Lancet Public Health最新文献

{"title":"Changes in the epidemiology of under-5 mortality in China from 2016 to 2022: an observational analysis of population-based surveillance data","authors":"Chunhua He, Leni Kang, Yuxi Liu, Xue Yu, Qi Li, Juan Liang, Li Dai, Xiaohong Li, Yanping Wang, Jun Zhu, Hanmin Liu","doi":"10.1016/s2468-2667(24)00267-6","DOIUrl":"https://doi.org/10.1016/s2468-2667(24)00267-6","url":null,"abstract":"<h3>Background</h3>Sustainable Development Goal (SDG) 3.2 aims to end preventable deaths of newborns and children younger than 5 years. China's progress towards SDG 3.2 has not been evaluated on multiple dimensions. We aimed to assess mortality rates in children younger than 5 years (hereafter referred to as under-5 mortality) and to quantify preventable child mortality and geospatial and temporal trends in child mortality in China from 2016 to 2022.<h3>Methods</h3>In this observational analysis, we used data from the Chinese National Maternal and Child Health Surveillance System (MCHSS) for the period Jan 1, 2016, to Dec 31, 2022 and conducted all-cause mortality and cause-specific mortality analyses for different age groups (age 0–6 days, 7–27 days, 0–27 days, 1–5 months, 6–11 months, 12–23 months, 24–59 months, and birth to 59 months) separately at the national, residential (rural <em>vs</em> urban), and regional (eastern <em>vs</em> central <em>vs</em> western China) levels. All mortality rates were adjusted by age group, type of residency, region, and region-residency strata using a 3-year moving average of the under-reporting rates. National deaths were estimated using the number of livebirths from 2016 to 2022 from the Health Statistics Yearbook of China. Estimated national-level and regional-level mortality rates were weighted by the proportion of the population living in urban and rural areas from the 2010 national census. Optimal survival metrics for neonates and children younger than 5 years were calculated by cause of death in 2020–22 (termed the national optimum), on the basis of the lowest mortality observed among the six region-residency strata.<h3>Findings</h3>In 2022, approximately 65 700 (95% CI 62 700–68 800) children younger than 5 years died in China, with 45·1% (42·7–47·4) of these deaths occurring in the neonatal period (age <28 days). China's under-5 mortality rate decreased from 10·2 deaths (9·9–10·5) per 1000 livebirths in 2016 to 6·8 deaths (6·5–7·2) per 1000 livebirths in 2022; the neonatal mortality rate decreased from 4·9 deaths (4·7–5·1) per 1000 livebirths in 2016 to 3·1 deaths (2·9–3·3) per 1000 livebirths in 2022. The relative risk of death in children younger than 5 years in rural areas compared with urban areas decreased from 2·4 (2·2–2·6) in 2016 to 1·9 (1·7–2·1) in 2022, and in the western region compared with the eastern region decreased from 3·4 (3·0–3·9) in 2016 to 2·3 (1·9–2·8) in 2022. The leading causes of under-5 mortality in 2022 were injuries (23·1% [21·1–25·1] of all-cause deaths), congenital malformations (14·8% [13·1–16·4]), preterm birth complications (14·1% [12·5–15·7]), intrapartum-related events (10·1% [8·7–11·5]), and acute respiratory infections (9·5% [8·2–10·9]). The leading cause of death in the neonatal period was preterm birth complications (12·8% [11·4–14·2] of deaths in children younger than 5 years).<h3>Interpretation</h3>Under-5 mortality in China declined between 2016 and 2022. D","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":"19 1","pages":""},"PeriodicalIF":50.0,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142776442","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Integrating prevention and treatment: rethinking China's health financing","authors":"Zhicheng Wang, Kit Yee Chan, Qianyi Xia, Jiantuo Yu, Minghui Ren","doi":"10.1016/s2468-2667(24)00247-0","DOIUrl":"https://doi.org/10.1016/s2468-2667(24)00247-0","url":null,"abstract":"Preventive health measures offer superior economic returns compared with the ever-increasing costs of treating established diseases, which place unsustainable pressure on health systems. By reducing the incidence and severity of illness, prevention minimises health-care expenditure and maximises societal welfare by lowering the burden of disease. In China, the principle of making prevention a priority is recognised in the Healthy China 2030 Initiative, which aims to shift the health system's focus towards prevention. However, this goal faces substantial challenges due to structural, legislative, and financial barriers.","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":"77 1","pages":""},"PeriodicalIF":50.0,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142776436","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Associations of long-term nitrogen dioxide exposure with a wide spectrum of diseases: a prospective cohort study of 0·5 million Chinese adults","authors":"Xi Xia, Xia Meng, Cong Liu, Yi Guo, Xinyue Li, Yue Niu, Kin Bong Hubert Lam, Neil Wright, Christiana Kartsonaki, Yiping Chen, Ling Yang, Huaidong Du, Canqing Yu, Dianjianyi Sun, Jun Lv, Junshi Chen, Xiaoming Yang, Ruqin Gao, Shaowei Wu, Haidong Kan, Chan Qu","doi":"10.1016/s2468-2667(24)00264-0","DOIUrl":"https://doi.org/10.1016/s2468-2667(24)00264-0","url":null,"abstract":"<h3>Background</h3>Little evidence is available on the long-term health effects of nitrogen dioxide (NO<sub>2</sub>) in low-income and middle-income populations. We investigated the associations of long-term NO<sub>2</sub> exposure with the incidence of a wide spectrum of disease outcomes, based on data from the China Kadoorie Biobank.<h3>Methods</h3>This prospective cohort study involved 512 724 Chinese adults aged 30–79 years recruited from ten areas of China during 2004–08. Time-varying Cox regression models yielded adjusted hazard ratios (HRs) for the associations of long-term NO<sub>2</sub> exposure with aggregated disease incidence endpoints classified by 14 ICD-10 chapters, and incidences of 12 specific diseases selected from three key ICD-10 chapters (cardiovascular, respiratory, and musculoskeletal diseases) found to be robustly associated with NO<sub>2</sub> in the analyses of aggregated endpoints. All models were stratified by age-at-risk (in 1-year scale), study area, and sex, and were adjusted for education, household income, smoking status, alcohol intake, cooking fuel type, heating fuel type, self-reported health status, BMI, physical activity level, temperature, and relative humidity.<h3>Findings</h3>The analysis of 512 709 participants (mean baseline age 52·0 years [SD 10·7]; 59·0% female and 41·0% male) included approximately 6·5 million person-years of follow-up. Between 5285 and 144 852 incident events were recorded for each of the 14 aggregated endpoints. Each 10 μg/m<sup>3</sup> higher annual average NO<sub>2</sub> exposure was associated with higher risks of chapter-specific endpoints, especially cardiovascular (n=144 852; HR 1·04 [95% CI 1·02–1·05]), respiratory (n=73 232; 1·03 [1·01–1·05]), musculoskeletal (n=54 409; 1·11 [1·09–1·14]), and mental and behavioural (n=5361; 1·12 [1·05–1·21]) disorders. Further in-depth analyses on specific diseases found significant positive supra-linear associations with hypertensive disease (1·08 [1·05–1·11]), lower respiratory tract infection (1·03 [1·01–1·06]), arthrosis (1·15 [1·09–1·21]), intervertebral disc disorders (1·13 [1·09–1·17]), and spondylopathies (1·05 [1·01–1·10]), and linear associations with ischaemic heart disease (1·03 [1·00–1·05]), ischaemic stroke (1·08 [1·06–1·11]), and asthma (1·15 [1·04–1·27]), whereas intracerebral haemorrhage (1·00 [0·95–1·06]), other cerebrovascular disease (0·98 [0·96–1·01]), acute upper respiratory infection (1·03 [0·96–1·09]), and chronic lower respiratory disease (0·98 [0·95–1·02]) showed no significant association. NO<sub>2</sub> exposure showed robust null association with external causes (n=32 907; 0·98 [0·95–1·02]) as a negative control.<h3>Interpretation</h3>In China, long-term NO<sub>2</sub> exposure was associated with a range of diseases, particularly cardiovascular, respiratory, and musculoskeletal diseases. These associations underscore the pressing need to implement the recently tightened WHO air quality guidelines.<h3>Funding</h3","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":"155 1","pages":""},"PeriodicalIF":50.0,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142776452","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Digital mental health: a potential opportunity to improve health equity in China","authors":"Hao Fong Sit, Wen Chen, Dan Wu, Yangmu Huang, Dong (Roman) Xu, Brian J Hall","doi":"10.1016/s2468-2667(24)00249-4","DOIUrl":"https://doi.org/10.1016/s2468-2667(24)00249-4","url":null,"abstract":"Mental health is an important public health issue in China, compounded by a shortage in psychiatric services. Against this backdrop, digital technologies could offer solutions. Digital mental health interventions use technologies, such as smartphone applications, to improve mental health outcomes. Although there has been a drastic increase in mental health mobile apps available in recent years, current evidence-based digital interventions for mental health are scarce and seldom evaluated for effectiveness and implementation in China. In this Viewpoint, we review digital mental health interventions in China and propose a framework that could guide the development of culturally sensitive digital mental health innovations, with the adoption of co-creation and community engagement strategies. We also provide recommendations to address issues related to usage, interventions, and implementation to improve health equity and implementation of digital mental health interventions in the Chinese context.","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":"2 1","pages":""},"PeriodicalIF":50.0,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142776443","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"All-cause and cause-specific mortality inequalities between people with and without disability: a nationwide data linkage study in Australia","authors":"Yi Yang, Peter Summers, Zoe Aitken, Anne Kavanagh, George Disney","doi":"10.1016/s2468-2667(24)00266-4","DOIUrl":"https://doi.org/10.1016/s2468-2667(24)00266-4","url":null,"abstract":"<h3>Background</h3>Without high-quality statistics on mortality inequalities, designing policies to improve the health of people with disability is challenging. We aim to quantify mortality inequalities experienced by people with disability in Australia.<h3>Methods</h3>In this nationwide, data linkage study we used Census mortality linked data (2011–20) to construct a cohort of Australians aged 0–74 years. Disability was measured as requiring assistance or supervision in core daily activities. We estimated age-standardised and age-specific mortality rates, and absolute and relative mortality inequalities between people with and without disability.<h3>Findings</h3>15 216 195 people were included in the study, comprising 7 763 047 females and 7 453 148 males. Of the participants, 258 109 (3·5%) males and 228 658 (2·9%) females reported disability, with 462 990 deaths occurring over 138 540 359 person-years of follow-up. Per 100 000 person-years, there were 2067 (95% CI 2043–2091) more deaths in males and 1697 (1677–1718) more deaths in females with disability (3·69 and 4·64 times higher, respectively) than those without disability. Cancer and cardiovascular disease had the highest absolute inequalities, with rate differences of 462 (95% CI 449–476) for males and 368 (356–379) for females for cancer, and 471 (95% CI 459–483) for males and 333 (324–342) for females for cardiovascular disease. Less common causes among people without disability—neurological conditions, chronic lung diseases, endocrine diseases, and digestive diseases—are relatively common among people with disability, translating to high relative mortality inequalities. The largest relative inequalities were from neurological conditions, with rate ratios of 9·66 (95% CI 9·31–10·02) for males and 11·61 (11·13–12·10) for females. Relative and absolute inequalities were also substantial for unintentional injury and for suicide mortality. Age-specific mortality was consistently higher in people with disability. The leading contributors to absolute inequalities shifted from neurological conditions in younger ages to cancer, cardiovascular diseases, and chronic lung diseases in older ages.<h3>Interpretation</h3>People with disability experience large mortality inequalities. Identifying intervention-amenable factors contributing to these inequalities should be a priority. Targeted interventions and policy reforms to create a more inclusive social and health-care environment for people with disability might be necessary.<h3>Funding</h3>The University of Melbourne.","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":"4 1","pages":""},"PeriodicalIF":50.0,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142759983","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Closing the mortality gap for people with disabilities","authors":"Hannah Kuper, Sara Rotenberg","doi":"10.1016/s2468-2667(24)00274-3","DOIUrl":"https://doi.org/10.1016/s2468-2667(24)00274-3","url":null,"abstract":"There are about 1·3 billion people with disability globally, and their higher mortality rates mean that they are dying about 14 years earlier than people without disability.<span><span>1</span></span>, <span><span>2</span></span> In this issue of <em>The Lancet Public Health</em>, Yi Yang and colleagues’ study<span><span>³</span></span> adds to this literature. Using large-scale longitudinal data from 15 million Australians, they showed that people with disability have high inequalities—whether measured on an absolute or relative scale and across different causes of death. Overall, mortality rates were about 3·7-times higher for men with disability and about 4·6-times higher for women with disability than their non-disabled peers. This Article<span><span>³</span></span> adds to the growing, unequivocal evidence on the relationship between mortality and disability. It also highlights three key questions that need to be addressed before public health actors start to take this issue seriously.","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":"153 1","pages":""},"PeriodicalIF":50.0,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142760267","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction to Lancet Public Health 2024; 9: e295–305","authors":"","doi":"10.1016/s2468-2667(24)00297-4","DOIUrl":"https://doi.org/10.1016/s2468-2667(24)00297-4","url":null,"abstract":"<em>Tetzlaff F, Sauerberg M, Grigoriev P, et al. Age-specific and cause-specific mortality contributions to the socioeconomic gap in life expectancy in Germany, 2003–21: an ecological study.</em> Lancet Public Health <em>2024;</em> 9: <em>e295–305</em>—In figure 1 of this Article, sex data were plotted incorrectly. This correction has been made as of Nov 25, 2024.","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":"20 1","pages":""},"PeriodicalIF":50.0,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142713192","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Determinants of childhood obesity in China","authors":"Changzheng Yuan, Yanhui Dong, Hui Chen, Le Ma, Lihong Jia, Jiayou Luo, Qin Liu, Yifei Hu, Jun Ma, Yi Song","doi":"10.1016/s2468-2667(24)00246-9","DOIUrl":"https://doi.org/10.1016/s2468-2667(24)00246-9","url":null,"abstract":"Over the past four decades, China has witnessed an important nutritional transition, characterised by a heightened overnutrition burden among children. The country now has the largest population of children with obesity globally. In this paper, we review the epidemiology of childhood obesity in China, its determinants, and risk factors, with a particular focus on school-aged children. Evidence unveils substantial variations across age, gender, and region. We describe multilevel obesogenic determinants, including macro-level social, cultural, and environmental factors; meso-level factors related to schools and communities; and micro-level factors tied to families and individuals from the perinatal-infant stage to childhood and adolescence. The primary drivers of childhood obesity appear to be rooted in the broader macro-level social, economic, and technological environment; obesogenic factors, which have affected school, community, and family environments; and accelerated unhealthy behaviour uptake. Identifying and characterising the catalysts behind the rise in childhood obesity in China is imperative for the development of scalable, effective, and tailored prevention, control, and intervention strategies.","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":"1 1","pages":""},"PeriodicalIF":50.0,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142678613","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Obesity in China: what we know and what we can do","authors":"Xiong-Fei Pan, Zhong-Ze Fang","doi":"10.1016/s2468-2667(24)00271-8","DOIUrl":"https://doi.org/10.1016/s2468-2667(24)00271-8","url":null,"abstract":"Overweight and obesity in children have emerged as a major public health challenge in China. National statistics show that the prevalence of overweight and obesity reached up to 10% in children younger than 6 years and 20% in those aged 6–17 years,<span><span>¹</span></span> which is projected to continue rising in the next few years.<span><span>²</span></span> In response to this public health imperative, 16 Chinese national agencies, including the National Health Commission and the Ministry of Civil Affairs, have collaboratively developed the Implementation Plan for the Weight Management Years Campaign to promote population-level weight control measures for 3 years commencing in 2024.<span><span>³</span></span> More recently, the National Health Commission also officially issued the Guidelines for the Diagnosis and Treatment of Obesity, for the first time, to advance standardised clinical management of obesity.<span><span>⁴</span></span> In alignment with these initiatives, a consortium of Chinese experts comprehensively assessed the epidemiology and determinants of childhood obesity, and critically evaluated potential interventions and policies for mitigating the challenge of obesity in this issue of <em>The Lancet Public Health</em>.<span><span>5</span></span>, <span><span>6</span></span>, <span><span>7</span></span> The timely review Series complements governmental strategic directives, and offers pragmatic insights and evidence-based recommendations to inform policy makers, health-care professionals, and multisectoral stakeholders in their concerted efforts for the prevention and control of childhood obesity in China. Although the work makes considerable contributions, several additional perspectives on childhood obesity warrant consideration.","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":"57 1","pages":""},"PeriodicalIF":50.0,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142678614","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diabetes in China part 2: prevention, challenges, and progress","authors":"Yu Xu, Jieli Lu, Mian Li, Tiange Wang, Kan Wang, Qiuyu Cao, Yi Ding, Yu Xiang, Siyu Wang, Qianqian Yang, Xuan Zhao, Xiaoyun Zhang, Min Xu, Weiqing Wang, Yufang Bi, Guang Ning","doi":"10.1016/s2468-2667(24)00251-2","DOIUrl":"https://doi.org/10.1016/s2468-2667(24)00251-2","url":null,"abstract":"During the past 40 years, the prevalence of diabetes in China has increased from less than 1·0% in 1980 to 12·4% in 2018, an increase in line with the rapid growth of the nation's economy. To address such a burden, the Healthy China 2030 initiative and subsequent Action Plan, including a diabetes prevention and control campaign, were launched. A shift from a disease-centred approach to a health-centred approach and from treatment to prevention is the core of the Action Plan and diabetes management in China. In this Review, we discuss the challenges of diabetes prevention in China, including unhealthy lifestyle, increasing young-onset type 2 diabetes, and substantial diabetes care disparities. To address such challenges, countermeasures across different stages of diabetes prevention and targeted at different populations, are needed. Such countermeasures include primordial prevention of risk factors in the general population, primary prevention of diabetes onset in high-risk populations, and secondary prevention of cardiovascular complications for individuals with diabetes. We reflect on China's current progress, strategies, and achievements.","PeriodicalId":56027,"journal":{"name":"Lancet Public Health","volume":"1 1","pages":""},"PeriodicalIF":50.0,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142678615","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}