Projected impact of urbanization on cardiovascular disease in China

Comparison of 10-year atherosclerotic cardiovascular disease (ASCVD) risk in metropolitan and rural areas of South of Iran

The first step to reducing the growing burden of cardiovascular disease (CVD) is to find modifiable risk factors with the highest burden in each population. Urban and rural citizens may have different priorities in this regard. This study aimed to compare the 10-year incidence probability of CVD events and its associated risk factors between rural and urban areas in Iran. Data was extracted from two big cohorts, Fasa Adults Cohort Study (FACS) and Shiraz Heart Study (SHS), with participation of over 12,000 general population. Linear regression models were used to test the difference in CVD risk between two populations. Totally, 6,258 FACS and 6,101 SHS participants entered the study. Urban participants had a significantly higher mean ASCVD score (4.43% vs. 5.51%, p-value < 0.001). Also, they significantly showed higher body mass index, waist circumference, cholesterol level, fasting blood glucose level, systolic blood pressure, educational attainment, and occupational status. However, the prevalence of smoking was higher in rural areas. Notably, socioeconomic parameters including marital, occupational, and educational statuses seem to have strong impact on cardiovascular risk factors. After adjustment for all confounders, living in the urban areas seemed to be associated with higher atherosclerotic CVD risk (β = 0.78, 95%CI: [0.69-1.05]), which was consistent across both sexes. Given the higher risk of cardiovascular events in urban areas and different profiles of risk factors between these two regions, preventive strategies should be precisely and separately designed for each population by the health authorities and policymakers in order to reduce the CVD toll efficiently.

Hypertension risk pathways in urban built environment: the case of Yuhui District, Bengbu City, China

Introduction

The rapid development of urbanization has brought about changes in residents' living environment and behavior, leading to health challenges such as hypertension. An improvement in the built-up environment in the community could contribute to the construction of a healthy city, promote the active life of the residents, and prevent and relieve hypertension. However, there is little research on the relationship between the built environment of the community and hypertension. This cross-sectional study aims to evaluate the relationship between communities' built environment, health behavior, and hypertension grade of residents in Yuhui District of Bengbu City.

Methods

This study is based on data from the 2022 Health Survey of Residents in 21 communities. To investigate the impact of the community's built environment on residents' hypertension and the underlying mechanisms, regression and structural equation modeling were employed.

Results and discussion

The results show that the built environment of urban communities has a significant impact on the residents' hypertension. The presence of high densities of supermarkets, convenience stores, parks and plazas, but low densities of clinics and hospitals, has been identified as a significant risk factor for the development of high blood pressure among the residents. Nevertheless, the adoption of healthy behaviors, including regular walking, physical activity, and a diet rich in fruit and vegetables, can play an important role in reducing the risk of hypertension. The findings of this study show that enhancements to the built environment in urban neighborhoods could contribute to a reduction in the prevalence of hypertension among residents. Furthermore, the implementation of efficacious health interventions in urban settings would facilitate the alteration of residents' health behaviors and enhance their overall health status.

The effect of residential greenness on cardiovascular mortality from a large cohort in South China: An in-depth analysis of effect modification by multiple demographic and lifestyle characteristics

BACKGROUND

The potential for residential greenness to improve cardiovascular health through both physical and psychological mechanisms is well recognized. However, evidence from rapidly urbanizing developing countries and cohort-based causal inference approaches, remains limited. We aim to examine the effect of residential greenness and time to cardiovascular mortality in South China.

METHODS

We utilized data from a community-based population survey involving 748,209 participants at baseline from 2009 to 2015, followed up until 2020. Residential greenness exposure was assessed by the annual Normalized Difference Vegetation Index (NDVI) in the 500 m radius of each participant's residence. We used time-varying proportional hazard Cox models coupled with inverse probability weighting to fit marginal structural models and obtain hazard ratios (HRs) for cardiovascular disease (CVD) mortality after adjusting for confounders. Multiple effect modifiers on both additive and multiplicative scales were further explored.

RESULTS

A total of 15,139 CVD-related deaths were identified during a median of 7.9 years of follow-up. A protective effect was found between higher greenness exposure and reduced CVD mortality, with a 9.3 % lower rate of total CVD mortality (HR 0.907, 95 % CI 0.859-0.957) based on a 0.1 increase in annual average NDVI. Demographic (age, marital status) and lifestyle factors (smoking, drinking status) were found to modify the association between residential greenness and CVD mortality (all P interaction values < 0.05 or 95 %CI for RERI excluded the value 0). Notably, this effect was more pronounced among older adults, married, and individuals having healthier lifestyles, indicating a greater benefit from greenness for these subgroups.

CONCLUSIONS

Our findings support a causal link between increased residential greenness exposure and a reduced risk of CVD mortality in South China with marked heterogenous effects, which has public health implications for cultivating greener urban environments to mitigate the impact of CVD within the context of rapid urbanization.

Existing Datasets to Study the Impact of Internal Migration on Caregiving Arrangements among Older Adults in China

Massive rural-to-urban migration in China has a significant impact on informal caregiving arrangements among Chinese older adults. To stimulate research on the intersection of migration and caregiving, we conducted an inventory of longitudinal aging survey datasets from mainland China. Large publicly available datasets that included measures related to migration and caregiving were searched and reviewed for eligibility. Key characteristics of each dataset, including study design, sample size, and measures, were extracted. Seven eligible datasets were identified, and five included nationally representative samples. Measures for migration varied across datasets. Some datasets included information on the migration history of older adults, whereas others focused on the migration of adult children. Similarly, caregiving was measured using different questions in each dataset. Caregiving activities were assessed with regard to their type, source, and amount. High-quality datasets exist to support research on migration and caregiving arrangements among Chinese older adults.

Preliminary study of perceived cardiovascular disease risk and risk status of adults in small rural and urban locations in Ibadan, Nigeria

The burden of cardiovascular disease (CVD) has been on the rise in developing countries like Nigeria recently. Studies on perceived CVD risk and the risk status of adults in Ibadan are not readily available, hence this study. A mixed-method design involving a cross-sectional survey and an exploratory qualitative study was utilized. Convenience sampling was used to recruit 418 participants (209 from rural and 209 from urban) for the cross-sectional survey, while purposive sampling was used to recruit 14 participants for the qualitative aspect. The INTERHEART risk score and the Perception of Risk of Heart Disease Scale were used to investigate participants' CVD risk status and perceived risk, respectively. The data from the cross-sectional survey were summarized by using descriptive statistics, and the data were then analyzed by using the chi-square test of association and a multiple logistic regression model, while content thematic analysis was used to analyze the qualitative data. In the rural and urban areas, respectively, 39.7% and 52.2% had a positive perception of CVD risk. In the rural and urban areas, 44% and 41.6% of individuals respectively had moderate-to-high risk of CVD. Participants with at least secondary school education [2.66 (0.61-11.53)] and participants in the urban area [2.62 (0.78-7.08)] had twice higher odds of positive CVD risk perception. Males [3.91 (1.58-9.68)], adults aged 40 and above [1.59 (0.63-4.00)] and urban dwellers [1.21 (0.33-4.39)] had higher odds of a high CVD risk status. The qualitative aspect of the study corroborated the findings from the survey, as many participants did not perceive themselves as being at risk of CVD. The majority of the participants in this study were found to have a moderate-to-high risk of CVD, and many had a negative perception of their risk. Health education and CVD prevention programs are required to curb the burden of CVD.

Forecast of myocardial infarction incidence, events and prevalence in England to 2035 using a microsimulation model with endogenous disease outcomes

Background

Models that forecast non-communicable disease rates are poorly designed to predict future changes in trend because they are based on exogenous measures of disease rates. We introduce microPRIME, which forecasts myocardial infarction (MI) incidence, events and prevalence in England to 2035. microPRIME can forecast changes in trend as all MI rates emerge from competing trends in risk factors and treatment.

Materials and methods

microPRIME is a microsimulation of MI events within a sample of 114,000 agents representative of England. We simulate 37 annual time points from 1998 to 2035, where agents can have an MI event, die from an MI, or die from an unrelated cause. The probability of each event is a function of age, sex, BMI, blood pressure, cholesterol, smoking, diabetes and previous MI. This function does not change over time. Instead population-level changes in MI rates are due to competing trends in risk factors and treatment. Uncertainty estimates are based on 450 model runs that use parameters calibrated against external measures of MI rates between 1999 and 2011.

Findings

Forecasted MI incidence rates fall for men and women of different age groups before plateauing in the mid 2020s. Age-standardised event rates show a similar pattern, with a non-significant upturn by 2035, larger for men than women. Prevalence in men decreases for the oldest age groups, with peaks of prevalence rates in 2019 for 85 and older at 25.8% (23.3–28.3). For women, prevalence rates are more stable. Prevalence in over 85s is estimated as 14.5% (12.6–16.5) in 2019, and then plateaus thereafter.

Conclusion

We may see an increase in event rates from MI in England for men before 2035 but increases for women are unlikely. Prevalence rates may fall in older men, and are likely to remain stable in women over the next decade and a half.

Maternal internal migration and child growth and nutritional health in Peru: an analysis of the demographic and health surveys from 1991 to 2017

BACKGROUND

Peru has historically experienced high rural-to-urban migration. Despite large reductions in undernutrition, overweight is increasing. Elsewhere, internal migration has been associated with differences in children's growth and nutritional health. We investigated how child growth and nutritional status in Peru varied over time and in association with maternal internal migration.

METHODS

Using data from Demographic & Health Surveys from 1991 to 2017, we assessed trends in child growth (height-for-age [HAZ], weight-for-age [WAZ], weight-for-height [WHZ] z scores) and nutritional health (stunting, underweight, overweight) by maternal adult internal migration (urban [UNM] or rural non-migrant [RNM], or urban-urban [UUM], rural-urban [RUM], rural-rural [RRM], or urban-rural migrant [URM]). Using 2017 data, we ran regression analyses, adjusting for confounders, to investigate associations of maternal migration with child outcomes and the maternal and child double burden of malnutrition. We further stratified by timing of migration, child timing of birth and, for urban residents, type of area of residence. Results are given as adjusted predictive margins (mean z score or %) and associated regression p-values [p].

RESULTS

In 1991-2017, child growth improved, and undernutrition decreased, but large differences by maternal migration persisted. In 2017, within urban areas, being the child of a migrant woman was associated with lower WHZ (UUM = 0.6/RUM = 0.5 vs UNM = 0.7; p = 0.009 and p < 0.001 respectively) and overweight prevalence ((RUM 7% vs UNM = 11% [p = 0.002]). Results however varied both by child timing of birth (birth after migration meant greater overweight prevalence) and type of area of residence (better linear growth in children of migrants [vs non-migrants] in capital/large cities and towns but not small cities). In rural areas, compared to RNM, children of URM had higher HAZ (- 1.0 vs - 1.2; p < 0.001) and WAZ (- 0.3 vs - 0.4; p = 0.001) and lower stunting (14% vs 21%; [p < 0.001]). There were no differences by timing of birth in rural children, nor by time since migration across all children. The mother and child double burden of malnutrition was higher in rural than urban areas but no differences were found by maternal internal migration.

CONCLUSIONS

Migration creates a unique profile of child nutritional health that is not explained by maternal ethnic and early life factors, but which varies depending on the pathway of migration, the child timing of birth in relation to migration and, for urban dwellers, the size of the place of destination. Interventions to improve child nutritional health should take into consideration maternal health and migration history.

Clustering of countries for COVID-19 cases based on disease prevalence, health systems and environmental indicators

The coronavirus has a high basic reproduction number ( R 0 ) and has caused the global COVID-19 pandemic. Governments are implementing lockdowns that are leading to economic fallout in many countries. Policy makers can take better decisions if provided with the indicators connected with the disease spread. This study is aimed to cluster the countries using social, economic, health and environmental related metrics affecting the disease spread so as to implement the policies to control the widespread of disease. Thus, countries with similar factors can take proactive steps to fight against the pandemic. The data is acquired for 79 countries and 18 different feature variables (the factors that are associated with COVID-19 spread) are selected. Pearson Product Moment Correlation Analysis is performed between all the feature variables with cumulative death cases and cumulative confirmed cases individually to get an insight of relation of these factors with the spread of COVID-19. Unsupervised k-means algorithm is used and the feature set includes economic, environmental indicators and disease prevalence along with COVID-19 variables. The learning model is able to group the countries into 4 clusters on the basis of relation with all 18 feature variables. We also present an analysis of correlation between the selected feature variables, and COVID-19 confirmed cases and deaths. Prevalence of underlying diseases shows strong correlation with COVID-19 whereas environmental health indicators are weakly correlated with COVID-19.

Using Nomogram to Predict the Hospitalization Forgone Among Internal Migrants in China: A Nationally Representative Cross-Sectional Secondary Data Analysis

Background

Migrants are one of the most vulnerable populations facing many health issues. Inadequate health care access and unequal insurance are the most challenging. This study aimed to construct a nomogram to predict the risk of hospitalization forgone among internal migrants in China.

Methods

We analyzed the 2014 Mobile Population Social Integration and Mental Health Survey (MPSIMHS) launched by National Health and Family Planning Commission. Using the Probability Proportionate to Size Sampling method (PPS), MPSIMHS sampled from eight cities (districts) with a total sample size of 15,999. Of total 589 patients who were diagnosed with hospitalization requirement, 116 forwent their hospitalization, 473 had no forgone. Demographics, socioeconomic status, and health conditions were analyzed using univariate analysis and multivariate logistic regression. A nomogram was built and validated by applying bootstrap resampling.

Results

After model selection, gender, age group, marital status, migration range, insurance (having NRMI), and self-evaluated health were chosen into the nomogram to predict the risk of hospitalization forgone. The nomogram that predicted the risk of hospitalization forgone was validated for discrimination and calibration using bootstrap resampling. The calibration curves illustrated optimal agreement between the actual and predicted probabilities of the nomogram. The value of C-index from bootstrap was 0.80 (95% CI: 0.76–0.85).

Conclusion

This study identified some possible factors contributing to migrant’s hospitalization forgone: being single, male and middle-aged, having fixed health insurance, and having bad or great self-evaluated health. By integrating significant and easy-to-get prognostic factors, a nomogram was developed to estimate an individual patient’s risk of hospitalization forgone, which might have practical utility and the potential to assist clinicians in making hospitalization recommendations.

Non-fasting lipid profile for cardiovascular risk assessments using China ASCVD risk estimator and Europe SCORE risk charts in Chinese participants

Background

Previous studies have shown that non-fasting lipids have similar values in cardiovascular risk estimation as fasting, but it is not clear whether this could also be applicable to Chinese participants.

Methods

A total of 127 (76 men, 51 women) participants without atherosclerotic cardiovascular diseases (ASCVD) were enrolled in the study. Serum levels of blood lipids were monitored at 0 h, 2 h and 4 h after a daily breakfast. Ten-year cardiovascular disease (CVD) risk was estimated with China ASCVD risk estimator and European SCORE risk charts. Kappa statistic was used to determine agreement among estimators.

Results

China ASCVD risk estimator assessed half of the participants as low risk, while European risk charts assessed half of the participants as moderate risk in the same participants. Reliability analysis in China ASCVD risk estimator and Europe SCORE risk charts based on fasting and or non-fasting lipids profile were relatively high (Kappa =0.731 or 0.718, P<0.001), (Kappa =0.922 or 0.935, P<0.001) (Kappa =0.886 or 0.874, P<0.001), but agreement between two were relatively poor in both fasting and non-fasting states (Kappa =0.339 or 0.300, P<0.001), (Kappa =0.364 or 0.286, P<0.001).

Conclusions

Promoting use of non-fasting lipids in diagnosis, evaluation, and prediction of CVD are feasible. Furthermore, non-fasting lipids could be used in China ASCVD risk estimator to evaluate 10-year risk of ASCVD among Chinese general participants.

[What do we Know About the Link Between Urbanisation and Mental Illness? - A Systematic Review]

OBJECTIVE

The proportion of peoples living in cities or urban areas will increase till 2050 enormously. The present paper investigated the effect of urbanization on mental health.

METHODS

We systematically searched electronic databases (Medline, Health Evidence and Google Scholar) for systematic reviews and single studies.

RESULTS

Analyzed findings showed mostly increased incidence or prevalence ratios for the occurence of schizophrenia, other psychotic disorders and depression. The relationship between urbanisation and mental health among immigrants (migration: country to city) is not clearly established. Sociodemographic and economic factors have a moderating effect. Urbanization is not conceptualised in a uniform way.

CONCLUSION

Further research is needed with standardized and consistent approaches of urbanization as well as focusing current birth cohorts.

Validating World Health Organization cardiovascular disease risk charts and optimizing risk assessment in China

Background

World Health Organization (WHO) released region-specific cardiovascular disease (CVD) risk prediction charts recently, but the extent to which the charts can apply to Chinese population is unknown. We aimed to validate the WHO CVD risk charts for East Asia, and evaluate their practicability combining with China-PAR (Prediction for Atherosclerotic Cardiovascular Disease Risk in China) equations among Chinese adults.

Methods

The China-PAR cohort with 93,234 participants aged 40–80 years was followed up during 1992–2015, including 29,337 participants from three sub-cohorts with follow-up period of over 10 years. We validated the WHO CVD risk charts using the China-PAR cohort by assessment of the predicted number of events, C index, calibration χ², and calibration plots, further elaborated the concordance between the China-PAR equations and the WHO risk charts.

Findings

During an average follow-up of 13•64 years, 1849 incident CVD cases were identified from 29,337 participants. Both the laboratory-based and non-laboratory-based charts overestimated CVD events by 59% and 58% in men, and by 72% and 85% in women, respectively. However, 92% of participants identified as high risk by the China-PAR equations could be successfully detected by the laboratory-based charts at the cut-off point of 10%. We also observed that the non-laboratory-based charts demonstrated the poor performance for diabetic population, with high proportion of high-risk individuals (17% for men, 31% for women) would be missed.

Interpretation

Although the WHO CVD risk charts for East Asia apparently overestimated CVD risk among Chinese population, they could be pragmatic pre-selection tools, as potential supplement to the China-PAR equations. The widespread use of the WHO risk charts along with the China-PAR equations might facilitate the implementation of the risk-based CVD prevention in China.

Funding

Full funding sources are listed at the end of the paper (see Acknowledgments).

Association of Socioeconomic Status and Overweight/Obesity in Rural-to-Urban Migrants: Different Effects by Age at Arrival

This study aims to investigate the association between socioeconomic status and overweight/obesity in rural-to-urban Yi migrants in China, and to explore whether the association varied by the age at arriving urban areas. The cross-sectional population-based data from the Yi Migrants Study in 2015 was used, which included 1,181 Yi migrants aged 20–80 years. Socioeconomic status was evaluated by education level, personal annual income, and a composited variable (socioeconomic status index, SESI). Measured weight and height were used to calculate BMI and to define overweight/obesity (BMI ≥ 24 kg/m²). The results suggested that the association of income and SESI with overweight/obesity was not significant when age at arrival (two groups, <20 and ≥20 years) was considered as a covariate. In the stratification analysis, reversed association was observed in the two groups of age at arrival. In migrants of <20 years of age at arrival, higher level of education and SESI were related to decreased risk of overweight/obesity. In contrary, in those of ≥20 years at arrival, higher socioeconomic status level was found to be related to increased risk. Our findings suggest that the effect of socioeconomic status on overweight/obesity was modified by the age at arrival in Yi migrants. Especially, the association between socioeconomic status and overweight/obesity was negative when migration before 20 years of age, and transfer to positive after 20 years.

Rural-to-urban migration, discrimination experience, and health in China: Evidence from propensity score analysis

This research examines how rural-to-urban migration influences health through discrimination experience in China after considering migration selection bias. We conducted propensity score matching (PSM) to obtain a matched group of rural residents and rural-to-urban migrants with a similar probability of migrating from rural to urban areas using data from the 2014 China Family Panel Studies (CFPS). Regression and mediation analyses were performed after PSM. The results of regression analysis after PSM indicated that rural-to-urban migrants reported more discrimination experience than rural residents, and those of mediation analysis revealed discrimination experience to exert negative indirect effects on the associations between rural-to-urban migration and three measures of health: self-reported health, psychological distress, and physical discomfort. Sensitivity analysis using different calipers yielded similar results. Relevant policies and practices are required to respond to the unfair treatment and discrimination experienced by this migrant population.

Validation of 10-Year Stroke Prediction Scores in a Community-Based Cohort of Chinese Older Adults

A stroke prediction model based on the Prediction for Atherosclerotic Cardiovascular Disease Risk in China (China-PAR) project was developed. We compared its predictive ability with the revised Framingham Stroke Risk Score (R-FSRS) for 5-year stroke incidence in a community cohort of Chinese adults, namely the Beijing Longitudinal Study of Aging (BLSA). Calibration, discrimination, and recalibration were used to compare the predictive ability between the two prediction models. Category-less net reclassification improvement (NRI) and integrated discrimination improvement (IDI) values were also assessed. During a mean follow-up duration of 5.1 years, 106 incidents of fatal or non-fatal strokes occurred among 1,203 participants aged 55–84 years. The R-FSRS applied to our cohort underestimated the 5-year risk for stroke in men and women. China-PAR performed better than the R-FSRS in terms of calibration (men, R-FSRS: χ²-value 144.2 [P < 0.001], China-PAR: 10.4 [P = 0.238]; women, R-FSRS: 280.1 [P < 0.001], China-PAR: 12.5 [P = 0.129]). In terms of discrimination, R-FSRS and China-PAR models performed modestly in our cohort (C-statistic 0.603 [95% CI: 0.560–0.644] for men using China-PAR and 0.568 [95% CI: 0.524–0.610] using the R-FSRS; the corresponding numbers for women were 0.602 [95% CI: 0.564–0.639] and 0.575 [95% CI: 0.537–0.613). The recalibrated China-PAR model significantly improved the discrimination in C statistics and produced higher category-less NRI and IDI for stroke incidence than the R-FSRS. Although China-PAR fairly estimated stroke risk in our cohort, it did not sufficiently identify adults at high risk of stroke. Caution would be exercised by practitioners in applying the original China-PAR to Chinese older adults. Further studies are needed to develop an adequate prediction model based on the recalibrated China-PAR or to find new risk markers which could upgrade this model.

Modifiable risk factors and overall cardiovascular mortality: Moderation of urbanization

Background: Modifiable risk factors are associated with cardiovascular mortality (CVM) which is a leading form of global mortality. However, diverse nature of urbanization and its objective measurement can modify their relationship. This study aims to investigate the moderating role of urbanization in the relationship of combined exposure (CE) of modifiable risk factors and CVM. Design and Methods: This is the first comprehensive study which considers different forms of urbanization to gauge its manifold impact. Therefore, in addition to existing original quantitative form and traditional two categories of urbanization, a new form consisted of four levels of urbanization was duly introduced. This study used data of 129 countries mainly retrieved from a WHO report, Non-Communicable Diseases Country Profile 2014. Factor scores obtained through confirmatory factor analysis were used to compute the CE. Age-income adjusted regression model for CVM was tested as a baseline with three bootstrap regression models developed for the three forms of urbanization. Results: Results revealed that the CE and CVM baseline relationship was significantly moderated through the original quantitative form of urbanization. Contrarily, the two traditional categories of urbanization could not capture the moderating impact. However, the four levels of urbanization were objectively estimated the urbanization impact and subsequently indicated that the CE was more alarming in causing the CVM in levels 2 and 3 urbanized countries, mainly from low-middle-income countries. Conclusion: This study concluded that the urbanization is a strong moderator and it could be gauged effectively through four levels whereas sufficiency of two traditional categories of urbanization is questionable.

Association between age at arrival, duration of migration, and overweight/obesity in Chinese rural-to-urban migrants: the Yi migrant study

Background:

Urbanization in China is rapidly proceeding, but rural-to-urban migration and its association with overweight and obesity is not well studied. This study aimed to explore the age at arrival, duration of migration, and the corresponding association with overweight/obesity in Yi migrants in China.

Methods:

A cross-sectional study was conducted in rural and urban areas in 2015 in Sichuan province, China. Demographic characteristics, lifestyle factors, and anthropometry were collected. General linear regression models were used to assess the effect of duration of migration (1–10, 11–20, 21–30, and >30 years) on body mass index (BMI). Multi-variable logistic regression was used to examine the association between duration of migration and overweight/obesity (BMI ≥ 25 kg/m²).

Results:

A total of 3056 Yi people (1894 Yi farmers and 1162 Yi migrants) aged 20 to 80 years were enrolled. After adjusting for age, sex, and other potential confounders, Yi migrants had 1.71 kg/m² (95% confidence interval [CI]: 1.36–2.06) higher BMI and a 2.13-fold (95% CI: 1.71–2.65) higher risk of overweight/obesity than Yi farmers. In Yi migrants, stratified by age at arrival, no significant association between duration of migration and overweight/obesity was observed in those who were 0 to 20 years old at arrival. In comparison, in migrants >20 years old at arrival, compared with the reference group (1–10 years), long-term migration (>30 years) was found to be associated with overweight/obesity after adjustment (odds ratio: 1.85, 95% CI: 1.04–3.29).

Conclusions:

Yi migrants were observed to have greater risk of overweight/obesity than Yi farmers. In Yi migrants, the risk of overweight/obesity increased according to the duration of migration, especially in those who were older upon their arrival.

Two Time Point Analysis of the Change in Risk and Aging Factors for Major Cancers: A 10-Year Longitudinal Study in China

OBJECTIVE

To quantify the change in risk and aging factors with a two time point analysis for major cancers to assess supportive strategies.

METHODS

The 2004 and 2015 mortality statistics in China were accessed. The standardized mortality rates of the two periods were used to calculate the ratio of change (RC) value to assess the risk of death associated with time (social development with time) for cancers. The role of age in mortality with time was evaluated by the interaction between time and age using a Poisson regression.

RESULTS

In ascending order of RC, the factors were uterus; other malignant neoplasms; esophagus; stomach; skin; liver; leukemia; "lip, oral cavity, and pharynx"; bladder; "colon and rectum"; breast; prostate; lung; ovary; pancreas; "lymphoid, hematopoietic, and related tissue"; and cervix cancers. According to their location on the scatter diagram, the 17 neoplasms could be divided into three groups, comprising undeveloped cancers (including four cancers), developed cancers (including three cancers), and cancers insensitive to social development. Unexpectedly, about 60% (as assessed by type of cancer) and two-thirds (as assessed by constituent ratio of death from all cancers) of cancers did not change with time.

CONCLUSIONS

Most cancers may be insensitive to social development. Internal factors, including aging, may be a key factor for the occurrence of cancer.

Twenty-year time trends in hypertension prevalence in Yi people of China: three successive cross-sectional studies, 1996-2015

OBJECTIVE

To explore the trend of hypertension prevalence and related factors in Yi people from 1996 to 2015.

METHODS

Three successive cross-sectional surveys were conducted in Liangshan Yi Autonomous Prefecture in 1996, 2007 and 2015, respectively. A total of 8448 participants aged 20-80 years (5040 Yi farmers, 3408 Yi migrants) were included in final analysis.

RESULTS

Overall, the age-standardised prevalence of hypertension in migrants was significantly higher than in farmers. Furthermore, the age-standardised prevalence rates increased from 10.1% to 15.3% to 19.6% in Yi migrants and from 4.0% to 6.3% to 13.1% in Yi farmers during 1996 to 2007 to 2015. The highest 2015-to-1996 ratio of age-standardised hypertension prevalence was in male farmers (ratio=4.30), whereas despite the highest prevalence of hypertension, the equivalent figure in male migrants was 1.57. The older age, overweight and obesity were persistent risk factors of hypertension in three periods. After adjusted for age and body mass index, the difference of hypertension prevalence between 1996 and 2015 then vanished in male migrants (OR=1.335; 95% CI: 0.884 to 2.015) and female farmers (OR=1.267; 95% CI: 0.590 to 2.719). The disparities of hypertension prevalence between Yi migrants and farmers were not statistically significant in all subgroups when adjusted for age, body mass index and education.

CONCLUSIONS

Over the past two decades, the hypertension prevalence in Yi people has significantly increased. Yi migrants were more likely to be hypertensive than Yi farmers which was predominantly driven by the discrepancy of body mass index between them.

Quantifying the effects of aging and urbanization on major gastrointestinal diseases to guide preventative strategies

BACKGROUND

This study aimed to quantify the effects of aging and urbanization on major gastrointestinal disease (liver cirrhosis, hepatitis B, diarrhea, liver cancer, stomach cancer, pancreas cancer, hepatitis C, esophagus cancer, colon/rectum cancer, gastrointestinal ulcers, diabetes, and appendicitis).

METHODS

We accessed 2004 and 2011 mortality statistics from the most developed cities and least developed rural areas in China using a retrospective design. The relative risk of death associated with urbanization and age was quantified using Generalized linear model (the exp.(B) from model is interpreted as the risk ratio; the greater the B, the greater the impact of urbanized factors or aging factor or effect of aging factor with urbanization). The interaction between region (cities and rural areas) and age was considered as indicator to assess role of age in mortality with urbanization.

RESULTS

Greater risk of disease with urbanization were, in ascending order, for diabetes, colon/rectum cancer, hepatitis C and pancreas cancer. Stronger the effect of aging with urbanization were, in ascending order, for stomach cancer, ulcer, liver cancer, colon/rectum cancer, pancreas cancer, diabetes, hepatitis C, appendicitis and diarrhea. When the effects of aging and urbanization on diseases were taken together as the dividing value, we were able to further divide the 12 gastrointestinal diseases into three groups to guide the development of medical strategies.

CONCLUSIONS

It was suggested that mortality rate for most gastrointestinal diseases was sensitive to urbanization and control of external risk factors could lead to the conversion of most gastrointestinal disease.

Perceived Discrimination, Screen Use, and BMI Among Rural-to-Urban Migrant Children in China: Evidence from a Nutrition Transition Context

Discrimination promotes sedentary behavior and obesity among Western adults. The obesogenic impact of discrimination has yet been examined in developing countries. Participants were 1755 seventh grade rural-to-urban migrant students in the first three waves (2013-2016) of China Education Panel Survey-Junior High Cohort. Latent growth curve models evaluated associations of perceived origin-based discrimination with intercepts and slopes for BMI and screen use trajectories over a 3-year period. Most migrant students came from families of low socioeconomic status. Around 20% of the migrant students reported origin-based discrimination at school. After adjusting for covariates, origin-based discrimination was positively associated with intercepts of TV watching (b = 0.18, p < .001) and internet use (b = 0.24, p < .001), but was not associated with either the intercept or slope of BMI. Perceived discrimination increases screen use for Chinese migrant children, though its contribution to BMI growth is unclear. As the nutrition transition penetrates deeper into lives of all social strata, future studies need to monitor whether perceived discrimination may emerge as an important source of social disparity in obesity in China.

Increasing prevalence of overweight and obesity in Yi farmers and migrants from 2007 to 2015 in China: the Yi migrant study

Background

With the social development and lifestyle transition, increasing trends of overweight and obesity prevalence are commonly reported worldwide. Data focusing on overweight and obesity trends in rural residents and rural-to-urban migrants in China are limited. This study aims to assess the changes and related factors of overweight and obesity in Yi farmers and migrants in southwest China from 2007 to 2015, and to assess the disparities in prevalence changes.

Methods

Pseudo-panel data was obtained from two cross-sectional studies conducted in Sichuan province, southwest China in 2007 and 2015. Standardized prevalence of overweight and obesity were evaluated by direct method using the 2010 national census population as the standard. Prevalence differences of overweight and obesity were calculated in each group and compared between groups to evaluate the disparity in prevalence changes. Generalized linear mixed model was performed to determine factors related to overweight/obesity.

Results

Standardized prevalence of overweight increased in both groups (from 5.54 to 16.65% in Yi farmers, from 27.91 to 33.61% in Yi migrants). Standardized prevalence of obesity increased only in Yi farmers (from 0.37 to 3.13%). Prevalence difference of overweight in Yi farmers was higher than that in Yi migrants (11.11 vs. 5.70), but prevalence differences of obesity were not significantly different between Yi farmers and migrants.

Conclusions

Prevalence of overweight and obesity in Yi farmers, and prevalence of overweight in Yi migrants increased from 2007 to 2015. Yi farmers were developing overweight at a greater pace than migrants. More attention should be paid to spread health knowledge and encourage healthy lifestyle in Yi people, especially Yi farmers.

Electronic supplementary material

The online version of this article (10.1186/s12889-018-5577-4) contains supplementary material, which is available to authorized users.

Self-Rated Health Status and Risk of Ischemic Heart Disease in the China Kadoorie Biobank Study: A Population-Based Cohort Study

BACKGROUND

Self-rated health (SRH) is a strong predictor of mortality in different populations. However, the associations between SRH measures and risk of ischemic heart disease (IHD) have not been extensively explored, especially in a Chinese population.

METHODS AND RESULTS

More than 500 000 adults from 10 cities in China were followed from baseline (2004-2008) through December 31, 2013. Global and age-comparative SRH were reported from baseline questionnaires. Incident IHD cases were identified through links to well-established disease registry systems and the national health insurance system. During 3 423 542 person-years of follow-up, we identified 24 705 incident cases of IHD. In multivariable-adjusted models, both global and age-comparative SRH was significantly associated with incident IHD. Compared with excellent SRH, the hazard ratios for good, fair, and poor SRH were 1.02 (95% confidence interval [CI], 0.98-1.07), 1.32 (95% CI, 1.27-1.37), and 1.76 (95% CI, 1.68-1.85), respectively. Compared with better age-comparative SRH, the hazard ratios for same and worse age-comparative SRH were 1.23 (95% CI, 1.19-1.27) and 1.78 (95% CI, 1.70-1.86), respectively. The associations persisted in all subgroup analyses, although they were slightly modified by study location, education, and income levels.

CONCLUSIONS

A simple questionnaire for self-assessment of health status was significantly associated with incident IHD in Chinese adults. Individuals and healthcare providers can use SRH measures as a convenient tool for assessing future IHD risk.

Predicting the 10-Year Risks of Atherosclerotic Cardiovascular Disease in Chinese Population: The China-PAR Project (Prediction for ASCVD Risk in China)

BACKGROUND

The accurate assessment of individual risk can be of great value to guiding and facilitating the prevention of atherosclerotic cardiovascular disease (ASCVD). However, prediction models in common use were formulated primarily in white populations. The China-PAR project (Prediction for ASCVD Risk in China) is aimed at developing and validating 10-year risk prediction equations for ASCVD from 4 contemporary Chinese cohorts.

METHODS

Two prospective studies followed up together with a unified protocol were used as the derivation cohort to develop 10-year ASCVD risk equations in 21 320 Chinese participants. The external validation was evaluated in 2 independent Chinese cohorts with 14 123 and 70 838 participants. Furthermore, model performance was compared with the Pooled Cohort Equations reported in the American College of Cardiology/American Heart Association guideline.

RESULTS

Over 12 years of follow-up in the derivation cohort with 21 320 Chinese participants, 1048 subjects developed a first ASCVD event. Sex-specific equations had C statistics of 0.794 (95% confidence interval, 0.775-0.814) for men and 0.811 (95% confidence interval, 0.787-0.835) for women. The predicted rates were similar to the observed rates, as indicated by a calibration χ² of 13.1 for men (P=0.16) and 12.8 for women (P=0.17). Good internal and external validations of our equations were achieved in subsequent analyses. Compared with the Chinese equations, the Pooled Cohort Equations had lower C statistics and much higher calibration χ² values in men.

CONCLUSIONS

Our project developed effective tools with good performance for 10-year ASCVD risk prediction among a Chinese population that will help to improve the primary prevention and management of cardiovascular disease.

Obesity risk in rural, urban and rural-to-urban migrants: prospective results of the PERU MIGRANT study

BACKGROUND

Although migration and urbanization have been linked with higher obesity rates, especially in low-resource settings, prospective information about the magnitude of these effects is lacking. We estimated the risk of obesity and central obesity among rural subjects, rural-to-urban migrants and urban subjects.

METHODS

Prospective data from the PERU MIGRANT Study were analyzed. Baseline data were collected in 2007-2008 and participants re-contacted in 2012-2013. At follow-up, outcomes were obesity and central obesity measured by body mass index and waist circumference. At baseline, the primary exposure was demographic group: rural, rural-to-urban migrant and urban. Other exposures included an assets index and educational attainment. Cumulative incidence, incidence ratio (IR) and 95% confidence intervals (95% CI) for obesity and central obesity were estimated with Poisson regression models.

RESULTS

At baseline, mean age (±s.d.) was 47.9 (±12.0) years, and 53.0% were females. Rural subjects comprised 20.2% of the total sample, whereas 59.7% were rural-to-urban migrants and 20.1% were urban dwellers. A total of 3598 and 2174 person-years were analyzed for obesity and central obesity outcomes, respectively. At baseline, the prevalence of obesity and central obesity was 20.0 and 52.5%. In multivariable models, migrant and urban groups had an 8- to 9.5-fold higher IR of obesity compared with the rural group (IR migrants=8.19, 95% CI=2.72-24.67; IR urban=9.51, 95% CI=2.74-33.01). For central obesity, there was a higher IR only among the migrant group (IR=1.95; 95% CI=1.22-3.13). Assets index was associated with a higher IR of central obesity (IR top versus bottom tertile 1.45, 95% CI=1.03-2.06).

CONCLUSIONS

Peruvian urban individuals and rural-to-urban migrants show a higher incidence of obesity compared with their rural counterparts. Given the ongoing urbanization occurring in middle-income countries, the rapid development of increased obesity risk by rural-to-urban migrants suggests that measures to reduce obesity should be a priority for this group.

Changes in human health parameters associated with a touch tank experience at a zoological institution

Association of Zoos and Aquariums (AZA) institutions provide a variety of benefits to visitors. However, one area that has received little study is the direct human health benefits from zoo and aquarium visits. With the increase in stress related non-infectious diseases in industrialized countries, understanding the extent of these benefits is important. We studied the effects on visitor stress of an experience at a touch tank exhibit featuring stingrays, sharks, and horseshoe crabs. Stress was measured by physiological and psychological parameters. Heart rate was recorded before, during, and after interacting with the animals, and mood was assessed before and after the experience using a psychological instrument. Multilevel models of heart rate show a quadratic trend, with heart rate elevated (b = -3.01, t = 26.4, P < 0.001) and less variable (b = 3.60, t = 15.9, P < 0.001) while touching the animals compared to before or after. Wilcoxon signed-rank tests on mood data suggest that most visitors felt happier (V = 174.5, P < 0.001), more energized (V = 743.5, P < 0.001), and less tense (V = 5618, P < 0.001) after the experience. This suggests that interacting with animals led to a physiological response during interactions reminiscent of a theme park experience along with a decrease in mental stress. The effects of confounding variables such as crowd size are also discussed. Further studies should be conducted to help deepen our understanding of the health benefits of experiences at AZA institutions.

Defining migration and its health impact in China

The scale and rapid expansion of urbanization resulting from socio-economic transformation in China at the beginning of the 21st century has accelerated rural-urban migration. Public health concerns from this increasing internal population mobility are now receiving attention from researchers. The health problems from internal migration pose particular demands on healthcare systems and relate to its demographic characteristics, with many younger and older people being left behind in the rural countryside. A review of literature, census, policy reports, government documents and media was undertaken to look at the classification system and health characteristics of China's internal migrants. It suggests that public health bears the consequences of political and economic decisions made elsewhere in society.

Association of the AGXT2 V140I polymorphism with risk for coronary heart disease in a Chinese population

AIM

Asymmetric dimethylarginine (ADMA) is a nitric oxide synthase (NOS) inhibitor that decreases NO production and promotes the development of cardiovascular diseases. Alanine-glyoxylate aminotransferase 2 (AGXT2) plays an important role in ADMA metabolism. This study was designed to explore the association of the AGXT2 V140I (rs37369 G＞A) polymorphism with risk for coronary heart disease (CHD) in a Chinese population.

METHODS

A case-control study including 1103 controls and 942 CHD patients was performed. The patients were genotyped for rs37369 using the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method. Plasma ADMA concentration in healthy controls was measured by an enzyme-linked immunosorbent assay (ELISA).

RESULTS

The rs37369 GG genotype was significantly overrepresented in CHD patients compared to the controls (18.5% versus 14.8%, p=0.025), and it was significantly associated with increased risk for CHD in smokers (OR=2.21, 95% CI: 1.24-3.92, p=0.007) and marginally increased CHD risk for individuals with diabetes mellitus (OR=1.92; 95% CI: 0.94-3.91, p=0.074). The association between rs37369 and CHD risk was further increased in smokers with diabetes mellitus (OR=3.32, 95% CI:1.14-9.67, p=0.028). Patients who smoked and were rs37369 GG homozygous showed significantly higher plasma ADMA levels than carriers of the rs37369 A allele (p=0.004). However, in non-smokers, patients homozygous for rs37369 GG showed significantly lower plasma ADMA concentrations than carriers of the rs37369 A allele (p=0.003). Furthermore, smokers homozygous for rs37369 GG showed significantly higher plasma ADMA concentrations than non-smokers with the same genotype (p=0.012).

CONCLUSION

The AGXT2 rs37369 polymorphism is associated with increased risk for CHD in smokers and in diabetes mellitus patients. This increased risk may be due to increased plasma ADMA levels.

Psychometric testing of the Chinese Mandarin version of the Mental Health Inventory among Chinese patients with coronary heart disease in Mainland China

This study aimed to develop a Chinese Mandarin version of the Mental Health Inventory (CM:MHI). The English version MHI was translated into Chinese (simple Chinese character) using the forward-backward translation method while establishing the semantic equivalence and content validity. A convenience sample of 204 coronary heart disease (CHD) patients was recruited to evaluate the internal consistency, concurrent validity and construct validity of the CM:MHI. Forty patients completed the CM:MHI to evaluate the test-retest reliability after 2 weeks. The CM:MHI demonstrated good semantic equivalent rate (92%) and satisfactory content validity index (0.91). The internal consistency was acceptable for total and all subscales with Cronbach's alpha greater than 0.70, with the exception of the subscale of Emotional Ties (Cronbach's alpha = 0.64). The test-retest reliability was also satisfactory with intraclass correlation coefficients higher than 0.75. The concurrent validity was acceptable with significantly strong correlations between the CM:MHI and the Chinese Mandarin versions of Short Form 36 Health survey and Hospital Anxiety and Depression Scale. Confirmatory factor analysis further supported the five-factor structure of the CM:MHI. The CM:MHI demonstrated to be a valid and reliable measure for assessing psychological distress and well-being in Chinese-speaking CHD patients.

Development of ventricular assist devices in China: present status, opportunities and challenges

The growing number of heart failure patients and the scarcity of organ donors account for the huge need for the development of mechanical circulatory systems, including ventricular assist devices (VADs) and artificial hearts, in China. Several research programmes on blood pumps have been under way for the last three decades. However, unlike in other countries, the development of VADs has been extremely slow, and no system is currently approved and available for clinical application. There are many reasons for this situation. This article provides an overview of the present development of experimental and clinical research on VADs in China. In addition, the challenges for the clinical development of mechanical circulatory support in China are discussed.

Health of China's rural-urban migrants and their families: a review of literature from 2000 to 2012

BACKGROUND

Socioeconomic transformation in China at the beginning of the twenty-first century has led to rapid urbanization and accelerated rural-urban migration. As a result, the concerns about public health problems triggered by increasing internal population mobility have been more widely studied in recent years.

SOURCES OF DATA

Published data in Chinese and English on health of migrants and their families in mainland China from 2000 to 2012.

AREAS OF AGREEMENT

The shifting patterns of disease distribution due to rural-urban migration, health equity and health reform strategies that cater for this specific yet substantial subpopulation are outstanding concerns. Infectious diseases, mental health, occupational health and women's health are emerging public health priorities related to migration.

AREAS OF CONTROVERSY

The high mobility and large numbers of Chinese rural-urban migrants pose challenges to research methods and the reliability of evidence gained.

GROWING POINTS

While the theme of working migrants is common in the literature, there have also been some studies of health of those left behind but who often remain unregistered. Migration within China is not a single entity and understanding the dynamics of new and emerging societies will need further study.

AREAS TIMELY FOR DEVELOPING RESEARCH

Social, economic, emotional, environmental and behavioural risk factors that impact on health of migrants and their families call for more attention from health policy-makers and researchers in contemporary China.