National Center for Chronic and Noncommunicable Disease Control and Prevention

Beijing, China

National Center for Chronic and Noncommunicable Disease Control and Prevention

Beijing, China
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Wang W.J.,National Center for Chronic and Noncommunicable Disease Control and Prevention
Zhonghua yu fang yi xue za zhi [Chinese journal of preventive medicine] | Year: 2016

OBJECTIVE: To establish a scale of knowledge, attitude, and behavior of lifestyle interventions among a population at high risk of diabetes with good cultural adaptability, validity, and reliability.METHODS: The original item pool was formed based on a literature review, group discussions, and interviews with experts. We used the Delphi method to determine core items of the scale (30 cases in the first round and 26 cases in the second round, respectively). We invited 30 experts from clinical medicine, nursing, preventive medicine, health education, and community diabetes prevention and control to completed expert consultation tables. For each item, experts were asked to provide an importance score, the judgment basis, and a familiarity score. We analyzed the positive coefficient, authoritative coefficient, degree of concentration, and harmonious coefficient, to determine the selected items. Using face-to-face questionnaire surveys, 31 participants at high risk of diabetes were selected for the pilot study. We analyzed understanding of the scale's content and presentation and corrected the scale based on the analysis.RESULTS: We received 26 and 23 inquiry forms, respectively, in two rounds of consultation. Responses rates of the two rounds were 87% and 88%. The scores of authoritative coefficients were 0.79 ± 0.14 and 0.87 ± 0.10. The score of total scale in the first consultation was 4.32±0.25, the coefficient of variation was 0.06, and the coefficient of concordance was 0.163; in the second consultation, these were 4.58±0.21, 0.05, 0.150, respectively. In the first consultation, 22 experts proposed amendments and made suggestions, a rate of 85% (22/26). After the second round, 30 items were included in the final scale. In the pilot study, 13 males and 18 females with high risk of diabetes were interviewed. Average age of the population was (62.24 ± 10.23) years. The time to complete the survey was (9.35 ± 2.71) minutes. After the pilot study was completed, the order of the items was adjusted to ensure a reasonable and logical scale.CONCLUSION: We developed the scale of knowledge, attitude, and behavior of lifestyle intervention in a diabetes high-risk population, using the Delphi method and a pilot study. Overall, the findings indicate that input from experts during development facilitates achievement of satisfactory concentration and coordination levels, and the use of this scale will produce credible results.


Wu Y.Z.,National Center for Chronic and Noncommunicable Disease Control and Prevention
Zhonghua yu fang yi xue za zhi [Chinese journal of preventive medicine] | Year: 2016

OBJECTIVE: To evaluate the validity, reliability, and acceptability of the brief version of the self-management knowledge, attitude, and behavior (KAB) assessment scale for diabetes patients.METHODS: Diabetes patients who were managed at the Xinkaipu Community Health Service Center of Tianxin in Changsha, Hunan Province were selected for survey by cluster sampling. A total of 350 diabetes patients were surveyed using the brief scale to collect data on knowledge, attitudes, and behaviors of self-management. Content validity was evaluated by Pearson correlation coefficient between the brief scale and subscales of knowledge, attitude, and behavior. Structure validity was evaluated by factor analysis, and discrimination validity was evaluated by an independent sample t-test between the high-score and low-score groups. Reliability was tested by internal consistency reliability and split-half reliability. The evaluation indexes of internal consistency reliability were Cronbach's α coefficients, θ coefficient, and Ω coefficient. Acceptability was evaluated by valid response rate and completion time of the brief scale.RESULTS: A total of 346(98.9%) valid questionnaires were returned, with average survey time of (11.43±3.4) minutes. Average score of the brief scale was 78.85 ± 11.22; scores of the knowledge, attitude, and behavior subscales were 16.45 ± 4.42, 21.33 ± 2.03, and 41.07 ± 8.34, respectively. Pearson correlation coefficients between the brief scale and the knowledge, attitude, and behavior subscales were 0.92, 0.42, and 0.60, respectively; P-values were all less than 0.01, indicating that the face validity and content validity of the brief scale were achieved to a good level. The common factor cumulative variance contribution rate of the brief scale and three subscales was from 53.66% to 61.75%, which achieved more than 50% of the approved standard. There were 11 common factors; 41 of the total 42 items had factor loadings above 0.40 in their relevant common factor, indicating that the brief scale and three subscales had good construct validity. Patients were divided into a high-score group and a low-score group, then scores of the brief scale and three subscales were compared between the groups using a t-test. The results were all significant, indicating that the brief scale and three subscales had good discriminate validity. Mean scores of the brief scale and three subscales of the high-score group were 91.55±6.81, 19.51±2.17, 22.74±1.88, and 49.30±6.20, respectively; these were higher than the low-score group (65.89±5.79, 12.29±4.76, 20.22±1.88, and 33.39±6.17, respectively) with t-values 27.76, 13.31, 9.20, and 17.56 (P-values were less than 0.001). The Cronbach's α coefficient, θ coefficient, Ω coefficient, and split-half reliability of the brief scale were 0.83, 0.87, 0.96, and 0.84, respectively. These values for the three subscales were all above 0.70, except for the θ coefficient of the attitude subscale with 0.64, indicating that the brief scale and three subscales had acceptable internal consistency reliability.CONCLUSION: The brief version of the diabetes self-management knowledge, attitude, and behavior assessment scale showed good acceptability, validity, and reliability, to responsibly evaluate self-management KAB among patients with diabetes.


Zhao Y.F.,National Center for Chronic and Noncommunicable Disease Control and Prevention
Zhonghua yu fang yi xue za zhi [Chinese journal of preventive medicine] | Year: 2016

Objective: To analyze the burden of disease attributed to high fasting plasma glucose(FPG)in China in 1990 and 2013. Methods: The analysis used data obtained from the 2013 Global Burden of Diseases Study and examined deaths, death rate, disability-adjusted life years(DALY), years lived with disability(YLD)and years of life lost(YLL)attributed to high FPG in 1990 and 2013 in China(not including Taiwan, China). An average world population age-structure for the period 2000- 2025 was adopted to calculate age-standardized rates. Results: In 2013, the number of deaths attributed to high FPG in China increased to 621.9 thousand from 320.3 thousand in 1990. From 1990- 2013, the age-standardized death rate attributable to high FPG increased from 45.69/100 000 to 48.64/100 000. DALYs caused by high FPG increased to 20.389 1 million in 2013 from 10.648 3 million in 1990. In 2013, high FPG caused 8.751 5 million YLD and 11.637 6 million YLL, and the percentage of YLL in DALY decreased to 57.1% in 2013 from 68.7% in 1990. Compared with 1990, the age-standardized DALY rate attributed to high FPG increased by 10.81%. In 2013, the top three provinces with the highest burden of disease attributed to high FPG were Xinjiang, Jilin and Liaoning provinces, with standardized death rates of 83.38, 74.01 and 68.64/100 000, respectively, and the standardized DALY rate was 2 217.96, 2 001.84 and 1 837.79/100 000 in the three provinces, respectively. Conclusion: Compared with 1990, the burden of disease attributed to high FPG in 2013 increased substantially in China, in particular the burden of attributed YLD. However, the burden of YLL attributed to high FPG has decreased modestly. The burden of disease caused by high FPG shows variation among different provinces in China.


Zeng X.Y.,National Center for Chronic and Noncommunicable Disease Control and Prevention
Zhonghua yu fang yi xue za zhi [Chinese journal of preventive medicine] | Year: 2016

Objective: To analyze and compare deaths(mortality)attributable to high body mass index(BMI)in Chinese population aged ≥15 years between 1990 and 2013. Methods: We used the results of the 2013 Global Burden of Disease Study for China, based on population attributable fractions(PAF)to analyze deaths attributable to high BMI in all provinces(not including Taiwan, China)in 1990 and 2013. The average world population from 2000 to 2025 was used as a reference to calculate age-standardized mortality rates, and to compare the change of attributable deaths in 1990 and 2013. Results: In 2013, the number of deaths attributable to high BMI was 640 294, compared with 301 231 in 1990, an increase of 114.27%. Compared with 1990, in 2013, the number of deaths and age-standardized mortality rate attributable to high BMI showed a higher growth rate in men(142.81% and 30.74%, respectively)than women(84.69% and 2.88% , respectively). The growth rate of attributable deaths increased with age. Compared with 1990, in 2013, the growth rates of attributable deaths among 15-49, 50-69 and ≥70 years age groups were 63.37%, 89.11% and 183.64%, respectively. In both 1990 and 2013, the top three diseases in terms of deaths attributable to high BMI were stroke(128 657 and 247 042, respectively), ischemic heart disease(57 173 and 156 614, respectively), and hypertensive heart disease(34 960 and 58 435, respectively). Compared with 1990, in 2013, the standardized mortality rates of chronic kidney disease(129.44%), pancreatic cancer(101.76%), colorectal cancer(85.45%)and breast cancer(63.86%)showed more substantial increases. In 1990, the top three provinces with most deaths attributable to high BMI were Henan(31 376), Shandong(27 969)and Hebei(24 164), while in 2013 they were Shandong(61 897), Hebei(58 383)and Henan(57 501). Compared with 1990, in 2013, the age-standardized mortality rate attributable to high BMI increased in 26 of 33 provinces, with a faster increase in Qinghai(56.96%), Guizhou(45.30%)and Yunnan(39.39%). The rate declined in the other seven provinces, declining faster in Tianjin(20.68%), Macao(14.08%)and Jilin(6.86%). Conclusion: Deaths and age-standardized mortality rates attributable to high BMI increased rapidly between 1990 and 2013, with higher increases in men than in women. Age-standardized mortality rates of chronic kidney disease, pancreatic cancer, colorectal cancer and breast cancer attributable to high BMI showed much higher growth rates than other attributed diseases. The highest BMI-attributed age-standardized mortality rates were found in northeast and northern provinces, and the fastest growth rates of BMI-attributed age-standardized mortality rates were observed in southwest and northwest provinces.


Yang J.,National Center for Chronic and Noncommunicable Disease Control and Prevention
Zhonghua yu fang yi xue za zhi [Chinese journal of preventive medicine] | Year: 2016

Objective: To analyze the burden of disease attributed to high total cholesterol(TC)in 2013 in China. Methods: We used data from the 2013 Global Burden of Disease Study. The population attributable fraction was calculated to estimate the deaths and disability-adjusted life years(DALY)attributed to high TC. Disease burden was compared by age, gender, diseases and province(not including Taiwan, China). An average world population age structure for the period 2000- 2025 was adopted to calculate age-standardized rates. Results: In 2013, high TC caused 298 952 deaths in China, accounting for 3.3% of total deaths, and caused 6 332 thousand DALYs. DALYs attributed to high TC were highest among the 50-69 years age group(3 165 thousand person years), accounting for 50.0% of the total attributed DALYs. The DALY rate in the ≥70 years age group was 2 053.3/100 000, which was 10.3 times that of 15-49 age group(198.6/100 000). DALYs among men were 4 431 thousand person years, which was 2.3 times higher than in women(1 900 thousand person years), and the age-standardized DALY rate among men was 590.6/100 000, which was 2.3 times higher than in women(257.1/100 000). DALYs attributed to high TC were mainly caused by ischemic heart disease(IHD; 5 572 thousand person years), accounting for 88.0% of the total attributed DALYs. Deaths and DALYs attributed to high TC were highest in Shandong(31 002 and 628 thousand person years for deaths and DALYs, respectively), Henan(27 398 deaths and 587 thousand person years, respectively), Hebei(25 744 deaths and 589 thousand person years, respectively), accounting for 28.1% of total attributed deaths and 28.5% of total attributed DALYs. The number of deaths and DALY were lowest in Macao(75 deaths and 1 thousand person years, respectively)and Tibet(385 deaths and 10 thousand person years, respectively). The age standardized DALY rates were highest in Beijing(794.8/100 000), Hebei(732.7/100 000), and Jilin(709.1/100 000), and lowest in Shanghai(151.4/100 000), Zhejiang(168.1/100 000), and Hong Kong(182.0/100 000). Conclusion: The burden of disease attributed to high TC in 2013 in China was mainly the result of the IHD it causes, with greater influence among males and those aged ≥50 years, and variation among provinces.


Wang W.J.,National Center for Chronic and Noncommunicable Disease Control and Prevention
Zhonghua yu fang yi xue za zhi [Chinese journal of preventive medicine] | Year: 2016

OBJECTIVE: To evaluate the validity, reliability, and acceptability of the scale of knowledge, attitude, and behavior of lifestyle intervention in a diabetes high-risk population (HILKAB), and provide scientific evidence for its usage.METHODS: By convenient sampling, we selected 406 individuals at high risk for diabetes for survey using the HILKAB. Pearson correlation coefficient, factor analysis, independent sampling, and t-test for high- and low-score groups were used to evaluate the content validity, construct validity, and discriminant validity of the scale. Reliability of the scale was evaluated by internal consistency, which included Cronbach's α coefficient, θ coefficient, Ω coefficient, and split-half reliability. Scale acceptability was evaluated by acceptance rate and completion time of the survey.RESULTS: In this study, 366 questionnaires (90.1%) was qnalified and the completion time was (8.62±2.79) minutes. Scores for knowledge, attitude, and behavior were 10.60±3.73, 26.56±3.58, 17.09±9.74, respectively. The scale had good face validity and content validity. The correlation coefficient of items and the dimension to which they belong was between 0.25 and 0.97, and the correlation coefficient of three dimensions and the entire scale was between 0.64 and 0.91, all with P<0.001. Factor analysis of the scale extracted eight common factors. The cumulative variance contribution rate was 65.23%, thereby reaching the 50% approved standard. Of 30 items there were 29 items with factor loadings ≥0.40, indicating the scale had good construct validity. For the high-score group, scores for knowledge, attitude, and behavior dimensions were 13.89±2.55, 29.56± 2.46, 28.05 ± 2.93, respectively, which were higher than those for the low-score group (7.67 ± 2.78, 23.89 ± 3.35, 6.25 ± 3.13); t-values were 55.14, 119.40, 95.29, respectively, with P<0.001. The scale consisted of three dimensions: knowledge, attitude, and behavior. The Cronbach's α coefficient was between 0.84 and 0.92, the θ coefficient was between 0.85 and 0.96, the Ω coefficient was between 0.90 and 0.94, and the split-half reliability was between 0.77 and 0.95, reaching the 0.70 standard letter.CONCLUSION: The validity, reliability, and acceptability of the HILKAB scale were satisfactory for use in a population at high risk of diabetes.


Zhou M.G.,National Center for Chronic and Noncommunicable Disease Control and Prevention
Zhonghua yu fang yi xue za zhi [Chinese journal of preventive medicine] | Year: 2016

Population health is affected by distal factors such as social, economic, cultural factors, proximal factors such as behavior, environment and health services, and biologic factors such as genetics and local microbial populations. Nowadays, China is in the throes of rapid economic and social development, which may affect disease patterns through changes in behavior, environment or communicable disease. This paper addresses the burden of disease attributable to common behavior, environmental and disease risk factors in 2013, and changes in their influence between 1990 and 2013. According to these findings, we can discern critical factors that affecting population health, identify the target populations of public health intervention projects, and design effective and more targeted prevention strategies to control the burden of chronic diseases.


Liu M.,National Center for Chronic and Noncommunicable Disease Control and Prevention
Zhonghua yu fang yi xue za zhi [Chinese journal of preventive medicine] | Year: 2016

Objective: To examine the burden of disease(BOD)attributable to high-sodium diets in China in 2013. Methods: Data were extracted from the 2013 Global Burden of Disease Study for China to examine the BOD attributable to high-sodium diets in 2013, gender, and disease composition. Measurements for attributable BOD were population attributable fraction(PAF), deaths, standardized mortality and disability-adjusted life years(DALY)(not including Taiwan, China). An average world population age-structure for the period 2000-2025 was adopted to calculate age-standardized rates. Results: In 2013, deaths attributable to high-sodium diets accounted for 12.6% of all deaths and 14.5% of chronic disease deaths. Overall, 7.8% of deaths because of neoplasms, 25.2% of cardiovascular disease deaths, and 22.9% of chronic kidney disease deaths were attributable to high-sodium diets. A total of 1 176 553 deaths were attributable to high-sodium diets and the standardized mortality was 91.5/100 000, which was higher in men than in women(121.7/100 000 and 63.0/100 000, respectively). Overall, 22.759 million DALYs were attributable to high-sodium diets. The DALY standardized rate was 1 588.0/100 000, which was higher in men than in women(2 189.7/100 000 and 993.2/100 000, respectively). When compared by province, PAF in Xinjiang(25.0%), Qinghai(23.7%), Shanxi(23.2%), Tibet(22.1%)and Shandong(20.5%)was higher than other provinces. The standardized mortality in Xinjiang(239.4/100 000), Qinghai(238.9/100 000), Tibet(221.7/100 000), Shanxi(166.2/100 000)and Hebei(149.9/100 000)were higher than other provinces. The DALY standardized rate attributable to high-sodium diets was highest in Xinjiang(4 430.8/100 000), Qinghai(4 422.5/100 000), Tibet(4 021.4/100 000), Shanxi(2 816.6/100 000), and Hebei(2 624.9/100 000). Conclusion: The BOD attributable to high-sodium diets is a serious issue in China, particularly in men and in the northern provinces. Effective measures should be taken in northern provinces to reduce sodium intake.


Jiang Y.,National Center for Chronic and Noncommunicable Disease Control and Prevention
Zhonghua yu fang yi xue za zhi [Chinese journal of preventive medicine] | Year: 2010

OBJECTIVE: To describe the epidemiologic characteristics of cerebrovascular disease (CVD) mortality in China from 2004 to 2005. METHODS: The data came from 2004-2005, the third national mortality retrospective sampling survey which collected the death cause information and covered 31 province-level regions and 160 surveillance spots in the interior of China. Total 142 660 482 person years were investigated. Based on the data, the crude death rates of ages, genders and diseases were calculated. Years of potential life lost (YPLL) were also calculated. Standardized death rates were calculated from census data in 2000 and each five-year was counted as an age group. RESULTS: The total number of residents died of CVD between 2004 and 2005 was 194 932 (male 108 414, female 86 518, urban 63 397, rural 131 535) in survey districts. The crude death rates of CVD were 136.6 per 100 000 and the standardized death rate was 120.1 per 100 000. The crude death rates of CVD were 148.6 per 100 000 in male and 124.1 per 100 000 in female; the standardized death rates were 144.2 and 98.2, respectively. The crude death rates of CVD were 132.4 per 100 000 in urban area and 138.8 per 100 000 in rural area; the standardized death rates were 107.3 and 127.6 per 100 000 population, respectively. With age increasing, the crude death rates of CVD showed a fast growth trend. The crude death rates of group aged 35 - 39, 55 - 59, 85 and above were 10.6 (1352/12 712 639), 177.6 (10 599/5 967 274) and 4051.4 (25 430/627 688) per 100 000 respectively. Intracerebral hemorrhage accounting for 50.4% (98 324 cases) of CVD deaths, followed by cerebral infarction, accounting for 24.8% (48 305 cases). The total cases of stroke, hemorrhagic stroke, ischemic stroke and not-specified stroke were 167 147, 105 766, 48 305 and 13 076, respectively, and the crude death rates were 117.2, 74.7, 33.9 and 11.3 per 100 000, respectively. The YPLL of Chinese people was 535.5 person years per 100 000. CONCLUSION: The mortality of CVD in male was higher than that in female; the mortality of CVD in urban area was higher than that in rural area. As the age increasing, the mortality of CVD appeared a rapid increment. Intracerebral hemorrhage was the main cause of CVD death.


Wang L.,National Center for Chronic and Noncommunicable Disease Control and Prevention
BMC nephrology | Year: 2014

BACKGROUND: Microalbuminuria has been shown to be a risk factor for cardiovascular and renal disease in patients with hypertension and diabetes as well as in the general population. Urinary albumin excretion over 24 h is considered a 'gold standard' to detect microalbuminuria. Few studies have used 24-h urinary albumin excretion to analyze the prevalence of and related factors for microalbuminuira in a general Chinese population.METHODS: This study included 1980 adults aged 18-69 years from the Shandong-Ministry of Health Action on Salt and Hypertension (SMASH) Project 2011 survey. Blood pressure, height, weight and waist circumference were measured, and a venous blood and timed 24-h urine samples were collected from each participant. Linear and logistic regression analyses were used to test associations between established cardiovascular risk factors and microalbuminuria.RESULTS: The median (25th-75th percentile) of 24-h urinary albumin excretion was 6.1 mg/d (4.5-8.7 mg/d) for all adults, 6.0 mg/d (4.4-8.5 mg/d) for men and 6.2 mg/d (4.6-8.9 mg/d) for women. The overall prevalence of microalbuminuria was 4.1% (95% confidence interval [CI]: 3.2-5.0%), 3.7% (95% CI: 2.9-4.5%) for men and 4.6% (95% CI: 3.7-5.5%) for women. Microalbuminuria was present in 8.1% (95% CI: 6.9-9.3%) of individuals with hypertension, 11.4% (95% CI: 10.0-12.8%) of those with diabetes and 15.6% (95% CI: 14.0-17.2%) of those with both. Multiple logistic regression analysis indicated that systolic blood pressure (odds ratio [OR] 1.02; 95% CI: 1.01-1.03) and fasting blood glucose (OR 1.19; 95% CI: 1.05-1.35) were the independent risk factors for microalbuminuria.CONCLUSIONS: Adults in the general population of Shandong Province have a moderate prevalence of microalbuminuria. Those with hypertension and diabetes are at high risk of having microalbuminuria, suggesting the need for screening and early intervention for microalbuminuria among these individuals.

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