Background The trends of COPD mortality and prevalence over the past 2 decades across all provinces remain unknown in China. We used data from the Global Burden of Disease Study 2013 (GBD 2013) to ...estimate the mortality and prevalence of COPD during 1990 to 2013 at a provincial level. Methods Following the general analytic strategy used in GBD 2013, we analyzed the age- sex- and province-specific mortality and prevalence of COPD in China. Levels of and trends in COPD mortality and prevalence were assessed for 33 province-level administrative units during 1990 to 2013. Results In 2013, there were 910,809 deaths from COPD in China, accounting for 31.1% of the total deaths from COPD in the world. From 1990 to 2013, the age-standardized COPD mortality rate decreased in all provinces, with the highest reduction in Heilongjiang (70.2%) and Jilin (70.0%) and the lowest reduction in Guizhou (26.8%). In 2013, the death rate per 100,000 was highest in Guizhou (196.0) and lowest in Tianjin (34.0) among men and highest in Gansu (141.1) and lowest in Beijing (23.7) among women. The number of COPD cases increased dramatically from 32.4 million in 1990 to 54.8 million in 2013. The age-standardized prevalence rate of COPD remained stable overall and varied little for all provinces. Conclusions COPD remains a huge health burden in many western provinces in China. The substantial increase in COPD cases represents an ongoing challenge given the rapidly aging Chinese population. A targeted control and prevention strategy should be developed at a provincial level to reduce the burden caused by COPD.
Abstract Background Research in the USA and in west European countries has shown that long-term exposure to fine particles (PM2.5) is associated with an increased risk of mortality from ...cardiovascular disease, but no such studies have been done in China to date. We have estimated the association between long-term exposure to PM2·5 and cardiovascular mortality from cardiovascular disease in a cohort of Chinese men. Methods For this prospective cohort study, we monitored men aged 40–79 years from 44 counties or cities in China since 1990–91. Annual average PM2·5 levels for the years 2000 and 2005 were estimated for each of the 44 cohort locations using a combination of satellite-based estimates, chemical transport models, and ground-level measurements developed for the Global Burden of Disease study. We used a Cox proportionate hazards regression model to estimate hazard ratios (HR) for cardiovascular mortality during 15 years of follow-up, adjusting for age, urbanicity (ie, urban vs rural), smoking status, alcohol consumption, and body-mass index (BMI). This study was approved by the ethics committee of Chinese Center for Disease Control and Prevention. Findings 186 399 men were included in the cohort. 52 000 deaths were reported during the 15 years of follow-up, of which 18 773 (36%) were due to cardiovascular disease, which included 3726 deaths from ischaemic heart disease, 6765 deaths from haemorrhagic stroke, and 2688 deaths from ischaemic stroke. The mean PM2·5 concentration between year 2000 and 2005 was 43·7 μg/m3 and ranged from 4·2 μg/m3 to 83·8 μg/m3 . An increase in PM2·5 of 10 μg/m3 was associated with a 9·7% increase in the risk of mortality from ischaemic heart disease (HR 1·097, 95% CI 1·079–1·116), a 4·4% increase in the risk of mortality from haemorrhagic stroke (HR 1·044, 95% CI 1·031–1·057), and a 13·5% increase in the risk of mortality from ischaemic stroke (HR 1·135, 95% CI 1·113–1·158). Interpretation This study estimated cardiovascular mortality risk associated with exposure to ambient PM2·5 over a broader range than in previous studies, including the high levels currently observed in China and other low-income and middle-income countries. Long-term exposure to PM2·5 was associated with cause-specific cardiovascular mortality in Chinese men. Relative risks were comparable to those reported in studies in high-income Western countries. As limitations of the study, we only included men in our cohort, and we were not able to assess the effect of within-city air pollution contrasts on mortality because personal exposure measurements were not available during the period of follow-up. Funding This study was supported by the National Basic Research Program of China (“973 Program”, number 2012CB955500) and Gong-Yi Program of China Ministry of Environmental Protection (201402022).
Summary Background China has experienced a remarkable epidemiological and demographic transition during the past three decades. Far less is known about this transition at the subnational level. ...Timely and accurate assessment of the provincial burden of disease is needed for evidence-based priority setting at the local level in China. Methods Following the methods of the Global Burden of Disease Study 2013 (GBD 2013), we have systematically analysed all available demographic and epidemiological data sources for China at the provincial level. We developed methods to aggregate county-level surveillance data to inform provincial-level analysis, and we used local data to develop specific garbage code redistribution procedures for China. We assessed levels of and trends in all-cause mortality, causes of death, and years of life lost (YLL) in all 33 province-level administrative units in mainland China, all of which we refer to as provinces, for the years between 1990 and 2013. Findings All provinces in mainland China have made substantial strides to improve life expectancy at birth between 1990 and 2013. Increases ranged from 4·0 years in Hebei province to 14·2 years in Tibet. Improvements in female life expectancy exceeded those in male life expectancy in all provinces except Shanghai, Macao, and Hong Kong. We saw significant heterogeneity among provinces in life expectancy at birth and probability of death at ages 0–14, 15–49, and 50–74 years. Such heterogeneity is also present in cause of death structures between sexes and provinces. From 1990 to 2013, leading causes of YLLs changed substantially. In 1990, 16 of 33 provinces had lower respiratory infections or preterm birth complications as the leading causes of YLLs. 15 provinces had cerebrovascular disease and two (Hong Kong and Macao) had ischaemic heart disease. By 2013, 27 provinces had cerebrovascular disease as the leading cause, five had ischaemic heart disease, and one had lung cancer (Hong Kong). Road injuries have become a top ten cause of death in all provinces in mainland China. The most common non-communicable diseases, including ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and cancers (liver, stomach, and lung), contributed much more to YLLs in 2013 compared with 1990. Interpretation Rapid transitions are occurring across China, but the leading health problems and the challenges imposed on the health system by epidemiological and demographic change differ between groups of Chinese provinces. Localised health policies need to be implemented to tackle the diverse challenges faced by local health-care systems. Funding China National Science & Technology Pillar Program 2013 (2013BAI04B02) and Bill & Melinda Gates Foundation.
