To provide a comprehensive overview of poisoning mortality patterns in China.Using mortality data from the Chinese national disease surveillance points system, we examined trends in poisoning mortality by intent and substance from 2006 to 2016. Differences over time between urban and rural residents among different age groups and across external causes of poisoning were quantified using negative binomial models for males and females separately.In 2016, there were 4936 poisoning deaths in a sample of 84 060 559 people (5.9 per 100 000 people; 95% confidence interval: 5.6-6.2). Age-adjusted poisoning mortality dropped from 9.2 to 5.4 per 100 000 people between 2006 and 2016. Males, rural residents and older adults consistently had higher poisoning mortality than females, urban residents and children or young adults. Most pesticide-related deaths (34 996 out of 39 813) were suicides among persons older than 15 years, although such suicides decreased between 2006 and 2016 (from 6.1 per 100 000 people to 3.6 for males and from 5.8 to 3.0 for females). In 2016, alcohol caused 29.3% (600/2050) of unintentional poisoning deaths in men aged 25-64 years. During the study period, unintentional fatal drug poisoning by narcotics and psychodysleptics in individuals aged 25-44 years increased from 0.4 per 100 000 people to 0.7 for males and from 0.05 to 0.13 for females.Despite substantial decreases in mortality, poisoning is still a public health threat in China. This warrants further research to explore causative factors and to develop and implement interventions targeting at-risk populations.Offrir un aperçu détaillé des schémas de mortalité par empoisonnement en Chine.À partir de données sur la mortalité provenant du système national chinois à points pour la surveillance des maladies, nous avons examiné les tendances de la mortalité par empoisonnement, suivant les intentions et les substances, de 2006 à 2016. Les différences au fil du temps entre résidents urbains et ruraux, de différentes tranches d'âge et pour différentes causes externes d'empoisonnement, ont été quantifiées à l'aide de modèles binomiaux négatifs, en séparant les hommes et les femmes.En 2016, on a compté 4936 empoisonnements mortels sur un échantillon de 84 060 559 personnes (5,9 pour 100 000 habitants; intervalle de confiance de 95%: 5,6–6,2). La mortalité par empoisonnement ajustée en fonction de l'âge est passée de 9,2 à 5,4 pour 100 000 habitants entre 2006 et 2016. Les hommes, les résidents ruraux et les adultes les plus âgés affichaient systématiquement une mortalité par empoisonnement supérieure à celle des femmes, des résidents urbains et des enfants ou jeunes adultes. La plupart des décès dus à des pesticides (34 996 sur 39 813) étaient des suicides de personnes de plus de 15 ans, bien que ce type de suicides ait diminué entre 2006 et 2016 (passant de 6,1 à 3,6 pour 100 000 habitants chez les hommes et de 5,8 à 3,0 chez les femmes). En 2016, l'alcool a causé 29,3% (600/2050) des empoisonnements mortels involontaires chez les hommes de 25 à 64 ans. Durant la période étudiée, les empoisonnements mortels involontaires dus à des narcotiques et des psychodysleptiques chez les personnes âgées de 25 à 44 ans sont passés de 0,4 à 0,7 pour 100 000 habitants chez les hommes et de 0,05 à 0,13 chez les femmes.En dépit de fortes baisses de la mortalité, les empoisonnements restent une menace pour la santé publique en Chine. Cela justifie de mener des recherches plus poussées afin d’étudier les facteurs qui en sont à l'origine et d’élaborer puis de déployer des interventions axées sur les populations à risque.Ofrecer una visión general integradora de los patrones de mortalidad por intoxicación en China.Utilizando datos de mortalidad del sistema nacional chino de puntos de vigilancia de enfermedades, examinamos las tendencias en la mortalidad por intoxicación con intención y fundamento de 2006 a 2016. Se cuantificaron las diferencias en el tiempo entre los residentes urbanos y rurales para diferentes grupos por edades y considerando causas externas de intoxicación, utilizando modelos binomiales negativos para hombres y mujeres de forma independiente.En 2016, hubo 4936 muertes por intoxicación en una muestra de 84 060 559 personas (5,9 por cada 100 000 personas; intervalo de confianza del 95%: 5,6–6,2). La mortalidad por intoxicación ajustada por edades disminuyó de 9,2 a 5,4 por cada 100 000 personas entre 2006 y 2016. Los hombres, los habitantes de zonas rurales y los adultos mayores tuvieron una mortalidad superior por intoxicación comparado con las mujeres, los habitantes de zonas urbanas y los niños o adultos jóvenes. La mayoría de las muertes relacionadas con pesticidas (34 996 de 39 813) fueron suicidios entre personas mayores de 15 años, aunque estos suicidios disminuyeron entre 2006 y 2016 (de 6,1 por cada 100 000 personas a 3,6 en los hombres y de 5,8 a 3,0 en las mujeres). En 2016, el alcohol provocó el 29,3% (600/2050) de las muertes por intoxicación no intencionadas en hombres entre las edades de 25 y 64 años. Durante el periodo de estudio, la intoxicación fatal con fármacos no intencionada por narcóticos y psicodislépticos en individuos entre las edades de 25 y 44 años aumentó de 0,4 por cada 100 000 personas a 0,7 en los hombres y de 0,05 a 0,13 en las mujeres.A pesar de la disminución sustancial en la mortalidad, la intoxicación sigue siendo una amenaza para la salud pública en China. Esto justifica más investigaciones para explorar factores causales y desarrollar e implementar intervenciones orientadas a las poblaciones en riesgo.تقديم نظرة شاملة لأنماط الوفيات الناتجة عن التسمم في الصين.من خلال استخدامنا لبيانات الوفيات من نظام النقاط الوطني الصيني لمراقبة الأمراض، قمنا بفحص النزعات السائدة في حالات وفيات التسمم من حيث القصد والمضمون من عام 2006 إلى عام 2016. وقد تم قياس الاختلافات على مدى فترات من الزمن بين سكان الحضر والريف وذلك ضمن فئات عمرية مختلفة وعبر أسباب خارجية للتسمم باستخدام نماذج ثنائية سلبية للذكور والإناث بشكل منفصل. : النتائج في عام 2016 كانت هناك 4936 حالة وفاة ناتجة عن التسمم في عينة مكونة من 84060559 شخصًا (بواقع 5.9 لكل 100 ألف شخص؛ وبنسبة أرجحية مقدارها 95%: 5.6–6.2). وقد انخفض معدل الوفيات المعدلة حسب العمر والناتجة عن التسمم من 9.2 إلى 5.4 لكل 100 ألف شخص بين عامي 2006 و2016. وقد وُجد أن حالات الوفيات الناتجة عن التسمم مرتفعة بشكل ثابت لدى الذكور وسكان الريف والبالغين الأكبر سنًا مقارنًة بالإناث وسكان الحضر والأطفال أو البالغين الأصغر سنًا. وقد كانت معظم الوفيات المرتبطة بمبيد الآفات (34996 من بين 39813) هي حالات انتحار بين أشخاص تزيد أعمارهم عن 15 عامًا، على الرغم من انخفاض هذه الحالات ما بين عامي 2006 و2016 (من 6.1 لكل 100 ألف شخص إلى 3.6 للذكور ومن 5.8 إلى 3.0 للإناث). وفي عام 2016 تسبب الكحول في نسبة 29.3% (600/2050) من حالات الوفيات غير المقصودة الناتجة عن التسمم بين الرجال الذين تتراوح أعمارهم من 25 إلى 64 عامًا. وخلال فترة الدراسة ارتفعت حالات تسمم العقاقير القاتل وغير المقصود بفعل العقاقير المخدرة وعقاقير الهلوسة لدى الأشخاص الذين تتراوح أعمارهم ما بين 25 و44 عامًا من 0.4 لكل 100 ألف شخص إلى 0.7 للذكور ومن 0.05 إلى 0.13 للإناث.بالرغم من الانخفاض الكبير في حالات الوفيات فإن التسمم لازال يمثل تهديدًا للصحة العامة في الصين، الأمر الذي يستدعي ضرورة إجراء المزيد من الأبحاث لاستكشاف العناصر المسببة وتطوير وتنفيذ التدخلات التي تستهدف القطاعات السكانية المعرضة للخطر.旨在全面综述中国中毒死亡概况。.我们采用《中国疾病监测系统死因监测数据集》，根据意图和物质分类研究了 2006 年至 2016 年间的中毒死亡趋势。我们分别针对男性和女性采用了负二项模型，对不同年龄段城市和农村居民及中毒的外部原因随着时间的差异变化进行了量化。.在 2016 年，84 060 559 人的样本中共有 4936 人中毒死亡（每 100 000 人中有 5.9 人；95% 置信区间：5.6–6.2）。2006 至 2016 年间，年龄标准化中毒死亡率从每 100 000 人中有 9.2 人降至 5.4 人。男性、农村居民和老年人群的中毒死亡率始终高于女性、城市居民和儿童或青壮年人群的中毒死亡率。大部分与杀虫剂有关的自杀死亡（39 813 例中有 34 996 例）发生于 15 岁以上人群，尽管此类自杀在 2006 至 2016 年间有所减少（男性死亡人数从每 100 000 人中由 6.1 人降至 3.6 人，女性死亡人数从 5.8 人降至 3.0 人）。在 2016 年，年龄在 25 岁至 64 岁之间的男性由于酒精而引起事故性中毒死亡的概率为 29.3%（600/2050）。本次研究期间，年龄在 25 岁至 44 岁之间的男性人群发生事故性致命药物（麻醉品和致幻药）中毒死亡的比例从每 100 000 人中有 0.4 人增至 0.7 人，女性从 0.05 人增至 0.13 人。.尽管由于中毒导致的死亡率已显著降低，但在中国，中毒仍旧会对公共健康造成威胁。有必要开展进一步的研究以探索诱发因素并制定和实施针对有中毒死亡风险人群的干预措施。.Предоставить всесторонний обзор показателей смертности в результате отравления в Китае.Используя данные о смертности, полученные из национальной системы эпиднадзора Китая, авторы изучили тенденции смертности в результате отравления по фактору преднамеренности и по отравляющему веществу с 2006 по 2016 год. Динамика различий между городскими и сельскими жителями среди разных возрастных групп, а также по внешним причинам отравления определялась количественно с использованием отрицательных биномиальных моделей отдельно для мужчин и женщин.В 2016 году было зарегистрировано 4936 случаев летального исхода в результате отравления в выборке из 84 060 559 человек (5,9 на 100 000 человек, 95%-й ДИ: 5,6–6,2). В период с 2006 по 2016 год стандартизированный по возрасту уровень смертности в результате отравления снизился с 9,2 до 5,4 на 100 000 человек. Мужчины, сельские жители и пожилые люди равным образом имели более высокий уровень смертности в результате отравления, чем женщины, жители городов, дети или молодые люди. Причиной большинства случаев летального исхода в результате отравления пестицидами (34 996 из 39 813) было самоубийство среди лиц старше 15 лет, хотя количество таких самоубийств снизилось в период между 2006 и 2016 годами (с 6,1 на 100 000 человек до 3,6 для мужчин и с 5,8 до 3,0 для женщин). В 2016 году алкоголь был причиной 29,3% случаев (600/2050) непреднамеренной смерти в результате отравления у мужчин в возрасте 25–64 лет. В течение периода исследования количество случаев непреднамеренного отравления лекарствами и наркотическими веществами с летальным исходом у лиц в возрасте 25–44 лет увеличилось с 0,4 на 100 000 человек до 0,7 для мужчин и с 0,05 до 0,13 для женщин.Несмотря на значительное снижение смертности, отравление по-прежнему представляет угрозу для общественного здравоохранения в Китае. Это требует дальнейших исследований для изучения причинно-следственных факторов, а также для разработки и реализации мероприятий, ориентированных на группы риска.
Objectives - To examine the modification of temperature-mortality association by factors at the individual and community levels.
Design and methods - This study investigated this issue using a national database comprising daily data of 66 Chinese communities for 2006–2011. A ‘threshold-natural cubic spline’ distributed lag non-linear model was utilised to estimate the mortality effects of daily mean temperature, and then examined the modification of the relationship by individual factors (age, sex, education level, place of death and cause of death) using a meta-analysis approach and community-level factors (annual temperature, population density, sex ratio, percentage of older population, health access, household income and latitude) using a meta-regression method.
Results - We found significant effects of high and low temperatures on mortality in China. The pooled excess mortality risk was 1.04% (95% CI 0.90% to 1.18%) for a 1°C temperature decrease below the minimum mortality temperature (MMT), and 3.44% (95% CI 3.00% to 3.88%) for a 1°C temperature increase above MMT. At the individual level, age and place of death were found to be significant modifiers of cold effect, while age, sex, place of death, cause of death and education level were effect modifiers of heat effect. At the community level, communities with lower socioeconomic status and higher annual temperature were generally more vulnerable to the mortality effects of high and low temperatures.
Conclusions - This study identifies susceptibility based on both individual-level and community-level effect modifiers; more attention should be given to these vulnerable individuals and communities to reduce adverse health effects of extreme temperatures.
At present, most iris segmentation methods based on deep learning have poor robustness in the face of iris images collected in non-cooperative environments (with partial occlusion, distortion, etc.), and their performance decreases to varying degrees. Inspired by the visual transformer (ViT), we combined the advantages of the ViT and ConvNeXts networks to propose a deep learning-based robust iris segmentation method called CINet. Specifically, we introduced global region aware (GRA) in ConvNeXts to capture global spatial information. It increases the sensitivity of the model to the inner and outer boundaries of the iris, achieving efficient iris segmentation. In addition, it also suppresses noise information irrelevant to the iris region, thus improving the robustness of the model. We used global channel normalization instead of batch normalization, which suppresses some unimportant channel information, further enhancing the network’s performance. Experimental results demonstrate that GRA provides important feature information, which is essential for efficient iris segmentation. We verify the effectiveness of the proposed method on three benchmark iris datasets.
IntroductionCancer is an important public health concern with heavy disease burden in China. In 2017, cancer is the leading cause of death, with around 2.60 million deaths, which accounts for 26.07% of all deaths. This study aims to present cancer mortality in China in 2018 to provide evidence for cancer control and prevention.
MethodsMortality data from China Cause of Death Reporting System (CDRS) and population data from National Bureau of Statistics are used for cancer mortality estimation. A descriptive analysis was conducted to demonstrate the results.
ResultsA total of 2,557,297 cancer deaths were estimated in China in 2018 with a mortality rate and age-standardized mortality rate of 183.89 and 145.60 per 100,000, respectively. Lung, liver, and stomach cancer were the three leading causes of cancer death and accounted for around 56.75% of all cancer deaths. The age-standardized mortality rate was higher in men (194.37 per 100,000) than in women (99.47 per 100,000), in urban areas (148.25 per 100,000) than in rural areas (144.62 per 100,000), and in eastern regions (150.57 per 100,000) than in central (142.09 per 100,000)/western regions (141.54 per 100,000). The age-specific mortality rate remains low for the population younger than 44 years old and reaches its peak after 80 years old. Leukemia is the leading cause of cancer death among those aged 0–14 years in both sexes, while breast cancer is the leading cause of cancer death in women aged 15–44 years.
Conclusions and Implications for Public Health PracticeThe cancer mortality patterns show substantial disparities among sexes, age groups, areas, and regions. Healthy lifestyle promotion, active vaccination uptake, and environmental governance are essential to eliminate cancer-related risk factors in the overall population. Tailored strategies for the early screening and diagnosis, therapeutic management, and palliative care should be a top priority for enforcement among target populations and regions.
Background: Disability weights (DWs) is basically pivotal parameter for disease burden calculation and to quantify the severity of health states from disease sequela. This study aimed to conduct a big survey and construct national and subnational DWs in mainland China and its provinces, and evaluate if the characteristics of age, sex, disease experience status, etc. have an impact on the valuation of these DWs.Methods: We conducted a web-based survey to assess DWs for 206 health states in 31 Chinese provinces in 2020-2021. We used two versions of DW questionnaire. The first version consisted of 16 paired comparison (PC) and 3 population health equivalence (PHE) questions; the second included 3 PC and 4 PHE questions. The health states that were depicted in the PC and PHE questions were randomly assigned to each respondent. The PC data was analyzed by probit regression analysis, and the regression results were anchored by results from the PHE responses on the DW scale units between 0 (no loss of health) and 1 (loss equivalent to death). The Pearson correlation analysis was performed for the probit coefficients between provinces and within province by participants’ characteristics.Findings: We considered 468 541 nationally representative respondents. The national DWs were bounded by mild distance vision impairment or mild anemia (0·009 [95% UI 0·0003-0·057]) and severe heroin and other opioid dependence (0·752, 0·640-0·841). In subnational analysis, we observed good PC responses and high correlations by province compared with the national data (p < 0·001): the lowest DW in distance vision mild impairment or mild anemia ranged from 0·008 (Henan and Ningxia) to 0·013 (Xinjiang) and the highest DW in severe heroin and other opioid dependence with a range of 0·693 (Henan)-0·813(Ningxia). Most of Chinese DWs for diabetes and digestive and genitourinary disease, mental, behavioural, and substance use disorders, hearing and vision loss, and disfigurement were larger than the GBD 2013 DW. The liner regression showed health states with mobility, mental and pain symptoms were significantly associated with lower DW in China compared with GBD 2013 and Japan; pain and sensory symptom with a higher Japanese DW than GBD 2013. Despite there are considerable disagreement, the DWs from the three regions are all highly correlated (p < 0·001). we put insights in other factors that might impact the valuation and found a slightly lower correlation of the probit coefficients between provinces (range rs: 0·980–0·997) than between medical background (rs = 0·985), profession (range rs = 0·987-0·998), income levels (range rs: 0·991–0·998), age groups (range rs: 0·992–0·998), educational level (rs: 0·991), sex (rs = 0·997) and disease status (rs = 0·998) (p< 0·001). Importantly, within province the lowest correlations of the probit coefficients were between low and high income level (range rs: 0·847–0·985, p < 0·001).Interpretation: This study created an empirical basis for national and subnational DW measurement in China. The considerable differences suggest that there might be contextual differences in evaluating the severity of health states between GBD regions and China, even among Asian countries. Apart from contextual differences, we found variations between income levels in health valuation within province, thus the effect of income level might be considered into valuating the severity of disease sequela.Funding Information: This work was supported by the National Key Research and Development Program of China [grant numbers 2018YFC1315302], the National Natural Science Foundation of China [grant number 81773552], and Wuhan Medical Research Program of Joint Fund of Hubei Health Committee [grant number WJ2019H304].Declaration of Interests: All other authors declare no competing interests.Ethics Approval Statement: This study was approved by the Ethics Committee of Medical Department of Wuhan University (2019YF2055), and a waiver of written informed consent obtained from participants prior to web-based survey participation was approved.
We investigated temporal trends and geographical variations in lung cancer mortality in China from 2006 to 2012. Lung cancer mortality counts for people aged over 40 years were extracted from the China Mortality Surveillance System for 161 disease surveillance points. Negative binomial regression was used to investigate potential spatiotemporal variation and correlations with age, gender, urbanization, and region. Lung cancer mortality increased in China over the study period from 78.77 to 85.63 (1/100,000), with higher mortality rates evident in men compared to women. Median rate ratios (MRRs) indicated important geographical variation in lung cancer mortality between provinces (MRR = 1.622) and counties/districts (MRR = 1.447). On average, lung cancer mortality increased over time and was positively associated with county-level urbanization (relative risk (RR) = 1.15). Lung cancer mortality seemed to decrease in urban and increase in rural areas. Compared to the northwest, mortality was higher in the north (RR = 1.98), east (RR = 1.87), central (RR = 1.87), and northeast (RR = 2.44). Regional differences and county-level urbanization accounted for 49.4% and 8.7% of provincial and county variation, respectively. Reductions in lung cancer mortality in urban areas may reflect improvements in access to preventive healthcare and treatment services. Rising mortality in rural areas may reflect a clustering of risk factors associated with rapid urbanization.
Cardiovascular disease (CVD) is the leading cause of death (COD) in China. Understanding the characteristics of place of death (POD) among CVD deaths would be of great importance to evaluate the healthcare service utilization at the end stage of life. Limited studies have reported the POD distribution among CVD deaths, and little was known about the associated factors of hospital CVD deaths.By using data from National Mortality Surveillance System (NMSS) in China, this study presented the characteristics of POD distribution during 2008 and 2020. Afterwards, multilevel logistic regression was used to explore associated factors of hospital CVD deaths and quantify the magnitude to which the spatial variations of hospital CVD deaths could be explained by those associated factors.During 2008-2020, there was 7101871 CVD deaths collected by NMSS in China, with 77·13% home deaths and 18·49% hospital deaths. Shanghai (59·40%) had the highest percentage of hospital CVD deaths. Age, sex, ethnicity, marital status, education, occupation, underlying COD were significant influential factors of hospital CVD deaths. Spatial variations were shown at provincial level, with 33·88% of them being explained by factors at individual level.Home was the leading POD among CVD deaths in China, those CVD decedents characterized as the female, the youngest, Han population, the married, the retiree, lived in urban areas, with higher socioeconomic status and died of chronic CVDs had a higher probability of hospital deaths. Providing accessible and available healthcare services were priorities to improve quality of end-of-life care, significant variations among provinces and sub-population also reminded us of the requirements for equal healthcare resources allocation and multiple options for minorities of POD preference at the end stage of life.National Key Research & Development Program of China (grant number 2018YFC1315301).
BackgroundThe estimation of influenza-associated excess mortality in countries can help to improve estimates of the global mortality burden attributable to influenza virus infections. We did a study to estimate the influenza-associated excess respiratory mortality in mainland China for the 2010–11 through 2014–15 seasons.MethodsWe obtained provincial weekly influenza surveillance data and population mortality data for 161 disease surveillance points in 31 provinces in mainland China from the Chinese Center for Disease Control and Prevention for the years 2005–15. Disease surveillance points with an annual average mortality rate of less than 0·4% between 2005 and 2015 or an annual mortality rate of less than 0·3% in any given years were excluded. We extracted data for respiratory deaths based on codes J00-J99 under the tenth edition of the International Classification of Diseases. Data on respiratory mortality and population were stratified by age group (age <60 years and ≥60 years) and aggregated by province. The overall annual population data of each province and national annual respiratory mortality data were compiled from the China Statistical Yearbook. Influenza surveillance data on weekly proportion of samples testing positive for influenza virus by type or subtype for 31 provinces were extracted from the National Sentinel Hospital-based Influenza Surveillance Network. We estimated influenza-associated excess respiratory mortality rates between the 2010–11 and 2014–15 seasons for 22 provinces with valid data in the country using linear regression models. Extrapolation of excess respiratory mortality rates was done using random-effect meta-regression models for nine provinces without valid data for a direct estimation of the rates.FindingsWe fitted the linear regression model with the data from 22 of 31 provinces in mainland China, representing 83·0% of the total population. We estimated that an annual mean of 88 100 (95% CI 84 200–92 000) influenza-associated excess respiratory deaths occurred in China in the 5 years studied, corresponding to 8·2% (95% CI 7·9–8·6) of respiratory deaths. The mean excess respiratory mortality rates per 100 000 person-seasons for influenza A(H1N1)pdm09, A(H3N2), and B viruses were 1·6 (95% CI 1·5–1·7), 2·6 (2·4–2·8), and 2·3 (2·1–2·5), respectively. Estimated excess respiratory mortality rates per 100 000 person-seasons were 1·5 (95% CI 1·1–1·9) for individuals younger than 60 years and 38·5 (36·8–40·2) for individuals aged 60 years or older. Approximately 71 000 (95% CI 67 800–74 100) influenza-associated excess respiratory deaths occurred in individuals aged 60 years or older, corresponding to 80% of such deaths.InterpretationInfluenza was associated with substantial excess respiratory mortality in China between 2010–11 and 2014–15 seasons, especially in older adults aged at least 60 years. Continuous and high-quality surveillance data across China are needed to improve the estimation of the disease burden attributable to influenza and the best public health interventions are needed to curb this burden.FundingNational Science Fund for Distinguished Young Scholars, National Science and Technology Major Project of China, National Institute of Health Research, the Harvard Center for Communicable Disease Dynamics from the National Institute of General Medical Sciences, and the China-US Collaborative Program on Emerging and Re-emerging Infectious Disease.
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