Dezheng Wang

Coronary heart disease mortality in China: age, gender, and urban-rural gaps during epidemiological transition

OBJECTIVE To examine and describe coronary heart disease (CHD) mortality and its pattern of change (trend) by sex, age, and area of residence (urban versus rural) in Tianjin, China, within the context of epidemiological transition, and compare it with current trends in the Americas and Europe. METHODS A total of 104 393 cases of CHD death in Tianjin occurring between 1999 and 2008 were monitored. Death due to CHD was coded using International Classification of Diseases (ICD) standards (ninth and tenth revisions). Standardized CHD mortality rates and their trends were analyzed by age, sex, and urban versus rural residence. RESULTS During the 10-year study period, the proportion of total deaths due to CHD in Tianjin increased significantly (from 16% to 24%) and age-standardized CHD mortality increased slightly (with no statistical differences), in contrast to CHD mortality trends in various countries in the Americas and Europe, which are declining. No difference was found in Tianjins CHD mortality trend by sex. Overall CHD mortality was consistently higher among older age groups, males, and residents of urban areas. The proportion of CHD deaths occurring outside hospitals was 55.81%, with a declining trend over the study period. Rural areas had a higher proportion of outside-hospital CHD mortality than urban areas, but no difference was found across age groups. CONCLUSIONS From 1999 to 2008, CHD mortality in Tianjin varied by sex, age, and urban versus rural area of residence. Future research to identify CHD risk factors and the populations most vulnerable to the disease is recommended to help strengthen CHD prevention. Strategies for CHD control similar to those used in various developed countries in the Americas and Europe should be developed to reduce the CHD burden in China.

Leading causes of death from injury and poisoning by age, sex and urban/rural areas in Tianjin, China 1999-2006

BACKGROUND Injury and poisoning are a growing public health concern in China due to rapid economic growth, which has resulted in many cases with an injury-prone environment, such as overcrowded traffic, booming construction, and work-related stress. This study investigates the distribution and trends of deaths from injury and poisoning in Tianjin, China, by age, sex and urban/rural status, from 1999 to 2006. METHODS The study used data from the all-cause mortality surveillance system maintained by the Tianjin Centers for Disease Control and Prevention (CDC). Each death certificate recorded 53 variables. Cause of death was coded using the International Classification of Diseases (ICD). Standardized mortality rates and proportions of deaths were analyzed. RESULTS Traffic accidents, suicide, poisoning, drowning and fall were the leading causes of fatal injuries in Tianjin from 1999 to 2006. Injury mortality rates were high in males, in rural areas, and in the older age groups. Despite low injury mortality rates, injury accounted for close to 50% of all deaths amongst the 5-29 year age group. Traffic accident mortality rates increased, although not significantly so, during the period from 1999 to 2006. CONCLUSION Injury prevention and control is a high public health priority in Tianjin. Our detailed table on the number of deaths by causes of fatal injuries and by age group provides important information to set prevention strategies in the nurseries, schools, workplace and seniors homes.

Surveillance of trend and distribution of stroke mortality by subtype, age, gender, and geographic areas in Tianjin, China, 1999-2006

Background The purpose of this study was to analyze the epidemiological trend and distribution of stroke mortality in the city of Tianjin, China, in order to provide evidence for the prevention and control of stroke. Methods The study was based on 102 718 cases of stroke mortality in Tianjin between 1999 and 2006. The cause of death was coded according to the International Classification of Diseases into stroke subtypes. Standardized mortality rates were calculated for stroke and its subtypes, adjusted for age and gender using the year 2000 world standard population. The age, gender, and geographic distribution of stroke and subtype mortality were analyzed. χ2-tests were used to determine the statistical significance of differences in mortality trends. Results The stroke mortality rate in Tianjin declined from 133·52/100000/year in 1999 to 102·52/100000/year in 2006. The stroke mortality rate for males was higher than that for females. Stroke mortality rates increased with increasing age. The subtypes of stroke have changed considerably in Tianjin. Hemorrhagic was major in 1999–2001, while cerebral infarction attained the first rank and accounted for more than 50% of stroke mortality in 2002–2006. The most pronounced finding was that the proportion of ischemic stroke was 66·65% in the urban population and over 20% higher than that in the rural area. Stroke in the suburban area was mainly hemorrhagic stroke, up to 62·67%. Conclusions There are significant differences in the distribution of stroke mortality by subtype, age, gender, and geographic areas in Tianjin, China. Various subtypes of stroke are associated with different risk factors and therefore require different public health prevention and control measures. This study provides pertinent information for formulation of measures for the prevention and control of stroke.

Smoking and Mortality in Tianjin, China: A Death Registry–Based Case-Control Study, 2010–2014

Introduction We conducted a mortality case-control study to assess the risks of all-cause and major causes of death attributable to smoking in Tianjin from 2010 through 2014. The death registry–based study used data from The Tianjin All Causes of Death Surveillance System, which collects information routinely on smoking of the deceased in the death certificate of Tianjin Centers for Disease Control and Prevention. Methods Cases (n = 154,086) and controls (n = 25,476) were deaths at 35 to 79 years from smoking-related and nonsmoking-related causes, respectively. Mortality rate ratios (RRs) for ever smokers versus never smokers, with adjustment for sex, 5-year age group, education, marital status, and year of death, and smoking-attributed fractions were calculated. Results The RRs in men were 1.38 (95% confidence interval [CI], 1.33–1.43) for all causes and 3.07 (95% CI, 2.91–3.24) for lung cancer, and in women were 1.46 (95% CI, 1.39–1.54) and 4.07 (95% CI, 3.81–4.35). The smoking-attributed fractions for all causes and for lung cancer in men were 15.4% and 50.2%, respectively, and in women were 7.3% and 32.7%, respectively. Smoking annually caused an average of 3,756 (9.4%) deaths, mostly from lung cancer in men (47.4%) and women (66.9%). Women who started smoking before 30 had a higher RR (1.79; 95% CI, 1.63–1.97) than men who did so (1.48; 95% CI, 1.41–1.56). Conclusion Lung cancer was the main cause of smoking-induced deaths in both sexes. Tobacco use is a major cause of premature deaths in men aged 35 to 79 years. Young women must be urged to not start smoking because they could have greater risk of all-cause and lung cancer deaths than men do.