(AP) – Heart disease, cancer and stroke are now the top killers of middle-aged people in China, fueled by high blood pressure and smoking, which have developed alongside the communist country’s economy, according to one of the largest surveys of its kind.

The research into the major causes of death in adults found that over the past 45 years, China has undergone a huge health transition. Infectious disease has been replaced by the same chronic killers that plague the West.

The findings from the study of nearly 170,000 Chinese men and women over age 40 showed that about two-thirds of the 20,033 people who died during that time were killed by heart disease, cancer or stroke. The conclusions were based on medical data collected in 1991 with followup evaluations in 1999 and 2000.

Of those deaths involving people in their 40s to mid-60s – prime working years – Chinese mortality rates from each of the three categories topped deaths among the same age group in the United States, according to the study.

“We are very surprised by this finding,” said lead co-author Jiang He of Tulane University’s Department of Epidemiology in New Orleans. “This study indicates that chronic disease is not only (the) leading cause of death in wealthy countries, but also (in) developing countries, such as China.”

The results, published in Thursday’s New England Journal of Medicine, back up what Robert Beaglehole, the World Health Organization’s director of chronic diseases, has known for a long time.

“I think it’s probably exactly what it was like in the United States a couple decades ago,” he said of China’s health situation.

” -When it was apparent that young people in the prime of their lives were dropping down dead from heart attacks (in the U.S.), it drew attention to the problem which had sort of a human impact as well as an economic impact.”

Beaglehole said the health transition occurred gradually as China became more prosperous: More people migrated from farms into cities, physical activity decreased, eating habits changed and smoking increased.

The findings also revealed more deaths occurred from the top three chronic diseases in China’s rural areas than in cities, indicating the problem is widespread. Beaglehole urged China to learn from the struggles of wealthier countries and to develop a strategy to combat chronic diseases, while still addressing high-profile infectious diseases like AIDS and bird flu.

“You can’t just do one or the other. You now have to start focusing on both and start getting the right balance,” he said by telephone from Geneva. “I think it’s true that many countries have neglected the chronic disease side of the balance for too long.”

The study found that Chinese men are slightly more at risk than women, with 68.7 percent of male participants dying from the top three killers compared to 62.6 percent of females.

High blood pressure was the top preventable contributing factor to the deaths, followed by cigarette smoking, physical inactivity and being underweight.

Lung cancer was the top cause of death in that disease category, and 63 percent of the men surveyed were smokers. Co-author Dongfeng Gu of the Cardiovascular Institute, Fu Wai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College in Beijing, called on the government to decrease tobacco advertising and raise taxes on cigarettes, while prohibiting smoking in public places.

“If we (promote) smoking cessation and prevent younger adults or students from smoking in the Chinese population, we can reduce quite a lot of premature deaths by cancer and by heart disease,” he said.

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