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China has experienced a remarkable epidemiological and demographic transition during the past three decades. Far less is known about this transition at the subnational level. Timely and accurate assessment of the provincial burden of disease is needed for evidence-based priority setting at the local level in China. Following the methods of the Global Burden of Disease Study 2013 (GBD 2013), we have systematically analysed all available demographic and epidemiological data sources for China at the provincial level. We developed methods to aggregate county-level surveillance data to inform provincial-level analysis, and we used local data to develop specific garbage code redistribution procedures for China. We assessed levels of and trends in all-cause mortality, causes of death, and years of life lost (YLL) in all 33 province-level administrative units in mainland China, all of which we refer to as provinces, for the years between 1990 and 2013. All provinces in mainland China have made substantial strides to improve life expectancy at birth between 1990 and 2013. Increases ranged from 4·0 years in Hebei province to 14·2 years in Tibet. Improvements in female life expectancy exceeded those in male life expectancy in all provinces except Shanghai, Macao, and Hong Kong. We saw significant heterogeneity among provinces in life expectancy at birth and probability of death at ages 0–14, 15–49, and 50–74 years. Such heterogeneity is also present in cause of death structures between sexes and provinces. From 1990 to 2013, leading causes of YLLs changed substantially. In 1990, 16 of 33 provinces had lower respiratory infections or preterm birth complications as the leading causes of YLLs. 15 provinces had cerebrovascular disease and two (Hong Kong and Macao) had ischaemic heart disease. By 2013, 27 provinces had cerebrovascular disease as the leading cause, five had ischaemic heart disease, and one had lung cancer (Hong Kong). Road injuries have become a top ten cause of death in all provinces in mainland China. The most common non-communicable diseases, including ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and cancers (liver, stomach, and lung), contributed much more to YLLs in 2013 compared with 1990. Rapid transitions are occurring across China, but the leading health problems and the challenges imposed on the health system by epidemiological and demographic change differ between groups of Chinese provinces. Localised health policies need to be implemented to tackle the diverse challenges faced by local health-care systems. China National Science & Technology Pillar Program 2013 (2013BAI04B02) and Bill & Melinda Gates Foundation.

Few studies have explored temperature–mortality relationships in China, especially at the multi-large city level. This study was based on the data of seven typical, large Chinese cities to examine temperature-mortality relationships and optimum temperature of China. A generalized additive model (GAM) was applied to analyze the acute-effect of temperature on non-accidental mortality, and meta-analysis was used to merge data. Furthermore, the lagged effects of temperature up to 40 days on mortality and optimum temperature were analyzed using the distributed lag non-linear model (DLNM). We found that for all non-accidental mortality, high temperature could significantly increase the excess risk (ER) of death by 0.33% (95% confidence interval: 0.11%, 0.56%) with the temperature increase of 1 °C. Similar but non-significant ER of death was observed when temperature decreased. The lagged effect of temperature showed that the relative risk of non-accidental mortality was lowest at 21 °C. Our research suggests that high temperatures are more likely to cause an acute increase in mortality. There was a lagged effect of temperature on mortality, with an optimum temperature of 21 °C. Our results could provide a theoretical basis for climate-related public health policy.

BackgroundSmoke-free legislation is an effective way to protect the population from the harms of secondhand smoke and has been implemented in many countries. On 31 May 2012, Tianjin became one of the few cities in China to implement smoke-free legislation. We investigated the impact of smoke-free legislation on mortality due to acute myocardial infarction (AMI) and stroke in Tianjin.MethodsAn interrupted time series design adjusting for underlying secular trends, seasonal patterns, population size changes and meteorological factors was conducted to analyse the impact of the smoke-free law on the weekly mortality due to AMI and stroke. The study period was from 1 January 2007 to 31 December 2015, with a 3.5-year postlegislation follow-up.ResultsFollowing the implementation of the smoke-free law, there was a decline in the annual trends of AMI and stroke mortality. An incremental 16% (rate ratio (RR): 0.84; 95% CI: 0.83 to 0.85) decrease per year in AMI mortality and a 2% (RR: 0.98; 95% CI: 0.97 to 0.99) annual decrease in stroke mortality among the population aged ≥35 years in Tianjin was observed. Immediate postlegislation reductions in mortality were not statistically significant. An estimated 10 000 (22%) AMI deaths were prevented within 3.5 years of the implementation of the law.ConclusionThe smoke-free law in Tianjin was associated with reductions in AMI mortality. This study reinforces the need for large-scale, effective and comprehensive smoke-free laws at the national level in China.

Background Tianjin is one of the cities with the highest prevalence of hypertension in China and one of the first regions to develop community management of hypertension. Our aim was to analyze the characteristics of hypertension in the last 16 years, and estimate the population attributable fraction for cardiovascular mortality in Tianjin, China. Methods We compared the epidemiological characteristics of hypertension between 2002 and 2018 by analyzing data from the National Nutrition and Chronic Disease Risk Factor Survey. Subsequently, we obtained the cause-specific mortality in the same year from the Tianjin All Cause of Death Registration System (CDRS), and the population attributable fraction was used to estimate the annual cardiovascular disease (CVD) deaths caused by hypertension. Results In 2002 and 2018, the crude prevalence, awareness, treatment rate in diagnosed, control rate in treated, and overall control rate of hypertension were 36.6% and 39.8%, 36.0% and 51.9%, 76.0% and 90.1%, 17.4% and 38.3%, 4.8% and 17.9%, respectively ( P  < 0.05). The mean SBP for males between the ages of 25 and 50 was significantly higher in 2018 than in 2002. The number of CVD deaths attributed to hypertension was 13.8 thousand in 2002 (account for 59.1% of total CVD deaths), and increased to 21.7 thousand in 2018 (account for 58.8% of total CVD deaths). The population attributable fraction have increased in the age groups of 25–44 and 75 and above, and decreased in the age group of 45–74 from 2002 to 2018. Conclusions Compare to 2002, the proportion of CVD deaths attributed to hypertension remains high, particularly among younger and older people, despite a very significant increase in treatment and control rates for hypertension in 2018.

Objective Compare the urban-rural disparity in cancer mortality and changing trend during the past 18 years in Tianjin, China. Methods Cancer death data were obtained from Tianjin All Cause of Death Registration System (CDRS), which covers the whole population of Tianjin. We calculated and compared the constituent ratio of cancer deaths, age-standardized mortality rate(ASR)and changing trends between urban and rural areas. Results From 1999 to 2016, a total of 245,744 cancer deaths were reported, accounting 21.7% of all deaths in Tianjin. The ASR of total cancer mortality was higher in urban areas than in rural areas. A total of 33,739 persons were avoided dying of cancers in rural area compared to the urban death level from 1999 to 2016, which was 40.1% compare to the current level of rural areas. But the gap between urban and rural areas became narrowed gradually. The urban-rural ratios (urban/rural) of total cancer mortality changed from 1.76 (125.7/71.5)[95%CI,1.67,1.84] in 1999 to 1.11 (99.6/90.0)[95%CI,1.06,1.15] in 2016. The ASR of lung, liver and esophagus cancer became higher in rural areas than in urban areas in 2016. Conclusion Cancer transition was obviously occurred in Tianjin and showed different speeds and big gap between urban and rural areas. Much more attention was needed to pay in rural areas which still have increasing trends in most cancers mortality recently.

Background In Tianjin, China, there is a relatively high prevalence of HIV in men who have sex with men (MSM). The number of HIV cases in Tianjin is also increasing. We investigated the HIV molecular transmission network, genetic tropisms, and drug resistance mutations in Tianjin. Methods Blood samples were collected from 510 newly diagnosed antiretroviral therapy (ART)-naïve HIV-1-infected subjects among MSM in Tianjin. Partial pol and env genes were sequenced and used for phylogenetic, genetic tropism, and genotypic drug resistance analyses. Molecular clusters were identified with 1.5% genetic distance and 90% bootstrap support. Results Among the 436 HIV-1 pol sequences obtained from the study participants, various genotypes were identified, including CRF01_AE (56.9%), CRF07_BC (27.8%), B (7.3%), CRF55_01B (4.1%), unique recombinant forms (URFs) (3.7%), and CRF59_01B (0.2%). A higher prevalence of X4 viruses was observed in individuals infected with CRF55_01B (56.3%) and CRF01_AE (46.2%) than with other subtypes. Of all 110 sequences in the 36 clusters, 62 (56.4%) were observed in 23 CRF01_AE clusters and 18 (16.4%) in four CRF07_BC clusters. Eight sequences clustered with at least one other shared the same drug resistance mutation (DRM). In different cluster sizes, the distributions of individuals by age, presence of sexually transmitted disease, and presence of DRMs, were significantly different. Conclusion We revealed the characteristics of HIV molecular transmission, tropism, and DRMs of ART-naïve HIV-infected individuals among the MSM population in Tianjin. Identifying infected persons at risk of transmission is necessary for proposing counseling and treating these patients to reduce the risk of HIV transmission.

Activated partial thromboplastin time (APTT) is the conventional test for monitoring unfractionated heparin (UFH) therapy, but discordance with anti-factor Xa results frequently occurs in clinical practice, potentially leading to suboptimal anticoagulation management. This study aimed to develop an in-house anti-factor Xa detection system, establish laboratory-specific APTT therapeutic ranges calibrated against anti-factor Xa levels, and identify predictors of discordance between these two monitoring methods. We developed and validated a chromogenic anti-factor Xa assay according to CLSI guidelines. From 110 patients receiving UFH, 190 samples were collected. Laboratory-specific APTT ranges were derived using linear regression and ROC analysis against anti-factor Xa target range (0.3-0.7 IU/ml). Random forest and logistic regression models identified predictors of discordance among clinical and laboratory variables. The optimized assay showed excellent analytical performance with strong correlation to the commercial platform (Pearson = 0.986, = 0.972). The derived laboratory-specific APTT therapeutic range was 79-127 s. Despite moderate correlation between APTT and anti-factor Xa (Spearman ρ = 0.678, < 0.001), classification concordance was poor, with 58.2% of specimens showing discordance. Random forest analysis (AUC = 0.79) and logistic regression identified five key predictors: fibrinogen, triglycerides, estimated glomerular filtration rate, C-reactive protein, and antithrombin III. This study developed a validated anti-factor Xa assay and identified substantial classification discordance between APTT and anti-factor Xa monitoring. Five clinical and laboratory factors were associated with monitoring discordance.

Background The aim of this study was to examine the trends in the mortality rate and years of life lost (YLL) rate of lung cancer in Tianjin, China, during the period from 1999 to 2016. Methods Lung cancer death data were obtained from Tianjin residents' all‐cause death monitoring system, which covers the whole population of Tianjin. Crude mortality rate, age‐standardized mortality rate, truncated rate (35–64 years), YLL and age‐standardized YLL rate data were calculated and trends examined. Results From 1999 to 2016, a total of 93 358 lung cancer deaths were reported in Tianjin, which accounted for 38.0% of all cancer deaths (93 358/245744). The crude mortality rate of lung cancer had increased 58.5% from 1999 (40.15/100000) to 2016 (63.64/100000), average annual percent change (AACP) = 2.9%, P < 0.01. However, the age‐standard YLL rate had decreased to 13.3% in 2016 than in 1999, AACP = –0.8%, P < 0.01, with a stable trend in males (AACP = –0.2%), and noticeable decreasing trend in females (AACP = –1.4%). The lung cancer mortality rate (ASRW) in urban areas was higher than that in rural areas in 1999, with a ratio of 1.99:1. However, it was lower in 2016, with the ratio of 0.98:1. For the truncated rate (35–64 years), it had decreased in urban areas compared with rural areas since the year 2013. Conclusion Lung cancer remains the most fatal cancer in Tianjin. However, the age‐standard YLL rate of lung cancer has decreased considerably accompanied by a decline in smoking rate years ago, especially in women and people living in urban areas. Considerable attention is therefore needed in the rural areas where cases of lung cancer are still rapidly increasing.

Introduction: This study aims to estimate the impact of smoking-attributable mortality of selected cancers, in the period 2010 – 2019 in Tianjin, China. Methods: A case-control study was conducted to assess the smoking-attributed major causes of cancer deaths. Unmatched multiple logistic regression was used to calculate mortality risk ratios. Results: Smoking-attributable cancer deaths were 23709 (28.87%) among adult males and 8648 (13.37%) among adult females in the period 2010 – 2019 in Tianjin, China. Lung cancer remains the largest cause of smoking-attributable deaths; among men, the death rates were 49.06% of lung cancers, 27.55% of mouth, pharynx, larynx, or esophagus cancers, 13.56% of kidney and other urinary cancers, and 10.11% of liver cancers; among women the corresponding death rates were 31.56% of lung cancers and 10.59% of the mouth, pharynx, larynx, or esophagus cancer, 10.56% of bladder cancers. Smoking-attributed cancer deaths in men increased from 1817 in 2010 to 2695 in 2019; for women, the number remained stable at just over 800 per year during the past decade. Conclusions: At least one in three cancer deaths in men and one in six in women would be potentially preventable through appropriate control of tobacco smoking in Tianjin, China. Effective control programs against tobacco smoking should be further implemented.

The use of specific combinations of antigens and adjuvant represents a promising approach for increasing the immunogenicity of DNA vaccines. In the present study, we evaluated the immunity and antitumor effects of DNA vaccines with G250 as the target antigen in a mouse model of renal cell carcinoma. We constructed two recombinant plasmids, pVAX1-G250 and pVAX1-CD40L. The recombinant plasmids were injected into mice by intramuscular injection and electrical pulse stimulation. ELISA and ELISPOT experiments were performed to evaluate the corresponding humoral and cellular immune responses following immunization. To further investigate the antitumor potential of the DNA vaccines, we established a tumor-bearing mouse model expressing G250 target antigen. Our results showed that immunization with the combination of the two plasmids exerted the strongest anti-tumor effects. Therefore, our findings demonstrated the effectiveness of CD40L as an adjuvant for DNA vaccines and highlighted the promising use of these vaccines for the treatment of tumors.