[Analysis on passive smoking exposure in adults aged 40 years and older in China, 2014]

Passive Smoking During the Periconceptional Period and Risk for Neural Tube Defects in Offspring - Five Counties, Shanxi Province, China, 2010-2016

WHAT IS ALREADY KNOWN ABOUT THIS TOPIC?

Passive smoking during pregnancy, which is prevalent in China, has been reported to be associated with an increased risk for neural tube defects (NTDs) in five counties of Shanxi Province in northern China.

WHAT IS ADDED BY THIS REPORT?

After 4 years since the implementation of the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC) in China, 59.4% of mothers of NTDs cases and 29.4% of mothers of healthy controls reported passive smoking during the periconceptional period. The association between periconceptional passive smoking and an increased risk for NTDs remains in the study population.

WHAT ARE THE IMPLICATIONS FOR PUBLIC HEALTH PRACTICE?

It's urgent to take measures to prevent passive smoking among pregnant women to minimize the harmful effects on offspring.

Smoking status affects clinical characteristics and disease course of acute exacerbation of chronic obstructive pulmonary disease: A prospectively observational study

Existing studies primarily explored chronic obstructive pulmonary disease (COPD) in smokers, whereas the clinical characteristics and the disease course of passive or nonsmokers have been rarely described. In the present study, patients hospitalized and diagnosed as acute exacerbation of COPD (AECOPD) were recruited and followed up until being discharged. Clinical and laboratory indicators were ascertained and delved into. A total of 100 patients were covered, namely, 52 active smokers, 34 passive smokers, and 14 nonsmokers. As revealed from the results here, passive or nonsmokers developed less severe dyspnea (patients with modified Medical Research Council scale (mMRC) <2, 0.0% vs. 8.8% vs. 14.3%, p < 0.05, active, passive, and nonsmokers, respectively), higher oxygenation index (206.4 ± 45.5 vs. 241.2 ± 51.1 vs. 242.4 ± 41.8 mmHg, p < 0.01), as well as lower arterial partial pressure of carbon dioxide (70.8 ± 12.7 vs. 58.85 ± 9.9 vs. 56.6 ± 6.5 mmHg, p < 0.001). Despite lower treatment intensity over these patients, amelioration of dyspnea, mitigation of cough, and elevation of oxygenation index were comparable to those of active smokers. However, in terms of patients exhibiting mMRC ≥2 and type 2 respiratory failure, amelioration of dyspnea was more common in nonsmokers as compared with passive smokers (46.4% vs. 83.3%, p < 0.05, passive and nonsmokers, respectively). In terms of patients exhibiting Global Initiative for COPD severity <3, mMRC ≥2, and type 2 respiratory failure, active smokers achieved the least mitigation of cough symptom (8.7% vs. 35.0% vs. 44.4%, p < 0.05). Similar results could be achieved after the effects of confounders were excluded, with the most prominent amelioration of dyspnea (odds ratio (OR) 3.8, 95% confidence interval (CI) 1.1-13.6, p < 0.05, as compared with active smokers) and cough (OR 3.3, 95% CI 1.0-10.7, p < 0.05) in nonsmokers, and relatively better amelioration of hypoxemia in passive smokers (oxygenation index change, 39.0 ± 34.6 vs. 51.5 ± 32.4 vs. 45.3 ± 25.4 mmHg, p < 0.05). In brief, passive or nonsmokers with AECOPD were subjected to less severe disease, and nonsmokers, especially patients with more severe disease, might achieve the optimal enhancement of clinical presentation after treatment.

Current status and preventive strategies of chronic obstructive pulmonary disease in China: a literature review

Chronic obstructive pulmonary disease (COPD) is a common respiratory disease that seriously threatens human health and wellbeing, thereby representing an important public health problem. At present, it is the fourth leading cause of death worldwide, and is estimated to become the third greatest cause of death by 2030. In China, the prevalence of COPD is increasing, secondary to an increase in smoking, air pollution and an aging population, resulting in a current the mortality of COPD in China which is higher than the global average. Moreover, the disability-adjusted life year (DALY) rate of COPD in China is still relatively high, with an associated heavy economic burden to patients, their families and society. Unfortunately, current measures for treatment and prevention of COPD in China are not optimal. This primarily results from limited public awareness of COPD and pulmonary function tests amongst residents of China, and the generally poor disease-specific knowledge of primary care doctors. In recent years, a series of preventative strategies have been introduced in China across at the level of national policy, societies and associations, and scientific research. This review focuses upon both the epidemiology of COPD and the current status of preventative and treatment strategies in China.

Cancer burden in China: trends, risk factors and prevention

As the most populous country in the world, China has made strides in health promotion in the past few decades. With the aging population, the burden of cancer in China continues to grow. Changes in risk factors for cancer, especially diet, obesity, diabetes, and air pollution, continue to fuel the shift of cancer transition in China. The burden of upper gastrointestinal cancer in China is decreasing, but still heavy. The rising burden of colorectal, prostate, and breast cancers is also significant. Lung cancer became the top cause of cancer-related deaths, together with smoking as the most important contributor to cancer deaths. The Chinese government has taken several approaches to control cancer and cancer-related risk factors. Many achievements have been made, but some challenges remain. Health China 2030 is ambitious and depicts a bright vision of the future for cancer control in China. The decrease in the cancer burden in China will require cross-sector collaboration and coordinated efforts on primary and secondary preventions by governments, public health organizations, and individuals. In this review, we describe the trends of cancer burden and discuss cancer-related risk factors in China, identifying strategies to reduce the burden of cancer in China.

Lung cancer occurrence attributable to passive smoking among never smokers in China: a systematic review and meta-analysis

Background

Quantifying the occurrence of lung cancer due to passive smoking is a necessary step when forming public health policy. In this study, we estimated the proportion of lung cancer cases attributable to passive smoking among never smokers in China.

Methods

Six databases were searched up to July 2019 for original observational studies reporting relative risks (RRs) or odds ratios (ORs) for the occurrence of lung cancer associated with passive smoking in Chinese never smokers. The population attributable fraction (PAF) was then calculated using the combined proportion of lung cancer cases exposed to passive smoking and the pooled ORs from meta-analysis. Data are reported with their 95% confidence intervals.

Results

We identified 31 case-control studies of never smokers and no cohort studies. These comprised 9,614 lung cancer cases and 13,093 controls. The overall percentages of lung cancers attributable to passive smoking among never smokers were 15.5% (9.0-21.4%) for 9 population-based studies and 22.7% (16.6-28.3%) for 22 hospital-based studies. The PAFs for women were 17.9% (11.4-24.0%) for the population-based studies and 20.9% (14.7-26.7%) for the hospital-based studies. The PAF for men was only calculable for hospital-based studies, which was 29.0% (95% CI: 8.0-45.2%). Among women, the percentage of lung cancer cases attributable to household exposure (19.5%) was much higher than that due to workplace exposure (7.2%).

Conclusions

We conclude that approximately 16% of lung cancer cases among never smokers in China are potentially attributable to passive smoking. This is slightly higher among women (around 18%), with most cases occurring due to household exposure.