Objective: It was recommended that the diagnosis of hypertension among children should be established on at least three separate occasions. However, the national prevalence of hypertension after three separate occasions was scant in China. The goal of our study was to determine the prevalence of hypertension on up to three separate visits in a Chinese pediatric population, and examined the association between hypertension and weight status. Design and Method: Data were obtained from a national representative sample of 43304 children aged 6–17 years. Initial measurements included height, weight, and three oscillometric blood pressure readings. Repeat measurements were obtained on two subsequent occasions in children with persistently elevated blood pressure. Hypertension was defined as elevated blood pressure on three separate occasions. Non-overweight, overweight and obese status was evaluated based on age- and sex-specific BMI percentiles as recommended by the International Obesity Task Force. Trend in prevalence of hypertension on different weight status was assessed by multiple logistical regression model controlling for sex, age and other covariates. Results: The prevalence of elevated blood pressure on three separate occasions decreased dramatically (16.6%, 7.3% and 4.2%). Isolated systolic hypertension was the most frequent subtype of childhood hypertension (67.4%). The prevalence of hypertension after three separate occasions increased significantly with increasing weight status (P < 0.001). Conclusions: Our study indicates the importance of confirming hypertension on multiple separate occasions and demonstrates that isolated systolic hypertension occurs commonly in childhood. In addition, preventing obesity is the key to promote cardiovascular health in childhood.
Previous studies have provided inconsistent findings on smoking among migrants, and very limited data exist on their second-hand smoke exposure. This study aims to investigate internal migrants' smoking prevalence, second-hand smoke exposure among non-smokers, and knowledge of the health hazards of smoking in 12 major migrant provinces in China in 2013. Data from the 2013 Migrant Dynamics Monitoring Survey in China published by the National Commission of Health and Family Planning was used in this study. Descriptive analysis, Chi-square analysis, and sex-stratified multivariate logistic regression analysis were used to explore the determinants of current smoking and second-hand smoke exposure. Among 7200 migrants, 34.1% (55% male, 4% female) were current smokers. For males, factors associated with current smoking were education year (aOR = 0.95, 95% CI: 0.93–0.98), duration of stay (aOR = 1.01, 95% CI: 1.00–1.03) and occupation (aOR = 1.25, 95% CI: 1.03–1.53). For females, household registration status (aOR = 1.70, 95% CI: 1.04–2.80) was the most important factor associated with current smoking. Sixty five percent of non-smokers were exposed to second-hand smoke. Factors associated with exposure to second-hand smoke were duration of stay (aOR = 1.01, 95% CI: 1.00–1.02), divorced/widowed marital status (aOR = 0.48, 95% CI: 0.25–0.91), occupation (aOR = 1.29, 95% CI: 1.05–1.58) and the nature of employer (aOR = 0.77, 95% CI: 0.60–0.97). About 95% of participants were aware that lung cancer is one of the hazards of smoking. Non-current smokers had a better knowledge of fertility reduction and accelerated aging as hazards of smoking than current smokers (p < 0.01). Knowledge of the impact of smoking on cardiovascular diseases was relatively low compared with knowledge of other smoking-related hazards (26.1–44.3%). Current smoking and exposure to second-hand smoke among internal migrants in China is high. Socio-demographic characteristics and migration status were strongly associated with current smoking and second-hand smoke exposure. We recommend specifically targeted tobacco control interventions to help to address these risk factors, such as focusing on divorced/widowed women.
Objective: The American Heart Association's (AHA) 2020 Strategic Goals defined a new concept of cardiovascular health (CVH) for adults and children, emphasizing the importance of early prevention of risk factors. CV disease risk factors track from childhood to adulthood, which should be closely monitored over time. However, detailed data on the trends in CVH among children are sparse. Therefore, by adopting the construct from the AHA, the present study seeks to evaluate the changes of ideal CVH, as well as each component, among Chinese children and adolescents in Beijing. Design and Method: We used data from cross-sectional surveys conducted in 2004 and 2014 including 5,596 children and adolescents aged 6–18years. Ideal CVH was defined as meeting all ideal levels of the following components: four behaviors (smoking, body mass index, physical activity and diet) and three factors (total cholesterol, blood pressure and glucose). Results: Almost all ideal CVH components decreased from 2004 through 2014 among children and adolescents in Beijing, while the prevalence of ideal physical activity increased (from 19.6% [95% CI, 18.3%–20.9%] to 47.6% [95% CI, 45.1%–50.1%]; p < 0.001). The prevalence of children meeting all seven CVH metrics was low, and declined from 2.5% [95% CI, 2.0%–3.1%] to 1.0% [95% CI, 0.4%–1.6%] over the study period. Disparities in ideal CVH behaviors were observed between parental education > 12 versus < 12 years, and poverty-income ratio of >2 versus <2 (all, p < 0.05). Conclusions: Adverse trends in ideal cardiovascular health over the past 10 years were observed among Chinese children and adolescents. Comprehensive individual and population-based interventions must be developed to promote cardiovascular health in China.
Objectives: Hypertension in children has attracted increasing attention. However, clinical-based studies investigating characteristics and secular trends of pediatric hypertension remain limited. This study aimed to investigate the clinical characteristics and secular trends of different types of hypertension among hospitalized children in China. Methods: This retrospective analysis was based on medical records from nine tertiary children's hospitals in China during 2010∼2020. A total of 5847 pediatric inpatients (aged <18 years) with the diagnosis of hypertension were enrolled. Information on the clinical characteristics of each patient was obtained from their first admission records. Results: During the past decade, secondary hypertension sustained to be the dominant type of hypertension in children, with the proportion increased from 51.2% during 2010∼2015 to 59.8% during 2016∼2020. The main causes of secondary hypertension were neurologic disorders in children aged 0∼2 years, which changed to renal diseases after 3 years of age. Compared with primary hypertension, secondary hypertension was common in girls (43.1 vs. 23.3%) and children under 5 years of age (32.2 vs. 2.1%). Moreover, over four-fifths of primary hypertensive individuals had obesity and obesity-related comorbidities, and the proportion of clusters of one or more comorbidities increased in the past decade (79.7 → 85.2%). Conclusion: Secondary hypertension sustained to be the dominant type of hypertension among children, especially in girls. Renal diseases were the most common causes of secondary hypertension in children, followed by rheumatic immune diseases. For primary hypertension, over four-fifths of inpatients had obesity and obesity-related diseases, and the proportion kept rising.
Objective: To investigate the incidence and risk factors of pediatric fracture in school-age children and adolescents in Beijing. Methods: A total of 12 056 students with complete fracture data of 2017 baseline survey and 2019 follow-up survey of School-based Cardiovascular and Bone Health (SCVBH) Promotion Program in Beijing were selected as study subjects. Logistic regression model was used to analyze associations of fracture incidence with age, BMI, fracture history and lifestyle. Results: The 2-year accumulative incidence rate of pediatric fracture was 3.1% (95%CI: 2.8%-3.4%) in school-age children and adolescents in Beijing, which was much higher in boys (4.1%) than in girls (2.1%) and increased with age in boys but decreased with age in girls. Fractures mainly occurred at upper-limb (69.0%), no gender and age specific significant in fracture sites were observed. Fracture history was the risk factor for fracture incidence in both boys and girls (boys: RR=1.81, 95%CI: 1.18-2.64; girls: RR=3.11, 95%CI: 1.74-5.13). In addition, higher duration and frequency of moderate to vigorous physical activities (≥120 min/day) and frequent consumption of sugar sweetened beverage (≥1 time/week) were also found to increase fracture risk in boys. Conclusion: The incidence of pediatric fracture was associated with gender, age, fracture history and lifestyle habits in school-age children and adolescents in Beijing. Targeted strategies are needed to prevent childhood fracture.目的： 了解学龄儿童青少年的骨折发生特点及影响因素。 方法： 选取参加“儿童青少年心血管与骨健康促进项目”2017年基线调查和2019年队列随访中骨折调查资料完整的12 056名（男童49.4%）学龄儿童青少年作为研究对象。采用logistic回归分析年龄分组、BMI分组、骨折史及生活行为方式等因素与骨折发生风险的关系。 结果： 北京地区学龄儿童青少年骨折的2年累计发生率为3.1%（95%CI：2.8%~3.4%），其中男童（4.1%）明显高于女童（2.1%），P<0.01；且在男童中呈现随年龄递增而在女童中递减的特点。骨折的发生部位以上肢为主（69.0%），不同性别年龄组间差异无统计学意义。此外，在男女童中均发现，骨折史是未来骨折发生的重要危险因素（男童：RR=1.81，95%CI：1.18~2.64；女童：RR=3.11，95%CI：1.74~5.13）。另在男童中发现，较长时间与频率的中高强度身体活动（≥120 min/d）和频繁饮用含糖饮料（≥1次/周）也可增加其未来骨折发生风险。 结论： 北京地区学龄儿童青少年骨折率受到性别、年龄、骨折史和生活行为习惯的影响。应面向不同个体开展相应的预防策略，以避免儿童骨折的发生。.
Objective: To understand the clinical characteristics and causes of HTN among pediatric inpatients in China. Design and method: Medical records were collected from 10 medical centers during 2016 to 2018 in China. Hypertensive inpatients were defined as patients who were under 18 years old and discharged with HTN diagnosis. For patients with multiple admissions during the study period, first admission records were included for analysis. Results: A total of 3,875 hypertensive discharge records were extracted from the 10 centers. After excluding multiple admission records, 2,394 hypertensive inpatients were included for analysis. The proportion of primary HTN, secondary HTN and unclear types of HTN were 24.4%, 46.5%, and 29.2%, respectively. Male patients accounted for a higher proportion than females among the three types of HTN. Compared with primary hypertensives, children with secondary HTN and unclear types were younger (0∼5 ages), especially for inpatients with unclear HTN, 41.0% were under 3 years old. In addition, most of patients with primary or secondary HTN were distributed in the eastern and developed regions (74.3% and 65.0%), while those with unclear HTN were mostly distributed in the western and undeveloped areas (74.6%). In patients with secondary HTN, renal diseases were the leading causes (54.5%), followed by rheumatic autoimmune diseases (15.5%). Conclusions: Secondary HTN was the most common type in Chinese hypertensive children. However, due to the high proportion of inpatients with unclear types, careful examinations should be mandatory in children with underlying disease for differential diagnosis.
BACKGROUND: The mediating role of inflammatory biomarkers in the causal relationship between body composition and hypertension remains unclear and requires further investigation. METHODS: This study used a combination of retrospective observational analysis and Mendelian randomization approaches. Observational data were derived from 4717 Chinese children and adolescents aged 6 to 18 years who underwent dual-energy X-ray absorptiometry to assess body composition. Mendelian randomization analyses utilized summary statistics from large-scale data sets, including UK Biobank, deCODE2021, International Consortium of Blood Pressure, FinnGen, and other consortia. The inflammatory biomarkers included leptin, insulin, adiponectin, osteocalcin, FGF23 (fibroblast growth factor 23), and PTH (parathyroid hormone). RESULTS: The observational analysis revealed that increased fat mass positively influenced diastolic blood pressure through osteocalcin, while fat-free mass had an inverse effect. Insulin mediated the association between fat mass and systolic blood pressure, diastolic blood pressure, and hypertension, with additional indirect effects observed for PTH (all P <0.05). The Mendelian randomization analyses demonstrated a causal relationship between childhood body mass index and hypertension mediated by insulin (indirect effect: odds ratio, 0.87 [95% CI, 0.78–0.97]) and adiponectin (odds ratio, 1.13 [95% CI, 1.04–1.23]). Adiponectin mediated the effects of fat-free mass (odds ratio, 0.81 [95% CI, 0.71–0.93]) and fat mass (odds ratio, 1.30 [95% CI, 1.11–1.51]) on hypertension. Leptin, adiponectin, and insulin also mediated the causal effects of body composition on systolic blood pressure, diastolic blood pressure, and hypertension. CONCLUSIONS: These findings indicate that body composition influences blood pressure through distinct inflammatory biomarkers. Targeting inflammatory biomarkers may provide tailored strategies for managing body composition and hypertension.
To validate the accuracy of Raycome RBP-1200 used for blood pressure (BP) measurements in Chinese children aged 3-12 years according to the Association for the Advancement of Medical Instrumentation (AAMI)/International Organization for Standardization 81060-2:2013(E) protocol.A prospective observational study was carried out using 'the same arm sequential method' as described in the AAMI protocol. Eighty-seven children participated in this examination and 255 paired-determinations were analyzed.The BP difference between the RBP-1200 and the mercury sphygmomanometer device was -0.9±5.3 mmHg for systolic BP and -1.1±5.0 mmHg for diastolic BP, which were within the range of ±5±8 mmHg as required by criterion 1 of the AAMI protocol. The SD of the averaged difference for each participant was 4.1 mmHg for systolic BP and 3.9 mmHg for diastolic BP, which were also within the requirement of criterion 2 of the AAMI protocol.The Raycome RBP-1200 device fulfills the requirements of the AAMI protocol and it can be recommended for BP measurements in Chinese children aged 3-12 years with low or normal BP values.
Objective: We explored whether medical health workers had more psychosocial problems than nonmedical health workers during the COVID-19 outbreak. Methods: An online survey was run from February 19 to March 6, 2020; a total of 2,182 Chinese subjects participated. Mental health variables were assessed via the Insomnia Severity Index (ISI), the Symptom Check List-revised (SCL-90-R), and the Patient Health Questionnaire-4 (PHQ-4), which included a 2-item anxiety scale and a 2-item depression scale (PHQ-2). Results: Compared with nonmedical health workers (n = 1,255), medical health workers (n = 927) had a higher prevalence of insomnia (38.4 vs. 30.5%, p < 0.01), anxiety (13.0 vs. 8.5%, p < 0.01), depression (12.2 vs. 9.5%; p< 0.04), somatization (1.6 vs. 0.4%; p < 0.01), and obsessive-compulsive symptoms (5.3 vs. 2.2%; p < 0.01). They also had higher total scores of ISI, GAD-2, PHQ-2, and SCL-90-R obsessive-compulsive symptoms (p ≤ 0.01). Among medical health workers, having organic disease was an independent factor for insomnia, anxiety, depression, somatization, and obsessive-compulsive symptoms (p < 0.05 or 0.01). Living in rural areas, being female, and being at risk of contact with COVID-19 patients were the most common risk factors for insomnia, anxiety, obsessive-compulsive symptoms, and depression (p < 0.01 or 0.05). Among nonmedical health workers, having organic disease was a risk factor for insomnia, depression, and obsessive-compulsive symptoms (p < 0.01 or 0.05). Conclusions: During the COVID-19 outbreak, medical health workers had psychosocial problems and risk factors for developing them. They were in need of attention and recovery programs.
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