中国心血管健康与疾病报告 2020 英文

OUTLINE 1 Influencing Factors on Cardiovascular Health 1.1 Tobacco Use About 1.9 million avoidable deaths from coronary heart disease (CHD) per year (approximately one fifth of all CHD deaths globally) are attributable to tobacco use and exposure to second-hand smoke (SHS). An estimated 382 000 people died of CHD attributable to SHS exposure， representing 4.3% of all deaths from CHD. The prevalence rate of current smoking among Chinese residents aged ≥ 15 was 28.1% in 2010， and dropped to 26.6% in 2018. It was 50.5% in males and 2.1% in females， and was higher in rural areas (28.9%) than in urban areas (25.1%). The highest prevalence rate was found in the population aged 45-64 (30.2%)， while the lowest was among those with college education or above (20.5%). In 2019， the overall prevalence rate of current smokers was 5.9% among secondary school students， with 3.9%， 5.6%， and 14.7% for the students in junior high school， senior high school， and vocational senior high school， respectively. Compared with the 2014 youth survey， the prevalence rates of current smokers and experimental smokers among junior high school students in 2019 decreased by 33.9% (5.9% vs 3.9%) and 27.9% (17.9% vs 12.9%)， respectively. The rate of SHS exposure among non-smokers in China was 68.1% in 2018， of whom 35.5% were exposed to SHS almost every day. Internet cafes (89.3%)， bars and nightclubs (87.5%)， and restaurants (73.3%) were the most common indoor public places with severe exposure to SHS. The rate of SHS exposure had declined in comparison with that in 2010 (72.4%). In 2018， 86.0% of the people believed that smoking could cause serious diseases. The awareness of specific diseases caused by smoking ranked from high to low as lung cancer (82.8%)， heart disease (50.8%)， stroke (41.4%)， and impotence (26.0%). 71.4% of the people thought that SHS could also cause serious diseases. The awareness of these diseases ranked from high to low as children pulmonary disease (66.7%)， adult lung cancer (65.8%)， and adult heart disease (39.7%). The prevalence rate of smoking cessation among Chinese smokers was 18.7% in 2015， and increased to 20.1% in 2018. It was lower in males (19.6%) than in females (30.2%). No significant difference was found between urban (20.0%) and rural areas (20.3%). The prevalence rate of smoking cessation in young age group was relatively low. In 2018， 50% of smokers spent no more than 9.9 China Yuan (CNY) on a pack of cigarettes (10.0 CNY in urban areas and 8.4 CNY in rural areas). From 2015 to 2018， the ratio of the median cost on 100 packs of cigarettes to the gross domestic product (GDP) per capita decreased from 2.0% to 1.5%. The relative risk (RR) of death associated with cigarette smoking among Chinese population was 1.23 (95%CI: 1.18-1.27)， with 1.18 (95%CI: 1.13-1.23) in males and 1.27 (95%CI: 1.19-1.34) in females. The population attributable risk (PAR) was 7.9%， with 10.0% in males and 3.5% in females. An analysis of 2 Chinese prospective studies 15 years apart revealed that the proportional excess mortality among male smokers approximately doubled over this 15-year period. The annual number of deaths in China that are caused by tobacco will rise from about 1 million in 2010 to 2 million in 2030 and 3 million in 2050， unless there is widespread cessation. By January 2020， more than 20 cities had implemented local regulations on tobacco control in China， but only 13 cities， including Beijing， Shanghai， Shenzhen， Qingdao， Lanzhou， Changchun， Xi’an， Wuhan， Qinhuangdao， etc， met the requirements of Framework Convention on Tobacco Control， covering about 10% of the national population. According to the Beijing Medical Claim Data for Employees from January 2013 to June 2017， with 29 months before and 25 months after enforcement of the tobacco control policy package， after implementation of the policy， immediate reductions were observed in the hospital admissions for both acute myocardial infarction (MI) (-5.4%， 95%CI: -10.0%--0.5%) and stroke (-5.6%， 95%CI: -7.8%--3.3%). In addition， the secular increase trend for stroke was slowed down by -15.3% (95%CI: -16.7%--13.9%) annually. Compared with the hypothetical scenario where the policy had not taken place， an estimated 18 137 (26.7%) stroke hospital admissions had been averted during the 25 months of post-policy period. World Health Organization (WHO) has been advocating 3 to 10 minutes of brief interventions for smoking cessation in routine healthcare， but it is not practicable for the Chinese doctors， who are as busy as bees. The China Adult Tobacco Survey 2018 indicated that only 46.2% of current smokers had been provided with smoking cessation advice by their physicians during medical consultations. A randomized controlled trial was conducted in 13 671 Chinese adults who were daily cigarette smokers from 2015 to 2017. It confirmed the effectiveness of physicians’ very br