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Understanding the regional variations and mechanisms of rural hollowing-out in the Yellow River Basin (YRB) is crucial to guiding regional rural revitalization. However, further quantitative evaluation and analysis are essential to address the issue of rural hollowing-out caused by the decrease in rural population and expansion of residential land in the YRB at different spatio-temporal scales. Based on China's census data and residential areas extracted from remote sensing images, the rural hollowing-out in the YRB is classified into five types: smart development type (SDT), human–-land recession type (HRT), population loss type (PLT), land expansion type (LET), and human–land–vacant waste type (HLW). Then, the influential features shaping the spatial diversity of rural hollowing-out types are examined, and the feature importance values at different spatio-temporal scales are assessed using the XGBoost model. The results of rural hollowing-out in the YBR indicate that (1) the geographical types of rural hollowing-out in the YRB are dominated by the HRT type and show significant heterogeneity and distribution at different spatio-temporal scales. At different time stages, the number of counties dominated by HRT in lower reaches accounts for 57% of the total counties, whereas the number of counties in the middle reaches is only 37%. Compared to the rural hollowing-out results from 2000 to 2010, the number of counties dominated by PLT and HLW from 2010 to 2020 in the middle reaches increased by 19% and 16%, respectively. (2) Precipitation had a positive effect on the variability of the rural hollowing-out distribution results based on the feature importance values, whereas agricultural productivity had a negative effect and exhibited a decreasing trend. In the entire study area, economic non-agriculturalization had a negative impact, but the topographic relief was positively correlated with the rural hollowing-out results of regional areas, and the intensity of its effect showed an increased trend from 2000 to 2020. (3) The evaluation results in the entire study area show that the main functional type and the distance from provincial capitals are the most important factors affecting rural hollowing out. Compared to other factors, the level of non-agricultural economic development has a greater impact on the spatio-temporal differentiation of rural hollowing types in different Yellow River basins. Given the significant effect of non-agricultural economic development in the evaluation of regional rural hollowing-out, it can provide methodological and indicator references for the evaluation of rural hollowing-out in different regions. [ABSTRACT FROM AUTHOR]

Background: Pancreatic cancer is a growing public health concern in China, and depicting it from different perspectives would provide a comprehensive understanding of its epidemiological characteristics. Methods: Data from the National Mortality Surveillance System (NMSS) in China was used to estimate the number of deaths, years of life lost (YLL), age-standardized mortality rate (ASMR) and age-standardized YLL rate in China, its provinces and urban-rural areas from 2005 to 2020. Joinpoint regression analysis was employed to explore the temporal trends of ASMR and age-standardized YLL rate. Decomposition analysis was conducted to assess the contribution of population growth, population aging and cause-specific mortality rate to the increment of pancreatic cancer deaths. Results: A total of 100,427 pancreatic cancer deaths and 2,166,355 pancreatic cancer related YLL were estimated in China in 2020. The overall ASMR significantly increased from 6.6/100 000 in 2005 to 7.4/100 000 in 2020, and was higher in men than that in women. Age-standardized YLL rate showed a similar trend. The mortality rates of pancreatic cancer were generally higher in northeast China than in southwest China. The highest ASMRs were found in Jilin, Zhejiang, Inner Mongolia and Anhui, and the lowest ones in Guangxi, Yunnan, Tibet, and Hainan. The disease burden due to pancreatic cancer presented a significant upward trend in rural areas and a downward trend in urban areas. Conclusions: The burden associated with pancreatic cancer had been increasing in China from 2005 to 2020. The escalating disease burden of pancreatic cancer in rural areas necessitates the implementation of effective control and prevention measures. Relevant provinces should pay greater attention to the prevailing of pancreatic cancer, particularly those exhibiting higher mortality rates. [ABSTRACT FROM AUTHOR]

Objective: As a potentially life‐threatening condition, myasthenia gravis (MG) has limited epidemiological studies on mortality. We aim to provide demographic distribution, geographical variation, and temporal trend of MG‐related mortality in China. Methods: The national population‐based analysis was conducted based on records derived from the National Mortality Surveillance System of China. All deaths related to MG were identified from 2013 to 2020, and MG‐related mortality was evaluated by sex, age, location, and year. Results: A total of 4224 deaths were related to MG during 2013–2020, and the median age at death of MG was 59.45 years, significantly lower than that in the general population (75.47 years, P < 0.05). In 2020, the age‐standardized mortality rate of MG was 1.86 per million people and markedly higher in males than in females (2.37 vs. 1.31 per million). The mortality rate per million was lower than 1 in young children, peaking at 2.83 only in males (vs. 0.36 in females) aged 10–19 years, and substantially increased with age, reaching the highest rate of 13.31 for males and 10.58 for females aged 80 years and older. Geographical disparity across China was observed with the highest age‐standardized mortality rate in Southwest (2.53 per million). From 2013 to 2020, MG‐related mortality rate showed an increasing trend with the average annual percentage change of 3.5% (95% CI, 1.4–5.6). The notable increases occurred in age 10–19 years and over 70 years. Interpretation: In China, MG‐related mortality was notably high among adolescent males and the elderly. The increasing death burden due to MG highlight challenges to disease management. [ABSTRACT FROM AUTHOR]

The Apriori algorithm in association rules is the main algorithm used in the treatment and prevention of chronic diseases in data mining, and the algorithm in the current stage of China's medical field of association between chronic diseases has some problems, such as the need to scan the transaction database of cases several times, producing a large data set and more redundant rules. To address the above problems, a data mining algorithm of association rules combining clustering matrix and pruning strategy is proposed, which improves the algorithm by using the clustering matrix method to compress the stored transaction database and introducing the prepruning and postpruning strategy methods on the basis of adding constraint conditions. The experimental results show that the optimization algorithm has unique advantages in reducing the number of database scans and the number of candidate item sets generated and ultimately greatly reduces the running time and I/O load of the algorithm, and the running efficiency of the algorithm is greatly improved. [ABSTRACT FROM AUTHOR]

The development of grape varieties with cold resistance can be an advantage for the wine industry. 'Beimei', an interspecific hybrid wine grape variety with cold resistance and pleasant rose aroma, is now extensively cultivated in China. In the present study, the berry quality traits and metabolites of 'Beimei' and other "Bei" varieties were characterized. The sugar (234 g/L–391 g/L) and acid (6.2–8.3 g/L) contents of 'Beimei' and four additional "Bei" varieties, i.e., 'Beihong', 'Beixi', 'Beixin', and 'Xinbeichun' berries were smilar to that of traditional Vitis vinifera varieties. 'Beimei' grapes has the highest volatile compounds composition, especially the content of rose aroma compounds (2-phenyl-ethyl alcohol and neryl alcohol), which was significantly higher than that of the other "Bei" wine grape varieties. After fermentation, 'Beimei' wines showed improved quality, with a high resveratrol content (18 mg/L) compared to traditional Eurasian wines. In addition, the high content of main rose aroma compounds (acetic acid 2-phenylethyl acetate, phenylethyl alcohol, neryl alcohol and beta-damascenone) contribute to a pleasant rose aroma in 'Beimei' wines. In summary, these results indicate that 'Beimei' grapes could be used as a winemaking grape variety considering global climate changes. [ABSTRACT FROM AUTHOR]

Background: Pneumoconiosis refers to a class of serious diseases threatening the health of workers exposed to coal or silicosis dust. However, the burden of pneumoconiosis is unavailable in China.Methods: Incident cases, deaths, and disability-adjusted life years (DALYs) from pneumoconiosis and its subtypes in China were estimated from the Global Burden of Disease Study 2019 using a Bayesian meta-regression method. The trend of the burden from pneumoconiosis was analyzed using percentage change and annualized rate of change (ARC) during the period 1990-2019. The relationship between subnational socio-demographic index (SDI) and the ARC of age-standardised death rate was measured using Spearman's Rank-Order Correlation.Results: In 2019, there were 136.8 (95% uncertainty interval [UI] 113.7-162.5) thousand new cases, 10.2 (8.1-13.6) thousand deaths, and 608.7 (473.6-779.4) thousand DALYs from pneumoconiosis in China. Of the global burdens from pneumoconiosis, more than 60% were in China. Both the total number of new cases and DALYs from pneumoconiosis was keeping increasing from 1990 to 2019. In contrast, the age-standardised incidence, death, and DALY rates from pneumoconiosis and its subtypes, except for the age-standardised incidence rate of silicosis, and age-standardised death rate of asbestosis, experienced a significant decline during the same period. The subnational age-standardised death rates were higher in western China than in eastern China. Meanwhile, the subnational ARC of age-standardised death rates due to pneumoconiosis and its subtypes were significantly negatively correlated with SDI in 2019.Conclusion: China suffers the largest health loss from pneumoconiosis in the world. Reducing the burden of pneumoconiosis is still an urgent task in China. [ABSTRACT FROM AUTHOR]

Objective: The study aimed to clarify the association of the 21 single nucleotide polymorphisms (SNPs) with Alzheimer's disease (AD) in the population of southern China. Methods: A case-control study was conducted with a total sample size of 490 subjects (246 patients with AD and 244 age- and gender-matched healthy controls) enrolled in this study. Twenty-one selected SNPs were detected using SNaPshot assay and polymerase chain reaction (PCR) technique. Then, we assessed how these SNPs correlated with AD susceptibility. Results: The results showed that rs3764650 of ABCA7 was closely correlated with risen AD morbidity in the allele [ P = 0.010, odds ratio (OR) = 1.43, 95% confidence interval (CI) 1.09–1.89], dominant (P = 0.004, OR = 1.71, 95% CI 1.19–2.46), and additive (P = 0.012, OR = 1.42, 95% CI 1.08–1.86) models. However, rs4147929 of ABCA7 was related to higher AD risk in the allele (P = 0.006, OR = 1.45, 95% CI 1.11–1.89), dominant (P = 0.012, OR = 1.59, 95% CI 1.11–2.27), and additive (P = 0.010, OR = 1.40, 95% CI 1.08–1.81) models. In addition, the frequencies of the G-allele at rs3764650 (P = 0.030) and the A-allele at rs4147929 (P = 0.001) in AD were statistically higher in APOE ε4 carriers in comparison to non-carriers. Conclusion: This study demonstrated that the G-allele at rs3764650 and the A-allele at rs4147929 appeared at higher risk for developing AD, particularly in APOE ε4 carriers. Moreover, it was observed that rs3764650 and rs4147929 of ABCA7 were linked to AD. More in-depth research with a relatively large sample is needed to make the results more convincing. [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]

Purpose: NDM-1-producing Citrobacter portucalensis and Citrobacter freundii simultaneously occurred in a hospital. This study aims to characterize the blaNDM-1-carrying plasmids in these Citrobacter strains. Methods: Cf7303, Cf7308, and Cf7313 were recovered from three patients in a teaching hospital from September 24 to October 1, 2021. Bacteria were identified by MALDI-TOF mass spectrometry, and antibiotics susceptibility tests were determined by VITEK® 2 compact system. Whole-genome sequencing (WGS) was performed using the HiSeq Illumina and QNome platform to characterize the genomes. Results: Cf7303 was identified as C. portucalensis Sequence Type 328 by WGS, and harbored two plasmids, namely pCf7303 and a novel IncFIB pNDM-Cf7303 on which antibiotic-resistant genes (blaTEM-1, blaCTX-M-14, blaNDM-1, aac (3)-IId, aadA2, fosA3, sul1, sul2, catA2, tetD, dfrA12, qacEdelta1, mph(A), and bleMBL) are located. C. freundii strain Cf7308 and Cf7313 belonged to the same Sequence Type 98. Cf7308 contained two plasmids, pCf7308, and an IncN1 pNDM-Cf7308 with homology to pNDM-BTR in E. coli and pNDM-CWH001 in C. freundii. Conclusion: We characterized a putatively novel IncFIB plasmid carrying blaNDM-1 in C. portucalensis. In addition, the closely related blaNDM-1-carrying IncN1 plasmids in E. coli and C. freundii suggest that interspecies or intraspecies horizontal transfer occurs in China. [ABSTRACT FROM AUTHOR]

Background: Cigarette smoking is associated with nasopharyngeal cancer (NPC) risk. Whether quitting reduces the risk is unclear. We investigated the associations of NPC with duration of and age at quitting in an endemic region. Methods: We investigated the associations between NPC and quitting in a multicenter case-control study in Hong Kong with 676 newly diagnosed NPC cases and 1,285 hospital controls between 2014 and 2017, using a computer-assisted self-administered questionnaire. Multivariable unconditional logistic regression yielded adjusted odds ratios (AORs) of NPC by quitting status, duration and age of quitting, combinations of duration and age of quitting, and quitting to smoking duration ratio, compared with current smoking. Results: Quitting (AOR: 0.72; 95% CI: 0.53–0.98) and never smoking (0.73, 0.56–0.95) were associated with lower NPC risk. NPC risk decreased with (i) longer quitting duration (p < 0.01), reaching significance after 11–20 (0.62, 0.39–0.99) and 21+ years (0.54, 0.31–0.92) of quitting; (ii) younger quitting age (p = 0.01), reaching significance for quitting at <25 years (0.49, 0.24–0.97); and (iii) higher quitting to smoking duration ratio (p < 0.01), reaching significance when the ratio reached 1 (0.60, 0.39–0.93). Quitting younger (age <25) appeared to confer larger reductions (49% for ≤10 years of quitting, 50% for 11+ years) in NPC risk than quitting at older ages (25+) regardless of quitting duration (16% for ≤10 years, 39% for 11+ years). Conclusions: We have shown longer duration and younger age of quitting were associated with lower NPC risk, with dose-response relations. Our findings support including smoking as a cause of NPC. Stronger tobacco control measures and quitting services are needed to prevent NPC. [ABSTRACT FROM AUTHOR]

This study described the trend and distribution of coronary heart disease (CHD) in the Hexi Corridor region of Gansu. The CHD mortality rates from 2006-2015 were obtained through the Death Reporting System of Gansu Centers for Disease Control (CDC) for 2006-2015. The overall mortality rate of CHD in the Hexi Corridor showed a decreasing trend, increasing in winter and spring and lowest in summer. The CHD mortality rate was higher in men than in women (P < 0.05) and increased with age (P < 0.05). The mortality rate was higher in rural areas than in urban areas (P < 0.05). A ten-year mortality rate trend analysis showed that CHD mortality rate in women has significantly decreased. Specifically, women aged 18-39 years experienced increased There was little change in CHD mortality among women aged 40-59 years, and a declined in CHD mortality among women 60 years and older and women in urban areas. Further analysis showed that in the 18-39-year-old and 40-59-year-old groups and in urban areas, CHD mortality rate was higher in men than in women (P < 0.05). From 2006 to 2015, the mortality rate of CHD in the Hexi Corridor of Gansu was lower than in the national average, but in certain populations such as men, young and middle-aged group and rural areas, the CHD mortality rate was gradually increased. There has been a gradual and progressive decline in CHD mortality rate compared to the rising trend in China. This is due to fewer risk factors in the region, effective drug treatment and improvements in environmental pollution. However, there is still a need to enhance the experience of effective prevention and control for specific subgroups such as men, young people and rural residents, and to take appropriate measures to prevent the occurrence of CHD. [ABSTRACT FROM AUTHOR]

Background: Most deaths in China occur at home, making it difficult to collect reliable cause of death (CoD) information. Verbal autopsy (VA) was applied using the SmartVA tool to a sample of home deaths in China to explore its feasibility as a means of improving the quality of CoD data. Methods: The study was carried out in 22 districts in 9 provinces, located in north-east, central, and western areas of China during 2017 and 2018. Trained interviewers selected suitable respondents in each household to collect information using the Population Health Metrics Research Consortium (PHMRC) shortened and validated electronic VA questionnaire on tablets. The CoD was diagnosed from the interview data using the SmartVA-Analyze 2.0 software (Tariff 2.0). Results: Non-communicable diseases (NCDs) dominated the leading causes of death in all age groups and for both sexes. After redistribution of undetermined causes, stroke (24%), ischemic heart diseases (IHD) (21%), chronic respiratory diseases (11%), and lung cancer (6%) were the leading causes of death. The cause fractions for level-one cause categories and ranking of specific causes were similar between SmartVA and results from the Global Burden of Disease (GBD) study. Conclusion: Evidence from this large pilot study suggests that SmartVA is a feasible and plausible tool and could be a valuable tool to improve the quality and standardization of CoD information across China. [ABSTRACT FROM AUTHOR]

The European sunflower moth, Homoesoma nebulellum (Denis et Schiffermüller), emerged as a major new pest in Bayannur, China, in 2006. Insecticidal control with a single application is problematic because timing is critical, and multiple applications increase production and environmental costs. Management of H. nebulellum by planting date adjustment can be effective, but the optimal time window for late planting is unknown. Natural levels of H. nebulellum infestation were compared among sunflowers planted on five dates from April 25 to June 5 in two years, and the relationship between timing of adult abundance and flowering assessed. Delaying planting of sunflower from the traditional planting period of April 25 –May 5 to May 15 –June 5 significantly decreased damage by H. nebulellum. Seed infestation rate was 30–40 times higher, and number of larvae/head 75–100 times higher in the earliest two plantings than in the latest two. Within two years of implementing delayed planting in Bayannur city, infestation area decreased from 72% in 2006 to 1.5% in 2008, and production losses decreased from 4.5 ton/ha in 2006 to 0.36 ton/ha in 2008, a 97% decrease compared to 2006. Moreover, the infestation area caused by H. nebulellum was continuously controlled below 5.3% of the planting area since 2008. We found the overlap between the first two days of flowering and peak adult presence was the key factor influencing level of damage caused by H. nebulellum. Because the number of eggs laid in the first two days of flowering accounted for 68% of the total, and sunflower seed infestation rate was positively correlated with the number of trapped adults weighted by proportion of daily oviposition. Oviposition of the majority of eggs in the first two days of flowering suggests an evolutionary mechanism whereby females choose host plants most conducive to larval development, consistent with the preference-performance hypothesis. [ABSTRACT FROM AUTHOR]

Listeriosis, caused by Listeria monocytogenes , is a severe food-borne infection. The nationwide surveillance in China concerning listeriosis is urgently needed. In the present study, 144 L. monocytogenes isolates were collected from the samples of blood, cerebrospinal fluid (CSF), and fetal membrane/placenta in China for 12 years from 2008 to 2019. We summarized these listeriosis patients' demographical and clinical features and outcomes. The susceptibility profile for 12 antibiotics was also determined by the broth microdilution method. Multilocus sequence typing (MLST) and serogroups of these listeria isolates were analyzed to designate epidemiological types. We enrolled 144 cases from 29 healthcare centers, including 96 maternal-neonatal infections, 33 cases of bacteremia, 13 cases of neurolisteriosis, and two cutaneous listeriosis. There were 31 (59.6%) fetal loss in 52 pregnant women and four (9.8%) neonatal death in 41 newborns. Among the 48 nonmaternal-neonatal cases, 12.5% (6/48) died, 41.7% (20/48) were female, and 64.6% (31/48) occurred in those with significant comorbidities. By MLST, the strains were distinguished into 23 individual sequence types (STs). The most prevalent ST was ST87 (49 isolates, 34.0%), followed by ST1 (18, 12.5%), ST8 (10, 6.9%), ST619 (9, 6.3%), ST7 (7, 4.9%) and ST3 (7, 4.9%). Furthermore, all L. monocytogenes isolates were uniformly susceptible to penicillin, ampicillin, and meropenem. In summary, our study highlights a high genotypic diversity of L. monocytogenes strains causing clinical listeriosis in China. Furthermore, a high prevalence of ST87 and ST1 in the listeriosis should be noted. [ABSTRACT FROM AUTHOR]

Background: To explore the relationship between geographical differences of mortality and related risk factors in ischemic heart disease (IHD) in China.Methods: Data were collected from the nationally representative China Mortality Surveillance System to calculate annual IHD mortality counts (2010-2015). Descriptive analysis was used to analyze the IHD mortality among Chinese population from 2010 to 2015. Negative binomial regression was used to investigate potential spatiotemporal variation and correlations with age, gender, urbanization, and region.Results: The overall IHD mortality was 221.17/100,000, accounting for 1.51 million deaths in 2015. The standardized IHD mortality rate increased by 5.51% from 2010 to 2015 among people aged 40 years and older. Multilevel analysis indicated significant differences in gender, regions, and age. High urbanization rate (risk ratio [RR] = 0.728, 95% confidence interval [CI] = (0.631, 0.840)) and average high-density lipoprotein (HDL) (RR = 0.741, 95%CI: 0.616,0.891) were negatively associated with IHD mortality. IHD mortality was significantly higher in populations with a low rate of medical insurance coverage (RR = 1.218, 95%CI: 1.007, 1.473), as well as the average body mass index (BMI) (RR = 1.436, 95%CI: 1.135, 1.817) and systolic blood pressure (SBP) (RR = 1.310, 95%CI: 1.019, 1.684). While the relationship with current smoking rate, excessive intake of red meat, insufficient vegetable or fruits intake didn't show the statistical significance. The negative correlation between the average sedentary time and IHD mortality was not conclusive due to the possible deviation of the data.Conclusions: The mortality of IHD showed an upward trend for people aged 40 years and older in China during 2010-2015, which should be paid attention to. Therefore, some risk factors should be controlled, such as SBP, overweight/obesity. HDL is a protective factor, as well as higher urbanization rate, family income level, and medical insurance coverage. [ABSTRACT FROM AUTHOR]

Staphylococcus aureus (S. aureus) constantly evolves under host and environment pressures. The monitoring network is essential in assessing the epidemiology of S. aureus infections. A total of 555 S. aureus isolates were collected from five hospitals in three different geographical regions of China for the investigation of molecular characteristics, antibiotic resistance, virulence gene, and wall teichoic acid (WTA) glycosyltransferase gene profiles. 233 (42.0%) isolates were identified as MRSA, and 323 (58.2%) were defined as multidrug-resistant (MDR) isolates. MRSA prevalence showed no significant difference among the three regions. In contrast, the MDR prevalence was significantly higher in central China than that in northern China (63.5% vs. 50.8%, P < 0.05). Thirty-eight sequence types (STs) belonging to 17 clone complexes (CCs) and 126 distinct spa -types were identified. The most prevalent clone was ST59-t437 (9.7%, 54/555), followed by ST22-t309 (7.6%, 42/555) and ST5-t2460 (7.2%, 40/555). Most ST59-t437 and ST5-t2460 were MRSA isolates, whereas most ST22-t309 was MSSA isolates. The predominant clones varied in different geographical areas. The distribution of the pvl , etb , tsst , clfb , sdrC , sdrD , hlg , fnbA , and hla genes showed significant differences among different regions. We found five WTA glycosyltransferase gene profiles, with tarP -/ tarS +/ tarM -/ tagN - being the most common combination. Remarkably, the tarP gene was identified in more CCs than just CC5 and CC398. All of 16 tarP -positive isolates also contained the tarS. Moreover, tarS was present in almost all S. aureus isolates except 10 ST630 isolates. The tagN gene was only detected in 10 of 12 ST630 S. aureus isolates without tarS. The tarM gene was absent in CC5 and CC398. In brief, there were regional differences among molecular characteristics, antibiotic resistance, and virulence gene profiles. The tarS -negative ST630 lineage carried the tagN , which was never found before, indicating that it may be capable of expressing GroP-α-GalNAc WTA and exchanging mobile genetic elements with coagulase-negative staphylococci (CoNS). [ABSTRACT FROM AUTHOR]

Background: Death registration completeness has never been assessed at the county level in China. Such analyses would provide critical intelligence to monitor the performance of the vital registration system and yield adjustment factors to correct death registration data, thereby increasing their policy utility.Methods: We estimated the completeness of death registration for 31 provinces and 2844 counties of China in 2018 based on death data from the China Cause of Death Reporting System (CDRS) by using the empirical completeness method. We computed the root mean square difference (RMSD) of county-level completeness compared with provincial-level completeness to study intra-provincial variations. A two-level (province and county) logistic regression model was fitted to explore the association between county-level registration completeness and a set of covariates reflecting socioeconomic status, healthcare quality, and specific strategies and regulations designed to improve registration.Results: In 2018, the overall death registration completeness for the CDRS in China was 74.2% (95% uncertainty interval [UI] 66.2-80.4), with very little difference for males and females. Geographical differences in completeness were higher across counties than across provinces. The county-level completeness ranged from 2.4% (95% UI 1.0-5.0%) in Burang County, Tibet, to 100.0% (95% UI 99.9-100.0%) in Guandu District, Yunnan. The coastal provinces of Jiangsu, Guangdong, and Fujian, with higher overall completeness, contained counties with low completeness; conversely, the underdeveloped provinces of Guangxi and Guizhou, with lower overall completeness, included some counties with high completeness. GDP, education, population density, minority population, healthcare access, and registration strategies were important drivers of the geographical differences in registration completeness.Conclusions: There are marked inequalities in registration completeness at the county level and within provinces in China. The socioeconomic condition, the implementation of specific registration-enhancing initiatives, and the availability and quality of medical care were the primary drivers of the observed geographical variation. A more strategic approach, with more research, is required to identify the main reasons for death under-reporting, especially in the poorer performing counties, to guide remedial action. [ABSTRACT FROM AUTHOR]

Background: China has more than 18% of the global population and over 770 million workers. However, the burden of disease attributable to occupational risks is unavailable in China. We aimed to estimate the burden of disease attributable to occupational exposures at provincial levels from 1990 to 2017.Methods: We estimated the summary exposure values (SEVs), deaths and disability-adjusted life years (DALYs) attributable to occupational risk factors in China from 1990 to 2017, based on Global Burden of Disease Study (GBD) 2017. There were 18 occupational risks, 22 related causes, and 35 risk-outcome pairs included in this study. Meanwhile, we compared age-standardized death rates attributable to occupational risk factors in provinces of China by socio-demographic index (SDI).Results: The SEVs of most occupational risks increased from 1990 to 2017. There were 323,833 (95% UI 283,780 - 369,061) deaths and 14,060,210 (12,022,974 - 16,125,763) DALYs attributable to total occupational risks in China, which were 27.9 and 22.1% of corresponding global levels, respectively. For attributable deaths, major risks came from occupational particulate matter, gases, and fumes (PGFs), and for the attributable DALYs, from occupational injuries. The attributable burden was higher in males than in females. Compared with high SDI provinces, low SDI provinces, especially Western China, had higher death rates attributable to total occupational risks, occupational PGFs, and occupational injuries.Conclusion: Occupational risks contribute to a huge disease burden in China. The attributable burden is higher in males, and in less developed provinces of Western China, reflecting differences in risk exposure, socioeconomic conditions, and type of jobs. Our study highlights the need for further research and focused policy interventions on the health of workers especially for less developed provinces in China to reduce occupational health losses effectively. [ABSTRACT FROM AUTHOR]

Background: Ambient fine particulate matter pollution (PM2.5) is one leading cause of disease burden, but no study has quantified the association between daily PM2.5 exposure and life expectancy. We aimed to assess the potential benefits in life expectancy by attaining the daily PM2.5 standards in 72 cities of China during 2013-2016.Methods and Findings: We applied a two-stage approach for the analysis. At the first stage, we used a generalized additive model (GAM) with a Gaussian link to examine the city-specific short-term association between daily PM2.5 and years of life lost (YLL); at the second stage, a random-effects meta-analysis was used to generate the regional and national estimations. We further estimated the potential gains in life expectancy (PGLE) by assuming that ambient PM2.5 has met the Chinese National Ambient Air Quality Standard (NAAQS, 75 μg/m3) or the ambient air quality guideline (AQG) of the World Health Organization (WHO) (25 μg/m3). We also calculated the attributable fraction (AF), which denoted the proportion of YLL attributable to a higher-than-standards daily mean PM2.5 concentration. During the period from January 18, 2013 to December 31, 2016, we recorded 1,226,849 nonaccidental deaths in the study area. We observed significant associations between daily PM2.5 and YLL: each 10 μg/m3 increase in three-day-averaged (lag02) PM2.5 concentrations corresponded to an increment of 0.43 years of life lost (95% CI: 0.29-0.57). We estimated that 168,065.18 (95% CI: 114,144.91-221,985.45) and 68,684.95 (95% CI: 46,648.79-90,721.11) years of life lost can be avoided by achieving WHO's AQG and Chinese NAAQS in the study area, which corresponded to 0.14 (95% CI: 0.09-0.18) and 0.06 (95% CI: 0.04-0.07) years of gain in life expectancy for each death in these cities. We observed differential regional estimates across the 7 regions, with the highest gains in the Northwest region (0.28 years of gain [95% CI: 0.06-0.49]) and the lowest in the North region (0.08 [95% CI: 0.02-0.15]). Furthermore, using WHO's AQG and Chinese NAAQS as the references, we estimated that 1.00% (95% CI: 0.68%-1.32%) and 0.41% (95% CI: 0.28%-0.54%) of YLL could be attributable to the PM2.5 exposure at the national level. Findings from this study were mainly limited by the unavailability of data on individual PM2.5 exposure.Conclusions: This study indicates that significantly longer life expectancy could be achieved by a reduction in the ambient PM2.5 concentrations. It also highlights the need to formulate a stricter ambient PM2.5 standard at both national and regional levels of China to protect the population's health. [ABSTRACT FROM AUTHOR]

Background: The accurate information about burden of multiple myeloma (MM) at national and provincial level remains unknown in China. Methods: Following the general analytical strategy used in GBD 2016, the age-, sex-, and province-specific incidence and mortality in China were analyzed. Trends in the incidence and mortality from 2006 to 2016 were evaluated. Results: It was estimated that there were 16,500 new cases and 10,300 deaths of multiple myeloma in China in 2016. The age-standardized incidence rates (ASIR) and mortality rates (ASMR) per 100,000 population were 1.03 (95% UI, 0.88–1.17) and 0.67 (95% UI, 0.59–0.77) in 2016. Males had higher incidence and mortality rates than females in all age groups. An upward trend with age in incidence and mortality was observed. Higher incidence and mortality rates clustered in the developed provinces. The incidence of MM in China increased significantly from 2006 to 2016, while the mortality increased from 2006 to 2014, and remained stable from 2014 to 2016. Conclusion: The burden of MM showed a heterogeneous pattern in China, which highlighted the need of tailored disease prevention and control strategies in both national and provincial levels. [ABSTRACT FROM AUTHOR]

Atmospheric particulate matter (PM 2.5 and PM 10) samples were collected at urban and suburban sites in Xi'an City from December 2016 to November 2017. Sixteen priority polycyclic aromatic hydrocarbons (PAHs) associated with PM 2.5 and PM 10 were analyzed for their seasonal variations, sources, health risks, and influencing factors. The results showed that the annual average concentrations of PM 2.5 and PM 10 were 111 and 185 μg/m3, respectively, exceeding the National Ambient Air Quality Standard of China (35 μg/m3 for PM 2.5 and 70 μg/m3 for PM 10 in Grade II). The annual averages of PM 2.5 - and PM 10 -bound total PAHs were 63.1 and 66.8 ng/m3, respectively, with a PM 2.5 decrease in the order of winter (115 ng/m3) > > spring (47.6 ng/m3) > summer (33.2 ng/m3) > autumn (30.8 ng/m3) and a PM 10 decrease in the order of winter (127 ng/m3) > > spring (55.6 ng/m3) > autumn (32.6 ng/m3) > summer (30.2 ng/m3). The most abundant PAHs were benzo[ a ]anthracene, benzo[ b ]fluoranthene, and fluoranthene. The PM 2.5 - and PM 10 -bound PAHs were originated mainly from traffic emissions (51.0% and 43.4%), followed by combustion of biomass (20.4% and 23.6%) and coal (16.8% and 23.1%). Pressure and relative humidity were positively correlated with PM 2.5 and PM 10 as well as PM 2.5 - and PM 10 -bound PAHs, while temperature, visibility and wind speed had negative correlations. The annual means of TEQs (toxic equivalency quantities) for the 16 PAHs in PM 2.5 and PM 10 were 10.1 and 10.2 ng/m3, respectively, being attributed to 7 carcinogenic PAHs (> 95%). The ECRs (lifetime excess cancer risks) for PM 2.5 - and PM 10 -bound PAHs were 1.12 × 10−3 and 1.17 × 10−3, i.e., 1125 and 1169 lung cancer cases per million, respectively. The ILCRs (incremental lifetime cancer risks) due to PM 2.5 - and PM 10 -bound PAHs for adults (1.21 × 10−6 and 1.26 × 10−6) were larger than those for children (2.09 × 10−7 and 2.17 × 10−7), with acceptable carcinogenic risks. The ambient levels of PM and most PM-bound PAHs as well as their TEQs, ECRs and ILCRs exhibited a spatial pattern of the suburban site > the urban site and a seasonality with winter and spring > summer and autumn. The results suggest that it is important to control PM 2.5 and PM 10 for local air quality improvement and special attention should be paid to PM and PM-bound PAHs in suburban areas, particularly in winter and spring. • PM 2.5 - and PM 10 -bound PAHs were investigated in a semi-arid city, Xi'an of China. • PM and PM-bound PAH levels were higher in suburb, particularly in winter and spring. • PM-bound PAHs were dominated by high molecular weight PAHs, i.e., BaA, BbF and Fla. • Meteorological conditions had significant influences on the PM and PM-bound PAHs. • PM-bound PAHs incurred a high lung cancer risk in Xi'an relative to other study areas. [ABSTRACT FROM AUTHOR]

Functional constipation (FC), a common symptom that is primarily associated with intestinal motility dysfunction, is a common problem worldwide. Arctiin (Arc) is a lignan glycoside isolated from the Chinese herbal medicine Arctium lappa L., which is a health food in China. The present study aimed to evaluate the laxative effects of Arc against FC in mice. A model of FC induced by loperamide (5 mg/kg) was established in male Institute of Cancer Research (ICR) mice. Arc was administered at a dose of 100 mg/kg as a protective agent. The faecal status, intestinal motility and histological analyses were evaluated. Furthermore, the levels of gastrointestinal motility-associated neurotransmitters, such as motilin (MTL), nitric oxide (NO), and brain-derived neurotrophic factor (BDNF) and the protective effect of Arc on interstitial cells of Cajal (ICC) were assessed. Arc treatment reversed the loperamide-induced reduction in faecal number and water content and the intestinal transit ratio in ICR mice. Histological analysis confirmed that Arc administration mitigated colonic injury. Moreover, Arc treatment increased levels of motilin and brain-derived neurotrophic factor while decreasing nitric oxide levels and ICC injury in the colon of FC mice. Arc decreased inflammation induction and aquaporin expression levels. Owing to its pro-intestinal motility property, Arc was shown to have a protective effect against FC and may thus serve as a promising therapeutic strategy for the management of FC. [ABSTRACT FROM AUTHOR]

A total of 62 urban soil samples were collected in the city of Xi'an in Northwest China, and analyzed for six U.S. Environmental Protection Agency priority phthalate esters (PAEs). Unlike earlier studies on PAEs in agricultural soil as well as urban soil in humid climates, this paper for the first time comprehensively assessed pollution characteristics and health risks of human exposure to PAEs in urban soil in a typical semi-arid climate. The total concentrations of the six PAEs (Σ6PAEs) in the urban soil varied between 193.0 and 19146.4 μg kg −1 with a mean of 1369.3 μg kg −1 . The PAEs were dominated by di- n -butyl phthalate and di(2-ethylhexyl) phthalate. Magnetic susceptibility and soil texture were controlling factors influencing the concentrations of PAEs in the urban soil. The concentrations of benzyl butyl phthalate, di(2-ethylhexyl) phthalate, and Σ6PAEs increased from the first to third ring roads, while the concentrations of di- n -octyl phthalate decreased. Relatively higher levels of PAEs were observed in industrial, traffic, and residential areas. The PAEs in the urban soil originated mainly from the application of plasticizers or additives, use of cosmetics and personal care products, emissions of construction materials and home furnishings, industrial processes, and atmospheric deposition. The concentrations of some PAEs in the urban soil exceeded soil allowable concentrations and environmental risk levels. The non-cancer and carcinogenic risks of human exposure to the PAEs were relatively low. [ABSTRACT FROM AUTHOR]

Background: Bacterial species belonging to the genus Exiguobacterium are facultative anaerobic, non-spore-forming, Gram-positive bacilli, and rarely associated with human infections. Herein, we reported the first case of community-acquired pneumonia (CAP) and bacteremia due to Exiguobacterium spp. in China.Case Presentation: An adult male with severe CAP was hospitalized. The pathogen was isolated from his bloodstream and broncho-alveolar lavage fluid. The correct identification of the micro-organism was achieved using 16S rRNA sequencing, and its antibiotic susceptibility test was performed by microdilution method. The Whole Genome Sequencing (WGS) was used to characterize its genetic features and to elucidate its potential pathogenic mechanisms. Furthermore, its genome sequence was also compared with those of 3 publicly-available Exiguobacterium strains. A PubMed search was performed for further understanding the features of Exiguobacterium infections. Phylogenetic analysis of the 16S rRNA gene sequence showed that the strain GX59 was most closely related to Exiguobacterium AT1b (99.7%). The genome of GX59 was 2,727,929 bp in size, harbouring 2855 putative protein-coding genes, 5 rRNA operons, 37 tRNA genes and 1 tmRNA. The multiple genome comparison of 4 Exiguobacterium strains demonstrated that Exiguobacterium contained 37 genes of secretion systems, including sec, tat, FEA, Type IV Pili and competence-related DNA transformation transporter (Com). Virulence factors of the micro-organism included tlyC, NprR, MCP, Dam, which might play a critical role in causing lethal infection.Conclusions: The study highlighted the potential pathogenicity of the genus Exiguobacterium for its unique genes encoding various virulence factors and those associated with antibiotic resistance, therefore, its clinical significance should be valued. [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. [ABSTRACT FROM AUTHOR]

The bioethanol is playing an increasingly important role in renewable energy in China. Based on the theory of circular economy, integration of different resources by polygeneration is one of the solutions to improve energy efficiency and to reduce environmental impact. In this study, three modes of bioethanol production were selected to evaluate the life cycle energy efficiency and environmental impact of sweet potato-based bioethanol. The results showed that, the net energy ratio was greater than 1 and the value of net energy gain was positive in the three production modes, in which the maximum value appeared in the circular economy mode (CEM). The environment emission mainly occurred to bioethanol conversion unit in the conventional production mode (CPM) and the cogeneration mode (CGM), and eutrophication potential (EP) and global warming potential (GWP) were the most significant environmental impact category. While compared with CPM and CGM, the environmental impact of CEM significantly declined due to increasing recycling, and plant cultivation unit mainly contributed to EP and GWP. And the comprehensive evaluation score of environmental impact decreased by 73.46% and 23.36%. This study showed that CEM was effective in improving energy efficiency, especially in reducing the environmental impact, and it provides a new method for bioethanol production. [ABSTRACT FROM AUTHOR]

There is a lack of research on the effects of acute exposure to ambient sulfur dioxide (SO 2) on mortality caused by asthma, especially nationwide research in China. To explore the acute effect of exposure to ambient SO 2 on asthma mortality using nationwide dataset in China from 2015 to 2020 and further evaluate the associations in subgroups with different geographical and demographic characteristics. We used data from China's Disease Surveillance Points system with 29,553 asthma deaths in China during 2015–2020. The exposure variable was the daily mean concentrations of SO 2 from the ChinaHighSO 2 10 km × 10 km daily grid dataset. Bilinear interpolation was used to estimate each individual's exposure to air pollutants and meteorological variables. We used a time-stratified case crossover design at the individual level to analyze the exposure response relationship between short-term exposure to SO 2 and asthma mortality. Stratified analyses were carried out by sex, age group, marital status, warm season and cold season, urbanicity and region. Significant associations between short-term exposure to ambient SO 2 and increased asthma mortality were found in this nationwide study. The excess risk (ER) for each 10 μg/m3 increase in SO 2 concentrations at lag07 was 7.78 % (95 % CI, 4.16–11.52 %). Season appeared to significantly modify the association. The associations were stronger in cold season (ER 9.78 %, 95 % CI:5.82 −13.89 %). The association remained consistent using different lag periods, adjusting for other pollutants, and in the analysis during pre-Corona Virus Disease 2019 (COVID-19) period. Our study indicates increased risk of asthma mortality with acute exposures to SO 2 in Chinese population. The current study lends support for greater awareness of the harmful effect of SO 2 in China and other countries with high SO 2 pollution. • The first nationwide study to explore the acute effect of SO 2 on asthma mortality. • Ambient SO 2 exposure may increase asthma mortality in China. • Season appeared to significantly modify the association. [ABSTRACT FROM AUTHOR]

Background. Whether carotid tortuosity/kinking of the internal carotid artery leads to cerebral ischemia remains unclear. There is very little research about the hemodynamic variation induced by carotid tortuosity/kinking in the literature. The objective of this study was to research the blood pressure changes induced by carotid tortuosity/kinking. Methods. We first created a geometric model of carotid tortuosity/kinking. Based on hemodynamic boundary conditions, the hemodynamics of carotid tortuosity and kinking were studied via a finite element simulation. Then, an in vitro system was built to validate the numerical simulation results. The mean arterial pressure changes before and after carotid kinking were measured using pressure sensors in 12 patients with carotid kinking. Results. Numerical simulation revealed that the pressure drops increased with increases in the kinking angles. Clinical tests and in vitro experiments confirmed the numerical simulation results. Conclusions. Carotid kinking leads to blood pressure reduction. In certain conditions, kinking may affect the cerebral blood supply and be associated with cerebral ischemia. [ABSTRACT FROM AUTHOR]

China's sustainable development goals and carbon neutrality targets cannot be achieved without revolutionary transitions of the agricultural sector. The rapid development of digital technologies is believed to play a huge role in this revolution. The ongoing prevention and control of COVID-19 has greatly boosted the penetration of digital technology services in all areas of society, and sustainable transformation driven by digital technologies and services is rapidly becoming an area of innovation and research. Studies have shown that the rapid advancement of digitalization is also accompanied by a series of new governance challenges and problems: (1) unclear strategic orientation and inadequate policy and regulatory responses; (2) various stakeholders have not formed a sustainable community of interest; (3) information explosion is accompanied by information fragmentation and digital divide between countries and populations within countries. Meanwhile, current research has focused more on the role of digital services in urban governance and industrial development and lacks systematic research on its role in sustainable agricultural and rural development. To address the realities faced by different stakeholders in the process of digital transformation of agriculture, this paper aims to propose an inclusive analytical framework based on the meta-governance theory to identify and analyze the demand, supply, actor networks, and incentives in the digital technology-and-services-driven sustainable agricultural transformation, starting from the goals and connotations of sustainable agricultural and rural transformation and the interactions among different stakeholders in governing information flows. This analytical framework is further applied to analyze the cases of China and the EU. Although China and the EU represent different development phases and policy contexts, the framework is valid for capturing the characteristics of information flows and actor networks along the flows. It is concluded that a common information platform based on the stakeholder network would benefit all stakeholders, help reach common framing of issues, and maintain a dynamic exchange of information. Depending on the country context, different types of stakeholders may play different roles in creating, supervising, and maintaining such platforms. Digital infrastructures/products as hardware and farmers digital capacity as 'software' are the two wings for digital sustainable transformation. Innovative incentives from different countries may inspire each other. In any case, farmers' actual farming behavior changes should be an important criterion for evaluating the effects and effectiveness of digital transition governance. [ABSTRACT FROM AUTHOR]

Few prior cohort studies exist in developing countries examining the association of ambient particulate matter (PM) with mortality. We examined the association of particulate air pollution with mortality in a prospective cohort study of 71,431 middle-aged Chinese men. Baseline data were obtained during 1990–1991. The follow-up evaluation was completed in January, 2006. Annual average PM exposure between 1990 and 2005, including TSP and PM10, were estimated by linking fixed-site monitoring data with residential communities. We found significant associations between PM10 and mortality from cardiopulmonary diseases; each 10 μg/m3 PM10 was associated with a 1.6% (95%CI: 0.7%, 2.6%), 1.8% (95%CI: 0.8%, 2.9%) and 1.7% (95%CI: 0.3%, 3.2%) increased risk of total, cardiovascular and respiratory mortality, respectively. For TSP, we observed significant associations only for cardiovascular morality. These data contribute to the scientific literature on long-term effects of particulate air pollution for high exposure settings typical in developing countries. [Copyright &y& Elsevier]

Background Forced expiratory volume in one second (FEV1) is inversely associated with mortality in Western populations, but few studies have assessed the associations of peak expiratory flow (PEF) with subsequent cause-specific mortality, or have used populations in developing countries, including China, for such assessments.Methods A prospective cohort study followed ∼170 000 Chinese men ranging in age from 40–69 years at baseline (1990–1991) for 15 years. In the study, height-adjusted PEF (h-PEF), which was uncorrelated with height, was calculated by dividing PEF by height. Hazard ratios (HR) for cause-specific mortality and h-PEF, adjusted for age, area of residence, smoking, and education, were calculated through Cox regression analyses.Results Of the original study population, 7068 men died from respiratory causes (non-neoplastic) and 22 490 died from other causes (including 1591 from lung cancer, 5469 from other cancers, and 10 460 from cardiovascular disease) before reaching the age of 85 years. Respiratory mortality was strongly and inversely associated with h-PEF. For h-PEF &geq; 250 L/min, the association was log-linear, with a hazard ratio (HR) of 1.29 (95% CI: 1.25–1.34) per 100 L/min reduction in h-PEF. The association was stronger but not log-linear for lower values of h-PEF. Mortality from combined other causes was also inversely associated with h-PEF, and the association was log-linear for all values of h-PEF, declining with follow-up, with HRs per 100 L/min reduction in h-PEF of 1.13 (1.10–1.15), 1.08 (1.06–1.11), and 1.06 (1.03–1.08) in three consecutive 5-year follow-up periods. Specifically, lower values of h-PEF were associated with higher mortality from cardiovascular disease and lung cancer, but not from other cancers.Conclusions A lower value of h-PEF was associated with increased mortality from respiratory and other causes, including lung cancer and cardiovascular disease, but its associations with the other causes of death declined across the follow-up period. [ABSTRACT FROM AUTHOR]

Background Regular alcohol drinking contributes both favourably and adversely to health in the Western populations, but its effects on overall and cause-specific mortality in China are still poorly understood.Methods A nationally representative prospective cohort study included 220 000 men aged 40–79 years from 45 areas in China in 1990–91, and >40 000 deaths occurred during 15 years of follow-up. Cox regression was used to relate alcohol drinking to overall and cause-specific mortality, adjusting for age, area, smoking and education.Results Overall, 33% of the participants reported drinking alcohol regularly at baseline, consuming mainly distilled spirits, with an estimated mean amount consumed of 372 g/week (46.5 units per week). After excluding all men with prior disease at baseline and the first 3 years of follow-up, there was a 5% [95% confidence interval (CI) 2–8] excess risk of overall mortality among regular drinkers. Compared with non-drinkers, the adjusted hazard ratios among men who drank <140, 140–279, 280–419, 420–699 and &geq;700 g/week were 0.97, 1.00, 1.02, 1.12 and 1.27, respectively (P < 0.0001 for trend). The strength of the relationship appeared to be greater in smokers than in non-smokers. There was a strong positive association of alcohol drinking with mortality from stroke, oesophageal cancer, liver cirrhosis or accidental causes, a weak J-shaped association with mortality from ischaemic heart disease, stomach cancer and lung cancer and no apparent relationship with respiratory disease mortality.Conclusion Among Chinese men aged 40–79 years, regular alcohol drinking was associated with a small but definite excess risk of overall mortality, especially among smokers. [ABSTRACT FROM PUBLISHER]

Abstract: For the fragile-ecosystem arid land, the macro and integral information about the land cover types and area is important for the restoration and the improvement of the ecological environment. In this paper, the arid Gaotai County of Gansu Province, China, was taken as a study case to discuss classified method of the arid land based on various indexes. Taking the advantages of different temporal images into account, two TM images acquired in October and June respectively were selected to conduct the research. Firstly, a series of indexes such as NDVI, vegetation coverage, MNDWI, Albedo, Wetness and SI were calculated. Secondly, combining Robert algorithms and artificial experience methods, the integrated index threshold for distinguishing vegetation from other land types was calculated. Thirdly, using the threshold and decision tree classifier, the middle-high and low coverage vegetation were extracted from both two images. Fourthly, the vegetation areas from two images were combined to form the total vegetation cover types (Oasis), which was used to mask October images, and the outside of mask area was continually classified into the types such as the salinization land, water, bare land and wetlands and other land cover types with decision tree classifier. At last, combining all cover types together, the land cover classification map of whole county was produced. Compared with the land cover types interpreted from the high resolution images and field investigation points, this method was found achieving the accuracy of 91.5%. [Copyright &y& Elsevier]

Abstract: As a developing country with most population, China is faced with developing economy and environmental protection. From the later 1970s, the China''s policies on environmental protection may be divided five stages. However, environmental pollution and ecological degradation in China have become to be severe problems and further impacted national economy and people''s health. The initials phase of the century is the crucial stage for China''s efforts towards improving economic development, intensifying environment conservation, and controlling ecological degradation. Its policies on environmental protection will be most important task for the China''s government and people. [Copyright &y& Elsevier]

[Display omitted] • Algal and bacterial organisms from saline environment were co-cultured. • Algal-bacterial consortium promoted carbon sink via CaCO 3 precipitation. • Mechanism of algal-bacterial consortium for biological-driven carbon sink in saline environment is proposed. • Saline environments provide significant carbon sink via algal-bacterial consortium. • Emphasize the ecological significance of saline lakes globally. The level of atmospheric CO 2 has continuously been increasing and the resulting greenhouse effects are receiving attention globally. Carbon removal from the atmosphere occurs naturally in various ecosystems. Among them, saline environments contribute significantly to the global carbon cycle. Carbonate deposits in the sediments of salt lakes are omnipresent, and the biological effects, especially driven by halophilic microalgae and bacteria, on carbonate formation remain to be elucidated. The present study aims to characterize the carbonates formed in saline environments and demonstrate the mechanisms underlying biological-driven CO 2 removal via microalgal-bacterial consortium. The carbonates naturally formed in saline environments were collected and analyzed. Two saline representative organisms, the photosynthetic microalga Dunaliella salina and its mutualistic halophilic bacteria Nesterenkonia sp. were isolated from the inhabiting saline environment and co-cultivated to study their biological effects on carbonates precipitation and isotopic composition. During this process, electrochemical parameters and Ca2+ flux, and expression of genes related to CaCO 3 formation were analyzed. Genome sequencing and metagenomic analysis were conducted to provide molecular evidence. The results showed that natural saline sediments are enriched with CaCO 3 and enrichment of genes related to photosynthesis and ureolysis. The co-cultivation stimulated 54.54% increase in CaCO 3 precipitation and significantly promoted the absorption of external CO 2 by 49.63%. A pH gradient was formed between the bacteria and algae culture, creating 150.22 mV of electronic potential, which might promote Ca2+ movement toward D. salina cells. Based on the results of lab-scale induction and 13C analysis, a theoretical calculation indicates a non-negligible amount of 0.16 and 2.3 Tg C/year carbon sequestration in China and global saline lakes, respectively. The combined effects of these two typical representative species have contributed to the carbon sequestration in saline environments, by promoting Ca2+ influx and increase of pH via microalgal and bacterial metabolic processes. [ABSTRACT FROM AUTHOR]

Ambient carbon monoxide (CO) has been linked with mortality and morbidity. Little evidence is available regarding the relation between CO and years of life lost (YLL). Using data from 48 major cities in China from 2013 to 2017, we applied generalized additive models and random effects meta-analyses to explore the effects of CO on YLL from various diseases. Stratified analyses and meta-regression were performed to estimate potential effect modifications of demographic factors, regions, meteorological factors, co-pollutants, urbanization rate, economic level and health service level. Additional life gains due to avoidable YLL under certain scenario were also evaluated. Results indicated that a 1-mg/m³ increase of CO concentrations (lagged over 0–3 d), was associated with 2.08% (95% confidence interval [CI], 1.35%, 2.80%), 2.35% (95% CI: 1.39%, 3.30%), 1.47% (95% CI: -0.01%, 2.93%), 2.28% (95% CI: 1.09%, 3.47%), 2.42% (95% CI: 1.31%, 3.54%), 2.09% (95% CI: 0.47%, 3.72%) increments in daily YLL from non-accidental causes, cardiovascular diseases, respiratory diseases, coronary heart disease, stroke and chronic obstructive pulmonary disease, respectively. These associations were robust to the adjustment of co-pollutants and varied substantially by geography and demographic characteristics. Associations were stronger in the elder people (≥65 years), females, population with low education attainment, and lived in south region, than younger people, males, high educated populations and those lived in north region. Moreover, the harmful impact of increasing CO concentration could be attenuated by city-level characteristics, including the growth of urbanization rate, gross domestic product (GDP), GDP per capita, number of hospital beds, doctors and hospitals. Finally, an estimated life of 0.081 (95% CI: -0.027, 0.190) years would be gained per deceased people if CO concentration could fall to 1 mg/m3. In conclusions, this nationwide analysis showed significant associations between short-term CO exposure and cause-specific YLL. The heterogeneity of both individual- and city-level characteristics should be considered for relevant intervention. These findings may have significant public health implications for the reduction of CO-attributed disease burden in China. • Ambient CO pollutant is significantly associated with increased cause-specific YLL. • Vulnerability on city- and individual-level characteristics should be considered. • The additional life gain by reducing CO concentration is significant. [ABSTRACT FROM AUTHOR]

The construction sector is an important industry in China's economic development and energy consumption, and research on its energy efficiency has attracted increasing attention from researchers. Currently, the traditional data envelopment analysis (DEA) model ignores the competition among regions, resulting in inaccurate estimation of efficiency. This paper employed traditional DEA, cross-efficiency DEA and game cross-efficiency DEA approaches to measure the energy efficiency of the construction industry in 30 of China's provinces from 2005 to 2016. The temporal trend and spatial distribution characteristics of energy efficiency determined through the game cross-efficiency method were then depicted by clustering analysis. Finally, the spatial heterogeneity of energy efficiency was analysed in detail. The results indicated that the efficiency calculated using the game cross-efficiency DEA model considering the competitive relationship was lower than the traditionally calculated efficiency and higher than the efficiency calculated using cross-efficiency DEA. Moreover, during the period of study, the energy efficiency showed a holistic growth trend with volatility. Clustering analysis demonstrated that the energy efficiency of eastern China was significantly higher than that of central and western China. Additionally, the spatial gaps in China's construction industry narrowed, while the spatial agglomerations strengthened. This paper also found a significant positive agglomeration in the energy efficiency of the construction sector in neighbouring provinces of China in the space dimension. In conclusion, province-specific policies based upon temporal and spatial heterogeneity were proposed to improve the energy efficiency of the construction industry in China. • Game cross-efficiency is first used in construction sector. • Provincial energy efficiencies of construction sector are examined in 2005–2016. • Spatial distribution characteristics of energy efficiency are depicted. • Energy efficiency is assessed in four agglomeration areas. • Positive spatial agglomeration exists in energy efficiency of construction sector. [ABSTRACT FROM AUTHOR]

Few multicity studies have been conducted in developing countries to distinguish the acute effects of ambient nitrogen dioxide (NO 2) on the years of life lost (YLL) from different subtypes of stroke. We aimed to differentiate the associations between NO 2 exposure and YLL from major pathological types of stroke in China, and estimate the relevant economic loss. A time-series study was conducted to explore the associations between short-term NO 2 exposure and YLL from ischaemic and haemorrhagic stroke from 2013 to 2017 in 48 Chinese cities. Daily NO 2 data and stroke mortality counts for each city were obtained from the National Urban Air Quality Real-time Publishing Platform and Chinese Center for Disease Control and Prevention, respectively. Generalized additive models were applied to estimate the cumulative effects of NO 2 in each city, and meta-analysis was used to combine the city-specific estimates. The relevant economic loss was estimated using the method of the value per statistical life year (VSLY). A 10 μg/m3 increase in ambient NO 2 concentration on the present day and previous day (lag 0–1) would lead to relatively higher increments in percentage change of YLL from ischaemic stroke (0.82%, 95% CI: 0.46%, 1.19%) than haemorrhagic stroke (0.46%, 95% CI: 0.09%, 0.84%). The association was significantly stronger in the low-education population than high-education population for ischaemic stroke. Furthermore, significantly higher association was found in South China than those in North China for both subtypes of stroke. Economic loss due to excess YLL from ischaemic stroke related to NO 2 exposure was higher than that for haemorrhagic stroke. Our study indicated higher association and economic loss of ischaemic than haemorrhagic stroke related to NO 2 exposure in China, which informed priorities for type-specific stroke prevention strategies related to NO 2 pollution and vulnerable population protection. Image 1 • Stronger association in ischaemic than haemorrhagic stroke related to NO 2 was found. • Higher association in low-than high-education population for ischaemic stroke. • Higher association in South than North China for ischaemic and haemorrhagic stroke. [ABSTRACT FROM AUTHOR]

Background: The accurate information about lymphoma burden at national and provincial levels remains unknown in China. Methods: Following the general analytical strategy used in GBD 2016, the age-, sex-, and province-specific incidence, mortality, and prevalence of lymphoma in China were analyzed. Trends in the incidence, mortality, prevalence, and disability-adjusted life years (DALYs) due to Hodgkin's lymphoma (HL) and non-Hodgkin's lymphoma (NHL) were assessed from 2006 to 2016. Results: It was estimated that there were 75,400 new cases and 40,500 deaths of lymphoma in 2016 in China, of which 6900 new cases and 2900 deaths were due to HL, while 68,500 new cases and 37,600 deaths were due to NHL. The age-standardized incidence rate (ASIR), mortality rate (ASMR), and prevalence rate (ASPR) per 100,000 were 0.46, 0.19, and 1.75 for HL, and 4.29, 2.45, and 14.9 for NHL, respectively. An upward trend with age in incidence and mortality was observed. Males had higher incidence and mortality rates than females in all age groups. Sociodemographic index had a correlation with the ASIR (r = 0.75), ASMR (r = − 0.74), ASPR (r = 0.84), and age-standardized DALYs (r = − 0.75) of HL, as well as with the ASIR (r = 0.80), ASPR (r = 0.83), and age-standardized DALYs (r = − 0.33) of NHL. From 2006 to 2016, the age-standardized DALYs of HL decreased significantly, while the age-standardized DALYs of NHL increased from 2006 to 2013 and remained stable from 2013 to 2016. Conclusions: The burden of lymphoma in China showed unexpected patterns varied by sex, age, and provinces, with an increased trend of NHL and a decreased trend of HL from 2006 to 2016. [ABSTRACT FROM AUTHOR]

Background: Headache has emerged as a global public health concern. However, little is known about the burden from headache disorders in China. The aim of this work was to quantify the spatial patterns and temporal trends of burden from headache disorders in China. Methods: Following the general analytic strategy used in the 2017 Global Burden of Disease study, we analyzed the prevalence and years lived with disability (YLDs) of headache and its main subcategories, including migraine and tension-type headache (TTH), by age, sex, year and 33 province-level administrative units in China from 1990 to 2017. Results: Almost 112.4 million individuals were estimated to have headache disorders in 1990 in China, which rose to 482.7 million in 2017. The all-age YLDs increased by 36.2% from 1990 to 2017. Migraine caused 5.5 million YLDs, much higher than TTH (1.1 million) in 2017. The age-standardized prevalence and YLDs rate of headache remained stable and high in 2017 compared with 1990, respectively. The proportion of total headache YLDs in all diseases increased from 1990 to 2017 by 5.4%. A female preponderance was observed for YLDs and the YLDs were mainly in people aged 20~54 years. Conclusions: Headache remains a huge health burden in China from 1990 to 2017, with prevalence and YLDs rates higher in eastern provinces than western provinces. The substantial increase in headache cases and YLDs represents an ongoing challenge in Chinese population. Our results can help shape and inform headache research and public policy throughout China, especially for females and middle-aged people. [ABSTRACT FROM AUTHOR]

Background: Infections by Streptococcus gallolyticus subsp. pasteurianus (SGSP) is often underestimated. Herein, the epidemiological features and resistant characteristics of SGSP in mainland China are characterized to enable a better understanding of its role in clinical infections.Methods: In the present work, 45 SGSP isolates were collected from the samples of bloodstream, urine, aseptic body fluid, and fetal membrane/placenta from patients in 8 tertiary general hospitals of 6 cities/provinces in China from 2011 to 2017. The identification of all isolates was performed using traditional biochemical methods, 16S rRNA and gyrB sequencing, followed by the characterization of their antibiotic resistance profiling and involved genes.Results: Among 34 non-pregnancy-related patients, 4 (4/34,11.8%) patients had gastrointestinal cancer, 10 (10/34, 29.4%) patients had diabetes, and one patient had infective endocarditis. Moreover, 11 cases of pregnant women were associated with intrauterine infection (9/11, 81.2%) and urinary tract infection (1/11, 9.1%), respectively. Except one, all other SGSP isolates were correctly identified by the BD Phoenix automated system. We found that all SGSP isolates were phenotypically susceptible to penicillin, ampicillin, cefotaxime, meropenem, and vancomycin. Forty strains (40/45, 88.9%) were both erythromycin and clindamycin-resistant, belonging to the cMLSB phenotype, and the majority of them carried erm(B) gene (39/40, 97.5%). Although the cMLSB/erm(B) constituted the most frequently identified phenotype/genotype combination (25/40, 62.5%) among all erythromycin-resistant cMLSB isolates, erm(B)/erm(A), erm(B)/mef(A/E), and erm(B)/erm(T) was detected in 7, 4, and 3 isolates, respectively. Furthermore, 43 strains (43/45, 95.6%) were tetracycline-resistant, and out of these, 39 strains (39/45, 86.7%) carried tet(L), 27(27/45, 60.0%) strains carried tet(O), and 7 (7/45, 15.6%) strains carried tet(M), alone or combined, respectively. All erythromycin-resistant isolates were also resistant to tetracycline.Conclusions: It is important to study and draw attention on SGSP, an underreported opportunistic pathogen targeting immunodeficient populations, notably elderly subjects, pregnant women and neonates. [ABSTRACT FROM AUTHOR]

Background: Despite revascularisation, a large proportion of acute coronary syndrome (ACS) patients continue to experience major adverse cardiovascular events (MACEs), which are worsened by diabetes mellitus (DM). Fibrinogen (FIB) is a risk factor for MACEs in coronary artery disease and often elevated in DM. However, the relationships between FIB, glucose metabolism (haemoglobin A1c [HbA1c] and fasting blood glucose [FBG]) and MACEs following percutaneous coronary intervention (PCI) in DM, non-DM or whole patients with ACS remains unknown. Methods: A total of 411 ACS patients undergoing PCI were enrolled in this study. We compared baseline FIB levels between DM (n = 103) and non-DM (n = 308) patients and divided participants into three groups according to FIB level, i.e. FIB-L, FIB-M and FIB-H, to compare baseline characteristics and MACEs. Linear regression analysis of the relationship between glucose metabolism and FIB, Cox regression, survival and landmark analyses of MACEs were also performed over a median of 27.55 months of follow-up. Results: Patients with DM had higher FIB levels than non-DM patients (3.56 ± 0.99 mg/dL vs. 3.34 ± 0.80 mg/dL, P < 0.05). HbA1c and FBG were significantly positively correlated with FIB in whole and DM patients but not in non-DM patients (all P < 0.05). Compared with the FIB-L group, the FIB-M (hazard ratio [HR] 1.797, 95% CI 1.117–2.892, P = 0.016) and FIB-H (HR 1.664, 95% CI 1.002–2.763, P = 0.049) groups were associated with higher MACEs in whole; the FIB-M (HR 7.783, 95% CI 1.012–59.854, P = 0.049) was associated with higher MACEs in DM patients. FIB was not associated with MACEs in non-DM patients. During landmark analysis, FIB showed better predictive value for MACEs after PCI in the first 30 months of follow up than in the subsequent period. Conclusion: In this study from China, FIB was positively associated with glucose metabolism (HbA1c and FBG) in whole and DM populations with ACS. Moreover, elevated baseline FIB levels may be an important and independent predictor of MACEs following PCI, especially amongst those with DM. However, as the follow-up period increased, the baseline FIB levels lost their ability to predict MACEs. [ABSTRACT FROM AUTHOR]

Background: There is a dearth of accurate information about patterns of mortality of lymphoid neoplasms and temporal trends in China. In this nationwide mortality study, we aimed to assess the mortality of lymphoma and myeloma in 2017 and the changes in the trend from 2004 to 2016. Methods: Death certificate data obtained from the Chinese Center for Disease Control and Prevention's disease surveillance points system (CDC-DSP) and population data from the National Bureau of Statistics of China were used in this study. We described the mortality of lymphoma and myeloma in 2017 by age group, sex, residence, and region and evaluated the temporal trend from 2004 to 2016 using joinpoint regression. Results: An estimated 52,000 deaths associated with lymphoma and myeloma occurred in 2017. The age-standardized mortality rate China (ASMRC) and age-standardized mortality rate worldwide (ASMRW) per 100,000 were 3.74 and 2.60, respectively. Males had higher ASMRC than females (4.54 vs. 2.91 per 100,000). The ASMRC in urban areas was significantly higher than that in rural areas (4.35 vs. 3.47 per 100,000). The age-specific mortality rate showed an upward trend with age and reached a maximum in the age group of over 85 years. In terms of regional variation, Eastern China had the highest mortality rate (3.43/100,000), followed by Central China (3.10/100,000) and Western China (3.02/100,000). The mortality rates of lymphoma and myeloma increased annually by 4.5% during the period 2004–2016, with a significant rapid upward trend in rural areas since 2007. Conclusions: The mortality of lymphoma and myeloma increased in China from 2004 to 2017. The rapid increase in disease burden in rural areas highlights new challenges for disease prevention and control strategies. [ABSTRACT FROM AUTHOR]

Abstract: The physicochemical properties and the contamination levels of mercury and arsenic in roadway dust from Baoji, NW China were investigated using an Atomic Fluorescence Spectrophotometer. Contamination levels were assessed based on the geoaccumulation index and the enrichment factor. The results show that magnetic susceptibilities of roadway dust were higher than Holocene loess–soil of central Shaanxi Loess Plateau. The mean contents of organic matter, PM10 and PM100 were 8.8%, 21.8% and 98.6%, respectively. Mercury concentration ranged from 0.48 to 2.32 μg g−1, with a mean value of 1.11 μg g−1, 17.1 times the Chinese soil mercury background value and 37 times the Shaanxi soil mercury background value. Arsenic concentration ranged from 9.0 to 42.8 μg g−1, with a mean value of 19.8 μg g−1, 1.8 times the Chinese and Shaanxi soil arsenic background values. The geoaccumlation index and enrichment factor indicate that mercury in the dust mainly originated from anthropogenic sources with ratings of “strongly polluted” and “strongly to extremely polluted”, whereas arsenic in dust originated from both natural and anthropogenic sources, with a ratings of “moderately to strongly polluted” and “strongly polluted”. Industrial activities, such as a coal-fired power station, coke-oven plant, and cement manufacturing plant, augmented by vehicular traffic, are the anthropogenic sources of mercury and arsenic in the roadway dust. [Copyright &y& Elsevier]

• Ambient exposure to PM 2.5 and PM c were associated with mortality from IHD and COPD. • Exposure to PM 2.5 exerted larger effects on mortality of IHD and COPD than PM c. • Substantial mortality burden of IHD and COPD could be attributable to PM 2.5 exposure. Both inhalable particles (PM 10) and fine particles (PM 2.5) are regulated in various countries mainly due to their adverse health effects. However, there is increasing evidence that PM 2.5 might be responsible for these effects and coarse particles (PM c) plays little role in adverse health effects, if so, it might be not necessary to monitor PM 10. In this study, we conducted a time-series analysis using a generalized additive model to explore the effects of PM 2.5 , PM c , and PM 10 on mortality from ischemic heart disease (IHD) and chronic obstructive pulmonary disease (COPD) in 96 Chinese cities during 2013–2016. The mortality number and attributable fraction were further estimated using the national air quality standard and WHO's guideline as the reference. We observed significant effects of PM 2.5 on IHD and COPD mortality; each 10 ug/m3 increase in lag 01 PM 2.5 was associated with a 0.26% (95% CI: 0.17%, 0.34%) increase in IHD mortality and a 0.19% (95% CI: 0.09%, 0.29%) increase in COPD mortality. We also found significant effects of PM c and PM 10 on mortality from IHD and COPD, but the magnitudes of effects were weaker than those of PM 2.5. The results were robust when adjusting for co-pollutants and altering model parameters. We further estimated that about 1.27% (95% CI: 0.29%, 2.30%) of IHD mortality and 1.25% (95% CI: 0.08%, 2.46%) of COPD mortality could be attributable to PM 2.5 exposure using WHO's guideline (25 ug/m3) as a reference, corresponding to 15,337 (95% CI: 3,375, 27,842) mortalities from IHD and 5,653 (95% CI: 379, 11,152) COPD mortalities in the 96 cities. Across all of China, almost fifty thousand cases of IHD mortality and twenty thousand cases of COPD mortality might be avoidable if the PM 2.5 concentration declined to the WHO guideline. Our study indicates that short-term exposure to PM 2.5 could be an important risk factor of mortality from IHD and COPD, and substantial cardiopulmonary mortality could be avoidable by reducing daily PM 2.5 concentrations. It is nonnegligible to consider the role of PM c in triggering in cardiopulmonary mortality. And it could be necessary to continue monitoring PM 10 in the study regions due to the adverse effects of PM c. [ABSTRACT FROM AUTHOR]

• No multisite studies have been conducted to examine the link between ozone and YLL. • Ozone was associated with YLL from nonaccidental causes and cardiopulmonary diseases. • Associations were stronger in cities with low CO or northern ones with low temperature. • A 0.055 year would be gained per deceased people if ozone fell to 100 μg/m3. Ozone is one of the dominant air pollutants due to its impact on disease burden and increasing trend in concentration. However, evidence regarding short-term effect of ozone on years of life lost (YLL) is scarce. A national time-series study was conducted in 48 large Chinese cities from 2013 to 2017. Generalized additive model coupled with random effects model were used to estimate national-average associations of ozone with YLL. Potential modifiers and additional life gain due to avoidable YLL under certain scenario were also evaluated. The average annual mean ozone concentration of these cities was 86.9 μg/m3. For 10 μg/m3 increase in 3-day moving average ozone concentration, we estimated 0.37% [95% confidence interval (CI): 0.29%, 0.46%] increase in YLL from nonaccidental causes, 0.38% (95% CI: 0.30%, 0.46%) increase in YLL from cardiovascular diseases, and 0.36% (95% CI: 0.16%, 0.56%) increase in YLL from respiratory diseases. Moreover, the associations were more evident in people with less education and in cities with lower carbon monoxide concentration or those located at north region with lower mean temperature. Finally, an estimated life of 0.055 (95% CI: 0.043, 0.068) years would be gained per deceased people if ozone concentration could fall to 100 μg/m3. Our findings indicated robust associations between short-term exposure to ozone and YLL from nonaccidental causes and cardiopulmonary diseases. Relevant intervention design should take the heterogeneity of both individual- and city-level characteristics into account. Implementation of more stringent standard is beneficial for alleviating YLL caused by ozone. [ABSTRACT FROM AUTHOR]

The Air Quality Index (AQI) has been criticized because it does not adequately account for the health effect of multi-pollutants. Although the developed Air Quality Health Index (AQHI) is a more effective communication tool, little is known about the best method to construct AQHI on long time and large spatial scales. To further evaluate the validity of existing approaches to the establishment of AQHI on both long time and larger spatial scales. By introducing 3 approaches addressing multi-pollutant exposures: cumulative risk index (CRI), supervised principal component analysis (SPCA), and Bayesian multi-pollutants weighted model (BMP), we constructed CRI-AQHI, SPCA-AQHI, BMP-AQHI and standard-AQHI on cardiovascular mortality in China from 2015 to 2019 at both the national and geographic regional levels. We further assessed the performance of the four methods in estimating the joint effect of multi-pollutants by simulations under various scenarios of pollution effect. The results of national China showed that the BMP-AQHI improved the goodness of fit of the standard-AQHI by 108.24%, followed by CRI-AQHI (5.02%), and all AQHIs performed better than AQI, consistent with 6 geographic regional results. In addition, the simulation result showed that the BMP method provided stable and relatively accurate estimations of the short-term combined effect of exposure to multi-pollutants. AQHI based on BMP could communicate the air pollution risk to the public more effectively than the current AQHI and AQI. • Short-term air pollution exposure increases mortality from cardiovascular. • All AQHIs predicted cardiovascular deaths more accurately than AQI. • BMP-AQHI communicates the air pollution risk most effectively than current AQHI. [ABSTRACT FROM AUTHOR]

A national and comprehensive evaluation is lacking on the relationship between short-term exposure to submicron particulate matter (PM 1) pollution and asthma mortality. Data was obtained from 29,553 asthma deaths from the China National Mortality Surveillance System from 2015 to 2020. We used a bilinear interpolation approach to estimate each participant's daily ambient particulate matter pollution and meteorological variables exposure based on their geocoded residential address and a 10 km × 10 km grid from China High Air Pollutants and the fifth generation of European ReAnalysis-Land reanalysis data set. The associations were estimated using a time-stratified case-crossover design and conditional logistic regressions. Our results revealed significant associations between short-term exposure to various particulate matter and asthma mortality. The 5-day moving average of particulate matter exposure produced the most pronounced effect. Compared to fine particulate matter (PM 2.5) and inhalable particulate matter (PM 10), significantly stronger effects on asthma mortality related to PM 1 pollution were noted. The ERs% for asthma mortality associated with each interquartile range (IQR) increase of exposures to PM 1 (IQR: 19.2 μg/m3) was 5.59% (95% CI: 2.11–9.19), which is 14% and 22% higher than that for PM 2.5 (IQR: 32.0 μg/m3, 4.82% (95% CI: 1.84–7.90)) and PM 10 (IQR: 52.2 μg/m3, 4.37% (95% CI: 1.16–7.69)), respectively. The estimates remained consistent in various sensitivity analyses. Our study provided national evidence that acute exposures to various ambient particulate matter pollution can increase mortality due to asthma in China, highlighting stronger associations with ambient PM 1 than PM 2.5 and PM 10. China needs to adjust the current ambient air quality standards urgently and pay greater attention to the adverse health effects of PM 1. [Display omitted] • Submicron particulate matter exposure may increase asthma mortality in China. • Smaller particles produced stronger effects on asthma mortality. • Risk of asthma mortality related to PM exists even at low concentration levels. [ABSTRACT FROM AUTHOR]