5] predicted stronger city-specific associations between [PM.sub.2.5-10] and total mortality. Conclusions: This analysis showed significant associations between short-term [PM.sub.2.5-10] exposure and daily nonaccidental and cardiopulmonary mortality based on data from 272 cities located throughout China. Associations appeared to be independent of exposure to [PM.sub.2.5], carbon monoxide, and ozone. https://doi.org/10.1289/EHP2711, Introduction Particulate matter (PM) air pollution concentrations are recorded by monitors that measure particles in various aerodynamic diameters, with the earliest monitors measuring the concentration of particles [less than or [...]

This time‐series study collects data on stroke‐related mortality, years of life lost (YLL), air pollution, and meteorological conditions in 96 Chinese cities from 2013 to 2016 and proposes a three‐stage strategy to generate the national and regional estimations of avoidable YLL, gains in life expectancy and stroke‐related population attributable fraction by postulating that the daily fine particulate matter (PM2.5) has been kept under certain standards. A total of 1 318 911 stroke deaths are analyzed. Each 10 µg m−3 increment in PM2.5 at lag03 is associated with a city‐mean increase of 0.31 (95% CI: 0.19, 0.44) years of life lost from stroke. A number of 914.11 (95% CI: 538.28, 1288.94) years of city‐mean life lost from stoke could be avoided by attaining the WHO's Air Quality Guidelines (AQG) (25 µg m−3). Moreover, by applying the AQG standard, 0.11 (0.08, 0.15) years of life lost might be prevented for each death, and about 0.91% (95% CI: 0.62%, 1.19%) of the total years of life lost from stroke might be explained by the daily excess PM2.5 exposure. This study indicates that stroke patients can have a longer life expectancy if stricter PM2.5 standards are put in place, especially ischemic stroke patients. [ABSTRACT FROM AUTHOR]

Background: Few large multicity studies have been conducted in developing countries to address the acute health effects of atmospheric ozone pollution. Objective: We explored the associations between ozone and daily cause-specific mortality in China. Methods: We performed a nationwide time-series analysis in 272 representative Chinese cities between 2013 and 2015. We used distributed lag models and over-dispersed generalized linear models to estimate the cumulative effects of ozone (lagged over 0-3 d) on mortality in each city, and we used hierarchical Bayesian models to combine the city-specific estimates. Regional, seasonal, and demographic heterogeneity were evaluated by meta-regression. Results: At the national-average level, a 10-[micro]g/[m.sup.3] increase in 8-h maximum ozone concentration was associated with 0.24% [95% posterior interval (PI): 0.13%, 0.35%], 0.27% (95% PI: 0.10%, 0.44%), 0.60% (95% PI: 0.08%, 1.11%), 0.24% (95% PI: 0.02%, 0.46%), and 0.29% (95% PI: 0.07%, 0.50%) higher daily mortality from all nonaccidental causes, cardiovascular diseases, hypertension, coronary diseases, and stroke, respectively. Associations between ozone and daily mortality due to respiratory and chronic obstructive pulmonary disease specifically were positive but imprecise and nonsignificant. There were no statistically significant differences in associations between ozone and nonaccidental mortality according to region, season, age, sex, or educational attainment. Conclusions: Our findings provide robust evidence of higher nonaccidental and cardiovascular mortality in association with short-term exposure to ambient ozone in China. https://doi.org/ 10.1289/EHP1849, Introduction Ambient air pollution has emerged as a major public health concern worldwide (Cohen et al. 2017). As a key component of the photochemical air pollution mixture, tropospheric ozone is [...]

BACKGROUND: Cohort studies in North America and western Europe have reported increased risk of mortality associated with long-term exposure to fine particles ([PM.sub.2.5]), but to date, no such studies have been reported in China, where higher levels of exposure are experienced. OBJECTIVES: We estimated the association between long-term exposure to [PM.sub.2.5] with nonaccidental and cause- specific mortality in a cohort of Chinese men. METHODS: We conducted a prospective cohort study of 189,793 men 40 y old or older during 1990-91 from 45 areas in China. Annual average [PM.sub.2.5] levels for the years 1990, 1995, 2000, and 2005 were estimated for each cohort location using a combination of satellite-based estimates, chemical transport model simulations, and ground-level measurements developed for the Global Burden of Disease (GBD) 2013 study. A Cox proportional hazards regression model was used to estimate hazard ratios (HR) for nonaccidental cardiovascular disease (CVD), chronic obstructive pulmonary disease (COPD), and lung-cancer mortality. We also assessed the shape of the concentration-response relationship and compared the risk estimates with those predicted by Integrated Exposure-Response (IER) function, which incorporated estimates of mortality risk from previous cohort studies in western Europe and North America. RESULTS: The mean level of [PM.sub.2.5] exposure during 2000-2005 was 43.7 [micro]g/[m.sup.3] (ranging from 4.2 to 83.8 [micro]g/[m.sup.3]). Mortality HRs (95% CI) per 10-[micro]g/[m.sup.3] increase in [PM.sub.2.5] were 1.09 (1.08, 1.09) for nonaccidental causes; 1.09 (1.08, 1.10) for CVD, 1.12 (1.10, 1.13) for COPD; and 1.12 (1.07, 1.14) for lung cancer. The HR estimate from our cohort was consistently higher than IER predictions. CONCLUSIONS: Long-term exposure to [PM.sub.2.5] was associated with nonaccidental, CVD, lung cancer, and COPD mortality in China. The IER estimator may underestimate the excess relative risk of cause-specific mortality due to long-term exposure to [PM.sub.2.5] over the exposure range experienced in China and other low- and middle-income countries. https://doi.org/10.1289/EHP1673, Introduction Air pollution and especially particulate matter (PM) with aerodynamic diameter less than 2.5 im ([PM.sub.2.5]) became a focus for both the Chinese government and the Chinese public since the [...]

At present, most iris segmentation methods based on deep learning have poor robustness in the face of iris images collected in non-cooperative environments (with partial occlusion, distortion, etc.), and their performance decreases to varying degrees. Inspired by the visual transformer (ViT), we combined the advantages of the ViT and ConvNeXts networks to propose a deep learning-based robust iris segmentation method called CINet. Specifically, we introduced global region aware (GRA) in ConvNeXts to capture global spatial information. It increases the sensitivity of the model to the inner and outer boundaries of the iris, achieving efficient iris segmentation. In addition, it also suppresses noise information irrelevant to the iris region, thus improving the robustness of the model. We used global channel normalization instead of batch normalization, which suppresses some unimportant channel information, further enhancing the network's performance. Experimental results demonstrate that GRA provides important feature information, which is essential for efficient iris segmentation. We verify the effectiveness of the proposed method on three benchmark iris datasets. [ABSTRACT FROM AUTHOR]

Trailing-edge mixing flows associated with coolant injection are complex, in particular at transonic flows, and result in significant aerodynamics losses. The objective of this paper is to evaluate the impacts of hole injection near the suction side throat on shock wave control and aerodynamic losses. A series of tests and calculations on effects of hole injection on the suction-side throat of a high-pressure turbine vane cascade with and without trailing-edge injection were conducted. Wake traverses with a five-hole probe and tests of pressure distributions on the turbine profile were taken for total injection mass flow ratios of 0% and 1.2% under test Mach numbers of 0.7, 0.78, and 0.87. Meantime, numerical predictions are carried out for exit isentropic Mach numbers of 0.7, 0.78, 0.87, and 1.1 and hole-injection mass flow ratios of 0%, 0.17%, 0.3%, and 0.89%. Numerical predictions show a reasonable agreement with the experimental data, and wake total pressure losses and flow angles as well as pressure distributions on the turbine profile were compared to calculations without hole injection, indicating a significant effect of hole injection on the profile wake development and its blockage effect on the shock-wave flow in the vane cascade passage. At subsonic flows, the hole injection on the suction side throat thickens the suction-side boundary layer, and increases the flow mixing, thus causing increased wake losses and flow angles. At transonic flows, while the trailing-edge injection reduces the strength of the shock wave at the trailing-edge pressure side, the hole injection on the suction side throat alters the local pressure fields, and then tends to enhance the shock-wave at the trailing-edge pressure-side; however, it seems to reduce the strength of the shock-wave at the trailing-edge suction side. [ABSTRACT FROM AUTHOR]

Background: The United Nation's Sustainable Development Goals for 2030 include reducing premature mortality from non-communicable diseases (NCDs) by one third. To assess the feasibility of this goal in China, we projected premature mortality in 2030 of NCDs under different risk factor reduction scenarios.Methods: We used China results from the Global Burden of Disease Study 2013 as empirical data for projections. Deaths between 1990 and 2013 for cardiovascular disease (CVD), diabetes, chronic respiratory disease, cancer, and other NCDs were extracted, along with population numbers. We disaggregated deaths into parts attributable and unattributable to high systolic blood pressure (SBP), smoking, high body mass index (BMI), high total cholesterol, physical inactivity, and high fasting glucose. Risk factor exposure and deaths by NCD category were projected to 2030. Eight simulated scenarios were also constructed to explore how premature mortality will be affected if the World Health Organization's targets for risk factors reduction are achieved by 2030.Results: If current trends for each risk factor continued to 2030, the total premature deaths from NCDs would increase from 3.11 million to 3.52 million, but the premature mortality rate would decrease by 13.1%. In the combined scenario in which all risk factor reduction targets are achieved, nearly one million deaths among persons 30 to 70 years old due to NCDs would be avoided, and the one-third reduction goal would be achieved for all NCDs combined. More specifically, the goal would be achieved for CVD and chronic respiratory diseases, but not for cancer and diabetes. Reduction in the prevalence of high SBP, smoking, and high BMI played an important role in achieving the goals.Conclusions: Reaching the goal of a one-third reduction in premature mortality from NCDs is possible by 2030 if certain targets for risk factor intervention are reached, but more efforts are required to achieve risk factor reduction. [ABSTRACT FROM AUTHOR]

The tip leakage vortex breakdown occurs under a few conditions in modern turbines, which leads to extra vortex breakdown losses, but the mechanisms of vortex breakdown and its influencing factors still remain unclear. This paper is a continuation of the previous effort and focuses on the effect of blade rotation on the leakage vortex dynamics in an unshrouded turbine. The analyses on leakage vortex breakdown characteristics are first shown, and then the isolating effects of relative casing motion and Coriolis and centrifugal forces on leakage vortex breakdown and loss are investigated. Based on these, the overall effects of blade rotation on leakage vortex breakdown characteristics are examined. Results indicate that the scraping effects of the casing endwall have a great influence on the blade tip leakage vortex breakdown and loss. However, the effect of Coriolis and centrifugal forces is relatively small. Although the mismatch of both velocity components of the leakage flow and the main flow becomes slightly small with the casing motion, the blade tip mixing loss per unit leakage flow increases due to the fact that the leakage vortex breaks down in advance. [ABSTRACT FROM AUTHOR]

Objectives: We aimed to explore the temporal trends and geographic variations in dementia mortality in China.Materials and Methods: Annual dementia mortality counts (years 2006 to 2012) in 161 counties and districts (Disease Surveillance Points, DSP) were extracted from the nationally representative China Mortality Surveillance System and stratified by 5-year age group (aged >65), sex, and time. These counts were linked to annually adjusted denominator populations. Multilevel negative binomial regression with random intercepts and slopes were used to investigate spatiotemporal variation in dementia mortality.Results: Dementia mortality varied over 2-fold between DSPs (median rate ratio: 2.59). Significant variation in DSP slopes through time (variance 0.075, SE 0.020) indicated spatiotemporal variations. Mortality rates were significantly higher in the east (rate ratio 2.28; 95% confidence intervals, 1.45-3.60) compared with the north. There was a declining trend in 2 (east and northwest) of the 7 regions. Dementia mortality decreased by 15% in urban areas but increased by 24% in rural areas.Conclusions: Our findings indicate that regional inequalities in dementia mortality are salient, and the increase in mortality rates in rural areas is an emerging public health challenge in China. Tailored preventive health strategies should be in place to narrow down this avoidable and wholly unnecessary inequality. [ABSTRACT FROM AUTHOR]

Mortality of Chronic Obstructive Pulmonary Disease (COPD) is on the decline in China. It is not known if this trend occurs across all areas or whether spatiotemporal variations manifest. We used data from the nationally representative China Mortality Surveillance System to calculate annual COPD mortality counts (2006–2012) stratified by 5-year age groups (aged > 20), gender and time for 161 counties and districts (Disease Surveillance Points, or DSP). These counts were linked to annually adjusted denominator populations. Multilevel negative binomial regression with random intercepts and slopes were used to investigate spatiotemporal variation in COPD mortality adjusting for age, gender and area-level risk factors. COPD mortality rate decreased markedly from 105.1 to 73.7 per 100,000 during 2006 to 2012 and varied over two-fold between DSPs across China. Mortality rates were higher in the west compared with the east (Rate ratio (RR) 2.15, 95% confidence intervals (CI) 1.73, 2.68) and in rural compared with the urban (RR 1.87, 95% CI 1.55, 2.25). Adjustment for age, gender, urban/rural, region, smoking prevalence, indoor air pollution, mean body mass index and socioeconomic circumstances accounted for 67% of the geographical variation. Urban/rural differences in COPD mortality narrowed over time, but the magnitude of the east-west inequality persisted without change. Immediate action via large-scale interventions to enhance the prevention and management of COPD are needed specifically within China's western region in order to tackle this crucial health inequality and leading preventable cause of death. [ABSTRACT FROM AUTHOR]

Objective: To examine cardiovascular disease (CVD) mortality burden attributable to ambient temperature; to estimate effect modification of this burden by gender, age and education level.Methods: We obtained daily data on temperature and CVD mortality from 15 Chinese megacities during 2007-2013, including 1,936,116 CVD deaths. A quasi-Poisson regression combined with a distributed lag non-linear model was used to estimate the temperature-mortality association for each city. Then, a multivariate meta-analysis was used to derive the overall effect estimates of temperature at the national level. Attributable fraction of deaths were calculated for cold and heat (ie, temperature below and above minimum-mortality temperatures, MMTs), respectively. The MMT was defined as the specific temperature associated to the lowest mortality risk.Results: The MMT varied from the 70th percentile to the 99th percentile of temperature in 15 cities, centring at 78 at the national level. In total, 17.1% (95% empirical CI 14.4% to 19.1%) of CVD mortality (330,352 deaths) was attributable to ambient temperature, with substantial differences among cities, from 10.1% in Shanghai to 23.7% in Guangzhou. Most of the attributable deaths were due to cold, with a fraction of 15.8% (13.1% to 17.9%) corresponding to 305,902 deaths, compared with 1.3% (1.0% to 1.6%) and 24,450 deaths for heat.Conclusions: This study emphasises how cold weather is responsible for most part of the temperature-related CVD death burden. Our results may have important implications for the development of policies to reduce CVD mortality from extreme temperatures. [ABSTRACT FROM AUTHOR]

Tip injection has shown potential for controlling turbine tip clearance flows; however, the effects of tip injection may behave differently at design and off-design incidences. This paper computationally investigates the sensitivity of endwall flowfields and aerodynamics to flow incidence for flat and cavity tips at different injection locations, in an attempt to explore the potential of further reduction of tip clearance losses at various incidences by non-uniform tip injection concept. First, a linear cascade validation is introduced, and the computations were compared with the experimental data to identify the ability of the computational fluid dynamics (CFD) code to predict the tip leakage flow. Flow patterns over the blade tip without injection (WI) at different incidences were shown, and then the sensitivity of endwall flowfields and aerodynamics to incidence at different injection locations was investigated. Also, the effects of non-uniform tip injection on aerodynamic performance at design and off-design incidences were examined. The results show that the injection in the front part performs better performance than that in the rear part, while it causes turbine performance to be more sensitive to flow incidence than the injection in the rear part. Compared to the flat tip, the coupling effect between cavity tip and tip injection reduces the sensitivity of turbine performance to incidence variation. The non-uniform tip injection, which takes into account the tip leakage flow mechanisms at different incidences, optimizes the mixing process between the tip clearance flow and the passage flow, further improving the design and off-design performance of turbines. [ABSTRACT FROM PUBLISHER]