Summary Background Moderate alcohol intake has been associated with reduced cardiovascular risk in many studies, in comparison with abstinence or with heavier drinking. Studies in east Asia can help determine whether these associations are causal, since two common genetic variants greatly affect alcohol drinking patterns. We used these two variants to assess the relationships between cardiovascular risk and genotype-predicted mean alcohol intake in men, contrasting the findings in men with those in women (few of whom drink). Methods The prospective China Kadoorie Biobank enrolled 512 715 adults between June 25, 2004, and July 15, 2008, from ten areas of China, recording alcohol use and other characteristics. It followed them for about 10 years (until Jan 1, 2017), monitoring cardiovascular disease (including ischaemic stroke, intracerebral haemorrhage, and myocardial infarction) by linkage with morbidity and mortality registries and electronic hospital records. 161 498 participants were genotyped for two variants that alter alcohol metabolism, ALDH2 -rs671 and ADH1B -rs1229984. Adjusted Cox regression was used to obtain the relative risks associating disease incidence with self-reported drinking patterns (conventional epidemiology) or with genotype-predicted mean male alcohol intake (genetic epidemiology—ie, Mendelian randomisation), with stratification by study area to control for variation between areas in disease rates and in genotype-predicted intake. Findings 33% (69 897/210 205) of men reported drinking alcohol in most weeks, mainly as spirits, compared with only 2% (6245/302 510) of women. Among men, conventional epidemiology showed that self-reported alcohol intake had U-shaped associations with the incidence of ischaemic stroke (n=14 930), intracerebral haemorrhage (n=3496), and acute myocardial infarction (n=2958); men who reported drinking about 100 g of alcohol per week (one to two drinks per day) had lower risks of all three diseases than non-drinkers or heavier drinkers. In contrast, although genotype-predicted mean male alcohol intake varied widely (from 4 to 256 g per week—ie, near zero to about four drinks per day), it did not have any U-shaped associations with risk. For stroke, genotype-predicted mean alcohol intake had a continuously positive log-linear association with risk, which was stronger for intracerebral haemorrhage (relative risk [RR] per 280 g per week 1·58, 95% CI 1·36–1·84, p<0·0001) than for ischaemic stroke (1·27, 1·13–1·43, p=0·0001). For myocardial infarction, however, genotype-predicted mean alcohol intake was not significantly associated with risk (RR per 280 g per week 0·96, 95% CI 0·78–1·18, p=0·69). Usual alcohol intake in current drinkers and genotype-predicted alcohol intake in all men had similarly strong positive associations with systolic blood pressure (each p<0·0001). Among women, few drank and the studied genotypes did not pr...

Background:Obesity, physical inactivity and reduced physical fitness may contribute to the rising burden of chronic diseases in China. We investigated these factors in China over a 14-year period using data from the randomized national surveys in 2000, 2005, 2010 and 2014. Methods:We conducted four national surveys among 151,656, 163,386, 154,931and 146,703 Chinese adults aged 20-59 in 2000, 2005, 2010 and 2014, respectively. Body mass index (BMI, kg/m 2 ) was used to evaluate underweight (BMI<18·5), overweight (BMI 23·0-27·5) and obesity (BMI≥27·5). Central obesity was defined as waist circumference >90 cm in men and >85 cm in women. Leisure-time physical activity (LTPA) was evaluated by whether or not the participants had completed the recommended minimum 150-min moderate or 75-min vigorous exercise per week. Indices for assessing physical fitness included forced vital capacity, resting heart rate, handgrip strength, sit and reach, and standing on one leg. Findings:The prevalence of obesity increased from 8·6% in 2000, 10·3% in 2005, and 12·2% in 2010 to 12·9% in 2014 (0·32% per year). Comparable estimates were 37·4%, 39·2%, 40·7% and 41·2% for overweight and 13·9%, 18·3%, 22·1% and 24·9% for central obesity. The corresponding upward trends per year were 0·27% and 0·78%, respectively. The prevalence of overweight, obesity and central obesity increased with age and was higher in men than women.. A simultaneous decrease was observed in the prevalence of underweight (5·4% in 2000 versus 4·6% in 2014, a downward trend of 0·06% per year). More participants met the minimum LTPA recommendation (17·2% in 2000 versus 22·8% in 2014), with the prevalence change per year being 0·33%, 0·50%, 0·37%, 0·06% for underweight, normal-weight, overweight, and obesity, respectively. Physical fitness deterioration was observed for all measures examined except resting heart rate. Interpretation:Despite increased participation in LTPA, we observed an upward trend in overweight/obesity and a decline in physical fitness in Chinese adults. Continued nationwide interventions are needed for promoting physical activity and other healthy lifestyles in China. Funding:National Physical Fitness Surveillance Center, Ministry of Science and Technology of the People's Republic of China. Introduction In recent decades, China has witnessed a rapid rise in the burden of noncommunicable diseases (NCDs). Despite differences in sampling methods and 3 diagnostic criteria, the estimated prevalence grew from 9.7% to 11.6% for type 2 diabetes, and from 15.5% to 50.1% for pre-diabetes between 2008 and 2010. 1 These diseases accounted for an estimated 80% of deaths and 70% of total disease burden in China. 2 While aging of the population is an important contributing factor, such health consequences are also likely attributed to the drastic changes in lifestyles following China's economic boom that result in obesity and physical inactivity. 3 These two factors, despite their strong correlation, have been independently linked to increased risk of ...

BackgroundMany countries are developing health financing mechanisms to pursue the goal of universal coverage. In China, a rural health insurance system entitled New Cooperative Medical Scheme (NCMS) is being developed since 2003. Although there is concern about whether the NCMS will influence the serious situation of inequity in health service utilization in rural China, there is only limited evidence available. This paper aims to assess the utilisation of outpatient and inpatient services among different income groups and provinces under NCMS in rural China.MethodsUsing multistage sampling processes, a cross-sectional household survey including 6,147 rural households and 22,636 individuals, was conducted in six counties in Shandong and Ningxia Provinces, China. Chi-square test, Poisson regression and log-linear regression were applied to analyze the association between NCMS and the utilization of outpatient and inpatient services and the length of stay for inpatients. Qualitative methods including individual interview and focus group discussion were applied to explain and complement the findings from the household survey.ResultsNCMS coverage was 95.9% in Shandong and 88.0% in Ningxia in 2006. NCMS membership had no significant association with outpatient service utilization regardless of income level and location.Inpatient service utilization has increased for the high income group under NCMS, but for the middle and low income, the change was not significant. Compared with non-members, NCMS members from Ningxia used inpatient services more frequently, while members from Shandong had a longer stay in hospital.High medical expenditure, low reimbursement rate and difference in NCMS policy design between regions were identified as the main reasons for the differences in health service utilization.ConclusionsOutpatient service utilization has not significantly changed under NCMS. Although utilization of inpatient service in general has increased under NCMS, people with high income tend to benefit more than the low income group. While providing financial protection against catastrophic medical expenditure is the principal focus of NCMS, this study recommends that outpatient services should be incorporated in future NCMS policy development. NCMS policy should also be more equity oriented to achieve its policy goal.

SummaryBackgroundThe age-specific association between blood pressure and vascular disease has been studied mostly in high-income countries, and before the widespread use of brain imaging for diagnosis of the main stroke types (ischaemic stroke and intracerebral haemorrhage). We aimed to investigate this relationship among adults in China.Methods512 891 adults (59% women) aged 30–79 years were recruited into a prospective study from ten areas of China between June 25, 2004, and July 15, 2008. Participants attended assessment centres where they were interviewed about demographic and lifestyle characteristics, and their blood pressure, height, and weight were measured. Incident disease was identified through linkage to local mortality records, chronic disease registries, and claims to the national health insurance system. We used Cox regression analysis to produce adjusted hazard ratios (HRs) relating systolic blood pressure to disease incidence. HRs were corrected for regression dilution to estimate associations with long-term average (usual) systolic blood pressure.FindingsDuring a median follow-up of 9 years (IQR 8–10), there were 88 105 incident vascular and non-vascular chronic disease events (about 90% of strokes events were diagnosed using brain imaging). At ages 40–79 years (mean age at event 64 years [SD 9]), usual systolic blood pressure was continuously and positively associated with incident major vascular disease throughout the range 120–180 mm Hg: each 10 mm Hg higher usual systolic blood pressure was associated with an approximately 30% higher risk of ischaemic heart disease (HR 1·31 [95% CI 1·28–1·34]) and ischaemic stroke (1·30 [1·29–1·31]), but the association with intracerebral haemorrhage was about twice as steep (1·68 [1·65–1·71]). HRs for vascular disease were twice as steep at ages 40–49 years than at ages 70–79 years. Usual systolic blood pressure was also positively associated with incident chronic kidney disease (1·40 [1·35–1·44]) and diabetes (1·14 [1·12–1·15]). About half of all vascular deaths in China were attributable to elevated blood pressure (ie, systolic blood pressure >120 mm Hg), accounting for approximately 1 million deaths (<80 years of age) annually.InterpretationAmong adults in China, systolic blood pressure was continuously related to major vascular disease with no evidence of a threshold down to 120 mm Hg. Unlike previous studies in high-income countries, blood pressure was more strongly associated with intracerebral haemorrhage than with ischaemic stroke. Even small reductions in mean blood pressure at a population level could be expected to have a major impact on vascular morbidity and mortality.FundingUK Wellcome Trust, UK Medical Research Council, British Heart Foundation, Cancer Research UK, Kadoorie Charitable Foundation, Chinese Ministry of Science and Technology, and the National Science Foundation of China.