Background With China's rapid economic development, the diseaseburden may have changed in the country. We studied the majorcauses of death and modifiable risk factors in a nationallyrepresentative cohort of 169,871 men and women 40 years of ageand older in China.
Methods Baseline data on the participants' demographic characteristics,medical history, lifestyle-related risk factors, blood pressure,and body weight were obtained in 1991 with the use of a standardprotocol. The follow-up evaluation was conducted in 1999 and2000, with a follow-up rate of 93.4 percent.
Results We documented 20,033 deaths in 1,239,191 person-yearsof follow-up. The mortality from all causes was 1480.1 per 100,000person-years among men and 1190.2 per 100,000 person-years amongwomen. The five leading causes of death were malignant neoplasms(mortality, 374.1 per 100,000 person-years), diseases of theheart (319.1), cerebrovascular disease (310.5), accidents (54.0),and infectious diseases (50.5) among men and diseases of theheart (268.5), cerebrovascular disease (242.3), malignant neoplasms(214.1), pneumonia and influenza (45.9), and infectious diseases(35.3) among women. The multivariate-adjusted relative riskof death and the population attributable risk for preventablerisk factors were as follows: hypertension, 1.48 (95 percentconfidence interval, 1.44 to 1.53) and 11.7 percent, respectively;cigarette smoking, 1.23 (95 percent confidence interval, 1.18to 1.27) and 7.9 percent; physical inactivity, 1.20 (95 percentconfidence interval, 1.16 to 1.24) and 6.8 percent; and underweight(body-mass index [the weight in kilograms divided by the squareof the height in meters] below 18.5), 1.47 (95 percent confidenceinterval, 1.42 to 1.53) and 5.2 percent.
Conclusions Vascular disease and cancer have become the leadingcauses of death among Chinese adults. Our findings suggest thatcontrol of hypertension, smoking cessation, increased physicalactivity, and improved nutrition should be important strategiesfor reducing the burden of premature death among adults in China.
Source Information
From the Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine (J.H., K.R., C.-S.C., J.C., R.P.W., P.K.W.), and the Department of Medicine, Tulane University School of Medicine (J.H., J.C., P.K.W.) — both in New Orleans; the Cardiovascular Institute, Fuwai Hospital of the Chinese Academy of Medical Sciences and Peking Union Medical College, and the National Center for Cardiovascular Disease Control and Research, Beijing (D.G., X.W., X.D.); Anzhen Hospital, Capital University of Medical Sciences, Beijing (C.Y.); West China College of Medicine, Sichuan University, Chendu, China (J.W.); and the Department of Medicine, Johns Hopkins University School of Medicine, Baltimore (M.J.K.).
Address reprint requests to Dr. He at the Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, 1430 Tulane Ave., Mail Stop SL18, New Orleans, LA 70112, or at jhe{at}tulane.edu.
Major Causes of Death in China
Wagner P. D., Viegi G., Luna C. M., Fukuchi Y., Kvale P. A., Sony A. E., Wei M., Wang K., Wang B., Barnett V. T., He J., Gu D., Whelton P. K.
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N Engl J Med 2006;
354:874-876, Feb 23, 2006.
Correspondence
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