Kathleen H. Reilly

Secular trends in the prevalence of general and abdominal obesity among Chinese adults, 1993–2009

The objective of this study is to examine the trends in body mass index (BMI), waist circumference (WC) and prevalence of overweight (BMI 25–27.49 kg m−2), general obesity (BMI ≥ 27.5 kg m−2) and abdominal obesity (WC ≥ 90 cm for men and ≥80 cm for women) among Chinese adults from 1993 to 2009. Data were obtained from the China Health and Nutrition Survey, which was conducted from 1993 to 2009 and included a total of 52,621 Chinese adults. During the period of 1993–2009, mean BMI values increased by 1.6 kg m−2 among men and 0.8 kg m−2 among women; mean WC values increased by 7.0 cm among men and 4.7 cm among women. The prevalence of overweight increased from 8.0 to 17.1% among men (P < 0.001) and from 10.7 to 14.4% among women (P < 0.001); the prevalence of general obesity increased from 2.9 to 11.4% among men (P < 0.001) and from 5.0 to 10.1% among women (P < 0.001); the prevalence of abdominal obesity increased from 8.5 to 27.8% among men (P < 0.001) and from 27.8 to 45.9% among women (P < 0.001). Similar significant trends were observed in nearly all age groups and regions for both men and women. The prevalence of overweight, general obesity and abdominal obesity among Chinese adults has increased greatly during the past 17 years.

Syphilis and HIV Seroconversion Among a 12-Month Prospective Cohort of Men Who Have Sex With Men in Shenyang, China

Background: Cross-sectional studies have found a high prevalence of syphilis and HIV infection among men who have sex with men (MSM) in China. Methods: A total of 218 HIV-negative MSM participated in this prospective cohort study. Interviewer-administered questionnaires were completed, and blood samples were obtained for HIV and syphilis testing, both upon enrollment and at 12-month follow-up. Results: Of enrolled participants, 56% (122) were retained for the full 12-month follow-up period. The cohort had an HIV incidence density of 5.4 (95% CI: 2.0–11.3)/100 person-year (PY) and a syphilis incidence density of 38.5(95% CI: 27.7–50.2)/100 PY. Having syphilis (odds ratio [OR]: 11.4, 95% CI: 1.2–104.7) and more than 5 male sexual partners within the past 12 months (OR: 6.5, 95% CI: 1.1–39.8) were independent risk factors for HIV seroconversion (each P < 0.05). Being married (OR: 3.5, 95% CI: 1.4–8.2) and having more than 5 male sexual partners within the past 12 months (OR: 4.7, 95% CI: 2.0–6.2) were risk factors for syphilis seroconversion, while age ≥30 (OR 2.1, 95% CI 0.7–9.5) and having recently engaged in unprotected receptive anal sex (OR: 2.4, 95% CI: 0.7–13.1) were marginally associated with syphilis seroconversion. Conclusion: The high incidence rates of HIV and syphilis in the Shenyang MSM community are significant cause for concern. The seroconversion rate for syphilis, in particular, indicates the high prevalence of high-risk sexual behaviors and the potential for increased HIV transmission. Appropriate interventions that address MSM-specific issues, including stigma, pressures from traditional society, and bisexual behavior, need to be tailored to inform and empower MSM in order to prevent HIV and syphilis in this community.

Blood pressure and clinical outcome among patients with acute stroke in Inner Mongolia, China.

Objectives The association between blood pressure and short-term clinical outcome of acute stroke is inconclusive. We studied the association between admission blood pressure and in-hospital death or disability among acute stroke patients in Inner Mongolia, China. Methods A total of 2178 acute ischemic stroke and 1760 hemorrhagic stroke patients confirmed by a computed tomography scan or magnetic resonance imaging were included in the present study. Blood pressure and other study variables were collected within the first 24 h of hospital admission. Clinical outcomes were evaluated by trained neurologists during hospitalization. Results The in-hospital case-fatality rate was higher for acute hemorrhagic stroke (5.9%) than it was for acute ischemic stroke (1.8%), whereas the disability rate was higher for those with acute ischemic stroke (41.3%) than those with acute hemorrhagic stroke (34.4%) at discharge. Blood pressure at admission was not significantly associated with clinical outcome in acute ischemic stroke. On the contrary, systolic and diastolic blood pressures were significantly and positively associated with odds of death or disability in acute hemorrhagic stroke. For example, compared to those with a systolic blood pressure less than 140 mmHg, multiple-adjusted odds ratio (95% confidence interval) of death/disability was 1.38 (0.96, 1.99), 1.42 (1.00, 2.03), 1.84 (1.28, 2.64), and 1.91 (1.35, 2.70) among participants with systolic blood pressure 140–159, 160–179, 180–199, and at least 200 mmHg, respectively (P < 0.0001 for linear trend). Conclusion Increased systolic and diastolic blood pressure were significantly and positively associated with death and disability among patients with acute hemorrhagic stroke, but not acute ischemic stroke, in Inner Mongolia, China.

Trends in prevalence, awareness, treatment, and control of hypertension among Chinese adults 1991-2009

Hypertension is the main risk factor for cardiovascular disease (CVD), accounting for nearly 45% of global CVD morbidity and mortality [1]. Based on previous national survey data in China, the prevalence of hypertension in adults has increased from 5% in 1959 to 11.3% in 1991 and 18% in 2002 [2–4]. Although many studies have suggested that the control of hypertension is an effective strategy to prevent CVD [5], only a small percentage of hypertensive patients achieved the goal of systolic and diastolic blood pressure (SBP/DBP)<140/90 mm Hg. The control rate of hypertension in China was only 3% in 1991 and 5% in 2002[3,4]. Recently, three studies from China have investigated the prevalence, awareness, treatment, and control of hypertension in three urban populations [6], and two rural populations [7,8]. Recent trends in hypertension prevalence and control in China on a national level, however, are still unknown. The China Health and Nutrition Survey (CHNS) is a large-scale, national and successive cross-sectional survey that was designed to explore how the health and nutritional status of the Chinese population has been affected by social and economic changes [9]. A multistage, random cluster process was used to draw study sample from nine provinces (Liaoning, Heilongjiang, Jiangsu, Shandong, Henan, Hubei, Hunan, Guangxi and Guizhou). Participants aged 18 years and older were included in the analysis. Information on age, gender, region (the urban and rural regions were clarified according to their characteristics of economy and social development using data from the China National Bureau of Statistics and China Ministry of Health Statistics), body mass index (BMI), and BP measurements were collected. A total of 8426, 7905, 8509, 9469, 8847, 8980 and 8503 participants were included in the analyses across the seven study periods (1991, 1993, 1997, 2000, 2004, 2006, 2009). Gender distributions across the seven survey periods were homogeneous (P=0.49). BP was measured by trained examiners using a mercury sphygmomanometer according to a standard protocol [10]. The three BP values were measured on one visit, and the last two of three readings were averaged as the BP values in this study. Prevalent pre-hypertension was defined as SBP/DBP of 120/80 to 140/90 mm Hg and hypertension was defined as SBP/DBP≥140/90 mm Hg or on antihypertensive medications [10]. The same criteria were used for both diabetic and nondiabetic participants [11]. Awareness of hypertension was determined as self-reported diagnosis of hypertension by a physician or other healthcare professional. Treatment of hypertension was defined as self-report use of antihypertensive medications. Treated participants were considered to have their hypertension controlled if their SBP/DBP was less than 140/90 mm Hg. Trends in BP values and the estimated percentages (prevalence, awareness, treatment, and control of hypertension) from 1991 to 2009 were assessed with a multiple linear regression (continuous outcomes) or logistical regression (dichotomous outcomes) model [12] with the adjustment for gender, age, region, and BMI. Since age distributions in the seven study periods varied, the estimated percentages were age-standardized to the China Census population in 2000. A p value<0.05 was considered statistically significant. The authors of this manuscript have certified that they comply with the Principles of Ethical Publishing in the International Journal of Cardiology [13]. Overall, both mean SBP and DBP values increased significantly across seven study visits (Table 1). Mean SBP values increased by 5.4 mm Hg and mean DBP increased by 4.1 mm Hg. Similar significant trends were observed in all subgroups defined by age, sex and region groups (all p 0.05). Notably, mean SBP and DBP values increased more rapidly among subjects aged 40–59 years and among those living in rural regions. Table 1 Trends in mean SBP and DBP values (mm Hg) among Chinese Adults: the CHNS 1991–2009 The prevalence of pre-hypertension and hypertension changed significantly from 29.4% and 14.5%, respectively, in 1991, to 38.7% and 21.4%, respectively, in 2009 (both p<0.001), with an absolute increase of 9.3% and 6.9% (Table 2). Similar significant trends were observed in each subgroup defined by age, sex or region (all p<0.05). The prevalence of hypertension increased more rapidly among subjects who were older than 40 years, men, and those who lived in rural regions (Table 2). Table 2 Trends in prevalence of pre-hypertension and hypertension among Chinese Adults: the CHNS 1991–2009 The awareness and treatment of hypertension decreased significantly from 22.4% and 12.0% respectively, in 1991, to 13.0% and 9.6%, respectively, in 1997 (all p 0.05) (Table 3). During the periods of 1997–2009, the awareness, treatment, and control of hypertension in all hypertensive patients and those treated increased significantly from 13.0%, 9.6%, 1.7% and 17.4% in 1997, respectively, to 26.1%, 22.8%, 6.1%, and 33.1% in 2009 (all p<0.05). In stratified analysis, during the periods of 1997–2009, the rates of awareness, treatment, and control of hypertension in all hypertensive patients and in those treated increased more rapidly in those aged 60 years or older. In addition, the rates of hypertension control in all hypertensive patients and in those treated increased more rapidly in urban regions (Table 3). Table 3 Trends in awareness, treatment, and control among Chinese hypertensive adults: the CHNS 1991–2009 To our knowledge, although three regional studies have been published [6–8], we firstly reported the recent trends in prevalence, awareness, treatment and control of hypertension among the partially representative Chinese adults from 1991 to 2009, based on the CHNS. The upward trend in mean SBP and DBP values and prevalence of hypertension was observed among Chinese adults from 1991 to 2009, which might be due to decreases in physical activity [14], increases in sedentary behavior, high fat diet, salt intake [15] and obesity [16]. In contrast, the United States National Health and Nutrition Examination Survey (NHNES) conducted for a similar period (1988–2008) showed that the prevalence of hypertension increased from 1988 to 2000, with little change between 2000 and 2008[17]. Better public health education and preventive measures from the government and health professionals might explain the increases in the awareness, treatment and control rates between 1997 and 2009. Similarly, the NHNES in the United States also demonstrated an increase in awareness, treatment and control of hypertension between 1988 and 2008[18]. Two limitations are noted. First, BP measurement at a single visit usually overestimates hypertension prevalence and underestimates control rate. Second, risk factors such as diabetes, hyperlipidemia, smoking, and family history of hypertension and data on treatment medications and prevalence of essential versus non-essential hypertension were unavailable presently. The overall prevalence of hypertension increased significantly in China between 1991 and 2009. The overall awareness, treatment, and control of hypertension (in hypertensive individuals) increased over time, but are still unacceptably low. Our results suggest an urgent need for a national hypertension education program to improve the prevention, detection, treatment, and control of hypertension in China, with the ultimate goal to lower hypertension-related morbidity and mortality.

Willingness to Take, Use of, and Indications for Pre-exposure Prophylaxis Among Men Who Have Sex With Men-20 US Cities, 2014.

BACKGROUND Pre-exposure prophylaxis (PrEP) is an effective prevention tool for people at substantial risk of acquiring human immunodeficiency virus (HIV). To monitor the current state of PrEP use among men who have sex with men (MSM), we report on willingness to use PrEP and PrEP utilization. To assess whether the MSM subpopulations at highest risk for infection have indications for PrEP according to the 2014 clinical guidelines, we estimated indications for PrEP for MSM by demographics. METHODS We analyzed data from the 2014 cycle of the National HIV Behavioral Surveillance (NHBS) system among MSM who tested HIV negative in NHBS and were currently sexually active. Adjusted prevalence ratios and 95% confidence intervals were estimated from log-linked Poisson regression with generalized estimating equations to explore differences in willingness to take PrEP, PrEP use, and indications for PrEP. RESULTS Whereas over half of MSM said they were willing to take PrEP, only about 4% reported using PrEP. There was no difference in willingness to take PrEP between black and white MSM. PrEP use was higher among white compared with black MSM and among those with greater education and income levels. Young, black MSM were less likely to have indications for PrEP compared with young MSM of other races/ethnicities. CONCLUSIONS Young, black MSM, despite being at high risk of HIV acquisition, may not have indications for PrEP under the current guidelines. Clinicians may need to consider other factors besides risk behaviors such as HIV incidence and prevalence in subgroups of their communities when considering prescribing PrEP.

A cross-sectional study of HIV and syphilis infections among male students who have sex with men (MSM) in northeast China: implications for implementing HIV screening and intervention programs

BackgroundChina has 76.2 million high school and college students, in which the number of reported HIV/AIDS cases is increasing rapidly. Most of these cases are attributed to male-to-male sexual contact. Few studies have explored HIV prevalence and behavioural characteristics of Chinese male students who have sex with men (MSM).MethodsA cross-sectional study of MSM high school and college students in Liaoning Province was conducted. Data were collected through face-to-face interviews and blood specimens were obtained and tested for HIV and syphilis.ResultsThere were 436 eligible participants. HIV and syphilis prevalence was 3.0% and 5.0%, respectively. In multivariate analysis, sexual orientation known by family members (OR: 7.3; 95% CI: 1.5-34.6), HIV/AIDS information obtained from clinical doctors (OR: 6.7; 95% CI: 1.7-25.9), HIV/AIDS information obtained through free educational services and materials such as voluntary counseling and testing (VCT) and condom distribution services (OR: 0.2; 95% CI: 0.4-1.0), inconsistent condom use (OR: 5.7; 95%: 1.3-25.3), sexual partner experienced anal bleeding after insertive anal intercourse (OR: 6.8; 95% CI: 1.6-28.4), and history of illegal drug use (OR: 18.9; 95% CI: 2.2-165.3) were found to be significantly associated with HIV infection.ConclusionsGreater effort should be made towards stemming the HIV and syphilis epidemics among Chinese student MSM. Immediate screening and comprehensive interventions towards student MSM should be implemented in order to curb the spread of HIV. Family and school-based interventions should be considered to target this educated, yet vulnerable, population.

Factors Associated With HIV Testing History and HIV-Test Result Follow-up Among Female Sex Workers in Two Cities in Yunnan, China

Background: The majority of people living with HIV/AIDS in China are unaware of their serostatus, and increasing the utilization of HIV testing may help to control the epidemic. Methods: This longitudinal study was conducted among female sex workers (FSWs) in 2 cities in Yunnan Province, China. Participants were surveyed in face-to-face interviews and tested for HIV and STDs. Factors associated with HIV-testing history and HIV-test follow-up were analyzed. Results: Of the 1642 study participants, 291 (17.7%) had been previously tested and 868 (52.9%) returned for post-test follow-up. Factors associated with having a previous HIV test included attending the Kaiyuan study (aOR: 4.9, 95% CI: 2.3–10.1), ≥9 years of schooling (aOR: 10.9, 95% CI: 2.6–45.5), <5 clients in the recent week (aOR: 1.7, 95% CI: 1.2–2.3), having a regular sexual partner (aOR: 1.9, 95% CI: 1.4–2.5), illegal drug use history (aOR: 2.2, 95% CI: 1.5–3.1), pelvic pain in the past 12 months (aOR: 1.9, 95% CI: 1.1–3.6), HIV-seropositivity (aOR: 1.8, 95% CI: 1.2–2.8), and high perception of HIV risk (aOR: 1.5, 95% CI: 1.1–2.2). FSWs who had ≥9 years of schooling (aOR: 1.4, 95% CI: 1.1–1.9), had <5 clients in the recent week (aOR: 1.3, 95% CI: 1.1–1.6), or were from another province (aOR: 1.9, 95% CI: 1.4–2.5) or city (aOR: 1.4, 95% CI: 1.1–1.8) were more likely to follow-up. Conclusions: The low HIV-testing history and follow-up rates found in this is study is a significant public health problem as many high-risk individuals are not aware of their serostatus. Immediate action needs to be taken to increase the utilization of HIV testing services and notify people of their HIV status.

Increase in Body Mass Index, Waist Circumference and Waist-to-Height Ratio is Associated with High Blood Pressure in Children and Adolescents in China:

This study compared the association between blood pressure (BP) and obesity in 1145 Chinese children and adolescents (608 males, 537 females) using data from the 2006 China Health and Nutrition Survey. Obesity was diagnosed by body mass index (BMI), waist circumference (WC) and waist-to-height ratio (WHtR). Analysis of variance was used to analyse the difference in BP among different subgroups. Odds ratios (OR) were calculated and multivariate logistic regression analysis was carried out. The prevalence of high systolic and diastolic BP increased directly with corresponding increments in BMI, WC and WHtR, although the prevalence and OR of high BP were higher when increased BMI was combined with WC (OR 3.39; 95% confidence interval [CI] 1.79, 6.41) or WHtR (OR 3.28; 95% CI 1.71, 6.30). In conclusion, increased BMI, WC and WHtR were directly associated with high BP in Chinese children and adolescents.

Risk Factors for Chronic Obstructive Pulmonary Disease Mortality in Chinese Adults

Chronic obstructive pulmonary disease mortality and risk factors were studied in a nationally representative sample of 169,871 Chinese men and women aged 40 years or older. Baseline data were collected in 1991 by using a standard protocol, and a follow-up evaluation was conducted in 1999-2000, with a response rate of 93.4%. Age-standardized mortality (per 100,000 person-years) was 179.9 for men and 141.3 for women. After adjustment for important covariables, the respective relative risks of chronic obstructive pulmonary disease-related mortality for baseline risk factors in men and women were 2.80 (95% confidence interval (CI): 2.64, 2.98) and 2.71 (95% CI: 2.53, 2.89) for each 10-year increase in age, 0.84 (95% CI: 0.74, 0.95) and 1.44 (95% CI: 1.07, 1.95) for alcohol consumption, 1.18 (95% CI: 1.04, 1.35) and 1.77 (95% CI: 1.45, 2.15) for >/=20 pack-years of smoking, 2.37 (95% CI: 1.91, 2.94) and 2.47 (95% CI: 1.66, 3.67) for non-high-school graduation, 1.57 (95% CI: 1.38, 1.79) and 1.35 (95% CI: 1.17, 1.56) for physical inactivity, 2.66 (95% CI: 2.34, 3.02) and 2.60 (95% CI: 2.25, 3.00) for underweight, 1.39 (95% CI: 1.23, 1.57) and 1.73 (95% CI: 1.50, 2.00) for living in northern China, and 2.14 (95% CI: 1.86, 2.46) and 1.79 (95% CI: 1.55, 2.07) for living in rural China. This study indicated that cigarette smoking, low educational level, physical inactivity, and underweight are important modifiable risk factors for chronic obstructive pulmonary disease-related mortality in China.

Recapitulation of four hypertension susceptibility genes (CSK, CYP17A1, MTHFR, and FGF5) in East Asians

OBJECTIVE A recent genome wide association study identified eight hypertension susceptibility loci in Europeans. Subsequently, several studies have investigated these associations in East Asian populations. The results of these studies, however, have been inconsistent. A meta-analysis was performed to assess the associations of the most published polymorphisms, including CSK rs1378942, CYP17A1 rs11191548, MTHFR rs17367504, and FGF5 rs16998073 polymorphisms with hypertension. METHODS Published literature from PubMed and Embase databases was retrieved. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using fixed- or random-effects model. RESULTS Seven studies (16,368 cases /19,707 controls) for CSK rs1378942 polymorphism, seven studies (15,688 cases /18,784 controls) for CYP17A1 rs11191548 polymorphism, four studies (7994 cases / 12,844 controls) for MTHFR rs17367504 polymorphism, and three studies (6026 cases / 8393 controls) for FGF5 rs16998073 polymorphism were included in the meta-analysis. The results suggested that both CYP17A1 rs11191548 and FGF5 rs16998073 polymorphisms were significantly associated with hypertension risk in East Asians (CYP17A1 rs11191548 (random effect model): OR=1.16, 95% CI 1.07-1.25, p=3.59×10(-4), I(2)=78.2%, p (heterogeneity)=1.14×10(-4); FGF5 rs16998073 (random effect model): OR=1.30, 95% CI 1.23-1.37, p=6.29×10(-21), I(2)=65.0%, p (heterogeneity)=0.009); whereas no significant association was observed for CSK rs1378942 (fix effect model: OR=1.09, 95% CI 0.98-1.22, p=0.128, I(2)=0.0%, p (heterogeneity)=0.820), or MTHFR rs17367504 (fix effect model: OR=1.06, 95% CI 0.98-1.14, p=0.126, I(2)=0.0%, p (heterogeneity)=0.822). CONCLUSION The present meta-analysis indicated significant associations of both CYP17A1 rs11191548 and FGF5 rs16998073 polymorphisms with hypertension susceptibility in East Asians.