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Healthy life expectancy (HLE) is an emerging field in aging studies. Nevertheless, understanding of HLE from the perspective of socioeconomic status (SES) is inadequate. To fill this gap, the present study explores differences in HLE by SES based on two nationally representative longitudinal databases in China. The study adopts education as a proxy of SES and employs the multistate life table method to compute HLE. Health is measured by the following four indicators: physical function, cognitive function, depression, and self-rated health. The results show that educational differences are associated with significantly different results in these four health indicators. Active life expectancy, cognitive-impairment-free life expectancy, and self-rated healthy life expectancy differ by existence of educational attainment among the old adults, with the nonilliterate group enjoying both longer cognitive-impairment-free life expectancy and self-rated healthy life expectancy, while unexpectedly, the illiterate group has a higher active life expectancy at most ages. In contrast, depression-free life expectancy is similar between the two educational categories. The positive association between educational attainment and cognitive-impairment-free life expectancy and self-rated healthy life expectancy might be explained by the beneficial effect of education in improving and maintaining cognitive ability and SES, while the negative association between educational attainment and active life expectancy might be interpreted by the higher rate of mortality and the absence of social-security support among less educated Chinese senior citizens. The lack of difference by educational attainment in depression-free life expectancy requires further investigation.

China's oldest old population is estimated to quadruple by 2050. Yet, poverty rate for the oldest old has been the highest among all age groups in China. This paper investigates the relationship between economic stress, quality of life, and mortality among the oldest-old in China. Both objective economic hardships and perceived economic strain are examined. We base our investigation on data drawn from the Chinese Longitudinal Healthy Longevity Survey conducted between 2000 and 2005. Our sample includes 10,972 men and women between the ages of 80 and 105 in 2000. The data show that about 16% of these oldest-old lived under economic stress in 2000. The risk factors that make one vulnerable to economic stress include age, being male, being widowed or never married, being a minority member, having no education, having no living children, and not having children as main source of income, and having no pension. Economic stress is negatively associated with indicators of quality of life, such as the quality of medical care and mental well-being. The poor quality of life contributes to the higher mortality rate for the oldest old who are under economic stress. Results also show that perceived economic strain increases the risk of mortality by 42% in rural areas, even after controlling for basic demographic characteristics, life style factors, and major health events. For the rural oldest-old, having children as a main source of income and having access to pension alleviates the negative impact of economic hardship on mortality hazard by 23 and 66% respectively. However, in urban areas, economic stress has no direct impact on the hazard of mortality.

Context: Urban-rural disparity is an important issue for injury control in China. Details of the urban-rural disparities in fatal injuries have not been analyzed. Purpose: To target key injury causes that most contribute to the urban-rural disparity, we decomposed total urban-rural differences in 2006 injury mortality by gender, age, and cause. Methods: Mortality data came from the Chinese Vital Registration data, covering a sample of about 10% of the total population. The chi-square test was used to test the significance of urban-rural disparities. Findings: For all ages combined, the injury death rate for males was 60.1/100,000 in rural areas compared with 40.9 in urban areas; for females, the respective rates were 31.5 and 23.6/100,000. The greatest disparity was at age less than 1 year for both sexes, where the rate from unintentional suffocation in rural areas was more than twice the urban rate. The higher mortality from drowning among males of all ages and among females ages 1-24 and 35+ contributed substantially to the age-specific urban-rural disparities. For both sexes, transportation incidents and suicide were the most important contributors to higher rates among rural residents ages 15+. Conclusions: Unintentional suffocation, drowning, transportation incidents, and suicide not only are the major causes of injury death, but also play a key role in explaining the urban-rural disparities in fatal injuries. Further research is needed to identify factors leading to higher rural death rates and to explore economical and feasible interventions for reducing injuries and narrowing the urban-rural gap in injury mortality.

Little is known about the differences in mortality among non-institutionalized geriatric and younger patients with schizophrenia. In this study long-term mortality and suicidal behavior of all the geriatric (age greater than or equal to 65 years), middle-age (age 41-64 years), and young (age 15-40 years) subjects with schizophrenia living in a Chinese rural community were compared. A 10 year follow-up investigation among a 1994 cohort (n = 510) of patients with schizophrenia was conducted in Xinjin County, Chengdu, China. Compared with young subjects, geriatric subjects with schizophrenia were more likely to be female, have more previous physical illness, never accepted treatment, and practice religious (p less than or equal to 0.01). There were no significant differences of suicide attempts among the three groups. Young subjects had a higher rate of suicide (1,033.8 per 100,000 person-years), and geriatric subjects had a higher rate of deaths due to other causes (accident and natural causes) (4,314.2 per 100,000 person-years). Standardized mortality ratios for both suicide and deaths due to other causes were highest in young subjects and the lowest in geriatric subjects. Patients with schizophrenia in all age groups had a marked increase in mortality and suicide. Specific intervention strategies for decreasing mortality and suicide should be developed for patients with schizophrenia in different age groups.

Examines demographic information about the status of young children around the world. Graphs nations with the largest populations of young children and highest percentage of their populations composed of young children in comparison to the aged, the percentage of regional populations under age 5 and over 64, and birth and infant mortality rates. Notes the overwhelming number of preschoolers residing in China, India, and sub-Saharan Africa. (JPB)

Introduction: In this study we estimate the burden of esophageal cancer (EC) in China and globally from 1990 to 2021, with a forecast to 2035, using Global Burden of Disease (GBD) data. We also analyze the related risk factors to investigate burden trends. Methods: Mortality, disability-adjusted life years (DALYs), crude rates, and agestandardized rates of EC were analyzed in China and globally from 1990 to 2035, utilizing GBD open data as a secondary dataset analysis of GBD data. Temporal change trends of EC risk factors were analyzed from 1990 to 2021. Joinpoint regression determined average annual percentage change (AAPC) of age-standardized rates. Descriptive analysis compared mortality and DALYs by age groups. Bayesian age-period-cohort (BAPC) predicted age-standardized mortality and DALYs rates for the next 14 years. Results: The ASMR and ASDR fluctuations in EC were significant in China, showing an overall downward trend. Globally, although there was also a downward trend, the fluctuations were relatively mild. The number of deaths and DALYs related to EC in China and globally showed a significant upward trend. Age-specific burden trends in China for EC indicated that the age group with the peak number of EC deaths shifted to the 70–74 years age group in 2021, while DALYs peaked in the 65–69 years age group. The crude mortality rate (CMR) peaked consistently in 1990 and 2021, both within the 90–94 years age range, while the crude DALY rate (CDR) shifted to the 85–89 years age group. Overall, the burden of EC deaths and DALYs in the population aged <40 years was relatively low, increasing rapidly after the age of 40 years, reaching a peak and gradually declining, and reaching a lower level after the age of 85 years. The predictive results of the BAPC model indicated that over the next 14 years, both ASMR and ASDR for EC in China and globally would show a slight overall increase. The GBD 2021 study identified smoking, high alcohol use, chewing tobacco, and diet low in vegetables as the main risk factors affecting EC mortality rate and DALYs. Among these, smoking and alcohol use were the most significant risk factors, with a higher impact on EC in China compared to the global level. From 1990 to 2021, the overall changes in ASMR and ASDR indicate a decreasing trend in the impact of these four risk factors on EC mortality rate and DALYs. Conclusions: The burden of EC is expected to steadily increase in China and globally until 2035, posing a significant challenge. Targeted prevention and control policies, such as calling on people to quit smoking and reduce alcohol use, may help curb this upward trend. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to examine the relative risk of risk factor in male and female breast cancer (BC) deaths in China and analyzed the changing trends in BC mortality rates from 1990 to 2019. Methods: Open data from the Global Burden of Disease database from 1990 to 2019 were analyzed to assess the number of BC deaths and age‐standardized mortality rates (ASMR) in China. The age‐period‐cohort model was employed to study age effects, period effects, cohort effects, as well as local drift and net drift of the data, determining the impact of changing risk factors on crude mortality rates and ASMR of BC. Results: In 2019, the number of BC deaths across all age groups in China increased by 130.38% compared to 1990, with an increase of 125.68% in females and 648.80% in males. The ASMR for BC and male BC increased in 2019, while female BC ASMR declined. Overall, alcohol consumption and smoking as risk factors contributed to increased mortality rates of BC with advancing age. Over the entire study period, the net drift of alcohol consumption in females for BC was 0.06% (95% confidence interval [CI]: −0.24% to 0.36%), while for smoking it was −0.64% (95% CI: −0.83% to −0.45%). For males, the net drift of alcohol consumption for BC was 6.75% (95% CI: 5.55% to 7.96%), and for smoking, it was 6.09% (95% CI: 2.66% to 9.64%). Conclusion: Hence, improving awareness of BC‐related risk factors and implementing prevention strategies are necessary to alleviate future BC burdens. [ABSTRACT FROM AUTHOR]

Aims: This study assessed diabetes (type 1 and type 2) mortality in China and globally from 1990 to 2019, predicting the next decade's trends. Materials and Methods: Data came from the Global Burden of Disease (GBD) database. The annual percentage change (AAPC) in age‐standardized mortality rates (ASMR) for diabetes (type 1 and type 2) during 1990–2019 was calculated. A Bayesian age‐period‐cohort (BAPC) model predicted diabetes (type 1 and type 2) mortality from 2020 to 2030. Results: In China, type 1 diabetes deaths declined from 6,005 to 4,504 cases (AAPC −2.827), while type 2 diabetes deaths rose from 64,084 to 168,388 cases (AAPC −0.763) from 1990 to 2019. Globally, type 1 diabetes deaths increased from 55,417 to 78,236 cases (AAPC 0.223), and type 2 diabetes deaths increased from 606,407 to 1,472,934 cases (AAPC 0.365). Both China and global trends showed declining type 1 diabetes ASMR. However, female type 2 diabetes ASMR in China initially increased and then decreased, while males had a rebound trend. Peak type 1 diabetes deaths were in the 40–44 age group, and type 2 diabetes peaked in those over 70. BAPC predicted declining diabetes (type 1 and type 2) mortality burden in China and globally over the next 10 years. Conclusions: Type 2 diabetes mortality remained high in China and globally despite decreasing type 1 diabetes mortality over 30 years. Predictions suggest a gradual decrease in diabetes mortality over the next decade, highlighting the need for continued focus on type 2 diabetes prevention and treatment. [ABSTRACT FROM AUTHOR]

Background: This study presented the mortality trend of ischemic heart disease (IHD) in Chinese residents from 2010 to 2019 and provided a basis for further establishment of relevant interventions. Methods: Data, such as sex, age, urban and rural areas, and death status, were extracted from the China Death Surveillance Dataset from 2010 to 2019, with mortality and age-adjusted death rates (AADRs) as the main indicators. The joinpoint regression model was used to analyze mortality and AADRs trends in IHD. A semi-structured expert interview was conducted to propose targeted intervention measures and countermeasures. Results: We observed an overall upward trend in IHD mortality rates and AADRs in China from 2010 to 2019 (average annual percentage change [AAPC] = 5.14%, AAPCAADRs = 1.60%, P < 0.001). Mortality rates and AADRs increased for both males (AAPC = 4.91%, AAPCAADRs = 1.09%, P < 0.05) and females (AAPC = 5.57%, AAPCAADRs = 1.84%, P < 0.001), with higher mortality rate for males than females but higher variation for females than males. Urban (AAPC = 4.80%, AAPCAADRs = 1.76%, P < 0.05) and rural (AAPC = 5.31%, P < 0.001; AAPCAADRs = 0.99%, P > 0.05) mortality rates increased, with the mortality rate higher in rural areas than in urban areas. In the age analysis, mortality rate was higher in middle-aged and older adults than in other age groups. The age-sex cross-analysis found the highest trend in mortality rates among females aged ≥ 75 years (annual percentage change [APC] = 2.43%, P < 0.05). Conclusions: The upward trend in IHD mortality in China from 2010 to 2019, especially among female residents aged ≥ 75 years, poses continuing challenges to public health policies and actions. [ABSTRACT FROM AUTHOR]

In the year 2023, 1 958 310 new cancer cases and 609 820 cancer deaths are projected to occur in the United States, estimated by Cancer Statistics, published by American Cancer Society. An accelerated decline in mortality rate of cancer continues since it reached the peak in 1991. The treatment advance brought survival benefit to patients which mainly contribute to the decline along with tobacco control and screening. COVID-19 pandemic caused 350 831 mortality and ranked 3rd in cause of death in 2020, and the mortality had a significant increase in multiple causes of death including cancer. By comparing the data of China and the United States released by GLOBOCAN database in 2020, it is found that, although the influence of the pandemic on cancer has not been evaluated. Although the incidence and mortality of cancer differ between US and China, the experiences are worth learning. Improving the standardization of diagnosis and treatment, enhancing the accessibility of cancer health care, upgrading the coverage of screening and increasing the human papillomavirus (HPV) vaccination rate are proven to be effective ways to reduce the mortality of cancer. [ABSTRACT FROM AUTHOR]

Evidence shows that rehabilitation is the most effective strategy to reduce the disability rate of patients with stroke. However, there is limited understanding about the factors associated with rehabilitation assessment among patients with intracerebral hemorrhage (ICH) in China. We aimed to investigate the factors associated with rehabilitation assessment in patients with ICH and the relationship between rehabilitation assessment and hospitalization outcomes. Data from 85,664 patients with ICH admitted to 1,312 hospitals between 1 August 2015 and 31 July 2019 were analyzed. A multivariable logistic regression model accounting for in-hospital clustering was used to identify patient and hospital factors associated with rehabilitation assessment during acute hospitalization. A total of 62,228 (72.6%) patients with ICH underwent rehabilitation assessments. In multivariable analyses, factors associated with an increased likelihood of undergoing a rehabilitation assessment (P <.05) included a higher Glasgow Coma Scale score on admission, a history of hypertension, a history of peripheral vascular disease, dysphagia screening, carotid vessel imaging, and a longer length of hospital stay. Conversely, patients admitted to the intensive care unit and tertiary-grade hospitals were less likely to undergo rehabilitation assessments during hospitalization for ICH. This study showed that the rate of rehabilitation assessment was 74.2%, which is low. Rehabilitation assessment was associated with longer hospital stays and lower mortality. Therefore, patients with acute cerebral haemorrhage should undergo comprehensive and professional rehabilitation assessment. [ABSTRACT FROM AUTHOR]

Purpose: Leptospirosis is a zoonotic disease caused by pathogenic spirochetes of the genus Leptospira. However, there is currently no consensual definition or diagnostic criteria for severe and different forms of leptospirosis. Therefore, more insight on clinical manifestations, risk factors, and outcomes of leptospirosis is warranted. The identification of leptospirosis with distinct clinical manifestations and prognosis in our population. Methods: Multiple correspondence analysis and hierarchical classification on principal components were presented to identify different clinical types of leptospirosis. The outcomes were clinical phenotypes, laboratory and imaging findings, and prognosis. Results: The 95 enrolled patients had median values of 54.0 years (39.0-65.0) for age, 9.0 (7.0-14.0) for total hospital stay lengths, of whom 86.3% was male and 40.0% was transferred to ICU. Three clinical types were distinguished: mild leptospirosis (n=43, 45.3%) with less organ dysfunction and shorter hospital stays; respiratory leptospirosis (n=28, 29.5%) with hemoptysis, and respiratory and circulatory failure; and hepato-renal leptospirosis (n=24, 25.3%) with worst liver and kidney dysfunction. Total hospital mortality was 15.8% and was associated with dyspnea and high levels of neutrophil counts. Conclusions: The identification of leptospirosis with distinct clinical manifestations and prognosis in our population may assist clinicians to distinguish leptospirosis-like disease. Moreover, dyspnea and neutrophil count were found to be independent risk factors for severe leptospirosis progression. [ABSTRACT FROM AUTHOR]

Functional traits regulate plant response to environmental changes, with consequences on population dynamics. However, how plant functional traits impact population dynamics, including growth, mortality, and recruitment, remains elusive in temperate forests across different successional stages. In this study, we compiled data on population dynamics and eight functional traits, encompassing hydraulic, wood, and leaf traits, from 35 species commonly found in a secondary poplar-birch forest and a broad-leaved Korean pine forest in Northeast China. We quantified the intrinsic relationships between plant population dynamics and assessed how plant functional traits influenced these dynamics. The results demonstrated a gradual increase in the correlation among population dynamics as forest succession progressed. In the secondary forest, tree growth rate and mortality rate were negatively correlated, while growth-death rate and growth-recruitment rate were not related. Conversely, in the broad-leaved Korean pine forest, there was a significant negative correlation between tree growth rate and mortality rate, as well as between growth rate and recruitment rate, while tree mortality rate positively correlated with recruitment rate. Additionally, functional traits effectively predicted population dynamics, but the predictive ability varied across successional stages. Functional traits, particularly xylem hydraulic traits ( e.g ., Huber value) and anatomical traits ( e.g ., mean xylem conduit diameter), were stronger predictors of tree growth, mortality, and recruitment rates at the late successional stage compared with the early stage. These findings indicated that population dynamics and functional traits exhibited strong regularity in the late successional stage of broad-leaved Korean pine forests.

Hypertensive brainstem hemorrhage (HBSH) is of high morbidity and mortality rate. But many clinical studies were written in Chinese and had not been reviewed. A systemic review of Chinese clinical studies for HBSH was performed. A systemic literature search in PubMed, Web of Science, China National Knowledge Infrastructure, and Weipu database and Wanfang database up to March 2020 was performed. Clinical control studies including a surgical evacuation (SE) group and a conservative management (CM) group were included. The clinical outcome and mortality rate were compared. Ten cohort studies were included, involving 944 participants (304 in the SE group and 640 in the CM group). All included patients were comatose, with the average age ranged from 45 to 65 years old. Among five studies using mRS or GOS as outcome score, a total of 16.6% (89/535) of patients achieve self-maintenance with minor disabilities, including 26.8% (34/127) in the SE group and 13.5% (55/408) in the CM group. The overall mortality rate in the SE group was 27.6%, ranged from 9.3 to 60% among different studies. The overall mortality rate in the CM group was 60.6%, ranged from 18.5 to 100.0%. Elder and comatose HBSH patients are not contraindicated for surgery. The review showed that this group of patients obtained a better outcome and lower mortality rate after surgical treatment. The quality of included studies was relatively low, but a high-level clinical study on HBSH is of great difficulty, as both clinicians and patients faced various sociological issues rather than pure medical problems. [ABSTRACT FROM AUTHOR]

Objective: This study, based on Global Burden of Disease (GBD) data, aimed to report the long-term trend in mortality rates caused by risk factors for esophageal cancer (EC) in China from 1990 to 2019 and predict the burden of EC mortality caused by these risk factors over the next 15 years., Methods: We examined six risk factors that influenced EC mortality rates in China and their respective rankings. Furthermore, we analyzed the number of deaths and crude mortality rates (CMR) caused by these risk factors for both sexes and different age groups. Age-standardized mortality rates (ASMR) and the number of deaths across all age groups were also analyzed. Finally, we utilized the Bayesian Age-Period-Cohort (BAPC) model to predict the trends in ASMR burden caused by these risk factors in the future., Results: From 1990 to 2019, the percentage changes in ASMR for EC caused by the six risk factors in China were as follows: smoking (- 33.4%), alcohol consumption (- 23.0%), low fruit intake (- 73.6%), low vegetable intake (- 96.0%), high Body Mass Index (BMI) (25.1%), and tobacco chewing (- 32.8%). In 2019, the top three risk factors contributing to EC ASMR in China were smoking, alcohol consumption, and high BMI. Overall, the ASMR for EC in China fluctuated and declined from 1990 to 2019. The most common risk factors for males were smoking and alcohol consumption, while low fruit intake and high BMI were the most common risk factors for females. The impact of these risk factors on EC mortality increased with age, except for the elderly population. BAPC analysis indicated that the influence of these risk factors on ASMR was expected to remain relatively stable in the next 15 years, suggesting a continued significant burden of EC., Conclusion: The projected burden of EC mortality in China was expected to continue increasing steadily over the next 15 years, highlighting the pressing need for disease control measures. To alleviate this burden, targeted prevention and control policies addressing risk factors for EC such as smoking, alcohol consumption, and high BMI are necessary., (© 2023. The Author(s), under exclusive licence to The Japanese Association for Thoracic Surgery.)

Introduction: Relatively little is known about the effects of mechanical ventilation (MV; including invasive MV [IMV] and noninvasive ventilation) on clinical outcomes of patients with idiopathic pulmonary fibrosis (IPF) and connective tissue disease‐associated interstitial lung disease (CTD‐ILD) in the intensive care unit (ICU) and risk factors for ICU death remain to be determined. Objectives: Our objective was to determine and compare mortality rates between IPF and CTD‐ILD patients receiving MV and to identify risk factors for ICU death in these patients. Methods: We conducted a retrospective cohort study in respiratory ICUs of three university hospitals in China during a 7‐year period. We compared clinical data and outcomes between patients with IPF and those with CTD‐ILD and performed logistic regression analyses to identify risk factors for ICU death. Results: Of the 94 patients in the analyses, 63 were diagnosed with IPF and 31 were diagnosed with CTD‐ILD. ICU mortality was significantly higher in the IPF group than in the CTD‐ILD group (86% vs 68%; P = 0.041) and was significantly lower in patients receiving noninvasive ventilation than in those receiving IMV (62% vs 88%; P = 0.004). Risk factors for ICU death were disease progression as the principal cause of acute respiratory failure and IMV. Conclusion: Based on current clinical practice in three ICUs, the mortality rate in IPF patients receiving MV might reach 86% and is higher than in CTD‐ILD patients. IMV might be initiated cautiously, especially in patients with disease progression as the principal cause of acute respiratory failure. [ABSTRACT FROM AUTHOR]

Regeneration plays an essential role in the restructuring of plant communities, with seedlings and sprouts representing two different regeneration strategies. As an important timber species, Cunninghamia lanceolata is widely distributed throughout southern and eastern China. However, the morphology and growth of its sprouts and seedlings under natural environments have not been examined in detail. Our study quantified the morphology and growth of Cunninghamia lanceolata during its early regeneration phase. We selected a secondary mixed coniferous forest in the Huangshan region of China as the research location, and examined sapling height, basal stem diameter, lateral branch length, as well as the relationships between main stem and lateral branch elongation, and between sapling basal stem diameter and height. The results showed that high light intensity promoted the extension growth of main stems and the elongation of lateral branches of seedlings. Meanwhile, sprouts generally had shorter height growth than seedlings with the same basal stem diameter, and the growth allocation of seedlings was generally more dependent on light intensity. Our findings suggest that the morphology and growth of C. lanceolata might vary depending on the interaction of regeneration mode (plants originating from sprouts or seedlings) and light intensity. [ABSTRACT FROM AUTHOR]

The outbreak of coronavirus disease (COVID-19) was first reported from Wuhan, China, on December 31st, 2019. As the number of coronavirus infections has exceeded 100,000 with toll deaths of about 5000 worldwide as of early March, 2020, scientists and researchers are racing to investigate the nature of this virus and evaluate the short and long term effects of this disease. Despite its negative impacts that obliged the World Health Organization to declare COVID-19 epidemic as a Public Health Emergency of International Concern, the rate of mortality of this infection has not exceeded 3.4% globally. On the other hand, the mortality rate caused by ambient air pollution has contributed to 7.6% of all deaths in 2016 worldwide. The outbreak of COVID-19 has forced China to lockdown its industrial activities and hence dropped its NO2 and carbon emissions by 30 and 25%, respectively. This work reports on the first case study that compares the air quality status before and after the crisis. It sheds light on the facts related to the demographics of deaths by gender, age and health status before infection. The historical data on air quality, estimates of annual deaths and its economic burden have been presented and analyzed. The actual daily deaths due to COVID-19 have been obtained from the official records of the daily Situation Reports published by World Health Organization as of March 11th. The rate of mortality due to COVID-19 was impacted by two factors: age and health status. Results show that 75% of deaths were related to cases that had underlying present diseases with the majority aged of 80+ years. The reported figures were compared with the average daily mortality due to poor air quality which reached up to 3287 deaths due to high levels of NO2, O3 and PM. The air quality status before the crisis was compared with the current situation showing that COVID-19 forced-industrial and anthropogenic activities lockdown may have saved more lives by preventing ambient air pollution than by preventing infection. [ABSTRACT FROM AUTHOR]

Leptospirosis is one of the most common and neglected tropical waterborne diseases in China, causing serious economic losses, and constituting a significant public health threat. Leptospirosis has recently received increased attention and is considered a re‐emerging infectious disease in many countries. The incidence of leptospirosis among people suggests that occupation, age, season, sex and water recreational activities are significant risk factors. The aim of this study was to describe the epidemiological profiles of leptospirosis in China during the 2007–2018 period. The morbidity data of leptospirosis by age, season (month), gender, occupation and geographic location (different provinces) were obtained from the public health science data centre of China for subsequent epidemiological analysis. The results indicate that the incidence of leptospirosis has shown a slow downward trend from 2007 to 2018, but morbidity rates were still relatively high (0.0660–0.0113). The incidence of leptospirosis varied in different provinces of China; cases localized mainly to the Southern and Central provinces, areas with warm weather and ample rainfall. Older people (aged 60–75), males, farmers, students and field workers were high‐risk populations. During the 2007–2018 observation period, morbidity rates increased beginning in May, remained at high levels in August and September and decreased after November. The present investigation highlights the re‐emergence of leptospirosis in some provinces of China (especially in Yunnan and Fujian) and shows that leptospirosis remains a serious public health threat. The results of this study should enhance measures taken for the prevention, control, and surveillance of leptospirosis in China. [ABSTRACT FROM AUTHOR]

Objectives: On 31 December 2019, the China Country Office of the World Health Organization (WHO) reported on cases of pneumonia with unknown etiology in the Wuhan city of the province of Hubei. On 7 January 2020, the factor was defined as a new Coronavirus (2019-nCoV) that had not been detected in humans before. The aim of this study is to analyze the pandemic in 8 different countries. Materials and Methods: In the study, we included the countries with the highest numbers of cases by the date 04.05.2020 (USA, China, Italy, Germany, Iran, France, Turkey), as well as South Korea. We comparatively analyzed the countries' total case and mortality numbers, mortality rates, over-65 years old population rates and dates of precautions that were taken. Results: The number of COVID cases in the entire world exceeded 3.6 million, and approximately 75.2% of these cases were seen in 7 countries (USA, Italy, China, Germany, France, Iran, Turkey), whereas the number of related deaths worldwide exceeded 250 thousand by the same date (04.05.2020). Conclusion: We are facing the greatest pandemic of the last century, or even the history of humanity, which has affected the society in all aspects from the field of medicine to economics. The greatest weapon for the history of humanity in the fight against the pandemic would be countries' transfer of their knowledge to each other. [ABSTRACT FROM AUTHOR]

The top priority of any nation is to lead the nation towards prosperity, progress, and economic growth, confronting several challenges and concerns arisen from global situations. The sudden outbreak of any disease defies the health care systems and economy of nations. COVID-19 is one of the viral diseases which broke out in Wuhan city of China in 2019. COVID-19 outbreak intermittently prevailed all over the world. It exposes the fragility of the established health care systems across the world in spite of comprising modern science and technology. Unfortunately, there is no chemotherapeutic agent in the regimen of antiviral drugs or no vaccine available to curb this infectious disease. As a consequence, this deadly infection has prevailed all over the world. The antiviral drugs used for viral diseases excluding COVID-19 infection are Ramdesvir, Favipiravir, and Ribavarin, and antimalarial agents (Chloroquine & Hydroxychloroquine) are being administered to the patients for redemption of this infection. Fortunately, these existing drugs have been found clinically active and are being used. In this review, we present the current scenario and status of epidemiology, diagnosis, treatment, vaccine development for COVID-19, and its impact on the socio-economic structure. [ABSTRACT FROM AUTHOR]

Background: With the rapid development of the socioeconomic status, the mortality of several cancers has been changed in China during the past 30 years. We aimed to estimate the trends of mortality and years of life lost (YLLs) of various cancers in urban and rural areas of China from 1990 to 2017. Methods: The mortality data were collected from Chinese yearbooks and the age structure of population from the Chinese sixth population census were used as reference to calculate age‐standardized mortality rates (ASMRs) and YLLs rates. Joinpoint regression analysis was implemented to calculate the annual percent change (APC) of mortality rates and YLL rates for cancers. YLLs owing to premature death were calculated as age‐specific cancer deaths multiplied by the reference life expectancy at birth of 80 years for male and 82.5 years for female. Results: The ASMRs of all cancers showed significant decreasing trends for urban residents from 1990 to 2017, such downward trend without significance was also observed among rural residents. Interestingly, ASMRs of lung cancer and breast cancer have raised continuously in rural areas since 1990. The age‐standardized YYL rates for urban and rural residents decreased with 1.02% and 0.85% per year, respectively. YLLs in rural areas were higher than those in urban areas, whereas YLLs of urban outstripped those of rural finally with the increasing in YLLs of urban areas (216.71% for men and 207.87% for women). Conclusion: The ASMRs and YLL rates of all cancers have declined in urban and rural areas from 1990 to 2017. YLLs increased in urban areas and remained higher level in rural areas after 2014 year. Preventive measures should be strengthened to against cancer, especially for lung cancer. [ABSTRACT FROM AUTHOR]

Data selection and methods for fitting coefficients were considered to test the self-thinning law. The Chinese fir (Cunninghamia lanceolata) in even-aged pure stands with 26 years of observation data were applied to fit Reineke's (1933) empirically derived stand density rule (N ∝ –1.605, N = numbers of stems, = mean diameter), Yoda's (1963) self-thinning law based on Euclidian geometry (∝ N–3/2, = tree volume), and West, Brown and Enquist's (1997, 1999) (WBE) fractal geometry (∝ –8/3). OLS, RMA and SFF algorithms provided observed self-thinning exponents with the seven mortality rate intervals (2%–80%, 5%–80%, 10%–80%, 15%–80%, 20%–80%, 25%–80% and 30%–80%), which were tested against the exponents, and expected by the rules considered. Hope for a consistent allometry law that ignores species-specific morphologic allometric and scale differences faded. Exponents α of N ∝ α, were significantly different from –1.605 and –2, not expected by Euclidian fractal geometry; exponents β of ∝ Nβ varied around Yoda's self-thinning slope –3/2, but was significantly different from –4/3; exponent γ of ∝ γ tended to neither 8/3 nor 3. [ABSTRACT FROM AUTHOR]

The provinces of China have suffered from severe PM2.5 pollution in recent years, presenting a significant threat to human health. Identifying associations between mortality rate and PM2.5 level is extremely useful for a range of purposes, such as the development of preventive measures, increasing health awareness, and establishing disaster warning systems. Based on remote sensing data, station monitoring data, and statistical data, this paper uses the exposure response function, regression analysis, and kriging to evaluate the number of deaths in China’s 31 provinces caused by PM2.5 pollution in 2015. Variations in the number of deaths and mortality rates in China under different PM2.5 concentration control standards have been simulated by a range of countries and organizations helping to develop optimal control standards for each province individually according to actual PM2.5 concentration. These results show that: 1) PM2.5 pollution has an important effect on the mortality rate in China. The rate caused by PM2.5 pollution in 2015 accounted for 1.75‰, or approximately 2.62 million people and 31.14% of all deaths in China. 2) Strict control standards for PM2.5 concentration can bring significant health benefits, with projections that if PM2.5 concentration in China's provinces were controlled to the level set by China, the EU, Japan, USA, and Australia, the number of deaths caused by PM2.5 pollution would be reduced by approximately 0.95, 1.52, 2.02, 2.26, and 2.49 million people, respectively, or 36.24%, 58.08%, 79.91%, 86.47%, and 95.20% compared with baseline year data. 3) Choosing appropriate control targets for limiting PM2.5 concentrations in different provinces in China is an effective way to obtain optimal health benefits. Beijing, Tianjin, Hebei, Shandong, and Henan should adopt a 35 μg/m3 standard with a 25 μg/m3 standard appropriate for Shanxi, Liaoning, Jilin, Shanghai, Jiangsu, Zhejiang, Anhui, Hubei, Hunan, Chongqing, Shanxi, and Xinjiang; 13 provinces, including Inner Mongolia, Heilongjiang, Fujian, Jiangxi, Guangdong, Guangxi, Sichuan, Guizhou, Yunnan, Tibet, Gansu, Qinghai, and Ningxia, should adopt the 15 μg/m3 standard; and Hainan should consider choosing a 12 μg/m3 standard. [ABSTRACT FROM AUTHOR]

Climate is closely related to human longevity. In China, there are many climate types. According to national population censuses from 1982 to 2000, most provinces with a high ratio of centenarians are located in western and northwestern China far from the sea; these areas are characterized by a dry, cold climate, very high altitude, very high daily temperature range, strong winds, and partial hypoxia. Meanwhile, provinces with a high ratio of nonagenarians from 1982 to 2000 are located in southern China near the sea. Previous studies have attributed the high ratio of centenarians in western and northwestern China to the extreme local climate. However, centenarians in these areas decreased greatly in 2010, whereas residents in southern China frequently reached 90 to 100 years old in 2010. This study aims to explain this strange phenomenon and find whether extreme climate in Tibetan plateau and northwestern China or moderate climate in southern China is more conducive to longevity. The study found that mortality rate in Tibetan plateau is much higher than southern China, then a population evolution experiment was proposed to compare longevity indicators between low mortality rate and high mortality rate and shows that longevity indicators will decrease in the near future and increase above their original levels after several decades when the mortality rate is decreased. Results of this study show individuals in northwestern China do not live as long as those in eastern and southern China. A moderate climate is more conducive to longevity than extreme climate in China. The longevity of a region should be judged by long-term longevity indicators. [ABSTRACT FROM AUTHOR]

Abstract: China is a populous country that is facing serious aging problems due to the single‐child birth policy. Debate is ongoing whether the liberalization of the single‐child policy to a two‐child policy can mitigate China's aging problems without unacceptably increasing the population. The purpose of this paper is to apply machine learning theory to the demographic field and project China's population structure under different fertility policies. The population data employed derive from the fifth and sixth national census records obtained in 2000 and 2010 in addition to the annals published by the China National Bureau of Statistics. Firstly, the sex ratio at birth is estimated according to the total fertility rate based on least squares regression of time series data. Secondly, the age‐specific fertility rates and age‐specific male/female mortality rates are projected by a least squares support vector machine (LS‐SVM) model, which then serve as the input to a Leslie matrix model. Finally, the male/female age‐specific population data projected by the Leslie matrix in a given year serve as the input parameters of the Leslie matrix for the following year, and the process is iterated in this manner until reaching the target year. The experimental results reveal that the proposed LS‐SVM‐Leslie model improves the projection accuracy relative to the conventional Leslie matrix model in terms of the percentage error and mean algebraic percentage error. The results indicate that the total fertility ratio should be controlled to around 2.0 to balance concerns associated with a large population with concerns associated with an aging population. Therefore, the two‐child birth policy should be fully instituted in China. However, the fertility desire of women tends to be low due to the high cost of living and the pressure associated with employment, particularly in the metropolitan areas. Thus additional policies should be implemented to encourage fertility. [ABSTRACT FROM AUTHOR]

Background: In the past 20 years, the trends of ischemic heart disease (IHD) mortality in China have been described in divergent claims. This research analyzes mortality trends for IHD by using the data from 102 continuous Disease Surveillance Points (DSP) from 1991 to 2009.Method: The 102 continuous DSP covered 7.3 million people during the period 1991-2000, and then were expanded to a population of 52 million in the same areas for 2004-2009. The data were adjusted by using garbage code redistribution and underreporting rate, mapped from international classification of diseases ICD-9 to ICD-10. The mortality rates for IHD were further adjusted by the crude death proportion multiplied by the total number of deaths in the mortality envelope, which was calculated by using logrt = a + bt. Age-standard death rates (ASDRs) were computed using China's 2010 census population structure. Trend in IHD was calculated from ASDRs by using a joinpoint regression model.Results: The IHD ASDRs increased in total in regions with an average annual percentage change (AAPC) 4.96%, especially for the Southwest (AAPC = 7.97%) and Northeast areas (AAPC = 7.10%), and for male and female subjects (with 5% AAPC) as well. In rural areas, the year 2000 was a cut-off point for mortality rate with annual percentage change increasing from 3.52% in 1991-2000 to 9.02% in 2000-2009, which was much higher than in urban areas (AAPC = 1.05%). And the proportion of deaths increased in older adults, and more male deaths occurred before age 60 compared to female deaths.Conclusion: By observing a wide range of areas across China from 1991 to 2009, this paper concludes that the ASDR trend for IHD increased. These trends reflect changes in the Chinese standard of living and lifestyle with diets higher in fat, higher blood lipids and increased body weight. [ABSTRACT FROM AUTHOR]

Growing socio-economic disparity is a global issue that could disturb community health. Numerous case studies have examined the health influences of income disparities as well as the patterns that implicate those disparities. Therefore, this study attempts to examine the core determinants of mortality rate, which are environmental degradation, green energy, health expenditures, and technology (ICT) for the 25 provinces of China over the period of 2005-2020. This study uses a series of estimators to investigate the preferred objectives in which CS-ARDL and common correlated effect mean group (CCE-MG). Estimated results show the significant contribution of environmental deterioration and income inequality to the mortality rate. Furthermore, health expenditures, ICT, and green energy significantly reduce the mortality rate. Similarly, the moderate effect of income inequality on health expenditure, green energy, and ICT significantly reduces the mortality rate in selected provinces of China. More interestingly, the current study suggests policy implications to reduce the rising trend of mortality rate., Competing Interests: 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 © 2023 Shao and Dou.)

Background: China is now under a period of social transition, and inequity is evident in the field of health care. We aimed to investigate regional health-care inequalities in children's survival in Zhejiang Province, China. Methods: In our study, monitoring data of Zhejiang Province from 2005 to 2014 was collected. The flow of data collection of community-district-city for urban areas or village-township-county rural areas was followed. The factors affecting equity was analyzed including regional economical level and household registry. We adopted standard measures of concentration curve and concentration index to evaluate degree of income-related inequity and the trend of mortality changes. Results: From 2005 to 2014, overall mortality rate in children under five decreased, and regional disparity reduced markedly, and with a reduced disparity of mortality rate among children from urban and rural areas. In 2014, the mortality rate in children from urban and rural areas was similar. In contrast, the mortality rate in the children from migrant population was more than two folds of that in the children from native residency (7.82‰vs. 3.89‰). The mortality rates of newborns (rs = -0.396, P < 0.001), infants (rs = -0.553, P < 0.001) and children under five (rs = -0.568, P < 0.001) were all negatively correlated with per capita GDP in different regions. CI in the newborns, infants and children under 5 years was -0.105, -0.107 and -0.118, respectively. The concentration curve was near to equity curve. The concentration curve was near to equity curve. The mortality rate of children was negatively related with economical level in this study. Conclusions: The survival status was near to equity. Regional economical development can improve children's survival but it was not the only social determinant. Migrant population will be the future monitor focus for reducing disparity on healthcare and increase equity in children's survival. [ABSTRACT FROM AUTHOR]

Background In 2011, Hebei Province, located in North China with a population of 71 794 239, accounted for approximately 6% of the national population. It is well known as a heavily air polluted area. This study reports the lung cancer burden and mortality trend in Hebei Province from 1973 to 2011. Methods Eight cancer registries in Hebei Province submitted data to the Hebei Provincial Cancer Registry Center. Pooled data were stratified by area (urban/rural), gender, and age group. The proportions, cumulative incidence/mortality rates, and median age at death of lung cancer were calculated. Lung cancer mortality data of 1973-1975, 1990-1992, and 2004-2005 were extracted from national death surveys. Data of lung cancer from Cixian and Shexian were obtained from population-based cancer registries in each county. Results The estimated numbers of newly diagnosed lung cancer cases and deaths in 2011 in Hebei Province were 32 623 and 27 612, respectively. The crude incidence rate of lung cancer was 45.44/100 000. The age-standardized incidence rate by world standard population was 39.01/100 000, ranking second among all cancers. The lung cancer mortality rate was 38.46/100 000, ranking first among all cancer deaths, with a significantly increasing trend in Hebei Province from 1973-1975 to 2010-2011, with an increased rate of 189.15%. Conclusion Hebei Province suffers a heavy disease burden of lung cancer and an obvious increasing trend has been observed over the past 40 years. Preventive and control strategies should be encouraged . [ABSTRACT FROM AUTHOR]

Background: Although the role of primary care for the management of patients with chronic heart failure (CHF) has been highly recommended, structural involvement of primary care in heart failure (HF) management programs is extremely limited. Aims: To examine the feasibility and applicability of two most recommended forms of care delivery mode, home visit and telephone support, for CHF management in the setting of community health service center (CHSC). Study Design: Prospective study. Methods: This study was conducted in two CHSCs in Beijing, China. Care delivery was led by trained general practitioners or community nurses via home visits in one CHSC and telephone support in the other. Data regarding the change in mortality and hospitalization rate during 12 months and self-care level at 6 months were prospectively collected and compared across the intervention groups. Results: A total of 329 patients were included, with 142 in the home visit group and 187 in the telephone support group. Patients in both groups had frequent visits to CHSC (8.1±5.9 in the home visit and 7.7±4.1 in the telephone support group, p=0.45) during the follow-up period. Compared to the telephone support group, patients in the home visit group showed a reduction in all-cause mortality (14.1% versus 20.3%, p=0.14), one or more hospitalizations due to any cause (33.8% versus 44.2%, p=0.12) and one or more hospitalizations due to cardiac cause (17.6% versus 24.6%, p=0.13) in the home visit group. The absolute differences were 6.2% (95% CI: 1.9%, 14.3%), 8.4% (95% CI: 2.1%, 18.9%) and 7.3% (95% CI: 1.5%, 16.1%), respectively, although the results were not statistically significant. After 6 months of intervention, patients in both groups achieved marked improvement in self-care with reference to their own baseline values. Conclusion: Although no statistical difference was observed between the two care delivery approaches regarding the clinical outcomes of interest, given the high participation rates, the acceptable rate of adverse events, frequent CHSC visits and patients' preferences in the current study, it was concluded that CHSC might be the optimal setting for delivering care to CHF patients in China. [ABSTRACT FROM AUTHOR]

The health and wellness of people through life expectancy, mortality rate improvement, and sustaining the productivity of labor contributes a lot to national income. Infrastructure development consumes energy and releases carbon dioxide at different stages of the construction process. The current study explores the nexus between CO 2 emission, energy consumption, mortality, life expectancy, and GDP in the top five carbon-emitting countries by using time series data from 1975 to 2015. The study used a cointegration technique to find the long- and short-run relationships between study variables. The study also used a structural break test to identify the break time. The results of the correlation matrix show strong positive correlation between CO 2 emissions and energy consumption. It also reflects a weak correlation with mortality and life expectancy in Japan and Russia. The results of the ADF test indicated that the series are stationary at first difference and provided evidence to use Johansen cointegration test for long- and short-run relationships between independent series. Vector error correction term and ECT method are used to find long-run relationships between cointegrated series and adjustment parameters. For the structural breaks of health indicators and energy consumption study, we used the Gregory Hanson structural break. Mortality rate and life expectancy rate of China, U.S., Russia, India, and Japan show relevant policy changes with economic policies of each country.

Aims: The aims of this study are to investigate injury mortality in children aged 1-4 years, to analyse prevalent mortality rates of childhood injury and to identify the leading causes of child injury deaths in China from 2000 to 2008. Methods: The data were obtained from a nationwide mortality surveillance system for children under 5 years of age in China. The injury mortality rates of children aged 1-4 years were compared between rural and urban areas, boys and girls and among five major injury types between 2000 and 2008. Results: During the 9-year study period, the injury mortality rates for children aged 1-4 years declined significantly by an average of 5.4% each year ( P < 0.001; 95% confidence interval (CI): 3.6-7.0%) overall in China, with a decrease of 4.8% ( P < 0.001; 95% CI: 2.5-7.1%) and 9.9% ( P < 0.001; 95% CI: 4.9-14.7%) in rural and urban areas, respectively. The proportion of injury-related deaths to total mortality rates dropped from 32.9% in 2000 to 18.8% in 2008 in urban areas but increased from 45.6% to 56.9% in rural areas. The injury mortality rates in both boys and girls decreased significantly by an average of 5.4% each year ( P < 0.001; 95% CI: 2.6-8.0%) and 6.1% ( P < 0.001; 95% CI: 2.7-9.4%), respectively. Drowning and traffic accidents were the most prevalent causes of injury-related deaths in children aged 1-4 years. Conclusion: Childhood injury is still the leading cause of death in children aged 1-4 years in China. Drowning and traffic accidents were the most prevalent causes of childhood deaths in this study. Boys living in rural areas are at a higher risk and therefore require increased attention to help control and prevent childhood injury. [ABSTRACT FROM AUTHOR]

A systematic field study was undertaken on the outbreaks of infectious bursal disease (IBD) during the period from June 2010 to May 2011 in commercial broiler farms of Bangladesh (562) and China (89). Overall prevalence due to the disease was recorded as 12.1 and 7.1% for Bangladesh and China, respectively, and mortality rate was 5.3 and 2.4% for Bangladesh and China, respectively. Dullness, depression, anorexia, ruffled feathers, inability to move and yellowish white diarrhea were observed in almost all the IBD-affected flocks. At necropsy, the gross lesions were observed mainly in the bursa of Fabricius followed by changes in thigh and breast muscles. Outbreaks of the disease were recorded throughout the year. Seasonal influence of IBD showed a significantly (P<0.05) higher prevalence 13.5% and mortality rate 7.7% in winter season in Bangladesh. On the other hand, in China, significantly higher prevalence 6.5% and mortality rate 3.2% was found in summer season. Significantly higher prevalence and mortality rate was observed in the young birds (≤5 weeks of age) than older birds in both the countries. The outbreak of IBD was also found in vaccinated birds (P<0.05) of the two countries. The findings of the study indicated the difference of occurrence of IBD in Bangladesh and China, thereby would help to develop appropriate control strategies for both the countries [ABSTRACT FROM AUTHOR]

Abstract: The life history of a species is a result of natural selection and reflects how the species is adapted to its environment. Knowledge of life history is crucial for further ecological studies and conservation management. This paper presents aspects of the life history of the plateau pika (Ochotona curzoniae), a small mammal native to alpine meadows of the Tibetan Plateau. The mean lifespan of juveniles from first litters was longer than the mean lifespan of juveniles from second litters. The population consisted of more juveniles than adults (over-wintered animals) in August and these juveniles came primarily from the first litter of the year. The sex ratio of juveniles was female-biased even though the sex ratio of adults did not differ from 1:1. The mortality rate of juveniles and adults during the warm season (May–August) was greater than the mortality rate of these groups during the cold season (September–April). Mean juvenile growth rate during the warm season was 1.4g/d and the growth rate of the first litters was remarkably slower than that of the second litters. [Copyright &y& Elsevier]

Background: Pneumoconiosis has been reported as one of the major global burdens of occupational health-related diseases. The global prevalence had increased since 1990. Prevention and treatment of pneumoconiosis in the project of occupational health have been a priority of the action plan of Healthy China 2030., Methods: A life table was used to explore the survival and fatality rate of pneumoconiosis. Using Cox proportional hazards regression model, the factors of survival time were investigated., Results: A total of 15,402 cases had several species of pneumoconiosis, including silicosis, coal worker pneumoconiosis and welder pneumoconiosis that accounted for 68.49%, 19.41% and 3.84% of total pneumoconiosis, respectively. Eighty percent of cases were initially diagnosed at stage I, 15.5% at stage II, and 4.5% at stage III. The overall average survival time was determined as 14.74±9.57 years, the life expectancy reached 34.324 years in total, and the total mortality of patients suffering from pneumoconiosis was 19.89%. The average dust exposure period, average survival time and life expectancy progressively decreased with the stage upgrade, whereas the age of onset and mortality rate tended to increase. Dust exposure years, initially diagnosed at stage II or stage III, stage I upgrade to stage II, stage I upgrade to stage III and low economic level were found as important risk factors for the survival of patients suffering from pneumoconiosis., Conclusions: Stage II and stage III of pneumoconiosis may have a direct effect on the survival time of patients suffering from pneumoconiosis. The prevention and delay of the progression of pneumoconiosis are critical to prolonging the survival time of cases.

Abstract: Background: Electronic medical record (EMR) systems have potential to improve care quality and efficiency. Yet little is known about the effects of EMR in Chinese hospitals. Objective: An inpatient EMR system was implemented in a large Chinese hospital. The objective of this research was to evaluate the impact of the EMR system on efficiency, quality, and cost of inpatient care in the hospital. Methods: A five-year (2005–2009) longitudinal dataset with monthly data involving 251 physicians and 298,760 patient visits was created by querying the hospital''s central database. Four key outcomes were examined: length of stay, infection rate, mortality rate, and cost per patient stay. Interrupted time series analysis was used to evaluate changes in level and slope for each outcome variable. Results: Length of stay grew at 0.027 bed-days per month in the pre-EMR period and declined at 0.043 bed-days per month in the post-EMR period. Infection rate rose at 0.036 infections per 100 patients per month in the pre-EMR period and declined at 0.062 infections per 100 patients per month in the post-EMR period. Mortality rate grew at 0.048 deaths per 1000 patients per month in the pre-EMR period and decreased at 0.005 deaths per 1000 patients per month in the post-EMR period. Cost per patient stay declined at 33 RMB per month in the pre-EMR period and increased at 16 RMB per month in the post-EMR period. Conclusions: The EMR was associated with the declining patterns of length of stay, infection rate, and mortality rate. It had no positive effect on patient costs. [Copyright &y& Elsevier]

Objective: Road traffic injuries (RTIs) have become the leading cause of injury deaths in China. This article analyzed the trends in all crashes, nonfatal injuries, and fatalities from road traffic crashes from 1951 to 2008 and compared the crash frequency, crash severity, and crash patterns by provinces, types of road, and injured road users. Methods: Road traffic crash data were obtained from the Bureau of Traffic Management at the Ministry of Public Security and National Bureau of Statistics of China. Descriptive statistical analyses were conducted. Results: Over the past 5 decades, road traffic injuries have increased substantially in China. From 1951 to 2008, the total number of road traffic crashes, nonfatal injuries, and fatalities increased by 43-fold, 58-fold, and 85-fold, respectively. Linear regression suggested a significant decline of 30.1 percent (95% confidence interval [CI]: 24.8–35.3) in the mortality rate per 100,000 people during the period 2002 to 2008. From 2004 to 2008, road traffic crash mortality rate per 100,000 people varied greatly in China from the lowest of 3.0 in Henan in 2008 to the highest of 21.7 in Xizang in 2004. RTIs in China disproportionally affected the following populations: males, persons 21 to 50 years of age, pedestrians, and motorcyclists/bicyclists. Adults aged more than 65 years accounted for approximately 10 percent of total road traffic deaths. Road types and RTIs severity were closely related; highways were associated with greater mortality rates. Conclusion: Road traffic injuries have become a burgeoning public health problem in China. Programs need to be developed to prevent nonfatal injuries and fatalities caused by road traffic crashes in this emerging country. [ABSTRACT FROM PUBLISHER]

Abstract: Assessment of the effectiveness of protected areas requires information on population characteristics of the target species. This study used a mark-and-recapture approach to examine the population structure, individual growth, and mortality of the commercially harvested short-spined sea urchin Anthocidaris crassispina in a small (18ha) no-take marine reserve and two nearby non-protected sites. Sea urchins were tagged with fluorochrome and recaptured 1 year later. The size-at-age relationship was modelled using the Tanaka function, and mortality estimated using an exponential decay function coupled with the Tanaka growth parameters. The urchin population in the reserve consisted of a higher proportion of older individuals than populations in the two non-protected areas, however, large sea urchins (>50mm) were absent in the reserve. Sea urchins occurring at high densities (>15ind.m−2) in the reserve grew much slower than those outside the reserve, suggesting a density-dependant effect on growth. Growth ring analysis from the rotulae supported the mark-and-recapture results with the maximum number of rings being higher in the reserve than in non-protected sites. Urchins with the same number of growth rings inside the reserve were smaller than those outside the reserve. Within the reserve, urchins with the same number of growth rings were smaller at locations with higher urchin density. Annual mortality rate was lower in the reserve population than in the non-protected populations. These results illustrate the effectiveness of this small reserve in protecting A. crassispina from fishing. However, further study is required to examine whether a high density of small/old individuals is better than a medium density of large individuals in order to maximize the potential spillover of larvae by such small urchin refugia to the surrounding overfished areas. [Copyright &y& Elsevier]

Introduction The population needs for palliative care service are rising. To ensure that prioritized palliative care services are provided in an integrated and sustainable way, the traditional model of hospice with emphasis on in-patient care was gradually transformed to a comprehensive model with an in-patient palliative care unit and ambulatory service. Between 2004 and 2009, seven strategies were implemented in a palliative care unit to optimize the use of in-patient beds and facilitate model shift. Methods This was a retrospective study that examined the service outcomes after implementing strategies in a palliative care unit in Hong Kong. Results A total of 2874 episodes of in-patient palliative care discharges and deaths occurred during the study period. The average length of stay in the unit dropped from 17.9 days in 2004 to 10.8 days in 2009 (P < 0.001). The in-patient bed occupancy rate rose from 88.9% in 2004 to 98% since 2005 (P < 0.001). There were no significant difference in the unplanned re-admission rate as defined by re-admission within 28 days (P = 0.496) and in-patient mortality rate (P = 0.453) over the study period. The out-patient attendances and palliative care coverage were also statistically significant increased over the study period. Conclusion Our experience in operating a palliative care unit with shorter length of stay would not increase the overall unplanned re-admission and mortality rate. Shifting the model of palliative care may be possible to achieve service outcomes. [ABSTRACT FROM AUTHOR]

The objective of our study was to understand the trend of AIDS deaths and the impact of AIDS-related deaths on the local mortality rate in seven villages in Shangcai County, Henan Province. A retrospective study survey among all deaths was conducted through household visits from 1 January 1995 to 31 October 2007 in seven administrative villages in Shangcai County of Henan Province. The cause of death and characteristics of the deceased were analyzed. There were a total of 2546 deaths, of which 521 (20.5%) were HIV/AIDS-related, 525 (20.6%) were suspected AIDS deaths, and 1500 (58.9%) were unrelated HIV/AIDS deaths. The proportion of deaths among people aged 20-49 years was less than 20% from 1995 to 1997, but increased to 27.4% in 1998, and reached 49.2% in 2001, followed by a decrease in succeeding years, dropping to 29.5% in 2007. HIV/AIDS-related and suspected deaths among those aged 20-49 years accounted for 63.9% and 70.9% of all deaths, respectively. The overall mortality rate was 7‰ from 1995 to 1999, and 14.9‰ in 2002. Our study shows that confirmed HIV/AIDS-related deaths and suspected AIDS deaths were the main cause of deaths at the local level after 1998, especially among those aged 20-49. [ABSTRACT FROM AUTHOR]

Shantou, China, is one of the endemic regions of esophageal cancer (EC) in the coastal areas, but the relationship between the multiple exposures of total N-nitroso compounds (TNOCs) and the high risk of EC to date is unclear. This study is to estimate the potential integrative role of multiple exposures of environmental and endogenous TNOC on the EC risk. We collected randomly the samples of 72 h diet and 24 h urine from 256 healthy male (aged 30–65 years) in the high- and low-risk area for EC, and determined the contents of TNOC and 4 N-nitrosamino acids (NAAs) by a method of chemical fission-Thermal Energy Analyzer (TEA) and gas chromatography — TEA, respectively. We used TNOC and NAAs index to evaluate the integrative effect of multiple TNOC exposures on the EC risk by a logistic model. TNOC intake and urinary TNOC content were higher in the high-risk subjects than that in the low-risk subjects by 1.60 μmol/day and 1.45 μmol/L, respectively. TNOC intake, urinary TNOC content and its interaction were significant factors involved in the higher risk of EC (R 2 =0.685, p =0.000) with predicted Correct Class of 85.6%. The risk of the occurrence of a larger SMR of EC may increase by 4.841-fold for every 1 μmol/day increase in TNOC intake (95% CI 2.370–9.888, p =0.000) and by 4.113-fold for every 1 μmol/L increase in urinary TNOC content (95% CI 2.108–8.023, p =0.000), respectively. The integrally role of multiple exposures of TNOC in environment and in vivo may increase the risk of EC in the coastal areas in eastern Guangdong, China. [Copyright &y& Elsevier]

Purpose: To examine age-related effects of smoking on lung cancer mortality in a large population-based case-control study that was incorporated into a nationwide retrospective survey of mortality in China. Methods: Two data sets were pooled for this analysis: national mortality survey data and data from a nationwide case-control comparison. These pooled data were used to calculate age-specific lung cancer death rates by smoking status and expected years of lost life expectancy for each smoking-associated death. Results: There was a significant excess of deaths (54% of urban deaths, 51% of rural deaths) at 35 to 69 years of age among male smokers and the average loss of life expectancy per smoking-associated death at these ages was 18.3 years. For women ages 35 to 69 years of age, 29% and 11% excess lung cancer mortality was observed in urban and rural smokers, respectively, with an average loss of life expectancy per smoking-associated death of 21.3 years. Conclusions: Tobacco smoking was associated with a large number of deaths from lung cancer. Utilizing information from a population-based retrospective mortality survey for conducting an analytic epidemiological study of main determinants of disease is feasible and can generate important results. [Copyright &y& Elsevier]

PM 2.5 pollution in China is becoming increasingly severe, threatening public health. The major goal of this study is to evaluate the mortality rate attributed to PM 2.5 pollution and design pollution mitigation schemes in a southern district of China through a two-objective optimization model. The mortality rate is estimated by health effect evaluation model. Subjected to limited data information, it is assumed that the meta-analysis method, through summarizing and combining the research results on the same subject, was suitable to estimate the percentage of deaths caused by PM 2.5 pollution. The critical parameters, such as the total number of deaths and the background concentration of PM 2.5 , were obtained through on-site survey, data collection, literature search, policy analysis, and expert consultation. The equations for estimating the number of deaths caused by PM 2.5 pollution were established by incorporating the relationship coefficient of exposure to reaction, calculated residual PM 2.5 concentration of affected region, and statistical total base number of deaths into a general framework. To balance the cost from air quality improvement and human health risks, a two-objective optimization model was developed. The first objective is to minimize the mortality rate attributable to PM 2.5 pollution, and the second objective is to minimize the total system cost over three periods. The optimization results demonstrated that the combination of weights assigned to the two objectives significantly influenced the model output. For example, a high weight value assigned to minimizing the number of deaths results in the increased use of treatment techniques with higher efficiencies and a dramatic decrease in pollutant concentrations. In contrast, a model weighted more toward minimizing economic loss may lead to an increase in the death toll due to exposure to higher air pollution levels. The effective application of this model in the Nanshan District of Shenzhen City, China, is expected to serve as a basis for similar work in other parts of the world in the future.