Search

Aims: To evaluate the effects of habitual leisure-time physical activity (LTPA) on incident type 2 diabetes in a prospective cohort of Chinese adults with impaired fasting glucose (IFG).Methods: 44 828 Chinese adults aged 20-80 years with newly detected IFG but free from cardiovascular and cerebrovascular disease were recruited and followed up from 1996 to 2014. Incident type 2 diabetes was identified by fasting plasma glucose ≥7 mmol/L. The participants were classified into four categories based on their self-reported weekly LTPA: inactive, low, moderate, or high. Hazard ratios (HRs) and population attributable fractions (PAFs) were estimated with adjustment for established diabetic risk factor.Results: After 214 148 person-years of follow-up, we observed an inverse dose-response relationship between LTPA and diabetes risk. Compared with inactive participants, diabetes risk in individuals reporting low, moderate and high volume LTPA were reduced by 12% (HR 0.88, 95% CI 0.80 to 0.99; P=0.015), 20% (HR 0.80, 95% CI 0.71 to 0.90; P<0.001), and 25% (HR 0.75, 95% CI 0.67 to 0.83; P<0.001), respectively. At least 19.2% (PAF 19.2%, 95% CI 5.9% to 30.6%) of incident diabetes cases could be avoided if the inactive participants had engaged in WHO recommendation levels of LTPA. This would correspond to a potential reduction of at least 7 million diabetic patients in the Greater China area.Conclusions: Our results show higher levels of LTPA are associated with a lower risk of diabetes in IFG subjects. These data emphasise the urgent need for promoting physical activity as a preventive strategy against diabetes to offset the impact of population ageing and the growing obesity epidemic. [ABSTRACT FROM AUTHOR]

Background: Social changes and economic development are associated with obesity epidemic. This study is to investigate the trends of socio-economic disparity in obesity from 2002 to 2010 in a Chinese population experiencing the world's fastest economic development.Methods: Four standardized surveys were conducted in a population of 85 million residents in Guangdong, China between 2002 and 2010. Multistage random cluster sampling was used to recruit representative samples. Information on socio-economic status (SES), proxied by education, occupation and residential area, was collected by face-to-face interviews. The weight, height and waist circumference of the participants were also measured.Results: Women with low education had an increased BMI of 0.85 kg/m(2), while women with high education had a decreased BMI of 0.16 kg/m(2) (p = 0.032 for interaction test). Similar trends were observed by using occupation and residential area as the SES indicators. Analysis in men yielded similar patterns. Waist circumference increased from 73.7 to 78.4 cm, and the increasing trends of statistical significance (p < 0.01) were observed in both genders and across all SES levels, with the magnitudes of increase in low SES levels being more pronounced. The impact of gradient in food attainment and occupational physical activity across the SES levels may wear off with further economic development, while factors such as health awareness, diet pattern and leisure activity may become increasingly important in driving the disparity.Conclusion: The impact of gradient in food attainment and occupational physical activity across the SES levels may wear off with further economic development, while factors such as health awareness, diet pattern and leisure activity may become increasingly important in driving the disparity. Our findings suggest that health education should focus on the disadvantaged populations on health awareness for adopting healthier diet pattern and increasing physical activity. [ABSTRACT FROM AUTHOR]

The objective of this study was to investigate the neurobehavioral effects of long-term occupational exposure to low levels of organic solvent among male printing workers in Hong Kong. A total of 115 printing workers exposed to organic solvents were recruited from the printing divisions of 3 printing factories, and 101 workers from the binding divisions of the same factories constituted the comparison group. Active and passive samplings were used to assess the occupational exposures to solvents. The World Health Organization Neurobehavioral Core Test Battery (WHO-NCTB) was applied to assess the neurobehavioral functions. Both active and passive sampling results showed that solvent levels were higher in the printing divisions than the binding divisions. The scores of Digit Symbol and Pursuit Aiming were poorer among workers in the printing divisions (all p values <.05). There were no significant differences found between the 2 divisions for other WHO-NCTB tests. The scores of Digit Symbol and Pursuit Aiming showed exposure-response relationship with various solvent exposure indices. Prolonged occupational exposure to low levels of organic solvents was associated with adverse neurobehavioral effects among male printing workers in Hong Kong. [ABSTRACT FROM AUTHOR]

Abstract: Aims: Smoking increases the risk of cardiovascular disease and inflammation plays a key role in the process of atherosclerosis. We therefore study the role of smoking and smoking cessation on the levels of inflammatory markers, C-reactive protein (CRP) and white blood cell (WBC) count, in older Chinese men. Methods: This cross-sectional analysis included 2999 men aged 50–85 years who received a medical check-up including measurement of fasting plasma vascular risk factors. Information on smoking status, socioeconomic and lifestyle factors was collected by standardized interview. Results: After adjustment for potential confounders, both CRP and WBC increased linearly across never, former and current smokers (both p <0.01). The odds ratios of elevated CRP and WBC (upper tertiles) were also increased across never, former and current smokers (both p <0.01). Dose–response relationships were observed among current smokers. Compared to current smokers, the odds ratios of elevated CRP and WBC and means of CRP and WBC declined with longer duration of smoking cessation (all p <0.01). Conclusions: Smoking is associated with increased CRP and WBC levels, and smoking cessation is associated with the reduction of the increase, confirming the benefits of quitting. Inflammation may be a potential mechanism by which smoking promotes atherosclerotic disease. [Copyright &y& Elsevier]

Abstract: Objective: To study the association between smoking, smoking cessation and aortic arc calcification (AAC) in an older Chinese population. Methods: A total of 3022 men and 7279 women aged 50–85 years were recruited and received a medical check-up including measurement of fasting plasma vascular risk factors. Two radiologists reviewed the posterior–anterior plain chest X-ray radiographs and assessed AAC together. Information on smoking status, socioeconomic and lifestyle factors was collected. Results: The crude prevalence of AAC in men (38.58%) was lower than that in women (41.37%). The adjusted odds ratios of AAC increased significantly across never, ex- and current smokers in both genders. Dose–response relationships were observed among current smokers for smoking amount (cigarettes/day), smoking duration (years) and cigarette pack-years in both genders (all p <0.01). The odds ratios decreased significantly (p =0.018) with longer duration of quitting in light ex-smoking men (<23.5 pack-years) but showed no beneficial effect (p =0.72) for heavy ex-smokers (≥23.5 pack-years). Conclusion: Smoking increased the risk of AAC in Chinese, while smoking cessation decreased the risk only in male light ex-smokers. Chest X-ray is a cheap and simple method to detect AAC, which should be an important warning signal for immediate smoking cessation. [Copyright &y& Elsevier]

Abstract: Aims: To examine the association between white blood cell count (WBC) and metabolic syndrome (MS) in an older Chinese population. Methods: Three thousand and twenty men and 7256 women aged 50–85 years were recruited and received a medical check-up including measurement of complete blood count, blood pressure, obesity indices, fasting total, LDL-, HDL-cholesterol, triglycerides, glucose and c-reactive protein (CRP). Information on socioeconomic and lifestyle factors was also collected. Results: Vascular risk factors including waist circumference, body mass index, triglyceride, total-, LDL-cholesterol, CRP and systolic and diastolic blood pressures were all positively associated with WBC in both men and women (p from 0.0085 to <0.001). The risk of MS increased significantly with higher total WBC, with adjusted odds ratios (95% confident interval) for second and third tertiles of 1.86 (1.43, 2.42), 2.56 (1.98, 3.32) in men and 1.67 (1.46, 1.90), 2.66 (2.34, 3.03) in women, respectively. Neutrophil and lymphocyte were strongly correlated with total WBC and showed similar association with the MS. Conclusion: There is a strong relationship between total WBC, neutrophil and lymphocyte and the constellation of MS components and associated vascular risk in this older Chinese population. [Copyright &y& Elsevier]

Human exposure to PM 2.5 , represented by population-weighted mean PM 2.5 concentration (c ρ), declines under three conditions: (1) mean PM 2.5 concentration declines, (2) PM 2.5 concentration within urban areas goes through more of a decrease than within rural areas, or (3) city planning relocates people into cleaner areas. Decomposing these effects on human exposure is essential to guide future environmental policies. The lack of ground PM 2.5 observations limits the assessment of human exposure to PM 2.5 over China. This study proposed a novel diagnostic framework using satellite observations to decompose the variation in c ρ resulting from change in the mean PM 2.5 concentration, spatial difference in PM 2.5 change, and demographic change. In this framework, we decomposed c ρ into mean PM 2.5 concentration (c 0) and pollution-population-coincidence induced PM 2.5 exposure (PPCE). We then used this framework to decompose the variation in c ρ over China within three recent Five-Year Plans (FYPs) (2001–2015). The results showed that the decline in c 0 reduced c ρ in most provinces within the eleventh and twelfth FYPs. The spatial difference in PM 2.5 change reduced the PPCE and c ρ in most provinces within the tenth and twelfth FYPs, with the most substantial reduction rate of −3.64 μg m−3·yr−1 in Tianjin within the twelfth FYP. Rural-to-urban migration resulting from rapid urbanization, however, increased the PPCE and c ρ (by as much as 0.22 μg m−3·yr−1) in all provinces except Taiwan within all three FYPs. The demographic change reduced c ρ in Taiwan because of the migration of population into less polluted areas. To better reduce human exposure, it is recommended that control efforts further target populous residential areas and urbanization planning relocates people into less polluted areas. Our decomposition framework paves a new way to decompose the human exposure to other air pollutants in China and other regions. • We proposed a novel framework to decompose the variation in human exposure. • We used satellite observations to delineate human exposure to PM 2.5 in China. • Spatial difference in PM 2.5 change extensively reduced population exposure. • Population migration increased human exposure in all provinces except Taiwan. • The framework paves a new way to apply for other air pollutants in other regions. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: To investigate the mortality pattern among a cohort of workers with asbestosis in Hong Kong, with special emphases on mesothelioma and lung cancer. Methods: All 124 male workers with confirmed asbestosis in Hong Kong during 1981–2008 were followed up to December 31, 2008 to ascertain the vital status and causes of death. Standardized mortality ratio (SMR) for each underlying cause of death was calculated by using person-year method. Axelson''s indirect method was applied to adjust for the potential confounding effect of cigarette smoking. Results: A total of 86 deaths were observed after 432.8 person-years of observations. The SMR for overall mortality (6.06, 95% CI: 4.90–7.51) increased significantly. The elevated risk of deaths from all cancers (7.53, 95% CI: 5.38–10.25) was mainly resulted from a significantly excess risk from lung cancer (SMR=7.91, 95% CI: 4.32–13.29, 14 deaths) and mesothelioma (SMR=6013.63, 95% CI: 3505.95–9621.81, 17 deaths). The SMR for lung cancer retained statistically significant after adjustment of smoking. An increased smoking adjusted SMR was also suggested for all heart diseases (2.32, 95% CI: 0.93–4.79, 7 deaths) and acute myocardial infarction (3.10, 95% CI: 0.84–7.94, 4 deaths), though the statistical significance was borderline. We found a positive association with net years of exposure to asbestos for mesothelioma and lung cancer. Conclusions: Our study provided further evidence on the carcinogenesis of asbestos/asbestosis with the risk of deaths from lung cancer and mesothelioma. This study also provided a preliminary support for a possible link between asbestosis and heart disease, but power is limited. [Copyright &y& Elsevier]

Abstract: We aimed to investigate the effects of ambient air pollutants on daily mortality in a relatively stable and homogeneous population in Guangzhou, China. Daily mortality, air pollution, and weather data between 2006 and 2009 were collected. The generalized additive model with poison regression was used to estimate the excessive risks (ERs) of air pollutants (PM10, SO2, and NO2) on total, cardiovascular and respiratory mortality. The effects of lag0–1 were the greatest for total non-accidental and cardiovascular deaths. The increments of 10μgm−3 in SO2, NO2, and PM10 were associated with ERs of 1.54% (95%CI: 1.03–2.06%), 1.42% (95%CI: 1.06–1.78%), and 1.26% (95%CI: 0.86–1.66%) respectively for total non-accidental deaths, and 2.28% (95%CI: 1.40–3.16%), 1.81% (95%CI: 1.20–2.41%), and 1.79% (95%CI: 1.11–2.47%) respectively for cardiovascular deaths. For persons who died from respiratory disease, however, the maximum effects occurred at lag0. The ERs for SO2, NO2, and PM10 were 1.36% (95%CI: 0.23–2.50%), 1.47% (95%CI: 0.66–2.29%) and 0.93% (95%CI: 0.03–1.83%), respectively. The effects of the three air pollutants on mortality were stronger in elderly and in women. The ERs in the present study were higher than those reported in Europe, the U.S., and most other Asian cities. Our findings show relatively higher ERs of daily mortality by ambient air pollutants in the center of Guangzhou, China, compared with estimates in other cities. Further studies with accurate exposure measurement among homogeneous population are needed to evaluate the precise magnitudes of the effects of the air pollutants. [ABSTRACT FROM AUTHOR]

Although the effects of meteorological factors on severe air pollution have been extensively investigated, quantitative decomposition of the contributions of meteorology and anthropogenic factors remains a big challenge. The novel coronavirus disease 2019 (COVID-19) pandemic affords a unique opportunity to test decomposition method. Based on a wind decomposition method, this study outlined an improved method to differentiate complex meteorological and anthropogenic effects. The improved method was then applied to investigate the cause of unanticipated haze pollution in China during the COVID-19 lockdown period. Results from the wind decomposition method show that weakened winds increased PM 2.5 concentrations in the Beijing–Tianjin area and northeastern China (e.g., by 3.19 μg/m3 in Beijing). Using the improved decomposition method, we found that the combined meteorological effect (e.g., drastically elevated humidity levels and weakened airflow) substantially increased PM 2.5 concentrations in northern China: the most substantial increases were in the Beijing–Tianjin–Hebei region (e.g., by 26.79 μg/m3 in Beijing). On excluding the meteorological effects, PM 2.5 concentrations substantially decreased across China (e.g., by 21.84 μg/m3 in Beijing), evidencing that the strict restrictions on human activities indeed decreased PM 2.5 concentrations. The unfavorable meteorological conditions, however, overwhelmed the beneficial effects of emission reduction, causing the severe haze pollution. These results indicate that the integrated meteorological effects should be considered to differentiate the meteorological and anthropogenic effects on severe air pollution. • An improved method was outlined to assess meteorological effect on air pollution. • The cause of haze pollution during the COVID-19 lockdown period was investigated. • Elevated humidity and weakened airflow greatly increased PM 2.5 in northern China. • On excluding the meteorological effects, PM 2.5 substantially decreased across China. [ABSTRACT FROM AUTHOR]

Evidence regarding the link between long-term ambient ozone (O 3 ) exposure and childhood sleep disorders is little. This study aims to examine the associations between long-term exposure to O 3 and sleep disorders in children. We conducted a population-based cross-sectional survey, including 185,428 children aged 6-18 years in 173 schools across 14 Chinese cities during 2012 and 2018. Parents or guardians completed a checklist using Sleep Disturbance Scale for Children, and O 3 exposure at residential and school addresses was estimated using a satellite-based spatiotemporal model. We used generalized linear mixed models to test the associations with adjustment for factors including socio-demographic variables, lifestyle, meteorology and multiple pollutants. Mean concentrations of O 3 , particulate matter with diameters ≤2.5 mm (PM 2.5 ) and nitrogen dioxide (NO 2 ) were 89.0 μg/m 3 , 42.5 μg/m 3 and 34.4 μg/m 3 , respectively. O 3 and NO 2 concentrations were similar among provinces, while PM 2.5 concentration varied significantly among provinces. Overall, 19.4% of children had at least one sleep disorder. Long-term exposure to O 3 was positively associated with odds of sleep disorders for all subtypes. For example, each interquartile increment in home-school O 3 concentrations was associated with a higher odds ratio for global sleep disorder, at 1.22 (95% confidence interval: 1.18, 1.26). Similar associations were observed for sleep disorder subtypes. The associations remained similar after adjustment for PM 2.5 and NO 2 . Moreover, these associations were heterogeneous regionally, with more prominent associations among children residing in southeast region than in northeast and northwest regions in China. We concluded that long-term exposure to O 3 is positively associated with risks of childhood sleep disorders. These associations varied by geographical region of China., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Cardiovascular diseases (CVDs) become a major public health concern. Evidence concerning the effects of outdoor artificial light at night (ALAN) on CVD in adults is scarce. We aimed to investigate the extent to which outdoor ALAN could affect the risk of CVD over a exposure range. Data from the China Health and Retirement Longitudinal Study, a population-based longitudinal study, launched in 2011-2012 and follow up till 2018, covering 28 provinces, autonomous regions and municipalities across mainland China. This study included 14,097 adults aged ≥45 years. Outdoor ALAN exposure (in nanowatts per centimeters squared per steradian) within 500 m of each participant's baseline residence was obtained from satellite image data. CVD was defined from medical diagnosis. The population was divided into three groups based on outdoor ALAN exposure from low to high. Cox regression model was used to estimate the association between outdoor ALAN exposure and incident CVD with hazard ratios (HRs) and 95 % confidence intervals (CIs). The mean (SD) age of the cohort was 57.6 (9.1) years old and 49.3 % were males. Outdoor ALAN exposure of study participants ranged from 0.02 to 39.79 nW/cm 2 /sr. During 83,033 person-years of follow-up, 2190 (15.5 %) cases of CVD were identified. Both low (HR: 1.21; 95 % CI: 1.02-1.43) and high (HR: 1.23; 95 % CI: 1.04-1.46) levels of outdoor ALAN exposure group were associated with higher risk of CVD compared with intermediate levels of outdoor ALAN exposure group. Body mass index was a significant effect modifier in the association between outdoor ALAN and risk of CVD, with stronger effects among those who was overweight or obese. The findings of this study suggest that low and high outdoor ALAN exposure were associated with a higher risk for CVD. More attention should be given to the cardiovascular effects associated with outdoor ALAN exposure., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier B.V.)

Background: There are few studies on the health effects of long-term exposure to neighborhood greenness in a longitudinal setting, especially in Asian countries with high population densities., Objectives: This study investigates the association between long-term exposure to neighborhood greenness and hypertension among adults in Taiwan., Methods: We selected 125,537 participants ( ≥ 18  years of age) without hypertension from Taiwan who had joined the standard medical examination program between 2001 and 2016. Neighborhood greenness was estimated using the normalized difference vegetation index (NDVI), derived from satellite images at a resolution of 250   m 2 . The 2-y average NDVI value within a 500 -m circular buffer around participants' residences was calculated. A time-varying Cox regression model was used to investigate the association between neighborhood greenness and incident hypertension. Mediation analyses were performed to examine whether the association was explained by air pollution, leisure-time physical exercise, or body mass index (BMI)., Results: Compared with living in areas within the first quartile of neighborhood greenness, living in areas within the second, third, and fourth quartiles of neighborhood greenness was found to be associated with a lower risk of hypertension, with hazard ratios (HRs) and 95% confidence intervals (CIs) of 0.95 (95% CI: 0.91, 1.00), 0.95 (95% CI: 0.90, 0.99), and 0.93 (95% CI: 0.88, 0.97), respectively. Each 0.1-unit increase in the NDVI was associated with a 24% lower risk of developing hypertension ( HR = 0.76; 95% CI: 0.66, 0.87), with this associations being stronger among males and those with higher education levels. This association was slightly mediated by BMI but not by air pollution or leisure-time physical exercise., Discussion: Our findings suggest the protective effects of neighborhood greenness on hypertension development, especially in males and well-educated individuals. Our results reinforced the importance of neighborhood greenness for supporting health. https://doi.org/10.1289/EHP13071.

Due to the non-linearity in ozone (O 3 ) formation, reducing the emission of nitrogen oxides (NO x ) may increase O 3 concentration. Given the counteractive O 3 response to NO x reduction, overall impact of air pollution controls can be ambiguous when the assessments focus on the changes in pollutant concentrations. In this study, a risk-based method was used to gauge the net effect of air pollution controls on mortality risk in the Beijing-Tianjin-Hebei (BTH) region during the 2022 Winter Olympics and Paralympics (WOP). This mega-event presents a unique opportunity to investigate the efficacy of deep cuts in pollutant emissions. Results show that O 3 concentrations greatly increased as nitrogen dioxide (NO 2 ) concentrations decreased in the BTH. Due to the active photochemical formations, O 3 became the dominant pollutant that affected human health during the WOP. Despite the substantial O 3 increases, the health benefits of NO 2 reductions overwhelmed the adverse health effects of O 3 increases in most regions of the BTH (at 81 out of 112 stations). After considering the impacts of particulate matter, the integrated health risk of air pollution mixtures declined almost everywhere in the BTH. Our results underscore the great necessity of changing the assessment paradigm of pollution control from using concentration-based methods to using risk-based methods. Together with the carbon neutrality policy, stringent control of NO x emission from combustion sources is a promising way to achieve synergistic control solutions for air pollution and climate change., Competing Interests: Declaration of Competing Interest The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022. Published by Elsevier B.V.)

Background: Data are limited on whether several easily measured indices are independent predictors of type 2 diabetes mellitus (T2DM) in hypertensive patients. This study aimed to assess the association of hypertriglyceridemic-waist phenotype, triglyceride glucose (TyG) index, lipid accumulation product (LAP), and visceral adiposity index (VAI) with T2DM risk in hypertensive patients., Methods: This cross-sectional study included 5321 hypertensive patients from the baseline survey of the Guangzhou Heart Study. Face-to-face questionnaire survey, physical examination, and fasting blood sample collection were completed for all subjects. Odds ratio (OR) with 95% confidence interval (95% CI) were calculated by using the logistic regression model. The potential nonlinear relationship was examined using restricted cubic spline regression., Results: The prevalence of T2DM was 19.98% among hypertensive patients. After adjusting for confounders, participants with elevated triglyceride levels and enlarged waist circumference (HTGW) were associated with a 2.57-fold risk of T2DM (OR 2.57, 95% CI 2.05, 3.23). When comparing with subjects within the lowest quartile of the indices, those in the highest quartile of TyG, LAP, and VAI were associated with 5.35-fold (95% CI 4.33, 6.64), 2.65-fold (95% CI 2.11, 3.34), and 2.17-fold (95% CI 1.77, 2.67) risk of T2DM after adjusting for confounders. Every 1-unit increment of TyG, LAP, and VAI was associated with 81%, 38%, and 31% increased risk of T2DM, respectively. The nonlinear association was observed for TyG, LAP, and VAI (all P Non-linear  < 0.001)., Conclusions: The results found that among hypertensive patients, HTGW and a higher level of TyG, LAP, and VAI were associated with an elevated risk of T2DM. The findings suggested that HTGW, TyG, LAP, and VAI may serve as simple and effective tools for T2DM risk assessment in the prevention and management of main chronic diseases., (© 2022. The Author(s).)

Background: This study aimed to assess the reproducibility and validity of a food frequency questionnaire (FFQ) developed for diet-related studies in a rural population., Methods: One hundred fifty-four healthy residents were interviewed with a 76-item FFQ at baseline (FFQ1) and 1 month later (FFQ2) to assess reproducibility, and required to complete two three-day dietary recalls (DRs) between two FFQs to determine the validity by comparing DRs with FFQ1., Results: Crude Spearman correlation coefficients between FFQ1 and FFQ2 ranged from 0.58 to 0.92 and energy-adjusted coefficients ranged from 0.62 to 0.92; weighted kappa statistic covered a spectrum from 0.45 to 0.81, depicting moderate to good agreements. For validity, there were moderate to strong associations (0.40-0.68) in most nutrients and food between FFQ1 and DRs; weighted kappa statistic demonstrated fair to moderate agreements for nutrients and food (0.21-0.49)., Conclusions: The results suggest that the FFQ has reasonably reproducibility and validity in measuring most nutrients and food intake, and it can be used to explore the dietary habits in studying the diet-disease relationship in Chinese rural populations., (© 2022. The Author(s).)

Previous studies on long-term ozone (O 3 ) variations in China have reported inconsistent conclusions on the role of meteorological factors in controlling said variations. In this study, we used an observation-based decomposition model to conduct an up-to-date investigation of the effects of meteorological factors on the variations in nitrogen dioxide (NO 2 ) and O 3 concentrations in China in the summer from 2013 to 2020. The variations in NO 2 and O 3 concentrations after removing the major meteorological effects were then analyzed to improve our understanding of O 3 formation regimes. Ground measurements show that both NO 2 and O 3 concentrations decreased in eastern, central, and southeastern China (e.g., NO 2 and O 3 concentrations in Wuhan reduced by 4.3 and 6.2 ppb, respectively), which was not anticipated. Analyses of meteorological effects showed that reduced wind strength, decreased temperature, and increased relative humidity significantly reduced O 3 concentrations in eastern and central China (e.g., by 10.5 ppb in Wuhan). After removing the major meteorological effects, the O 3 trends were reversed in eastern and central China (e.g., increased by 4.9 ppb in Wuhan). The contrasting trends in NO 2 and O 3 concentrations suggest that their O 3 formations were sensitive to volatile organic compounds (VOC-limited regime). In southeastern China, both NO 2 and O 3 concentrations decreased, implying that the O 3 formation regimes changed to mixed sensitive or nitrogen oxide-limited (NO x -limited) regimes. The meteorological effects varied by region and may play a dominant role in controlling the long-term O 3 variation. Our results indicate that the attribution of O 3 variation to emission control without accounting for meteorological effects can be misleading., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021. Published by Elsevier B.V.)

Novel corona virus disease 2019 (COVID-19), which first emerged in December 2019, has become a pandemic. This study aimed to investigate the associations between meteorological factors and COVID-19 incidence and mortality worldwide. This study included 1,908,197 confirmed cases of and 119,257 deaths from COVID-19 from 190 countries between 23 January and 13 April, 2020. We used a distributed lag non-linear model with city-/country-level random intercept to investigate the associations between COVID19 incidence and daily temperature, relative humidity, and wind speed. A series of confounders were considered in the analysis including demographics, socioeconomics, geographic locations, and political strategies. Sensitivity analyses were performed to examine the robustness of the associations. The COVID-19 incidence showed a stronger association with temperature than with relative humidity or wind speed. An inverse association was identified between the COVID-19 incidence and temperature. The corresponding 14-day cumulative relative risk was 1.28 [95% confidence interval (CI), 1.20-1.36] at 5 °C, and 0.75 (95% CI, 0.65-0.86) at 22 °C with reference to the risk at 11 °C. An inverse J-shaped association was observed between relative humidity and the COVID-19 incidence, with the highest risk at 72%. A higher wind speed was associated with a generally lower incidence of COVID-19, although the associations were weak. Sensitivity analyses generally yielded similar results. The COVID-19 incidence decreased with the increase of temperature. Our study suggests that the spread of COVID-19 may slow during summer but may increase during winter., Competing Interests: Declaration of competing interest The authors declared that they have no competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 Elsevier B.V. All rights reserved.)

The novel coronavirus disease 2019 (COVID-19), which first emerged in Hubei province, China, has become a pandemic. However, data regarding the effects of meteorological factors on its transmission are limited and inconsistent. A mechanism-based parameterisation scheme was developed to investigate the association between the scaled transmission rate (STR) of COVID-19 and the meteorological parameters in 20 provinces/municipalities located on the plains in China. We obtained information on the scale of population migrated from Wuhan, the world epicentre of the COVID-19 outbreak, into the study provinces/municipalities using mobile-phone positioning system and big data techniques. The highest STRs were found in densely populated metropolitan areas and in cold provinces located in north-eastern China. Population density had a non-linear relationship with disease spread (linearity index, 0.9). Among various meteorological factors, only temperature was significantly associated with the STR after controlling for the effect of population density. A negative and exponential relationship was identified between the transmission rate and the temperature (correlation coefficient, -0.56; 99% confidence level). The STR increased substantially as the temperature in north-eastern China decreased below 0 °C (the STR ranged from 3.5 to 12.3 when the temperature was between -9.41 °C and -13.87 °C), whilst the STR showed less temperature dependence in the study areas with temperate weather conditions (the STR was 1.21 ± 0.57 when the temperature was above 0 °C). Therefore, a higher population density was linearly whereas a lower temperature (<0 °C) was exponentially associated with an increased transmission rate of COVID-19. These findings suggest that the mitigation of COVID-19 spread in densely populated and/or cold regions will be a great challenge., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Aims: To evaluate the effects of habitual leisure-time physical activity (LTPA) on incident type 2 diabetes in a prospective cohort of Chinese adults with impaired fasting glucose (IFG)., Methods: 44 828 Chinese adults aged 20-80 years with newly detected IFG but free from cardiovascular and cerebrovascular disease were recruited and followed up from 1996 to 2014. Incident type 2 diabetes was identified by fasting plasma glucose ≥7 mmol/L. The participants were classified into four categories based on their self-reported weekly LTPA: inactive, low, moderate, or high. Hazard ratios (HRs) and population attributable fractions (PAFs) were estimated with adjustment for established diabetic risk factor., Results: After 214 148 person-years of follow-up, we observed an inverse dose-response relationship between LTPA and diabetes risk. Compared with inactive participants, diabetes risk in individuals reporting low, moderate and high volume LTPA were reduced by 12% (HR 0.88, 95% CI 0.80 to 0.99; P=0.015), 20% (HR 0.80, 95% CI 0.71 to 0.90; P<0.001), and 25% (HR 0.75, 95% CI 0.67 to 0.83; P<0.001), respectively. At least 19.2% (PAF 19.2%, 95% CI 5.9% to 30.6%) of incident diabetes cases could be avoided if the inactive participants had engaged in WHO recommendation levels of LTPA. This would correspond to a potential reduction of at least 7 million diabetic patients in the Greater China area., Conclusions: Our results show higher levels of LTPA are associated with a lower risk of diabetes in IFG subjects. These data emphasise the urgent need for promoting physical activity as a preventive strategy against diabetes to offset the impact of population ageing and the growing obesity epidemic., Competing Interests: Competing interests: None declared., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2019. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Background: Metabolic syndrome (MetSyn) increases the incidence of cardiovascular disease. Information on changes in prevalence of MetSyn in developing countries is limited. This study aims to compare MetSyn prevalence and its associated vascular risk over the period between 2002 and 2010 in a population which has had the world's fastest economic development over the past three decades., Methods: Two health surveys were conducted by using the multistage cluster random sampling method in a Chinese population of 85 million in southern China. The participants received a full medical check-up, including measurement of blood pressure (BP), obesity indices, fasting lipids and glucose levels. Data describing socio-economic status and lifestyle factors were also collected through interview. Metabolic syndrome was defined in accordance with the International Diabetes Federation criteria., Results: A total of 3,561 participants from Survey 2010 were included in the data analysis. Women had a significantly higher prevalence of MetSyn than men. Comparison between the two surveys shows that age-standardized prevalence of MetSyn increased fourfold (from 5.4% in 2002 to 21.3% in 2010) in those ≧ 20 years. Among the MetSyn components, prevalence of hyperglycaemia has increased most (from 9.1% to 53.1%). The age-standardized prevalence of central obesity, hypertension, hypertriglyceridaemia and low HDL-cholesterol increased from 13.5% to 25.4%, from 23.6% to 40.8%, from 12.1% to 17.4% and from 32.1% to 71.1%, respectively. Differences between rural and urban residents in the prevalence in MetSyn and its components narrowed in 2010., Conclusions: Cardiovascular risk escalated dramatically in this population between 2002 and 2010. The escalation may relate to the rapid economic development, which led to accelerating changes in nutrition, lifestyle, and socio-economic status. Our findings suggest that health transition in rapidly developing second- and third-world countries may be much faster than what has been observed in Western countries.

Background: The aim of this study was to investigate trends in the distribution, prevalence, awareness, treatment, and control of hypertension in a Chinese population that has had the fastest growing gross domestic product in the world over the past 3 decades., Methods: Four standardized cross-sectional health surveys were conducted between 2002 and 2010 in a population consisting of 85 million residents in Guangdong Province. Multistage cluster sampling was adopted to recruit representative samples. The data were obtained through on-site health examinations and face-to-face interviews., Results: The aging trend in this population was not significant (P = 0.17) during the survey period, whereas body mass index/waist circumference increased significantly (P = 0.047 for body mass index and P < 0.001 for waist circumference). The age-standardized prevalence of hypertension increased from 10.5% to 13.3%, averaging a 0.35% increase per year. A higher risk was observed in younger residents over the survey period. Awareness and treatment increased by 22.0% and 19.0%, respectively, in the rural areas, whereas there was no significant change in the urban area (the corresponding figures were 1.8% and -3.1%, respectively). There was no improvement in hypertension control (the age-standardized control prevalence in 2002 was 50.3%, whereas it was 43.2% in 2010)., Conclusions: The prevalence of hypertension increased slightly in this population with the fastest economic development. This increase mirrored the trend of increasing obesity. Awareness and treatment of hypertension have improved in the rural areas, although there were no significant changes in the urban areas. The prevalence of awareness and treatment remains at unacceptably low levels, suggesting that urgent and aggressive strategies are necessary to improve hypertension control and intervention., (© American Journal of Hypertension, Ltd 2013. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)

To investigate the occupational hazards among Chinese female workers in the electronics industry, the authors systematically sampled a total of 8,300 female workers at random across 4 provinces in a variety of electronics factories. A detailed questionnaire was used to collect information on occupational hazards and the occurrence of occupation-related diseases. The results show that 4,283 female workers (51.9%) were exposed to 1 or more occupational hazards. The most common chemical hazard was organic solvent, and the second most common was heavy metals. The ergonomic hazards included repetitive movements, poor standing posture, and the lifting of heavy goods. More than 60% of the female workers self-reported occupation-related diseases. These results showed that occupational health hazards were common in the electronics industry in China and that they caused serious occupation-related health problems for the female workers therein.

Background: The American Diabetes Association and World Health Organization have recently adopted the HbA1c measurement as one method of diagnostic criteria for diabetes. The change in diagnostic criteria has important implications for diabetes treatment and prevention. We therefore investigate diabetes using HbA1c and glucose criteria together, and assess the prevalent trend in a developing southern Chinese population with 85 million residents., Methods: A stratified multistage random sampling method was applied and a representative sample of 3590 residents 18 years of age or above was obtained in 2010. Each participant received a full medical check-up, including measurement of fasting plasma glucose, 2-hour post-load plasma glucose, and HbA1c. Information on history of diagnosis and treatment of diabetes was collected. The prevalence of diabetes obtained from the present survey was compared with the data from the survey in 2002., Results: The prevalence of diabetes based on both glucose and HbA1c measurements was 21.7% (95% CI: 17.4%-26.1%) in 2010, which suggests that more than 1 in 5 adult residents were suffering from diabetes in this developing population. Only 12.9% (95% CI: 8.3%-17.6%) of diabetic residents were aware of their condition. The prevalence of pre-diabetes was 66.3% (95% CI: 62.7%-69.8%). The prevalence of diabetes and pre-diabetes which met all the three diagnostic thresholds (fast plasma glucose, 2 hour post-load plasma glucose, and HbA1c) was 3.1% and 5.2%, respectively. Diabetes and pre-diabetes as determined by HbA1c measurement had higher vascular risk than those determined by glucose levels. The prevalence of diabetes increased from 2.9% (95% CI: 2.0%-3.7%) in 2002 to 13.8% (95% CI: 10.2%-17.3%) in 2010 based on the same glucose criteria., Conclusions: Our results show that the diabetes epidemic is accelerating in China. The awareness of diabetes is extremely low. The glucose test and HbA1c measurement should be used together to increase detection of diabetes and pre-diabetes.

Background: abitual snoring and elevated high-sensitive C-reactive protein (HsCRP) have both been associated with increased risk of cardiovascular disease. However, snoring and HsCRP are elevated in obese states which may thus be the primary determinant of both. We therefore investigated whether snoring may mediate the increased vascular risk directly through increased inflammation as indicated by HsCRP levels or if other determinants predominated in a large older Chinese population., Methods: A total of 2508 males and 5709 females aged 50-85 years received a medical check-up including measurement of blood pressure, obesity indices, fasting total, LDL-, HDL-cholesterol, triglycerides, glucose and HsCRP. Information on self-reported snoring status was collected by standardized interview., Results: The age-adjusted geometric mean HsCRP concentrations increased significantly with higher snoring frequency in both genders (linear trend, p=0.02 for men and p<0.001 for women), but the association was no longer significant after controlling for waist and BMI. Furthermore, HsCRP levels were not significantly associated with snoring frequency groups stratified by BMI/waist quintiles in both genders, except for the 4th waist quintile in men. No interaction was observed between snoring and BMI/waist on HsCRP levels. The multivariate analysis showed that, in both genders, obesity, but not HsCRP, was associated with snoring., Conclusions: Our results showed that snoring frequency did not have an independent effect on inflammation after adjusting for adiposity, and may thus contribute to vascular disease through alternative mechanisms., (Copyright © 2010 Elsevier Ltd. All rights reserved.)

Objective: To study the polymorphisms of cerebrovascular and cardiovascular disease genes using Taqman single nucleotide polymorphism (SNP) genotyping kits., Methods: A total of 2000 subjects were recruited from the Guangzhou Biobank Cohort Study (GBCS), and 15 SNPs were detected using Taqman SNP genotyping kits and an ABI 7900HT real time PCR system. The data were tested for the Hardy-Weinberg equilibrium, and then compared with the data of the Chinese population from the International HapMap Project (HapMap&#95;HCN)., Results: (1) All genotype data of the 15 SNPs were consistent with the Hardy-Weinberg rules. (2) The significant differences were observed among two SNPs, rs4220 and rs5368 and the HapMap&#95;HCN (rs4220 28.2% vs 17.8%; chi(2) = 4.891, P = 0.028; rs5368 22.1% vs 32.2%, chi(2) = 5.137, P = 0.024). Comparing other gene bank data, such as AFD-CHN-PANEL, the Allele Frequency Database (ALFRED) and JBIC-allele, it would be most likely that our observations represent differences between the Northern and Southern populations in China., Conclusion: Such Biobank study provided a useful platform for the study of the role of genetic and environmental determinants on cerebrovascular and cardiovascular disease.

Introduction: Valid measurements of self-reported physical activity are very limited in Chinese populations, especially the elderly. Therefore, we examined the validity and reliability of the Chinese version of the International Physical Activity Questionnaire (IPAQ-C) in older Chinese people., Methods: Two hundred twenty-four older adults (66.1% women, 33.9% men, mean age 65.2 +/- 5.7 yr) were randomly selected from the Guangzhou Biobank Cohort Study, a prospective cohort of older Chinese in Southern China. To examine the test-retest reliability, the participants completed the IPAQ-C twice during a 7-d interval. The criterion validity of the IPAQ-C was tested with pedometry., Results: Good reliability was observed between the repeated IPAQ-C, with intraclass correlation coefficients (ICC) ranging from 0.81 to 0.89. Total activity measured by IPAQ-C correlated moderately with the pedometer-measured steps (partial r = 0.33 adjusted for sex, age, and education; P < 0.001). The walking domain of IPAQ-C was strongly associated with the number of steps (partial r = 0.58, P < 0.001), but there were no significant associations between other activity domains of the IPAQ-C and the pedometer data., Conclusion: This is the first reported validation study of an international standardized questionnaire (IPAQ-C) in older Chinese adults. Our study shows that the IPAQ-C is adequately valid and reliable for assessing total physical activity and that it may be a useful instrument for generating internationally comparable data on physical activity in this population.

Objective: To examine the prevalence and characteristics of aortic arch calcification (AAC) in residents aged 50 or over in Guangzhou, China., Methods: Face-to-face interview, physical examination and laboratory tests were conducted on 10 413 Chinese adults aged 50 or over. Posterior-anterior plain chest X-ray radiographs were obtained from 10 305 subjects using a Toshiba KSO-15R machine. The radiographs were reviewed together by two radiologists while 300 radiographs were independently gone through by two radiologists to assess the agreement with Kappa coefficient method., Results: The rate of agreement on Diagnosis for the two radiologists was 85.0% and Kappa coefficient was 0.68, with P < 0.001 which showed a moderate agreement between the two radiologists. Among the 10 305 subjects, there were 3064 men and 7349 women, with their mean age (+/- standard deviation) as 64.0 +/- 6.0 and 66.2 +/- 5.8, respectively. Most of them had educational level of middle school or below, and most of their occupations were factory or agricultural workers. The prevalence of AAC was 40.6%. Women showed significantly higher prevalence rate than men (41.4% versus 38.6%, P < 0.001) and the prevalence of AAC increased significantly with age. Subjects with primary educational level or below had the highest prevalence of AAC. There was no significant association found between occupation and AAC prevalence. 98.7% of the subjects with AAC occurred in aortic arch. Most AAC had a length of 10 mm or longer and a width from 1-4 mm, which indicated the severity of AAC among the subjects., Conclusion: The prevalence of AAC among Guangzhou Biobank Cohort was about 40.6%, higher than those reported in foreign studies, while most of the lesions were quite serious.

Hyperglycemia increases cardiovascular disease risk, but the association between increasing glycemia and cardiovascular risk factors, angina, and coronary heart disease in normoglycemic subjects is less clear, particularly in Chinese. We report on possible associations in a large group of Mainland Chinese subjects. A total of 10,400 older subjects (> or = 50 years) were recruited, and vascular risk factors were measured, including anthropometry, blood pressure, and fasting plasma biochemical factors including glucose, lipid profile, and C-reactive protein (CRP). Subjects were categorized by glycemic status, and the relationship between glycemia and cardiovascular risk factors was investigated using analysis of variance and multiple linear regression analyses. Tertiles of fasting glucose levels showed a clear positive relationship with cardiovascular risk factors including age, obesity, blood pressure, lipid levels, and CRP (P < .001 for all). The overall prevalence of self-reported vascular disease was low, but significantly associated with increasing glycemia. Multiple regression showed that waist circumference (standardized regression coefficient beta = .10, P < .001), triglycerides (beta = 0.16, P < .001), CRP (beta = 0.06, P < .001), female sex (beta = .03, P = .007), high-density lipoprotein cholesterol (beta = -.02, P = .016), and mean arterial pressure (beta = .06, P < .001) were independently associated with fasting glucose levels. Among the normoglycemic subjects (n = 5190), increasing glycemia was still associated with increasing obesity indices, systolic blood pressure, triglyceride, and CRP levels (all P < .05). Increasing glycemia, even in the reference range, is associated with increasing prevalence of vascular risk factors. Control of these risk factors, particularly obesity, the most important avoidable independent determinant of glycemia in normoglycemic subjects, is critical to reduce the risk of the associated vascular disease.