[Introduction]
Suffering from chronic diseases has become a daily routine in Chinese. According to the latest report of the World Health Organization, Chinese has17%Will die prematurely because of chronic illness, specifically, on average every10 secondsOne person suffers from cancer; Average per10 secondsOne person suffers from diabetes; Average per30 secondsAt least one person died of cardiovascular and cerebrovascular diseases. Despite the continuous progress of medical technology, the situation of major chronic diseases is still not optimistic: the incidence of cancer ranks first in the world; The incidence of cardiovascular diseases continues to rise: the mortality rate of chronic obstructive pulmonary disease far exceeds the world level and the number of patients is close.100 million: the diabetic population has exceeded100 millionAnd keep growing.
Chronic diseases are the silent killers lurking around us.
Overdrawn life-the status quo of chronic diseases
Chronic disease, full name of chronic non-communicable disease.
Chronic diseases pose a serious threat to Chinese’s health. According to the World Health Organization’s 2020 global survey report on chronic diseases, the proportion of deaths due to chronic diseases in China has reached.89%The total death population is close to93 millionThe proportion of premature death due to chronic diseases has reached an alarming rate.17%. This means that about one in five people will end their original life course early because of chronic diseases.
Figure 1 Current situation of chronic diseases in China
"Long course of disease and usually slow progress" is a major feature of chronic diseases. The World Health Organization defines chronic diseases as "health problems that need to be managed continuously for several years or decades". In 2020, the average life expectancy in China is 77.8 years, but the average life expectancy in health is about 69.2 years. In other words, residents have roughly8.6 yearsThe time to live with illness.
Hypertension and diabetes, which we are familiar with every day, are all covered by chronic diseases. Among all chronic diseases, cardiovascular diseases cause the largest number of deaths from non-communicable diseases, resulting in17.9 millionPeople died, followed by cancer (9 million), respiratory diseases (3.9 million) and diabetes (1.6 million). These four types of diseases account for all deaths from non-communicable diseases.80%.
Major chronic diseases
Cancer, cardiovascular and cerebrovascular diseases, respiratory diseases, diabetes
In the summer of 2021, Zhou Ming, an employee of a big factory in a first-tier city and born in the 1980s, found himself suffering from liver cancer in his physical examination. After nearly a quarter of his liver was cut off by surgery, he chose to take only a few days off, dragging the unhealed incision and continuing to work without telling anyone in the company.
According to the latest statistics of the World Health Organization, there were 19.29 million new cancers in the world in 2020, including 4.57 million new cancers in China, accounting for 23.7% of the world, and the number of cancer deaths in China exceeded 3 million in 2020, all of which ranked first in the world.
Fig. 2 The prevalence rate increased in China from 1998 to 2007.
Middle-aged people like Zhou Ming are not alone. In the era of fast pace and high competition, high pressure and frequent staying up late seem to have become a tacit lifestyle popular among workers in the workplace and even academic dogs in colleges and universities.
In addition to the rising cancer incidence rate due to the aging society, the changes in living environment and lifestyle have also led to the signs of a younger cancer incidence rate in China, and the number of cancer patients aged 20-39 has increased significantly.Cancer is becoming a normal state of human life in the form of chronic diseases, but we don’t know how to deal with it.[3]
Cardiovascular and cerebrovascular diseases
According to the data of National Cardiovascular Center, the prevalence of cardiovascular diseases in China is on the rise.
Calculate the number of patients with cardiovascular disease290 millionAmong them, there are 13 million stroke, 11 million coronary heart disease, 5 million pulmonary heart disease, 4.5 million heart failure, 2.5 million rheumatic heart disease, 2 million congenital heart disease and 270 million hypertension.
Since 2009, the mortality rate of cardiovascular diseases in rural areas has exceeded and continuously exceeded the urban level. In 2015, the mortality rate of cardiovascular diseases among rural residents was298.42/100,000Among them, the death rate of heart disease is 1.4479/100,000, the death rate of cerebrovascular disease is 1.5363/100,000; the death rate of cardiovascular disease of urban residents is 2.6484/100,000, of which the death rate of heart disease is 1.3661/100,000, and the death rate of cerebrovascular disease is 1.2823/100,000.
Figure 3 Estimated number of hypertensive adults in China
Figure 4 Crude death rate of heart disease in cities
Respiratory diseases
COPD generally refers to chronic obstructive diseases. Although this term is unfamiliar to the public, COPD is the third leading cause of death in the world. In 2013, the number of deaths due to chronic obstructive pulmonary disease in China was much higher than that due to lung cancer in China.
According to the survey data of China Adult Lung Health Research (CPHS) in 2018, the prevalence rate of COPD in adults aged 20 and over is 8.6%, and it is as high as 13.7% in adults aged 40 and over.For the first time, it is clear that the number of patients with COPD in China is nearly 100 million. COPD has become a chronic disease with hypertension and diabetes, which constitutes a major disease burden. The mortality rate of COPD in China is much higher than the world average.
In our country, every2.5 minutesOne person died of COPD, which has the characteristics of high prevalence rate, high incidence rate, high disability rate, high mortality rate, high economic burden rate and low awareness rate.
Fig. 5 Comparison of prevalence of COPD between urban and rural areas in China
Chronic obstructive pulmonary disease (COPD) is called chronic obstructive pulmonary disease (COPD). In recent years, the prevalence rate has increased, and the death toll has exceeded that of lung cancer.
According to the statistics of the top ten major causes of death in some cities and rural areas in China, respiratory diseases (including lung cancer) account for the fourth cause of death in cities and the third in rural areas. Due to air pollution, smoking, physical and chemical factors caused by industrial economic development, biological factors inhalation and population aging, the incidence of respiratory diseases such as lung cancer and bronchial asthma has increased significantly in recent years, and chronic obstructive pulmonary disease remains high.
Diabetes
Back in 1980s, the national epidemiological survey showed that the prevalence rate of diabetes in China was only 0.67%. According to the regional data of national disease surveillance in 2010, the prevalence rate of diabetes among residents over 18 years old in China is 9.7%. By 2013, when China scholars and the Journal of the American Medical Association published their research, the number of diabetic patients in China had jumped from about 92.5 million in 2007 to.100 millionThe prevalence of diabetes is approaching.12%.
From 2000 to 2016, the number of diabetic patients in China increased from 55,167,473 to 89,783,100, with a growth rate of 62.7%. By 2016, nearly 90 million people in Chinese had diabetes. In 2016, 140,000 people died of diabetes, of which 51% were men.The average annual increase is 2.16 million cases, with an increase of 6,000 cases per day, an increase of 247 cases per hour and an increase of 4 cases per minute.
Figure 6 Top Ten Countries in the Number of Diabetes Patients Aged 20 -79
Fig. 7 Changes of incidence of diabetes in China.
Urban-rural comparison
Focusing on the comparison between urban and rural areas, the prevalence of chronic diseases shows a trend related to the degree of urbanization.
According to the vertical comparison of urban scale, from four types of rural areas to big cities, the prevalence of chronic diseases is on the rise with the improvement of urban development. This means that,It is precisely where the economy is more developed and medical resources are more concentrated that people are more likely to suffer from chronic diseases.
Fig. 8 Comparative map of chronic diseases prevalence between urban and rural areas in China.
Figure 9 Changes of Chronic Disease Mortality in Urban and Rural Areas
Behind the wealth-the cause of chronic diseases
With the economic prosperity of China, millions of Chinese have successfully "lifted out of poverty", but it is accompanied by a "rapid change" in epidemiology.
The Lancet, the world’s top medical journal, systematically analyzed the disease burden of China in the past 30 years in a paper. The paper shows that the burden of diseases in China is changing, especially infectious diseases, and the maternal and child mortality rates have dropped significantly. However, the chronic diseases, mainly cardiovascular and cerebrovascular diseases and cancer, have increased significantly, which has become the main cause of premature death in China.
There are also health risk factors that change with it. Hypertension, smoking, high-salt diet and outdoor air pollution are also the chief culprits of cardiovascular and cerebrovascular diseases and cancer. These bad habits are common and insignificant in life, but they unconsciously become a gray area, which spans the development process from "health" to "chronic disease".
:: dietary imbalance
Unreasonable dietary structure is an important factor to induce chronic diseases. According to the report of the World Health Organization, 4.1 million deaths can be attributed to excessive intake of salt/sodium every year, and 4.1 million lives are lost, which is equivalent to one fifth of the population of Beijing.
In the past 30 years, China has experienced a transition from the traditional dietary pattern to the western dietary pattern, with the consumption of grains and vegetables decreasing and the consumption of meat and packaged food increasing. With the continuous development and progress of the national economy, the sources of nutrients obtained by Chinese residents are more abundant, and the dietary quality has not been improved, but there is still a big gap between the overall dietary quality and the ideal dietary quality. This gap also leads to the huge challenge that people are still facing the rapid growth of chronic diseases such as obesity and hypertension while improving their living standards.
Zhang Bing, deputy director of the Institute of Nutrition and Health of China Center for Disease Control and Prevention, pointed out that a reasonable diet is an effective means to prevent chronic diseases and promote health. Although in recent years, the state and relevant organizations have been vigorously promoting the implementation of the three reduction policies (reducing oil, salt and fat). However, in the latest "Report on Nutrition and Chronic Diseases of China Residents (2020)" press conference, Li Bin, deputy director of the National Health and Wellness Commission, emphasized that the unhealthy lifestyle of residents is still widespread-the dietary fat energy supply ratio continues to rise, and rural areas have exceeded the recommended upper limit of 30% for the first time. The daily cooking salt and oil consumption per family is still much higher than the recommended value. Chinese’s various dietary indicators still inevitably exceed the standard.
Fig. 10 Chart of Dietary Structure Series
Irregular work and rest
Sleeping late, staying up late, insomnia … Bad work and rest habits have also spread to counties and cities with the continuous advancement of urbanization. The average sleep time in Chinese has also shrunk from 8 hours a hundred years ago to today’s.6.8 hours. For every modern person, a healthy and adequate sleep time is increasingly becoming a luxury.
According to the data of China Sleep Research Association, bad work and rest habits will lead to an increase in the risk of some serious chronic diseases, such as cancer, diabetes and heart disease.
Fig. 11 Regional Distribution of Late Sleeping Party in China in 2018
Figure 12 Staying up late in different cities of China in 2021.
It can be found that the causes of staying up late in first-tier cities focus on work and refreshing; Second-tier cities have a strong tendency to work and rest irregularly, and the cause may be due to the complicated behavior, which is not specifically pointed out; The causes of the population’s late sleep in third-tier cities may point more to the urban sleeping environment. In the horizontal comparison of young people staying up late between cities, the rate of young people staying up late in new first-tier cities and first-tier cities is over 70%, while the data in second-tier cities, third-tier cities and below are lower than the first two, but the rate of young people staying up late here is also over 60%.
When irregular work and rest becomes a tendency of a group, it is hard for us not to think about whether this is the detailed embodiment of the negative impact of urbanization and globalization in the fast-paced era, and how we can resist the spread of bad sleep environment from the perspective of individuals, groups and even society, so that the whole of China can sleep peacefully at night.
Lack of exercise
The World Health Organization points out that every year there are1.6 million casesDeath can be attributed to lack of exercise,
For Chinese, people are becoming more and more accustomed to sitting, instead of stretching their legs and moving around. With the advancement of urbanization, the degree of professional labor of people of all ages is generally reduced, and it is more and more convenient to travel. The popularity of electronic products has led to a general increase in residents’ static life time, a decrease in energy consumption, and an imbalance between energy intake and energy expenditure, which directly leads to individual obesity and increases the risk of chronic diseases.
Figure 12 Leisure exercise of China residents.
Timely intervention-before suffering from chronic diseases
In fact,There is a "transition period" from a healthy state to a chronic disease.. It is also the state in this transitional period that determines whether an individual’s physical state returns to health or falls into the abyss of chronic diseases.
Taking the intervention of diabetes as an example, the pre-diabetic population is in a "transition period" from high-risk groups to diabetes. Pre-diabetes refers to people with impaired fasting blood glucose or abnormal glucose tolerance, but they do not meet the diagnostic criteria of diabetes. They have a high risk of illness, accounting for more than one-third of adults in China. If they are intervened through an appropriate lifestyle, they can be transferred to the normal glucose metabolism population; But if left unchecked, it will be followed by lifelong disease development.
Therefore, it is not only important but also necessary to intervene in time for people in transition. Grasping the transition period is to grasp the floodgate of the spread of chronic diseases.
Social forces-environmental improvement
The control of diseases is not only the self-restraint of a certain group of people, but also the collective restraint of the whole society.
The World Health Organization has clearly pointed out that tobacco causes more than 7.2 million deaths every year (including deaths caused by exposure to second-hand smoke), and it is expected to increase significantly in the next few years. The personal behavior of tobacco use has also become an important issue in the field of public health because of its diffusion. With the arrival of Healthy 2030, the China Center for Disease Control and Prevention and the Tobacco Control Office jointly put forward the slogan "Healthy China must be a smoke-free China".
Thanks to the efforts of all parties in the tobacco control campaign, the adult smoking rate in China has also shown a good trend year by year.
Figure 13 National Adult Smoking Rate
Give priority to prevention and proceed from prevention.
The power of society is not only focused on tobacco control, but also committed to creating an all-round supporting environment. The National Health and Wellness Commission and relevant departments continue to take joint actions and promote in environmental governance, tobacco control, nutrition improvement, health education, physical fitness, medical care, etc., to build an all-round supporting environment and form a joint force for prevention and control.
Government power-macro planning
We need to pay attention to the progress of chronic disease control and face up to the grim situation of chronic disease prevention and control. Fat group, second-hand smoke and unbalanced diet caused by less exercise … These seemingly very personal living habits have become a systematic project that needs public attention and government supervision when they are related to the health status of a huge population.
China Health Development Report 2030 attempts to outline a healthier and more comfortable blueprint for our future with indicators and plans covering from top to bottom. Now, with only nine years left before the goal, the development situation of chronic diseases is not optimistic-can we achieve this goal?
Figure 14
Whether it is social forces or government planning, the final specific behavior still has to be implemented by individuals.
In the Outline of Healthy China 2030 Plan, all indicators are also divided into advocacy indicators, anticipation indicators and binding indicators. Among them, only binding indicators are mandatory by the government. The big goals in the field of health are all non-binding indicators.
This means that everyone must take action on the way to Health 2030.
Authors: Li Xiaoxiao, Quan Yi, Ding Ruifan,
Instructor: Wu Xiaokun
School: South China University of Technology
Editor: Wang Jing
Data source:
[1] Li Chengfu; Liu Hongyan; Liang Ying; Henry Hui Wang; Li Qianhui, Study on International Comparison of Healthy Life Expectancy and Prediction of Healthy Life Expectancy in China [J], Journal of Demography, 2018,40(01)
[2] the harm of lack of sleep. China Sleep Research Association
http://www.zgsmyjh.org/ndjsp? id=156#_np=107_1187
[3] National Cancer Center: The latest cancer report of China in 2019.
http://www.360doc.com/content/19/0130/00/52645714_812065860.shtml
[4] The Lancet, Mortality, Incidence and Risk Factors in China and Its Provinces from 1990 to 2017: Systematic Analysis of Global Disease Burden in 2017.
https://new.qq.com/cmn/20210106/20210106A0BJSW00.html
[5] Information of the annual meeting of chronic diseases in China.
[6] China Center for Disease Control and Prevention Nutrition Statistics Yearbook, National Death Monitoring System.