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BackgroundThe burden of valvular heart disease (VHD) is rising rapidly globally, accompanied by substantial geographical disparities. Although altitude may influence cardiovascular system, no community-based studies have yet explored altitudinal differences in VHD epidemiology.ObjectiveThis study aims to investigate the prevalence, spectrum and aetiology of VHD in different altitude areas.MethodsWe conducted two sequential community-based echocardiography screening programmes in Yunnan Province of China and included 5059 eligible participants aged 35 years and older. The multivariable Poisson regression models with robust variance were performed to assess the association of different altitude groups with VHD and its subtypes.ResultsThe prevalence of overall VHD, clinically significant VHD and clinically significant regurgitant VHD was 36.7%, 2.5% and 2.4%, respectively. After stratification by altitude, the prevalence of any VHD among participants in the <2000 m, 2000–2499 m, 2500–2999 m and ≥3000 m groups was 30.4%, 40.9%, 35.0% and 44.3%, respectively. The fully adjusted models showed that the prevalence ratios for VHD in the 2000–2499 m, 2500–2999 m and ≥3000 m groups were 1.28 (95% CI 1.15 to 1.42), 1.20 (95% CI 1.02 to 1.41) and 1.34 (95% CI 1.04 to 1.72), compared with the <2000 m group. Clinically significant VHD in the <3000 m altitude group was predominantly degenerative in aetiology, whereas functionality was most prevalent in the ≥3000 m altitude group. Subgroup analysis identified some high-risk populations, including male, minority ethnicity, 60 years and older and high systolic blood pressure.ConclusionsAdults living at high altitudes have a higher prevalence risk of VHD; significant altitudinal differences exist in the characteristics and aetiology of VHD. The findings could provide insights into primary prevention and early screening for VHD in low- and middle-income countries where a majority of the population lives at high altitudes.

Background Available evidence falls short in assessing the risk of long-term outcomes among individuals with hypertension residing at various altitudes. We aimed to investigate the association between residential altitude and the risk of all-cause and cardiovascular disease (CVD) mortality among hypertensive patients. Methods This cohort study encompassed 67,275 hypertensive patients aged ≥35 years who participated in China’s Basic Public Health Service Program in 2018. Participants were categorized into four groups based on their residence altitude: <500 m, 500-1,499 m, 1,500-2,500 m, and > 2,500 m. The associations between residential altitude and the risks of all-cause and CVD mortality were analyzed using Cox proportional hazards regression models. The dose-response relationship was performed by the restricted cubic spline with multivariable adjusted models. Results Among the 67,275 hypertensive patients included in the study (mean age of 63.9 years, with 45.3% male), 8,768 deaths were recorded, of which 5,666 were attributed to CVD. Following multivariate adjustment, when compared to the group residing at altitudes < 500 m, the groups living at altitudes of 500-1,499 m, 1500-2,500 m, and > 2,500 m exhibited significantly risks of all-cause mortality [HR = 1.45 (95% CI: 1.36–1.54), 1.35 (95% CI: 1.28–1.43), and 1.41 (95% CI: 1.28–1.54), respectively] and CVD mortality [HR = 1.47 (95% CI: 1.35–1.58), 1.42 (95% CI: 1.33–1.52), and 1.46 (95% CI: 1.31–1.62), respectively]. The restricted cubic spline curves revealed a nonlinear relationship between residential altitude and all-cause and CVD mortality. The risk of mortality was higher among participants with poorly controlled blood pressure, aged 65 years and above, and living in rural areas. Conclusions This study demonstrated a significant association between long-term residential high-altitude exposure and increased risks of all-cause and CVD mortality among hypertension patients. The implications of the findings call for a prioritization of public health resource allocation and early intervention efforts, especially for those living at high altitudes and in low-income areas where hypertension is prevalent.

Background The purpose of the study was to determine the prevalence and clustering changes of cardiovascular disease (CVD) risk factors, the atherosclerotic cardiovascular diseases (ASCVD) risk change in ethnic minority areas of the Southwest China Plateau from the perspective of sex disparity. Methods This study conducted two cross-sectional studies in Yunnan Province, China, in 2018 and 2024, respectively, enrolling 1,197 and 1,047 participants aged 35–75 years with no history of CVD. The China-PAR model was used to assess participants’ 10-year risk of ASCVD. Changes in the prevalence and clustering of 9 CVD risk factors were described. Multivariate-adjusted Poisson regression by robust was used to calculate the association between the number of CVD risk factors and high risk of ASCVD. Results Compared with 2018, the age-standardized prevalence of modifiable metabolic CVD risk factors such as hypertension (22.4% to 41.7%), central obesity (24.2% to 39.1%), and overweight and obesity (11.2% to 15.1%) has risen rapidly; the increase among males was much higher than among females, while the age-standardized prevalence of modifiable behavioral CVD risk factors has declined. There was no significant change in the clustering number of CVD risk factors, but there was a significant change in the combination of CVD risk factors, particularly a significant increase associated with hypertension. The proportion of individuals classified as being at high risk for ASCVD also increased significantly (6.7% vs 10.6%). For each CVD risk factor, the high risk of ASCVD increased by 5%, with a higher risk among males and 55–75 years. Conclusion From 2018 to 2024, modifiable metabolic CVD risk factors increased substantially in high-altitude ethnic minority regions of Southwest China. Comprehensive lifestyle interventions should be implemented in the future to promote the prevention and control of ASCVD risk and gradually reduce sex disparity.

Background The Basic Public Health Service (BPHS), a recently announced free healthcare program, aims to combat the most prevalent Noncommunicable Disease-“Hypertension” (HTN)-and its risk factors on a nationwide scale. In China, there is a rife that HTN less impacts women during their lifetime. We, therefore, aimed to evaluate the sex disparity in hypertension patients with comorbidities among south-west Chinese and the contribution of BPHS to address that concern. Methods We have opted for a multistage stratified random sampling method to enroll hypertensive patients of 35 years and older, divided them into BPHS and non-BPHS groups. We assessed the sex disparity in HTN patients with four major comorbidities- Dyslipidemia, Diabetes Mellitus (DM), Cardiovascular Disease (CVD), and Chronic Kidney Disease (CKD), and descriptive data were compiled. Odds ratios from logistic regression models estimated the effectiveness of BPHS in the management of HTN with comorbidities. Results Among 1521 hypertensive patients,1011(66.5%) were managed in the BPHS group. The proportion of patients who had at least one comorbidity was 70.7% (95% confidence interval [CI]: 66.3-76.8%), patients aged 65 years and older were more likely to have coexisting comorbidities. Participants who received the BPHS showed significant blood pressure (BP) control with two comorbidities (odds ratio [OR] = 2.414, 95% CI: 1.276–4.570), three or more (OR = 5.500, 95%CI: 1.174–25.756). Patients with dyslipidemia and DM also benefited from BPHS in controlling BP (OR = 2.169, 95% CI: 1.430–3.289) and (OR = 2.785, 95%CI: 1.242–6.246), respectively. In certain high-income urban survey centers, there was sex differences in the HTN management provided by BPHS, with men having better BP control rates than women. Conclusions Perhaps this is the first study in China to succinctly show the effectiveness and sex disparity regarding “management of hypertensive comorbidities”. This supports that the BPHS program plays a pivotal role in controlling BP, therefore should recommend the national healthcare system to give women a foremost priority in BPHS, especially to those from low-socioeconomic and low-scientific literacy regions.

Background: The relationship between different grades of compliance to antihypertensive medication and blood pressure (BP) control rate remains unclear. This study highlighted the Chinese Basic Public Health Service (BPHS) program upgraded antihypertension medication compliance to improve the blood pressure control rate contributing to the UN sustainable development goal of lowering chronic illness fatalities by one‐third by 2030. Methods: In 2015, 1254 hypertensive patients aged ≥ 35 years were selected in the baseline survey in Yunnan Province by a multistage stratified random sampling method and followed up from 2018 to 2022. Then, they were divided into three groups by tertiles as antihypertensive medicine compliance “poor,” “intermittent,” and “sustained” groups. Then, the robust variance Poisson regression models were performed to estimate the association between three groups and the number of referrals. Kaplan–Meier curves calculated the cumulative risk of onset and survival probability of cardiovascular events from three medication compliance groups. Results: A total of 1254 hypertension patients were included in the study; 992, 1218, 1121, 1066, and 999 hypertension patients were followed up annually. From the baseline to last follow‐up, systolic BP declined with the largest decrease in the sustained group (2015: 152.88 ± 21.64 mmHg vs. 2022: 134.61 ± 10.49 mmHg, p < 0.05) and the least decrease in the poor group (2015: 157.07 ± 15.37 mmHg vs. 2022: 140.33 ± 12.04 mmHg, p < 0.05). Under the management of BPHS, the BP control rate of all three groups increased significantly. Compared with the baseline, the control rate in the sustained group reached 70% in 2022 ( p < 0.01). The number of referrals from the poor group was 11.5%, higher compared with the sustained group (IRR = 1.115 and 95% CI: 1.043–1.193). The poor group also had the highest probability of cardiovascular disease (CVD). The survival probability in the sustained group was the highest and kept at 0.950 at the end of 5 years. Conclusions: High‐grade compliance to antihypertensive drugs significantly improves BP control rate and reduces the risk of CVD events and mortality. The decline of medication compliance grades is closely related to decreasing BP control rate and increased risk of CVD and mortality.

Background Under the background of similar geography and culture in Lancang-Mekong countries and rapid changes in the regional economy and lifestyle, this study aimed to describe and compare the prevalence, awareness, treatment, and control of hypertension and assess the hypertension care cascade in three provinces of China, Laos, and Cambodia. Methods A cross-sectional study was conducted between 2021 and 2023 in the three provinces of Lancang–Mekong River countries using consistent investigative procedures. We included 11,005 participants aged ≥ 18 years from three provinces, and data were collected through questionnaires, physical examinations, and biochemical tests. We analyzed the cascade of hypertension care and compared the prevalence, awareness, treatment, and control of hypertension. Results The hypertension care cascade indicated that 46.3%, 51.6%, and 63.1% of patients in Yunnan Province (China), Oudomxay Province (Laos), and Ratanakiri Province (Cambodia), respectively, were not diagnosed, and 10.7%, 12.8% and 21.1% of patients, respectively, did not receive treatment. After sex-age standardization, the prevalence rates of hypertension in the three provinces were 33.4%, 34.5%, and 23.6%, respectively. Higher awareness rate in Yunnan Province (53.4%) and Oudomxay Province (46.5%) than in Ratanakiri Province of Cambodia (39.7%). The treatment rate of hypertension in Yunnan Province (42.4%) was higher than that in Oudomxay Province (34.5%), and Ratanakiri Province (16.9%). In addition, less than 20% of the patients in the three provinces had their blood pressure under control. The factors associated with hypertension differed across the three provinces. Conclusions In the three provinces of the Lancang-Mekong River Basin countries, there is a high burden of hypertension and a significant unmet need for hypertension care. Targeted and precise intervention strategies are urgently needed to improve the awareness, treatment, and control of hypertension in low- and middle-income regions. Graphic Abstract

Background Congenital heart disease (CHD) is the leading cause of mortality in childhood worldwide. However, a large number of children with CHD are not diagnosed promptly in low- and middle-income regions, due to limited healthcare resources and lack the ability of prenatal and postnatal ultrasound examinations. The research on asymptomatic CHD in the community is still blank, resulting in a large number of children with asymptomatic CHD can not be found and treated in time. Through the China-Cambodia collaborative health care initiative, the project team conducted research, screened children’s CHD through a sampling survey in China and Cambodia, collected relevant data, and retrospectively analyzed the data of all eligible patients. Objectives The project aimed to evaluate the prevalence of asymptomatic CHD in a sample population of 3-18years old and effects on their growth status and treatment outcomes. Methods We examined the prevalence of ‘asymptomatic CHD’ among 3-18years old children and adolescents at the township/county levels in the two participating. A total of eight provinces in China and five provinces in Cambodia were analyzed from 2017 to 2020. During 1 year follow-up after treatment, the differences in heights and weights of the treated and control groups were evaluated. Results Among the 3,068,075 participants screened from 2017 to 2020, 3967 patients with asymptomatic CHD requiring treatment were identified [0.130%, 95% confidence interval (CI) 0.126 -0.134%]. The prevalence rate of CHD ranged from 0.02 to 0.88%, and was negatively related to local per capita GDP (p = 0.028). The average height of 3310 treated CHD patients were 2.23% (95% CI: -2.51%~-1.9%) lower than that of the standard group and the average weight was − 6.41% (95% CI: -7.17%~-5.65%) lower, the developmental gap widening with advancing age. One year after treatment, the relative height difference remained comparable while that, in weight was reduced by 5.68% (95% CI: 4.27% ~7.09%). Conclusions Asymptomatic CHD now is often overlooked and is an emerging public health challenge. Early detection and treatment are essential to lower the potential burden of heart diseases in children and adolescents.

Background: The relationship between different grades of compliance to antihypertensive medication and blood pressure (BP) control rate remains unclear. This study highlighted the Chinese Basic Public Health Service (BPHS) program upgraded antihypertension medication compliance to improve the blood pressure control rate contributing to the UN sustainable development goal of lowering chronic illness fatalities by one-third by 2030. Methods: In 2015, 1254 hypertensive patients aged ≥ 35years were selected in the baseline survey in Yunnan Province by a multistage stratified random sampling method and followed up from 2018 to 2022. Then, they were divided into three groups by tertiles as antihypertensive medicine compliance \"poor,\" \"intermittent,\" and \"sustained\" groups. Then, the robust variance Poisson regression models were performed to estimate the association between three groups and the number of referrals. Kaplan-Meier curves calculated the cumulative risk of onset and survival probability of cardiovascular events from three medication compliance groups. Results: A total of 1254 hypertension patients were included in the study; 992, 1218, 1121, 1066, and 999 hypertension patients were followed up annually. From the baseline to last follow-up, systolic BP declined with the largest decrease in the sustained group (2015: 152.88±21.64mmHg vs. 2022: 134.61±10.49mmHg, p<0.05) and the least decrease in the poor group (2015: 157.07±15.37mmHg vs. 2022: 140.33±12.04mmHg, p<0.05). Under the management of BPHS, the BP control rate of all three groups increased significantly. Compared with the baseline, the control rate in the sustained group reached 70% in 2022 (p<0.01). The number of referrals from the poor group was 11.5%, higher compared with the sustained group (IRR=1.115 and 95% CI: 1.043-1.193). The poor group also had the highest probability of cardiovascular disease (CVD). The survival probability in the sustained group was the highest and kept at 0.950 at the end of 5years. Conclusions: High-grade compliance to antihypertensive drugs significantly improves BP control rate and reduces the risk of CVD events and mortality. The decline of medication compliance grades is closely related to decreasing BP control rate and increased risk of CVD and mortality.

According to this strategic framework, we have put forward a series of five broad recommendations, covering reproductive health, maternal and newborn health, child and adolescent health, the health system, and social contexts. [...]RMNCAH not only plays a pivotal role in guaranteeing the health of each individual woman, child, and adolescent, but is also a cornerstone for the development of the next generation and the sustainable development of the whole society. RMNCAH have direct effects on the majority of family members—women and children—and men play an important role in contributing to RMNCAH. Because of the forecasted trends for population ageing and low fertility, the proportion of the Chinese population covered by RMNCAH (children aged 0–19 years and female individuals aged 20–49 years) will decline from 46·8% in 2015 to 39·9% in 2030 (appendix pp 1–2).2 Improving RMNCAH is vital for China in the context of rapid ageing and decreasing fertility. Following this, the Global Health Strategy for Women, Children and Adolescents (2016–30), which was developed under the framework of the Sustainable Development Goals (SDGs), explicitly recognised the need to extend the focus beyond mortality alone and to promote health across the developmental years: “By 2030, a world in which every woman, child and adolescent in every setting realizes their rights to physical and mental health and wellbeing, has social and economic opportunities, and is able to participate fully in shaping prosperous and sustainable societies”.

Background Adequate cytology is limited by insufficient cytologists in a large‐scale cervical cancer screening. We aimed to develop an artificial intelligence (AI)‐assisted cytology system in cervical cancer screening program. Methods We conducted a perspective cohort study within a population‐based cervical cancer screening program for 0.7 million women, using a validated AI‐assisted cytology system. For comparison, cytologists examined all slides classified by AI as abnormal and a randomly selected 10% of normal slides. Each woman with slides classified as abnormal by either AI‐assisted or manual reading was diagnosed by colposcopy and biopsy. The outcomes were histologically confirmed cervical intraepithelial neoplasia grade 2 or worse (CIN2+). Results Finally, we recruited 703 103 women, of whom 98 549 were independently screened by AI and manual reading. The overall agreement rate between AI and manual reading was 94.7% (95% confidential interval [CI], 94.5%‐94.8%), and kappa was 0.92 (0.91‐0.92). The detection rates of CIN2+ increased with the severity of cytology abnormality performed by both AI and manual reading (Ptrend < 0.001). General estimated equations showed that detection of CIN2+ among women with ASC‐H or HSIL by AI were significantly higher than corresponding groups classified by cytologists (for ASC‐H: odds ratio [OR] = 1.22, 95%CI 1.11‐1.34, P < .001; for HSIL: OR = 1.41, 1.28‐1.55, P < .001). AI‐assisted cytology was 5.8% (3.0%‐8.6%) more sensitive for detection of CIN2+ than manual reading with a slight reduction in specificity. Conclusions AI‐assisted cytology system could exclude most of normal cytology, and improve sensitivity with clinically equivalent specificity for detection of CIN2+ compared with manual cytology reading. Overall, the results support AI‐based cytology system for the primary cervical cancer screening in large‐scale population. This study aims to assess the role of Artificial Intelligence (AI) in the detection of early cervical cancer in a low resource setting. Our results showed that AI‐assisted cytology could identify most of negative cytology, and showed higher positive predictive value for CIN2 or worse when compared with cytologists. This study indicates that AI‐assisted cytology could be very useful tool as a primary screening method in a large‐scale cervical cancer screening program to improve its effectiveness.