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Public health is a priority for the Chinese Government. Evidence-based decision making for health at the province level in China, which is home to a fifth of the global population, is of paramount importance. This analysis uses data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 to help inform decision making and monitor progress on health at the province level. We used the methods in GBD 2017 to analyse health patterns in the 34 province-level administrative units in China from 1990 to 2017. We estimated all-cause and cause-specific mortality, years of life lost (YLLs), years lived with disability (YLDs), disability-adjusted life-years (DALYs), summary exposure values (SEVs), and attributable risk. We compared the observed results with expected values estimated based on the Socio-demographic Index (SDI). Stroke and ischaemic heart disease were the leading causes of death and DALYs at the national level in China in 2017. Age-standardised DALYs per 100 000 population decreased by 33·1% (95% uncertainty interval [UI] 29·8 to 37·4) for stroke and increased by 4·6% (–3·3 to 10·7) for ischaemic heart disease from 1990 to 2017. Age-standardised stroke, ischaemic heart disease, lung cancer, chronic obstructive pulmonary disease, and liver cancer were the five leading causes of YLLs in 2017. Musculoskeletal disorders, mental health disorders, and sense organ diseases were the three leading causes of YLDs in 2017, and high systolic blood pressure, smoking, high-sodium diet, and ambient particulate matter pollution were among the leading four risk factors contributing to deaths and DALYs. All provinces had higher than expected DALYs per 100 000 population for liver cancer, with the observed to expected ratio ranging from 2·04 to 6·88. The all-cause age-standardised DALYs per 100 000 population were lower than expected in all provinces in 2017, and among the top 20 level 3 causes were lower than expected for ischaemic heart disease, Alzheimer's disease, headache disorder, and low back pain. The largest percentage change at the national level in age-standardised SEVs among the top ten leading risk factors was in high body-mass index (185%, 95% UI 113·1 to 247·7]), followed by ambient particulate matter pollution (88·5%, 66·4 to 116·4). China has made substantial progress in reducing the burden of many diseases and disabilities. Strategies targeting chronic diseases, particularly in the elderly, should be prioritised in the expanding Chinese health-care system. China National Key Research and Development Program and Bill & Melinda Gates Foundation.

Background Tobacco advertisements or promotions (TAPs) can increase smoking susceptibility, especially among adolescents.China has made great progress in reducing TAPs, but has not yet achieved a total ban.This study estimated exposure to TAPs and smoking susceptibility and their changes from 2013–14 to 2021 among Chinese adolescents and examined their association. Methods Samples of middle school (MS) students in 2013 and MS and high school (HS) students in 2021 were examined, with national and provincial representativeness. Exposure to different TAPs and non-smokers’ smoking susceptibility were determined. Multilevel logistic regression was used to assess the association between exposure to TAPs and smoking susceptibility in different age groups, and whether this exposure moderated the association between anti-tobacco messages and smoking susceptibility. Results In 2021, MS and HS students had high exposure to TAPs on TV/movies (63.8% and 68.8%) and at points-of-sale (POS; 41.3% and 38.3%), but MS students had slightly lower percentages than in 2013–14. In 2021, 9.2% of MS students and 12.9% of HS students who were non-smokers were susceptible to smoking, a 5.6% decrease compared to 2013–14 among MS students. Exposure to TAPs had positive associations with susceptibility after adjusting for covariates in all age groups. Anti-tobacco messages decreased smoking susceptibility, but TAPs moderated this association. Conclusion Students had decreasing exposure to TAPs, but exposure remained high, especially at POS and TV/movies. Non-smokers had low smoking susceptibility, and this decreased over time. Exposure to TAPs was positively associated with smoking susceptibility, especially in younger students. Exposure to TAPs also reduced the benefits of anti-tobacco messages.

Background Oral cancer is among the most common malignant tumors worldwide, and it has become an increasingly important public health problem in China. This study systematically assesses the current state of oral cancer in China from 1990 to 2017, providing new information and perspectives for oral health researchers and public health policy makers. Methods Based on the Global Burden of Disease, Injuries, and Risk Factors Study 2017 (GBD 2017), we evaluated the incidence rates, mortality and disability-adjusted life year (DALY) rates for oral cancer in China and their changing trends between 1990 and 2017, making comparisons by gender and age. We also assessed the DALY rates associated with oral cancer at the provincial level for 33 provinces and their trends over time. Results From 1990 to 2017, the number of new cases and the age-standardized incidence rate for oral cancer in China increased by 280.0% and 79.7%, respectively; the number of deaths and the age-standardized mortality rose by 196.8% and 29.0%, respectively; and the number of DALYs and the age-standardized DALY rate increased by 149.1% and 21.0%, respectively. The incidence rates for oral cancer rose after 30 years of age and peaked at 65–69 years; the mortality for oral cancer rose after 50 years of age and peaked at 65–69 years; and the DALY rates for oral cancer rose after 45 years of age and peaked at 65–69 years. The incidence rates, mortality and DALY rates for oral cancer in males were significantly higher than those in females and showed an upward trend, while there was a decrease or no significant change in females. The DALY rates increased in 21 provinces and decreased in 12 provinces, with the largest growth in Henan Province and the largest decline in Hong Kong Province. Conclusions The burden of oral cancer in China continues to increase continuously. More prevention, control and intervention measures should be taken and increased attention paid to common risk factors is essential for the prevention of oral cancer.

To enhance tumor uptake and retention, we designed and developed bi-specific heterodimeric radiotracers targeting both FAP and αvβ3, [ Ga]Ga-FAPI-RGD. The present study aimed to evaluate the specificity, pharmacokinetics, and dosimetry of [ Ga]Ga-FAPI-RGD by preclinical and preliminary clinical studies. FAPI-RGD was designed and synthesized with the quinoline-based FAPI-02 and the cyclic RGDfK peptide. Preclinical pharmacokinetics were determined in Panc02 xenograft model using microPET and biodistribution experiments. The safety and effective dosimetry of [ Ga]Ga-FAPI-RGD was evaluated in 6 cancer patients, and compared with 2-[ F]FDG imaging. The [ Ga]Ga-FAPI-RGD had good stability in saline for at least 4 h, and showed favorable binding affinity and specificity and . Compared to [ Ga]Ga-FAPI-02 and [ Ga]Ga-RGDfK, the tumor uptake and retention of [ Ga]Ga-FAPI-RGD were very much enhanced than its monomeric counterparts at all the time points examined by microPET imaging. A total of 6 patients with various malignant tumors were prospectively enrolled. The effective dose of [ Ga]Ga-FAPI-RGD was 1.94E-02 mSv/MBq. The biodistribution of [ Ga]Ga-FAPI-RGD from 0 to 2 h after injection demonstrated rapid and high tumor uptake, prolonged tumor retention, and high tumor-to-background ratios (TBRs) which further increased over time. No significant difference in mean SUVmax of [ Ga]Ga-FAPI-RGD and 2-[ F]FDG was present in primary tumors (8.9±3.2 10.3 ± 6.9; p = 0.459). The dual targeting PET tracer [ Ga]Ga-FAPI-RGD showed significantly improved tumor uptake and retention, as well as cleaner background over Ga-labeled FAPI and RGD monospecific tracers. The first-in-human biodistribution study showed high TBRs over time, suggesting high diagnostic performance and favorable tracer kinetics for potential therapeutic applications.

Background Death registration completeness has never been assessed at the county level in China. Such analyses would provide critical intelligence to monitor the performance of the vital registration system and yield adjustment factors to correct death registration data, thereby increasing their policy utility. Methods We estimated the completeness of death registration for 31 provinces and 2844 counties of China in 2018 based on death data from the China Cause of Death Reporting System (CDRS) by using the empirical completeness method. We computed the root mean square difference (RMSD) of county-level completeness compared with provincial-level completeness to study intra-provincial variations. A two-level (province and county) logistic regression model was fitted to explore the association between county-level registration completeness and a set of covariates reflecting socioeconomic status, healthcare quality, and specific strategies and regulations designed to improve registration. Results In 2018, the overall death registration completeness for the CDRS in China was 74.2% (95% uncertainty interval [UI] 66.2–80.4), with very little difference for males and females. Geographical differences in completeness were higher across counties than across provinces. The county-level completeness ranged from 2.4% (95% UI 1.0–5.0%) in Burang County, Tibet, to 100.0% (95% UI 99.9–100.0%) in Guandu District, Yunnan. The coastal provinces of Jiangsu, Guangdong, and Fujian, with higher overall completeness, contained counties with low completeness; conversely, the underdeveloped provinces of Guangxi and Guizhou, with lower overall completeness, included some counties with high completeness. GDP, education, population density, minority population, healthcare access, and registration strategies were important drivers of the geographical differences in registration completeness. Conclusions There are marked inequalities in registration completeness at the county level and within provinces in China. The socioeconomic condition, the implementation of specific registration-enhancing initiatives, and the availability and quality of medical care were the primary drivers of the observed geographical variation. A more strategic approach, with more research, is required to identify the main reasons for death under-reporting, especially in the poorer performing counties, to guide remedial action.

Background The accurate information about burden of multiple myeloma (MM) at national and provincial level remains unknown in China. Methods Following the general analytical strategy used in GBD 2016, the age-, sex-, and province-specific incidence and mortality in China were analyzed. Trends in the incidence and mortality from 2006 to 2016 were evaluated. Results It was estimated that there were 16,500 new cases and 10,300 deaths of multiple myeloma in China in 2016. The age-standardized incidence rates (ASIR) and mortality rates (ASMR) per 100,000 population were 1.03 (95% UI, 0.88–1.17) and 0.67 (95% UI, 0.59–0.77) in 2016. Males had higher incidence and mortality rates than females in all age groups. An upward trend with age in incidence and mortality was observed. Higher incidence and mortality rates clustered in the developed provinces. The incidence of MM in China increased significantly from 2006 to 2016, while the mortality increased from 2006 to 2014, and remained stable from 2014 to 2016. Conclusion The burden of MM showed a heterogeneous pattern in China, which highlighted the need of tailored disease prevention and control strategies in both national and provincial levels.

PurposeThe formation of advanced plaques, which is characterized by the uninterrupted aggregation of macrophages with high expression of folate receptor-β (FR-β), is observed in several concomitant metabolic syndromes. The objective of this study was to develop a novel FR-β-targeted single-photon emission computed tomography (SPECT) radiotracer and validate its application to the noninvasive detection of atherosclerosis (AS) plaque and non-alcoholic fatty liver (NAFL).MethodsTwo radioiodinated probes, [131I]IPBF and [131I]IBF, were developed, and cell uptake studies were used to identify their specific targets for activated macrophages. Biodistribution in normal mice was performed to obtain the pharmacokinetic information of the probes. Apolipoprotein E knockout (ApoE−/−) mice with atherosclerotic aortas were induced by a high-fat and high-cholesterol (HFHC) diet. To investigate the affinity of radiotracers to FR-β, Kd values were determined using in vitro assays. In addition, the assessments of the aorta in the ApoE−/− mice at different stages were performed using in vivo SPECT/CT imaging, and the findings were compared by histology.ResultsBoth [131I]IPBF and [131I]IBF were synthesized with > 95% radiochemical purity and up to 3 MBq/nmol molar activity. In vitro assay of [131I]IPBF showed a moderate binding affinity to plasma proteins and specific uptake in activated macrophages. The prolonged blood elimination half-life (t1/2z) of [131I]IPBF (8.14 h) was observed in a pharmacokinetic study of normal mice, which was significantly longer than that of [131I]IBF (t1/2z = 2.95 h). As expected, the Kd values of [131I]IPBF and [131I]IBF in the Raw 264.7 cells were 43.94 ± 9.83 nM and 61.69 ± 15.19 nM, respectively. SPECT imaging with [131I]IPBF showed a high uptake in advanced plaques and NAFL. Radioactivity in excised aortas examined by ex vivo autoradiography further confirmed the specific uptake of [131I]IPBF in high-risk AS plaques.ConclusionsIn summary, we reported a proof-of-concept study of an albumin-binding folate derivative for macrophage imaging. The FR-β-targeted probe, [131I]IPBF, significantly prolongs the plasma elimination half-life and has the potential for the monitoring of AS plaques and concomitant fatty liver.

Background The accurate information about lymphoma burden at national and provincial levels remains unknown in China. Methods Following the general analytical strategy used in GBD 2016, the age-, sex-, and province-specific incidence, mortality, and prevalence of lymphoma in China were analyzed. Trends in the incidence, mortality, prevalence, and disability-adjusted life years (DALYs) due to Hodgkin’s lymphoma (HL) and non-Hodgkin’s lymphoma (NHL) were assessed from 2006 to 2016. Results It was estimated that there were 75,400 new cases and 40,500 deaths of lymphoma in 2016 in China, of which 6900 new cases and 2900 deaths were due to HL, while 68,500 new cases and 37,600 deaths were due to NHL. The age-standardized incidence rate (ASIR), mortality rate (ASMR), and prevalence rate (ASPR) per 100,000 were 0.46, 0.19, and 1.75 for HL, and 4.29, 2.45, and 14.9 for NHL, respectively. An upward trend with age in incidence and mortality was observed. Males had higher incidence and mortality rates than females in all age groups. Sociodemographic index had a correlation with the ASIR ( r  = 0.75), ASMR ( r  = − 0.74), ASPR ( r  = 0.84), and age-standardized DALYs ( r  = − 0.75) of HL, as well as with the ASIR ( r  = 0.80), ASPR ( r  = 0.83), and age-standardized DALYs ( r  = − 0.33) of NHL. From 2006 to 2016, the age-standardized DALYs of HL decreased significantly, while the age-standardized DALYs of NHL increased from 2006 to 2013 and remained stable from 2013 to 2016. Conclusions The burden of lymphoma in China showed unexpected patterns varied by sex, age, and provinces, with an increased trend of NHL and a decreased trend of HL from 2006 to 2016.

The Sustainable Development Goals (SDGs), adopted by all United Nations (UN) member states in 2015, established a set of bold and ambitious health-related targets to achieve by 2030. Understanding China's progress toward these targets is critical to improving population health for its 1.4 billion people. We used estimates from the Global Burden of Disease (GBD) Study 2016, national surveys and surveillance data from China, and qualitative data. Twenty-eight of the 37 indicators included in the GBD Study 2016 were analyzed. We developed an attainment index of health-related SDGs, a scale of 0-100 based on the values of indicators. The projection model is adjusted based on the one developed by the GBD Study 2016 SDG collaborators. We found that China has achieved several health-related SDG targets, including decreasing neonatal and under-5 mortality rates and the maternal mortality ratios and reducing wasting and stunting for children. However, China may only achieve 12 out of the 28 health-related SDG targets by 2030. The number of target indicators achieved varies among provinces and municipalities. In 2016, among the seven measured health domains, China performed best in child nutrition and maternal and child health and reproductive health, with the attainment index scores of 93.0 and 91.8, respectively, followed by noncommunicable diseases (NCDs) (69.4), road injuries (63.6), infectious diseases (63.0), environmental health (62.9), and universal health coverage (UHC) (54.4). There are daunting challenges to achieve the targets for child overweight, infectious diseases, NCD risk factors, and environmental exposure factors. China will also have a formidable challenge in achieving UHC, particularly in ensuring access to essential healthcare for all and providing adequate financial protection. The attainment index of child nutrition is projected to drop to 80.5 by 2025 because of worsening child overweight. The index of NCD risk factors is projected to drop to 38.8 by 2025. Regional disparities are substantial, with eastern provinces generally performing better than central and western provinces. Sex disparities are clear, with men at higher risk of excess mortality than women. The primary limitations of this study are the limited data availability and quality for several indicators and the adoption of \"business-as-usual\" projection methods. The study found that China has made good progress in improving population health, but challenges lie ahead. China has substantially improved the health of children and women and will continue to make good progress, although geographic disparities remain a great challenge. Meanwhile, China faced challenges in NCDs, mental health, and some infectious diseases. Poor control of health risk factors and worsening environmental threats have posed difficulties in further health improvement. Meanwhile, an inefficient health system is a barrier to tackling these challenges among such a rapidly aging population. The eastern provinces are predicted to perform better than the central and western provinces, and women are predicted to be more likely than men to achieve these targets by 2030. In order to make good progress, China must take a series of concerted actions, including more investments in public goods and services for health and redressing the intracountry inequities.

Background The United Nation’s Sustainable Development Goals for 2030 include reducing premature mortality from non-communicable diseases (NCDs) by one third. To assess the feasibility of this goal in China, we projected premature mortality in 2030 of NCDs under different risk factor reduction scenarios. Methods We used China results from the Global Burden of Disease Study 2013 as empirical data for projections. Deaths between 1990 and 2013 for cardiovascular disease (CVD), diabetes, chronic respiratory disease, cancer, and other NCDs were extracted, along with population numbers. We disaggregated deaths into parts attributable and unattributable to high systolic blood pressure (SBP), smoking, high body mass index (BMI), high total cholesterol, physical inactivity, and high fasting glucose. Risk factor exposure and deaths by NCD category were projected to 2030. Eight simulated scenarios were also constructed to explore how premature mortality will be affected if the World Health Organization’s targets for risk factors reduction are achieved by 2030. Results If current trends for each risk factor continued to 2030, the total premature deaths from NCDs would increase from 3.11 million to 3.52 million, but the premature mortality rate would decrease by 13.1%. In the combined scenario in which all risk factor reduction targets are achieved, nearly one million deaths among persons 30 to 70 years old due to NCDs would be avoided, and the one-third reduction goal would be achieved for all NCDs combined. More specifically, the goal would be achieved for CVD and chronic respiratory diseases, but not for cancer and diabetes. Reduction in the prevalence of high SBP, smoking, and high BMI played an important role in achieving the goals. Conclusions Reaching the goal of a one-third reduction in premature mortality from NCDs is possible by 2030 if certain targets for risk factor intervention are reached, but more efforts are required to achieve risk factor reduction.