Weekly Briefings for China CDC Weekly, Vol 6, No. 34, 2024

Assessment of the Respiratory Disease Mortality Risk from Single and Composite Exposures to PM_2.5 and Ozone — Guangzhou City, Guangdong Province, China, 2018–2021

Hongwei Tu^1,&; Yijun Hu^2,&; Keqi Hu^3,&; Peipei Dong^1,4; Yue Wen^1,4; Jing Jiang¹; Xuedan Xu¹; Jinxu Huang¹; Jiemin Zhu¹; Changyun He¹; Qiuxia Chen¹; Yongying Liu^1,#

1 Guangdong Provincial Center for Disease Control and Prevention, Guangzhou City, Guangdong Province, China;

2 Jinan University; Guangzhou City, Guangdong Province, China;

3 Department of Science and Education, Guangdong Second Provincial General Hospital; Guangzhou City, Guangdong Province, China;

4 Sun Yat-sen University, Guangzhou City, Guangdong Province, China;

^& Joint first authors.

^# Corresponding author: Yongying Liu, 24322487@qq.com.

This study assessed the single and composite effects of daily fine particulate matter (PM_2.5) and ozone (O₃) single and composite exposures on population deaths caused by respiratory disease in Guangzhou from 2018 to 2021. The generalized additive model was used to analyze the associations of daily average concentrations of PM_2.5 and O₃ on deaths from lung cancer, COPD, and respiratory diseases. The quantile g-computation (QG-C) was employed to estimate the joint effect of composite exposures. PM_2.5 concentrations showed a decreasing trend with a seasonal effect, which was higher in winter, while O₃ concentration was kept in a higher level from April to September. The maximum cumulative effect of PM_2.5 on deaths from selected diseases were observed at lag03 with ERs around 2.72% to 3.90%. The maximum cumulative effect of O₃ on deaths from lung cancer and COPD were observed at lag03, while the effect on respiratory diseases was at lag04 with an ER of 1.14% (95% CI: 0.60, 1.68). For each quartile increase in the composite exposure of two pollutants, the RR for the risk of death from respiratory disease, COPD, and lung cancer was 1.03 (95% CI: 1.01, 1.05), 1.03 (95% CI: 1.00, 1.07), and 1.05 (95% CI: 1.02, 1.08), respectively. An obvious association between single and composite exposure of PM_2.5 and O₃ and the mortality risk of respiratory disease, COPD, and lung cancer was observed, highlighting the importance of management of these pollutants.

PM_2.5和臭氧O₃单独及复合暴露对人群呼吸系统疾病死亡率的评估研究 — 中国广东省广州市，2018–2021年

屠鸿薇^1,&；胡轶君^2,&；胡克岐^3,&；董佩佩^1,4；温越^1,4；蒋静¹；许雪丹¹；黄锦叙¹；朱杰民¹；何昌云¹；陈秋霞¹；刘勇鹰^1,#

1 广东省疾病预防控制中心，广州市，广东省，中国；

2 暨南大学，广州市，广东省，中国；

3 广东省第二综合医院科教部，广州市，广东省，中国；

4 中山大学，广州市，广东省，中国。

&共同第一作者。

#通讯作者：刘勇鹰，24322487@qq.com。

本研究评估了2018年至2021年广州每日细颗粒物（PM_2.5）和臭氧（O₃）单独及复合暴露对人群呼吸系统疾病死亡率的影响。采用广义相加模型分析PM_2.5和O₃和日均浓度与肺癌、慢性阻塞性肺疾病（COPD）和呼吸系统疾病死亡率的关联。使用quantile g-computation（QG-C）法来估算复合暴露的联合效应。PM_2.5的环境浓度显示出季节性下降趋势，冬季浓度较高，而O₃浓度在4月至9月保持在较高水平。PM_2.5对所选疾病死亡的最大累积效应均出现在滞后第3天，超额风险（ER）约为2.72%到3.90%。O₃对肺癌和COPD死亡的最大累积效应出现在滞后第3天，而对呼吸系统疾病的效应出现在滞后第4天，其ER为1.14%（95% CI：0.60, 1.68）。每增加一个四分位数的两种污染物复合暴露，呼吸系统疾病、COPD和肺癌的死亡风险相对危险度（RR）分别为1.03（95% CI：1.01, 1.05）、1.03（95% CI：1.00, 1.07）和1.05（95% CI：1.02, 1.08）。本研究观察到PM_2.5和O₃的单独及复合暴露与呼吸系统疾病、COPD和肺癌死亡风险之间存在明显关联，因此进一步管理这些污染物是十分必要的。

For more information: https://weekly.chinacdc.cn/en/article/doi/10.46234/ccdcw2024.184

Analysis of Intelligent Equipment Usage for Work-Related Musculoskeletal Disorder Prevention in Miners — Shanxi Province, China, 2023

Haimiao Yu¹; Zepeng Xu¹; Ying Xia¹; Shuo Zhang¹; Xiaoting Jia^2,#

1 School of Economics and Management, China University of Mining Technology, Xuzhou, Jiangsu Province, China;

2 Administrators Training Center, National Health Commission of the People's Republic of China, Beijing, China.

^# Corresponding authors: Jia Xiaoting, jxt2635@163.com.

Job characteristics such as long working hours, heavy physical loads, working in confined spaces, and repetitive operations make miners a high-risk group for work-related musculoskeletal disorders (WMSDs). In 2023, our research group conducted a single-stage cluster sampling questionnaire survey of 2,165 coal miners in Shanxi Province, China, to analyze the impact of intelligent equipment usage on WMSDs among miners. The results of the study show that compared to the low-level intelligent equipment usage group (control group), high-level intelligent equipment usage reduced the prevalence of WMSDs by an average of 7.49% and decreased pain in each body part by an average of 13.69%. Stepwise regression results indicated that intelligent equipment usage played a negative moderating role in the effect of workload on body pain, thereby reducing the impact of workload on WMSDs among miners. The Chinese government is vigorously promoting intelligent mining projects and developing new quality productivity in the coal industry. As WMSDs are preventable workplace diseases, public health departments should seize this opportunity to use coal mines as a pilot industry for developing ergonomic certification standards for intelligent equipment. This approach can help companies integrate intelligent transformation with WMSDs prevention.

智能设备使用对预防矿工群体工作相关肌肉骨骼疾患的作用分析 — 中国山西省，2023年

于海淼¹；徐泽鹏¹；夏颖¹；张硕¹；贾小婷^2,#

1. 中国矿业大学经济管理学院，徐州市，江苏省，中国；

2. 国家卫生健康委员干部培训中心，北京，中国。

#通讯作者：贾小婷，jxt2635@163.com。

长工作时间、重体力负荷、有限空间内作业、重复性操作等工作特征，使矿工成为工作相关肌肉骨骼疾患（WMSDs）的高风险人群。本研究采用单阶段整群抽样的方法，于2023年在中国山西省对2,165位煤矿工人进行问卷调查，以了解智能设备使用对矿工WMSDs的影响。研究结果显示：以低程度智能化设备使用组为对照组，高程度智能化设备使用可使矿工WMSDs患病率平均降低7.49%，并将身体部位疼痛感平均降低13.69%。逐步回归结果显示，智能设备使用在工作负荷对身体疼痛的影响中起到了负向调节的作用，即智能设备使用可以减轻工作负荷对矿工肌肉骨骼系统的损害。中国政府正在大力推进煤矿智能化工程，发展煤炭新质生产力。WMSDs是一种可以在工作场所中预防的疾病，公共卫生部门应当利用这一时机，以煤矿为试点，推行智能化设备的人机工程学认证，帮助企业实现智能化转型与工作相关骨骼疾患预防的一体化。

For more information: https://weekly.chinacdc.cn/en/article/doi/10.46234/ccdcw2024.185

Association of Thallium Exposure with Decreased Renal Function among Chinese Adults — China, 2017–2018

Zheng Zhang^1,2; Miao Zhang¹; Yingli Qu¹; Feng Zhao¹; Saisai Ji¹; Zheng Li¹; Bing Wu^1,2; Chunxian Lyu¹; Haocan Song¹; Qi Sun¹; Yawei Li¹; Xu Zhang¹; Xulin Zheng^1,2; Yidan Qiu¹; Zihan Lu^1,2; Hui Fu¹; Lanjing Xu^1,3; Wenli Zhang¹; Yufei Luo^1,4; Fangyu Li^1,5; Jiayi Cai¹; Yuanduo Zhu¹; Ying Zhu¹; Zhaojin Cao¹; Yuebin Lyu^1,6; Xiaoming Shi^1,2,6,#

1 China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China;

2 Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing City, Jiangsu Province, China;

3 Department of Big Data in Health Science, School of Public Health, Zhejiang University, Hangzhou City, Zhejiang Province, China;

4 Department of Occupational Health and Environment Health, School of Public Health, Anhui Medical University, Hefei City, Anhui Province, China;

5 School of Public Health, China Medical University, Shenyang City, Liaoning Province, China;

6 National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases (NITFID), National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China.

^# Corresponding author: Xiaoming Shi, shixm@chinacdc.cn

Thallium in the external environment may act on the kidney and cause the decline of renal function after entering the human body through various channels. However, few epidemiological studies focused on the association of Tl exposure with kidney function. Our study aimed to explore the associations of urinary Tl with chronic kidney disease (CKD) and estimate glomerular filtration rate (eGFR), and further evaluate the underlying roles of inflammatory biomarkers among Chinese adults. A total of 9,238 subjects aged ≥ 18 years old were recruited from the China National Human Biomonitoring program (2017–2018). The associations of urinary Tl with CKD and eGFR were analyzed with multiple logistic regression models and multiple linear regression models, respectively. Restricted cubic spline (RCS) analysis was performed to assess the dose-response relationship. Mediation analysis was conducted to explore the mediating effect of inflammatory biomarkers. The results showed that urinary Tl in the highest quartile had a significantly higher odds of CKD [odds ratio (OR): 2.09, 95% CI: 1.26, 3.48] compared with the lowest quartile. For each additional IQR of urinary Tl, the odds of CKD increased by 19% and eGFR decreased by a 1.64 mL/[min•(1.73 m²)]. RCS analysis showed a positive nonlinear dose-response relationship of urinary Tl with CKD and a negative linear dose-response relationship with eGFR. In addition, stronger positive associations of Tl with CKD were observed in older men and women. However, it was not observed that inflammatory biomarkers played a mediating role in the association of urinary Tl with eGFR. Our study revealed that a significant association of urinary Tl with decreased renal function, especially in older adults. Further explorations were needed for the biological mechanisms.

成年人铊暴露与肾功能下降的关系 — 中国，2017-2018年

章正^1,2；张淼¹；曲英莉¹；赵峰¹；吉赛赛¹；李铮¹；吴兵^1,2；吕春贤¹；宋皓璨¹；孙琦¹；李亚伟¹；张绪¹；郑栩琳^1，2；裘一丹^1,3；卢子涵^1,2；付慧¹；徐岚静^1,3；张文丽¹；罗宇菲^1,4；李方玙^1,5；蔡嘉旖¹；朱元多¹；朱英¹；曹兆进¹；吕跃斌^1,6；施小明^1,2,6,#

1中国疾病预防控制中心环境与人群健康重点实验室，环境与健康相关产品安全所，北京，中国；

2 南京医科大学公共卫生学院全球健康中心，南京市，江苏省，中国；

3 浙江大学公共卫生学院大数据健康科学系，杭州市，浙江省，中国；

4 安徽医科大学公共卫生学院职业卫生与环境卫生学系，合肥市，安徽省，中国；

5 中国医科大学公共卫生学院，沈阳市，辽宁省，中国；

6 传染病溯源预警与智能决策全国重点实验室，环境与健康相关产品安全所，北京，中国。

&共同第一作者。

#通讯作者：施小明，shixm@chinacdc.cn。

外界环境中的铊（Tl）经各种途径进入人体后，可能会作用于肾脏，引起肾功能下降。然而，很少有流行病学研究关注Tl与肾功能的关系。本研究旨在中国成年人中探讨尿Tl与慢性肾脏疾病(CKD)和估计肾小球滤过率(eGFR)的关系，并进一步评估炎症生物标志物的潜在作用。从中国国家人体生物监测项目(2017-2018)中招募了9,238名年龄≥18岁的受试者。分别采用多元logistic回归模型和多元线性回归模型分析尿Tl与CKD和eGFR的关联关系。采用限制性三次样条(RCS)分析剂量—反应关系。采用中介分析探讨炎症生物标志物的中介作用。结果显示，与最低四分位数相比，尿Tl最高四分位数的调查对象患CKD的几率明显更高(比值比: 2.09, 95% CI: 1.26, 3.48)。尿Tl每增加1个四分位数间距, CKD的几率增加19%，eGFR降低1.64 mL/[min•(1.73 m²)]。RCS分析显示尿Tl与CKD呈正向非线性关系，与eGFR呈负向线性关系。此外，在老年男性和女性中观察到Tl与CKD有更强的正向关联。然而，没有观察到炎症生物标志物在尿Tl与eGFR的关联中发挥中介作用。本研究发现了尿Tl水平与肾功能下降存在显著关联，尤其是在老年人中，其生物学机制有待进一步探索。

For more information: https://weekly.chinacdc.cn/en/article/doi/10.46234/ccdcw2024.186

An Occupational Dimethylacetamide Poisoning Incident Responded Efficiently in Health Emergency Response Network — Zhuhai City, Guangdong Province, China, August 2023

Jiaxin Jiang¹; Jian Huang¹; Jintong He²; Chudong Zhang²; Weihui Liang¹; Qifeng Wu¹; Weifeng Rong¹; Xiaoyong Liu^1,#

1 Guangdong Province Hospital for Occupational Disease Prevention and Treatment, Guangdong Province, China

2 The Third People’s Hospital of Zhuhai (Zhuhai Hospital for Occupational Disease Prevention and Treatment, ZHOD), Zhuhai City, Guangdong Province, China

^# Corresponding author: Xiaoyong Liu, 4813545@qq.com

To investigate and analyze the outbreak of a mass occupational acute dimethylacetamide (DMA) poisoning incident, responded in The Health Emergency Response Network for Poisoning Emergencies (HERNPE) in Guangdong Province. This research provides an occupational DMA poisoning incident with 6 cases during post-fire management at a spandex manufacturing factory in Zhuhai City, Guangdong Province, August 2023, together with general course, clinical survey, field investigation, and toxicant identification. Health institutions in HERNPE exchanged information about outbreaks and co-responded. A joint team, of Guangdong Province Hospital for Occupational Disease Prevention and Treatment (GDHOD) and Zhuhai Hospital for Occupational Disease Prevention and Treatment (ZHHOD), field investigated the incident on August 20–21. All 6 male cases got poisoned for cleaning polymerizers (filled with spandex blended with DMA) as part of post-fire management at a spandex manufacturing factory. Between 5–13 days after exposure to DMA, 6 cases suffered from hepatopathy and varying degrees of skin irritation, and N-methylacetamide as biomonitoring indicator was detected in all the urine samples, up to 1639.78 mg/g Cr. Detection results on August 22 indicated that the C-STEL of DMA in the air was 33.60 mg/m³ and 36.06 mg/m³. In 2 sample of materials, DMA (30.09%) and DMA (13.74%) were detected. 6 workers were diagnosed with acute DMA poisoning (1 severe, 1 moderate, and 4 mild cases), while 163 others screened on August 21–26 (ambulatory surveillance until September 26 at most). A joint team also implemented supervision and provided industry guidelines. Targeted interventions, including timely information sharing through networks like HERNPE, expert guidance, prioritized patient referrals, and comprehensive screening, were crucial in managing mass incidents. This research highlights the importance of hiring qualified personnel, limiting work hours, enhancing health education, and strengthening occupational disease surveillance systems to prevent similar incidents.

卫生应急网络高效应对的一起职业性二甲基乙酰胺中毒事件 — 中国广东省珠海市，2023年8月

江嘉欣¹；黄健¹；何金铜²；张楚东²；梁伟辉¹；吴奇峰¹；戎伟丰¹；刘晓勇^1,#

1.广东省职业病防治院，广州市，广东省，中国；

2.珠海市第三人民医院（珠海市慢性病防治中心、珠海市职业病防治院），珠海市，广东省，中国。

#通讯作者：刘勇鹰，24322487@qq.com。

本研究对广东省突发中毒事件卫生应急网络应对的一起群体性职业性急性二甲基乙酰胺（DMA）中毒事件进行调查分析。研究分析了2023年8月在广东省珠海市某氨纶制造厂火灾后清理作业期间发生的一起6例职业性二甲基乙酰胺（DMA）中毒事件的事发过程、临床诊疗、现场调查和毒物鉴定等情况。HERNPE医疗卫生机构交流发病信息，启动联防联控。广东省职业病防治院（GDHOD）和珠海市职业病防治院（ZHHOD）组成的联合小组于8月20–21日开展了现场调查。6名男性病例因参加氨纶制造厂火灾后处理工作，负责清洗聚合釜（内装混有DMA的氨纶）而中毒。在接触 DMA 5–13天后，6名病例出现了肝病和不同程度皮肤刺激，尿液样本中均检测到了生物监测指标N-甲基乙酰胺，最高达1639.78 mg/g Cr。8月22日检测结果显示，空气中DMA的C-STEL为33.60 mg/m³ 和36.06 mg/m³。确诊6名工人急性DMA中毒（1例重度，1例中度，4例轻度），并于8月21–26日全面筛查了其他163名接触工人（门诊监护最长至9月26日）。联合小组还实施了事故监督，提供了行业指导。通过HERNPE等合作网络，开展及时信息沟通，给予专家指导，优先转诊病人，以及组织全面筛查等有针对性的干预措施，对早期发现和高效处置群体性事件来说至关重要。本研究还强调了聘用有资质人员、限制工作时间、加强健康教育和强化职业病监测，对预防类似事件很重要。

For more information: https://weekly.chinacdc.cn/en/article/doi/10.46234/ccdcw2024.114

PENG ZU Study on Healthy Aging in China (PENG ZU Cohort): Design and Goals

Ju Cui^1,&, Jing Pang^2,&, Liqun Zhang^3,&, Juan Li⁴, Xiaolan Wu⁵, Xinyi Zhu⁴, Wei Ma⁶, Senlin Luo⁷, Huafang Gao⁸, Zhao Wang⁹, Jianping Cai^2,#, Tiemei Zhang^1,#

1 The Key Laboratory of Geriatrics, Beijing Institute of Geriatrics, Institute of Geriatric Medicine, Chinese Academy of Medical Science, Beijing Hospital/National Center of Gerontology of National Health Commission, Beijing, China;

2 Beijing Institute of Geriatrics, Beijing Hospital, Beijing, China.

3 Institute of Geriatric Medicine, Chinese Academy of Medical Science, Beijing Hospital, Beijing, China;

4 Center on Aging Psychology, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China;

5 Institute of Healthy Ageing, China Research Center on Ageing, Beijing, China;

6 Institute of Statistics and Big Data, Renmin University of China, Beijing, China;

7 Beijing Institute of Technology, Beijing, China.

8 National Human Genetic Resources Center, National Research Institute for Family Planning, Beijing, China;

9 Department of Pharmacology, School of Pharmaceutical Sciences, Tsinghua University, Beijing, China.

^& Joint first authors.

^# Corresponding author: Jianping Cai, caijp61@vip.sina.com; Tiemei Zhang, tmzhang126@126.com.

China's population is aging rapidly. Improving the health status of the elderly is one of the key pathways to achieving healthy aging. The " Peng Zu Study on Healthy Ageing in China" (PENG ZU Cohort) aims to understand the natural course and patterns of health status with age in the Chinese population. This study seeks to establish novel techniques for identifying functional decline and disease risks, develop new strategies and measures to delay aging and prevent disease, and promote and maintain elderly health. In the period of baseline, The PENG ZU Study recruited 26,000 community-dwelling individuals aged 25 to 89 years from seven major geographical regions in China. Diversified data and biospecimens are collected according to standardized procedures, and follow-up visits will be conducted every 4 years. Baseline recruitment for the PENG ZU Study was completed in October 2021. The multi-dimensional health data and biological samples collected will be systematically analyzed to establish methods for assessing intrinsic capacity, develop models for assessing biological age, and discover biomarkers of aging. This comprehensive analysis will elucidate the multi-level, cross-scale changes in health status with age and inform corresponding intervention techniques. The establishment of this cohort and the study findings will enhance our understanding of health status changes due to aging, provide comprehensive health information for developing health assessment and intervention strategies, delay functional decline, and reduce the incidence and/or severity of age-related diseases, thereby promoting healthy aging..

彭祖中国健康老龄化研究（彭祖队列）：研究设计与目标

崔菊^1,&, 庞婧^2,&, 张立群^3,&, 李娟⁴, 伍小兰⁵, 朱心怡⁴, 马维⁶, 罗森林⁷, 高华方⁸, 王钊⁹, 蔡剑平^2,#, 张铁梅^1,#

1. 北京医院 国家老年医学中心，国家卫生健康委北京老年医学研究所，国家卫生健康委老年医学重点实验室，中国医学科学院老年医学研究院，北京，中国；

2. 北京医院，国家卫生健康委北京老年医学研究所，北京，中国；

3. 北京医院，中国医学科学院老年医学研究院，北京，中国；

4. 中国科学院心理研究所 心理健康院重点实验室 老年心理研究中心，北京，中国；

5. 中国老龄科学研究中心老龄健康研究所，北京，中国；

6. 中国人民大学统计与大数据研究院，北京，中国；

7. 北京理工大学，北京，中国；

8. 国家卫生健康委科学技术研究所国家人类遗传资源中心，北京，中国；

9. 清华大学药学院药理学系，北京，中国。

&共同第一作者。

#通讯作者：蔡剑平, caijp61@vip.sina.com; 张铁梅, tmzhang126@126.com。

中国的人口老龄化在不断加剧。改善老年人口的健康状况是实现健康老龄化的重要途径之一。“中国彭祖健康老龄化研究”（彭祖队列）的目的是了解中国人增龄健康状况的自然变化特点与规律；建立辨识功能减退和疾病风险的技术方法；研发延缓衰老和预防疾病发生的新策略和措施；维护与促进老年健康。彭祖队列研究包括来自中国七个主要地理区域的26,000名志愿者，年龄介于25至89岁之间。根据统一方案，采集多样化的健康数据和生物标本用于分析研究。彭祖队列的基线招募已于2021年10月完成。彭祖队列中收集的多维健康数据和生物样本将以建立内在功能评估方法、建立生物学年龄评估模型和发现衰老标志物为重点系统分析，阐明增龄健康状态的多层次跨尺度变化特点与相应技术应对途径。本研究队列的建立与发现将有助于了解因增龄引起的健康状况变化，提供有效的健康信息并用以建立健康评估、干预措施，延缓功能减退和年龄相关疾病的发生率和/或程度，促进健康老龄化进程。

For more information: https://weekly.chinacdc.cn/en/article/doi/10.46234/ccdcw2024.187