Risk Factors for Noncommunicable Chronic Diseases in Women in China: Surveillance efforts/Facteurs a Risque Pour Les Maladies Non Transmissibles Chroniques Chez Les Femmes En Chine: Efforts De surveillance/Los Factores De Riesgo De Las Enfermedades Cronicas No Transmisibles En Las Mujeres Chinas: Los Esfuerzos De Vigilancia

Article excerpt

Introduction

Chronic non-communicable diseases (NCDs) have become the leading causes of death among women in China owing to the substantial decrease in deaths from infectious diseases brought about by decades of economic development and improvements in health care, living conditions and nutrition. (1,2) In 2010, the leading causes of death among Chinese women were cardiovascular and cerebrovascular diseases and cancer, which together accounted for nearly 70% of all deaths. (3) According to the World Bank, the burden of NCDs in both sexes is expected to increase substantially between 2010 and 2030 and the social and economic impact of NCDs will be greatly amplified by the rapid growth of the elderly population and the relative reduction in the workforce if China does not mount an effective response. (4) A small number of modifiable behavioural risk factors are the main contributors to the development of NCDs. (5-7) These behavioural factors--tobacco use, the harmful use of alcohol, physical inactivity and an unhealthy diet--are causes of overweight and obesity, raised blood pressure, raised blood glucose and dyslipidemia, all important biological risk factors for NCDs. A better understanding of the epidemiological distribution of these biological risk factors is necessary to improve preventive measures and design public health interventions for reducing NCDs and the social burden they represent. An important way to gain a better understanding of these risk factors is to monitor their prevalence through surveillance systems and to analyse their social and economic determinants. Accordingly, the global monitoring framework for NCDs of the World Health Organization (WHO) has recommended a set of indicators, to be adopted in national NCD surveillance, for measuring the behavioural and biological risk factors for NCDs. (8) The behavioural risk factors include current tobacco use, harmful use of alcohol, low fruit and vegetable intake, physical inactivity, overweight and obesity; the biological risk factors comprise raised blood pressure, raised blood glucose, raised total serum cholesterol, fat intake and salt intake.

Many studies have examined the prevalence of risk factors for NCDs among Chinese women. The most recent studies have shown that smoking and harmful use of alcohol are found in 2.4% and 15.0% of Chinese women, respectively. (9-11) According to the 2002-2003 World Health Survey, 96.8% of Chinese women consumed insufficient fruit and vegetables, in comparison with 59.3% in Brazil and 74.0% in India. (12) On the other hand, a study of physical activity in 20 countries and regions based on surveys conducted between 2002 and 2004 showed that the rate of physical inactivity among women in mainland China was 6.4%, a figure much lower than in Japan (45.6%); Taiwan, China, (43.3%) and Hong Kong Special Administrative Region of China (16.8%). (13) Longitudinal studies conducted in recent decades have demonstrated an increase in obesity and overweight among Chinese women of all ages. (14-16) Chinas 2002 Health and Nutrition Survey showed that 18.8% of women in China were either overweight or obese, according to WHO definitions. (17)

Recent national surveys have examined the prevalence of some NCDs. For example, the China National Diabetes and Metabolic Disorders Study, conducted from June 2007 to May 2008, revealed that 8.8% of all women aged 20 years or older had diabetes, 0.51% had coronary heart disease, 0.60% had had a stroke and 1.10% had cardiovascular disease. (18,19) The 2002 China National Nutrition and Health Survey found that 17% of women aged 18 years or older had hypertension. (20) However, the prevalence in China of biological risk factors such as raised blood pressure, raised blood glucose and raised total serum cholesterol is still poorly known. The studies conducted in the country so far have generally focused on a single risk factor and have used different target populations, sampling techniques and statistical methods, and they have employed different definitions for the various risk factors examined. …