The National Center for Chronic and Noncommunicable Disease Control and Prevention

Beijing, China

The National Center for Chronic and Noncommunicable Disease Control and Prevention

Beijing, China
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Wang C.,Beijing Normal University | Zhang Z.,Beijing Normal University | Zhou M.,The National Center for Chronic and Noncommunicable Disease Control and Prevention | Zhang L.,Beijing Normal University | And 3 more authors.
Science of the Total Environment | Year: 2017

Background Numerous previous studies have reported that human health risk is extremely sensitive to temperature. Very few studies, however, have characterized the relationship between temperature and mortality in different temperature zones due to the previous conclusions deduced from a regional or administrative division. A research covers different temperature zones was indispensable to have a comprehensive understanding of regional ambient temperature effect on public health. Methods Based on the mortality dataset and meteorological variables of 122 communities in China from 2007 to 2012, a distributed lag nonlinear model (DLNM) was utilized to estimate the temperature effect on non-accidental mortality at the community level. Then, a meta-regression analysis was applied to pool the estimates of community-specific effects in various latitude-effected temperature zones. Results At the community level, the mean value of relative extreme cold risk (1.63) of all 122 communities was higher than that of extreme high temperature (1.15). At regional level, we found temperature-mortality relationship (e.g., U- or J-shaped) varied in different temperature zones. Meanwhile, the minimum-mortality temperature of each zone was near the 75th percentile of local mean temperature except the north subtropics (50th percentiles). Lag effect was also obvious, especially for cold effect. An interesting M-shaped curve for the relationship between cold risk and temperature was detected, while an inverted “U” shaped with a right tail for the heat effect. Such different responses might be attributed to the difference in social-economic status of temperature zones. Conclusion The temperature-mortality relationship showed a distinct spatial heterogeneity along temperature zones across the Chinese mainland. Different characteristics of mortality responding to cold and heat stress highlighted the fact that, apart from the circumstance of temperature, the social-economic condition was also linked with health risk. Our findings suggest decision-makers should take more adaptive and effective measures to reduce health risks in China. © 2017 Elsevier B.V.


Yang J.,Chinese National Institute for Communicable Disease Control and Prevention | Zhou M.,The National Center for Chronic and Noncommunicable Disease Control and Prevention | Ou C.-Q.,Southern Medical University | Yin P.,The National Center for Chronic and Noncommunicable Disease Control and Prevention | And 10 more authors.
Environmental Pollution | Year: 2017

Incidence rate of cardiovascular disease (CVD) has significant seasonal trend, being higher in winter. However, the extent to which the seasonal variation of CVD deaths was caused by temperature remains unclear. We obtained daily data on temperature and CVD and myocardial infarction (MI) mortality from nine Chinese mega-cities during 2007-2013. Distributed lag non-linear models were applied to assess the city-specific temperature-related daily excess deaths across lag 0-21 days, using the minimum-mortality temperature as reference. Then, estimates of excess deaths in four seasons were separately aggregated from the daily series, and its ratio to the corresponding total deaths produced seasonal attributable fraction (AF). In total, 1,079,622 CVD and 201,897 MI deaths were recorded in the nine Chinese cities. Significant and non-linear associations between temperature and mortality were observed, with a total of 195,516 CVD and 50,658 MI deaths attributable to non-optimum temperatures. 103,439 (95% empirical CI: 54,475-141,537) CVD and 24,613 (5891-36,279) MI deaths related to non-optimum temperature occurred in winter, compared with 15,923 (1436-28,853) and 4946 (-325-9016) in summer. Temperature-related AFs were higher among MI than CVD, with AFs of 42% (9-62%) and 35% (19-48%) in winter, and 13% (-1-23%) and 8% (1-14%) in summer, respectively. This study may have important implications for developing effective targeted intervention measures on CVD events. © 2017 Elsevier Ltd.


PubMed | Griffith University, Centers for Disease Control and Prevention, The National Center for Chronic and Noncommunicable Disease Control and Prevention and Guangdong Provincial Institute of Public Health
Type: | Journal: Environment international | Year: 2014

Many studies have reported increased mortality risk associated with heat waves. However, few have assessed the health impacts at a nation scale in a developing country. This study examines the mortality effects of heat waves in China and explores whether the effects are modified by individual-level and community-level characteristics.Daily mortality and meteorological variables from 66 Chinese communities were collected for the period 2006-2011. Heat waves were defined as 2 consecutive days with mean temperature 95th percentile of the year-round community-specific distribution. The community-specific mortality effects of heat waves were first estimated using a Distributed Lag Non-linear Model (DLNM), adjusting for potential confounders. To investigate effect modification by individual characteristics (age, gender, cause of death, education level or place of death), separate DLNM models were further fitted. Potential effect modification by community characteristics was examined using a meta-regression analysis.A total of 5.0% (95% confidence intervals (CI): 2.9%-7.2%) excess deaths were associated with heat waves in 66 Chinese communities, with the highest excess deaths in north China (6.0%, 95% CI: 1%-11.3%), followed by east China (5.2%, 95% CI: 0.4%-10.2%) and south China (4.5%, 95% CI: 1.4%-7.6%). Our results indicate that individual characteristics significantly modified heat waves effects in China, with greater effects on cardiovascular mortality, cerebrovascular mortality, respiratory mortality, the elderly, females, the population dying outside of a hospital and those with a higher education attainment. Heat wave mortality effects were also more pronounced for those living in urban cities or densely populated communities.Heat waves significantly increased mortality risk in China with apparent spatial heterogeneity, which was modified by some individual-level and community-level factors. Our findings suggest adaptation plans that target vulnerable populations in susceptible communities during heat wave events should be developed to reduce health risks.


PubMed | Griffith University, Centers for Disease Control and Prevention, The National Center for Chronic and Noncommunicable Disease Control and Prevention and Guangdong Provincial Institute of Public Health
Type: | Journal: Environmental research | Year: 2015

Previous studies examining temperature-mortality associations in China focused on a single city or a small number of cities. A multi-city study covering different climatic zones is necessary to better understand regional differences in temperature risk on mortality in China.Sixty-six communities from 7 regions across China were included in this study. We first used a Distributed Lag Non-linear Model (DLNM) to estimate community-specific effects of temperature on non-accidental mortality during 2006-2011. A multivariate meta-analysis was then applied to pool the estimates of community-specific effects.A U-shaped curve was observed between temperature and mortality at the national level in China, indicating both low and high temperatures were associated with increased mortality risk. The overall threshold was at about the 75th percentile of the pooled temperature distribution. The relative risk was 1.61 (95% CI: 1.48-1.74) for extremely cold temperature (1st percentile of temperature), and 1.21 (95% CI: 1.10-1.34) for extreme hot temperature (99th percentile of temperature) at lag0-21 days. The temperature-mortality relationship is different for different regions. Compared with north China, south China had a higher minimum mortality temperature (MMT), and there was a larger cold effect in the more southern parts of China and a more pronounced hot effect in more northern parts.Both cold and hot temperatures increase mortality risk in China, and the relationship varies geographically. Our findings suggest that public health policies for climate change adaptation should be tailored to the local climate conditions.


Ma W.,Guangdong Provincial Institute of Public Health | Ma W.,Griffith University | Zeng W.,Guangdong Provincial Institute of Public Health | Zhou M.,The National Center for Chronic and Noncommunicable Disease Control and Prevention | And 9 more authors.
Environment International | Year: 2015

Background: Many studies have reported increased mortality risk associated with heat waves. However, few have assessed the health impacts at a nation scale in a developing country. This study examines the mortality effects of heat waves in China and explores whether the effects are modified by individual-level and community-level characteristics. Methods: Daily mortality and meteorological variables from 66 Chinese communities were collected for the period 2006-2011. Heat waves were defined as ≥. 2 consecutive days with mean temperature ≥. 95th percentile of the year-round community-specific distribution. The community-specific mortality effects of heat waves were first estimated using a Distributed Lag Non-linear Model (DLNM), adjusting for potential confounders. To investigate effect modification by individual characteristics (age, gender, cause of death, education level or place of death), separate DLNM models were further fitted. Potential effect modification by community characteristics was examined using a meta-regression analysis. Results: A total of 5.0% (95% confidence intervals (CI): 2.9%-7.2%) excess deaths were associated with heat waves in 66 Chinese communities, with the highest excess deaths in north China (6.0%, 95% CI: 1%-11.3%), followed by east China (5.2%, 95% CI: 0.4%-10.2%) and south China (4.5%, 95% CI: 1.4%-7.6%). Our results indicate that individual characteristics significantly modified heat waves effects in China, with greater effects on cardiovascular mortality, cerebrovascular mortality, respiratory mortality, the elderly, females, the population dying outside of a hospital and those with a higher education attainment. Heat wave mortality effects were also more pronounced for those living in urban cities or densely populated communities. Conclusion: Heat waves significantly increased mortality risk in China with apparent spatial heterogeneity, which was modified by some individual-level and community-level factors. Our findings suggest adaptation plans that target vulnerable populations in susceptible communities during heat wave events should be developed to reduce health risks. © 2014 Elsevier Ltd.


Yang J.,Chinese National Institute for Communicable Disease Control and Prevention | Yin P.,The National Center for Chronic and Noncommunicable Disease Control and Prevention | Zhou M.,The National Center for Chronic and Noncommunicable Disease Control and Prevention | Ou C.-Q.,Southern Medical University | And 7 more authors.
Science of the Total Environment | Year: 2016

Few multi-city studies have been conducted to investigate the acute health effects of low and high temperatures on diabetes mortality worldwide. We aimed to examine effects of ambient temperatures on city-/gender-/age-/education-specific diabetes mortality in nine Chinese cities using a two-stage analysis. Distributed lag non-linear model was first applied to estimate the city-specific non-linear and delayed effects of temperatures on diabetes mortality. Pooled effects of temperatures on diabetes mortality were then obtained using meta-analysis, based on restricted maximum likelihood. We found that heat effects were generally acute and followed by a period of mortality displacement, while cold effects could last for over two weeks. The pooled relative risks of extreme high (99th percentile of temperature) and high temperature (90th percentile of temperature) were 1.29 (95%CI: 1.11-1.47) and 1.11 (1.03-1.19) over lag 0-21. days, compared with the 75th percentile of temperature. In contrast, the pooled relative risks over lag 0-21. days were 1.44 (1.25-1.66) for extreme low (1st percentile of temperature) and 1.20 (1.12-1.30) for low temperature (10th percentile of temperature), compared to 25th percentile of temperature. The estimate of heat effects was relatively higher among females than that among males, with opposite trend for cold effects, and the estimates of heat and cold effects were particularly higher among the elderly and those with low education, although the differences between these subgroups were not statistically significant (P. >. 0.05). These findings have important public health implications for protecting diabetes patients from adverse ambient temperatures. © 2015 2015 Published by Elsevier B.V.


PubMed | Health Science University, Sun Yat Sen University, Chinese National Institute for Communicable Disease Control and Prevention, Peking Union Medical College and 2 more.
Type: | Journal: Environment international | Year: 2016

Few data are available on the attributable burden, such as absolute excess or relative excess, of stroke death due to temperature.We collected data on daily temperature and stroke mortality from 16 large Chinese cities during 2007-2013. First, we applied a distributed lag non-linear model to estimate the city-/age-/gender-specific temperature-mortality association over lag 0-14days. Then, pooled estimates were calculated using a multivariate meta-analysis. Attributable deaths were calculated for cold and heat, defined as temperatures below and above the minimum-mortality temperature (MMT). Moderate and extreme temperatures were defined using cut-offs at the 2.5th and 97.5th percentiles of temperature.The city-specific MMT increased from the north to the south, with a median of 24.9(o)C. Overall, 14.5% (95% empirical confidence interval: 11.5-17.0%) of stroke mortality (114, 662 deaths) was attributed to non-optimum temperatures, with the majority being attributable to cold (13.1%, 9.7-15.7%). The proportion of temperature-related death had a decreasing trend by latitude, ranging from 22.7% in Guangzhou to 6.3% in Shenyang. Moderate temperatures accounted for 12.6% (9.1-15.3%) of stroke mortality, whereas extreme temperatures accounted for only 2.0% (1.6-2.2%) of stroke mortality. Estimates of death burden due to both cold and heat were higher among males and the elderly, compared with females and the youth.The burden of temperature-related stroke mortality increased from the north to the south. Most of this burden was caused by cold temperatures. The stroke burden was higher among males and the elderly. This information has important implications for preventing stroke due to adverse temperatures in vulnerable subpopulations in China.


PubMed | Chinese National Institute for Communicable Disease Control and Prevention, The National Center for Chronic and Noncommunicable Disease Control and Prevention, University of Queensland, Southern Medical University and 2 more.
Type: Journal Article | Journal: Heart (British Cardiac Society) | Year: 2015

To examine cardiovascular disease (CVD) mortality burden attributable to ambient temperature; to estimate effect modification of this burden by gender, age and education level.We obtained daily data on temperature and CVD mortality from 15 Chinese megacities during 2007-2013, including 1,936,116 CVD deaths. A quasi-Poisson regression combined with a distributed lag non-linear model was used to estimate the temperature-mortality association for each city. Then, a multivariate meta-analysis was used to derive the overall effect estimates of temperature at the national level. Attributable fraction of deaths were calculated for cold and heat (ie, temperature below and above minimum-mortality temperatures, MMTs), respectively. The MMT was defined as the specific temperature associated to the lowest mortality risk.The MMT varied from the 70th percentile to the 99th percentile of temperature in 15 cities, centring at 78 at the national level. In total, 17.1% (95% empirical CI 14.4% to 19.1%) of CVD mortality (330,352 deaths) was attributable to ambient temperature, with substantial differences among cities, from 10.1% in Shanghai to 23.7% in Guangzhou. Most of the attributable deaths were due to cold, with a fraction of 15.8% (13.1% to 17.9%) corresponding to 305,902 deaths, compared with 1.3% (1.0% to 1.6%) and 24,450 deaths for heat.This study emphasises how cold weather is responsible for most part of the temperature-related CVD death burden. Our results may have important implications for the development of policies to reduce CVD mortality from extreme temperatures.


PubMed | The National Center for Chronic and Noncommunicable Disease Control and Prevention, Institute for Environmental Health and Related Product Safety, Institute of Urban Meteorology and Columbia University
Type: | Journal: Scientific reports | Year: 2016

An aging population could substantially enhance the burden of heat-related health risks in a warming climate because of their higher susceptibility to extreme heat health effects. Here, we project heat-related mortality for adults 65 years and older in Beijing China across 31 downscaled climate models and 2 representative concentration pathways (RCPs) in the 2020s, 2050s, and 2080s. Under a scenario of medium population and RCP8.5, by the 2080s, Beijing is projected to experience 14,401 heat-related deaths per year for elderly individuals, which is a 264.9% increase compared with the 1980s. These impacts could be moderated through adaptation. In the 2080s, even with the 30% and 50% adaptation rate assumed in our study, the increase in heat-related death is approximately 7.4 times and 1.3 times larger than in the 1980s respectively under a scenario of high population and RCP8.5. These findings could assist countries in establishing public health intervention policies for the dual problems of climate change and aging population. Examples could include ensuring facilities with large elderly populations are protected from extreme heat (for example through back-up power supplies and/or passive cooling) and using databases and community networks to ensure the home-bound elderly are safe during extreme heat events.


PubMed | Southern Medical University, The National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese National Institute for Communicable Disease Control and Prevention and Peking Union Medical College
Type: Journal Article | Journal: The Science of the total environment | Year: 2015

Few multi-city studies have been conducted to investigate the acute health effects of low and high temperatures on diabetes mortality worldwide. We aimed to examine effects of ambient temperatures on city-/gender-/age-/education-specific diabetes mortality in nine Chinese cities using a two-stage analysis. Distributed lag non-linear model was first applied to estimate the city-specific non-linear and delayed effects of temperatures on diabetes mortality. Pooled effects of temperatures on diabetes mortality were then obtained using meta-analysis, based on restricted maximum likelihood. We found that heat effects were generally acute and followed by a period of mortality displacement, while cold effects could last for over two weeks. The pooled relative risks of extreme high (99th percentile of temperature) and high temperature (90th percentile of temperature) were 1.29 (95%CI: 1.11-1.47) and 1.11 (1.03-1.19) over lag 0-21 days, compared with the 75th percentile of temperature. In contrast, the pooled relative risks over lag 0-21 days were 1.44 (1.25-1.66) for extreme low (1st percentile of temperature) and 1.20 (1.12-1.30) for low temperature (10th percentile of temperature), compared to 25th percentile of temperature. The estimate of heat effects was relatively higher among females than that among males, with opposite trend for cold effects, and the estimates of heat and cold effects were particularly higher among the elderly and those with low education, although the differences between these subgroups were not statistically significant (P>0.05). These findings have important public health implications for protecting diabetes patients from adverse ambient temperatures.

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