Professor Liang Xiaofeng's team from the Chinese Center for Disease Control and Prevention published a blockbuster study in The Lancet[1], which analyzed the top 25 causes of death of people in 34 provinces (municipalities, autonomous regions, and special administrative regions) in China from 1990 to 2017, as well as the high risk factors for death.
In 1990 and 2017, the top 10 causes of death of mainland residents were:
Source: The Lancet
Issues for concern:
1. The top 5 causes of death in Chinese are mainly stroke, ischemic heart disease, chronic obstructive pulmonary disease, lung cancer, Alzheimer's disease and other dementias.
The impact of infectious diseases and maternal and infant diseases is declining, and the diseases that affect the health of the Chinese people are basically non-communicable chronic diseases.
2. Ischemic heart disease climbed from 3rd to 2nd in 1990, and the mortality rate increased by 20.6% and continues to climb.
This is related to aging, but also related to the chinese people's life is getting richer, eat more and move less, resulting in three highs and an increase in obesity.
3, lung cancer is becoming a new health killer.
Compared to 1990, the mortality rate from lung cancer increased by 28.2%, and its disability-adjusted life years (DALY, which can be understood as healthy life years lost due to disease and disability) rose sharply from the humble 14th of the year to 4th. This is not unrelated to air pollution and aging.
In addition, liver cancer also rose from 11th to 7th.
4. The threat of high blood pressure cannot be underestimated. In 2017 alone, there were 2.54 million deaths from high blood pressure, of which 96.7% died from cardiovascular disease. In addition to Taiwan, hypertension ranks in the top 2 among all provinces in the country in terms of high risk factors.
5. Alzheimer's disease and other dementias have a growing impact and have become the fifth leading cause of death. This is also closely related to aging and the three highs, such as a major sequelae of stroke is vascular dementia.
6, Beijing, Macao is the healthiest, followed by Hong Kong and Shanghai.
Judging from the age-standardized life loss years (YLL) ranking (which can be understood as "how many years have passed away in total for people who died due to a certain disease"), among the top 20 causes of death, the total number of years of disease life loss in Beijing and Macao is lower than that of the whole country.
Except for colorectal cancer, which has a higher than average life loss and a suicide equal to the mean, Hong Kong is lower than the whole country.
In addition to colorectal cancer and congenital defects, the loss of life caused by other diseases in Shanghai is lower than that of the whole country.
Today, Uncle Dian will "take out" the key points of the top 10 causes of death in the country, and see how the 10 major causes of death are different in various provinces in the country.
concentrate:
The "average age of death" in the chart below is a rough estimate based on "Life Expectancy in China of 76.5 years" in the 2018 World Health Statistics Report, minus the average age of each deceased person per 100,000 people.
The provincial rankings in the chart below are ranked by year of life loss (YLL) due to disease (which can be understood as "how many years people who died from a disease died in total"), rather than the mortality rate rankings of each province.
Provinces with more early deaths due to stroke tend to be areas with more economic conditions.
· One of the high risk factors for stroke is hypertension, and the top 2 high risk factors in the country except Taiwan are on the list.
· In addition to high blood pressure, the high-sodium diet is also in the top 3 of the high risk factors in most provinces, and only a few regions such as Taiwan, Beijing, Shanghai, Macao, and Guangxi have eaten lightly. A high-sodium diet can be popularly understood as "eating more salty", and eating more processed foods, such as bread, milk tea, etc., is one of the important factors leading to high blood pressure.
Hong Kong, Macao, Taiwan and Beijing and Shanghai belong to economically developed places, and there are more hospitals with thrombolysis conditions and more timely rescue.
Hong Kong, Macao and Taiwan have done a more mature job in the rehabilitation of stroke, which can reduce the risk of death of patients after stroke.
Ischemic heart disease, also known as "coronary heart disease", is mostly caused by the "blockage" of blood vessels that nourish the myocardium, resulting in hypoxia of myocardial cells and necrosis of insufficient nutrition.
Heilongjiang, ranked No. 1, has hypercholesterolemia, more hyperglycemia, and too little consumption of vegetables and nuts (unsaturated fatty acids), which are all factors that contribute to unhealthy blood vessels.
In addition to the problem of hypercholesterolemia in Inner Mongolia, vegetables and seafood (omega-3 fatty acids) are also eaten less.
Chronic obstructive pulmonary disease (COPD) is a disease of old age that causes dyspnea and continues to worsen, and is often not easily detected early.
Risk factors include smoking and second-hand smoke, air pollution, and recurrent infections of the lower respiratory tract.
Tibet and Yunnan are provinces with better overall air quality, but the proportion of smoking is relatively large, and the southwest region is also the main producer of tobacco.
Both Beijing and Hong Kong are cities with strict tobacco control. In Beijing, for example, tobacco control regulations were introduced in 2014, and citizens can also complain through hotlines, and volunteers have joined the tobacco control work.
The most serious areas of air pollution are Beijing, Tianjin and Hebei, but the impact is much smaller than that in the northeast, perhaps because the medical conditions in Beijing and Tianjin are better, and the awareness of lung cancer screening is also higher among residents.
In addition, the phenomenon of charcoal-grilled food and coal burning for heating in the northeast region is widespread, coupled with the concentration of mining and industry, which will also cause atmospheric particle pollution.
Smoking is more severe in the Northeast. According to a 2015 survey conducted by the Chinese Center for Disease Control and Prevention in collaboration with WHO, Shenyang had the highest overall smoking rate of 24.5% of the 14 cities surveyed, followed by Changchun. [2]
Alzheimer's disease is a type of dementia, age and sex are the main risk factors, women are significantly higher than men, high blood pressure, high blood sugar, smoking, brain trauma, low education can increase the risk.
Early detection is difficult due to the inconspicuous early manifestations. Shanghai, Beijing, and Macao all began to pay attention to this aspect relatively early, and Shanghai first established a treatment center for elderly dementia as early as 1998, and some elderly people in Macao will include dementia screening in the physical examination.
More than half of the liver cancer deaths are caused by the hepatitis B virus.
The southeast coast is a high incidence of hepatitis in the mainland, such as Fusui and Long'an in Guangxi, Xiamen and Tong'an in Fujian, Qidong in Jiangsu, Haimen, etc., and the infection rate of hepatitis B virus is higher than the national average. Factors such as high population density and the consumption of contaminated seafood are responsible for the high incidence of hepatitis in the region.
In addition, the climate in these areas is humid and hot, and food is prone to mold, and aflatoxin pollution is particularly serious.
The more developed areas (such as Beijing, Shanghai, Hong Kong), the higher the vaccination rate, and the lower the rate of hepatitis B and C infection.
Why is the incidence of liver cancer higher in the southeast coastal areas of the mainland?
Qinghai loves salt, and a high-salt diet can lead to an increased risk of stomach cancer.
Ningxia is a Hui autonomous region, and the Hui people smoke and drink less than the Han people, but some underdeveloped areas in Ningxia have poor food preservation conditions, and there is still a habit of high-salt pickled food.
Gansu also has the habit of picking vegetables for the winter.
In addition, there are no obvious symptoms in the early stage of stomach cancer, and it is easy to miss diagnosis. More people know about stomach cancer in more developed areas and will screen for it.
Hypertensive heart disease, simply put, is that high blood pressure is not controlled for a long time, resulting in a weakened blood pumping function of the heart, and eventually leading to heart failure and other complications.
Less developed areas of the economy may have insufficient awareness of the control of hypertension.
The high altitude in Tibet is a severe test for cardiopulmonary function.
Irregular driving, two lines of tears for loved ones, and the average age of death caused by road traffic is only 36 years old, which is more terrible than cancer!
The top rankings are mostly more remote areas, hospitals may be far from the accident site, coupled with the complex terrain, it is difficult to get timely rescue in the event of a car accident.
Hong Kong, Macao, and Beijing, Shanghai, and Guangzhou are all places with a large number of motor vehicles, but the traffic accident mortality rate is low, and one of the reasons may be because the traffic penalties in these places are very strict. Just in June, Shenzhen, which is known for traffic law enforcement in the country, once again increased the punishment.
Jiangsu people drink more liquor, Sichuan people love to eat hot pot, Henan (such as Linxian County) love to eat hot food, Fujian people love to eat salted fish and other pickled foods, which will increase the risk of esophageal cancer.
Finally, let's take another plate of the 10 factors that have the greatest impact on the health of the Chinese people:
1. Hypertension
2. Smoking
3. High sodium diet
4. Particulate air pollution
5. High blood sugar
6. High cholesterol
7. Obesity (high body mass index - BMI)
8, whole grains eat too little
9, eat too little fruit
10. Drink alcohol
Of these, diet-related factors combined cause 3.1 million deaths each year, more serious than tobacco (2.5 million)!
How can I live a long and healthy life? Uncle Dian summed up three proverbs and remembered:
Do not smoke, do not drink, do not go out on smog days;
Control blood sugar and obesity, eat more fruits and whole grains;
Keep your mouth shut, open your legs, and live a healthy life, you are more beautiful!
bibliography
[1]. Maigeng Zhou, Haidong Wang, et al. Mortality, morbidity, and risk factors in China and its provinces, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017[J]. The Lancet, June 24, 2019. DOI:https://doi.org/10.1016/S0140-6736(19)30427-1.
Liang Xiaofeng, editor-in-chief. 2013-2014 Adult Tobacco Survey Report in Some Cities in China[M].2013-2014 Adult Tobacco Survey Report in Some Cities in China / -Beijing : Military Medical Science Press, 2015.4:8.
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