Investing in Primary Care to Reduce the Burden of Chronic Obstructive Pulmonary Disease

Ting Yang^1,2,3,4,#, Jing Wu⁵, Chunhua Chi⁶

1. Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China;

2. National Center for Respiratory Medicine, Beijing, China;

3. Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China;

4. National Clinical Research Center for Respiratory Diseases, Beijing, China;

5. School of Pharmaceutical Science and Technology, Tianjin University, Tianjin, China;

6. Department of General Medicine, Peking University First Hospital, Beijing, China.

^# Corresponding author: Ting Yang, yangting@zryhyy.com.cn.

As the most prevalent chronic respiratory disease globally, Chronic Obstructive Pulmonary Disease (COPD) now affects more than 300 million patients worldwide and accounted for 3.3 million deaths. This article presents a comprehensive analysis of the existing data on COPD. In China, COPD ranks as the third most prevalent non-communicable disease, following hypertension and type 2 diabetes, and affects 99.9 million people. Over the next three decades, China's economic losses attributable to COPD will reach $1.36 trillion, representing nearly 30% of the total global economic burden. Primary care-based COPD management in China have proven cost-effective.This article further summarizes the policies introduced in China to improve respiratory care over the past decade, and illustrates that the inclusion of COPD management within the National Basic Public Health Programme represents an important milestone toward achieving Healthy China 2030 goals.

加大基层医疗卫生投入，减轻慢阻肺病疾病负担

杨汀^1,2,3,4,#；吴晶⁵；迟春花⁶

1. 呼吸与危重症医学科，中日友好医院，北京，中国；

2. 国家呼吸医学中心，北京，中国；

3. 呼吸病学研究院，中国医学科学院，北京，中国；

4. 国家呼吸系统疾病临床医学研究中心，北京，中国；

5. 药物科学与技术学院，天津大学，天津，中国；

6. 全科医学科，北京大学第一医院，北京，中国。

^# 通信作者: 杨汀，yangting@zryhyy.com.cn。

慢阻肺病是全球发病率最高的慢性呼吸系统疾病之一，全球有超过3亿患者，每年导致330万人死亡。本文对慢阻肺病现有数据进行了综合分析。在我国,慢阻肺病是仅次于高血压、糖尿病的第三大常见慢性病，患病总人数约1亿人。预计至2050年，我国慢阻肺病经济负担将达1.36万亿美元，约占全球的三分之一。在我国基层开展慢阻肺病防治具有较高的成本效益。本文进一步对我国慢阻肺病防治政策的演进进行了总结，并阐述了2024年9月国家正式将慢阻肺病医疗照护纳入国家基本公共卫生服务项目有助于加大我国基层医疗卫生投入，减轻慢阻肺病疾病负担，助力实现"健康中国2030"的宏伟目标。

For more information: https://weekly.chinacdc.cn/en/article/doi/10.46234/ccdcw2025.245

Cardiovascular Morbidity and Mortality Attributable to Potentially Inappropriate Medication Use Among Primary Prevention Populations — China, 2015–2023

Zhenping Zhao¹; Mei Zhang¹; Limin Wang¹; Maigeng Zhou^1,#

1. National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.

^# Corresponding author: Maigeng Zhou, maigengzhou@ncncd.chinacdc.cn.

This study aimed to quantify potentially inappropriate medication (PIM) use for primary cardiovascular disease (CVD) prevention in China and its attributable mortality and morbidity. Data from the 2015, 2018, and 2023 China Chronic Disease and Risk Factor Surveillance were analyzed for adults aged ≥30 years without diagnosed CVD. PIM use was defined according to guideline adherence for aspirin, statins, antihypertensives, and glucose-lowering agents. Population attributable fractions (PAFs) were calculated using weighted prevalence and relative risks, and CVD outcomes were derived from the Global Burden of Disease 2023. From 2015 to 2023, PIM prevalence for primary CVD prevention declined by half, with larger relative reductions observed among women and older adults. The number of PIM-attributable CVD deaths decreased by 39%, and its rank among CVD risk factors dropped from 17th to 21st after 2018. Before 2018, 15 provinces showed increases in PIM-attributable CVD mortality and morbidity, but subsequent declines occurred in 30 provinces for mortality and 28 for morbidity, with Inner Mongolia and Tianjin showing the largest improvements. Despite marked progress, disparities persist across regions and populations. Establishing population-based PIM surveillance and implementing targeted interventions in high-burden areas are essential to further reduce preventable CVD morbidity and mortality.

归因于潜在不适当用药的心血管病一级预防人群的发病与死亡负担 — 中国, 2015–2023年

赵振平¹；张梅¹；王丽敏¹；周脉耕¹

1. 中国疾病预防控制中心慢性非传染性疾病预防控制中心，北京，中国。

^# 通信作者：周脉耕，zhoumaigeng@ncncd.chinacdc.cn。

本文量化我国心血管病一级预防人群中潜在不适当用药的流行水平及其归因的心血管病发病与死亡负担。基于2015、2018与2023年中国居民慢性病及危险因素监测数据，纳入≥30岁、无既往确诊心血管病史的对象。心血管病一级预防人群潜在不适当用药的定义为：是否按照现行指南规范使用阿司匹林、他汀类、降压药和降糖药。采用复杂加权估计潜在不适当用药率，结合相对风险值计算人群归因分值。心血管病发病与死亡数据来自2023年全球疾病负担研究。2015至2023年间，心血管病一级预防人群潜在不适当用药率下降逾半，女性相对降幅更大，而高龄人群的绝对降幅更显著。2015至2023年，潜在不适当用药归因的心血管病死亡负担累计下降39%；潜在不适当用药在心血管病危险因素的归因死因数顺位从2018年的第17位降至2023年的第21位。2015—2018年有15个省的潜在不适当用药归因心血管病发病/死亡呈上升趋势，而2018—2023年有30个省的归因心血管病死亡率与28个省的归因心血管病发病率呈下降趋势，其中内蒙古自治区与天津市降幅最为显著。中国心血管病一级预防领域的合理用药取得显著进展，但仍存在地区与人群差异。建议建立基于人群的潜在不适当用药监测系统，聚焦高负担地区与高危人群，配套精准干预措施，以进一步降低可避免的心血管病事件与死亡。

For more information: https://weekly.chinacdc.cn/en/article/doi/10.46234/ccdcw2025.246

Prevalence of Metabolic Dysfunction-Associated Steatotic Liver Disease with Clinically Significant Fibrosis in Obese Patients with Type 2 Diabetes Mellitus — China, 2017–2024

Yuping Chen^1,&; Xiao Liang^2,&; Yuxia Qi^3,&; Chuan Liu¹; Bingtian Dong⁴; Xia Li⁵; Jie Shen⁶; Xiqiao Zhou⁷; Xuan Liang⁸; Minghua Zheng⁹; Huating Li¹⁰; Vincent Wai-Sun Wong¹¹; Zobair M Younossi¹²; Yuemin Nan^13,#; Xiaolong Qi^1,#

1. Liver Disease Center of Integrated Traditional Chinese and Western Medicine, Zhongda Hospital, Medical School, Southeast University; Nurturing Center of Jiangsu Province for State Laboratory of AI Imaging & Interventional Radiology (Southeast University); Basic Medicine Research and Innovation Center of Ministry of Education, Zhongda Hospital, Southeast University; State Key Laboratory of Digital Medical Engineering, Nanjing City, Jiangsu Province, China;

2. Zhejiang Key Laboratory of Multi-omics Precision Diagnosis and Treatment of Liver Diseases, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou City, Zhejiang Province, China;

3. Qingdao Public Health Clinical Center, Qingdao City, Shandong Province, China;

4. The First Affiliated Hospital of Anhui Medical University, Hefei City, Anhui Province, China;

5. National Clinical Research Center for Metabolic Diseases; Key Laboratory of Diabetes Immunology, Ministry of Education; The Second Xiangya Hospital of Central South University, Changsha City, Hunan Province, China;

6. Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde), Foshan City, Guangdong Province, China;

7. Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine, Nanjing City, Jiangsu Province, China;

8. The Sixth People’s Hospital of Shenyang, Shenyang City, Liaoning Province, China;

9. MAFLD Research Center, the First Affiliated Hospital of Wenzhou Medical University; Key Laboratory of Diagnosis and Treatment for the Development of Chronic Liver Disease in Zhejiang Province, Wenzhou City, Zhejiang Province, China;

10. Shanghai Belt and Road International Joint Laboratory for Intelligent Prevention and Treatment of Metabolic Disorders, Department of Computer Science and Engineering, School of Electronic, Information, and Electrical Engineering, Shanghai Jiao Tong University; Department of Endocrinology and Metabolism, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine; Shanghai Diabetes Institute; Shanghai Clinical Center for Diabetes, Shanghai, China;

11. Medical Data Analytics Center, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong Special Administrative Region; State Key Laboratory of Digestive Disease, Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China;

12. Global NASH Council, Washington, DC, USA; Center for Outcomes Research in Liver Disease, Washington, DC, USA;

13. Department of Traditional and Western Medical Hepatology, Third Hospital of Hebei Medical University, Shijiazhuang City, Hebei Province, China.

^& Joint first authors.

^# Corresponding author: Xiaolong Qi, 101013436@seu.edu.cn; Yuemin Nan, nanyuemin@hebmu.edu.cn.

This study investigated the prevalence of metabolic dysfunction-associated steatotic liver disease (MASLD) with clinically significant fibrosis among obese patients with type 2 diabetes mellitus (T2DM). This multicenter study enrolled T2DM patients from tertiary hospitals and primary care facilities across 21 cities in China between 2017 and 2024. Clinically significant fibrosis was defined as liver stiffness measurement (LSM) ≥8 kPa assessed by vibration-controlled transient elastography (VCTE) or biopsy-confirmed fibrosis stage ≥F2. Of the 10,281 patients included, 9,725 comprised the VCTE cohort (5,171 from clinics and 4,554 from primary care), while 556 comprised the biopsy cohort. Overall, 25.6% were obese. The prevalence of MASLD with clinically significant fibrosis reached 26.7% in obese patients, significantly exceeding that in non-obese patients (8.4%). This prevalence increased progressively with rising body mass index and demonstrated a strong association with the number of cardiometabolic risk factors. Furthermore, a non-invasive model incorporating age, waist circumference, alanine aminotransferase, total bilirubin, and triglycerides exhibited reliable performance in stratifying the risk of MASLD with clinically significant fibrosis among obese patients with T2DM (AUC: 0.799 [[95% _CI_: 0.767-0.832]). MASLD with clinically significant fibrosis is highly prevalent among obese patients with T2DM, emphasizing the necessity for systematic risk stratification and integrated management of these interconnected metabolic conditions.

肥胖合并2型糖尿病患者代谢相关脂肪性肝病伴临床显著性肝纤维化的患病率 — 中国，2017–2024年

陈玉萍^1,&, 梁霄^2,&, 齐玉霞^3,&, 刘川¹, 董丙田⁴, 李霞⁵, 沈洁¹⁵, 周希乔¹⁷, 梁煊¹⁶, 郑明华⁴⁵, 李华婷⁴⁶, 黄炜燊⁴⁷, Zobair M Younossi⁴⁸, 南月敏^49,#, 祁小龙^1,#

1. 东南大学附属中大医院中西医结合肝病中心，教育部基础医药创新中心，数字医学工程全国重点实验室，南京市，江苏省，中国；

2. 浙江大学医学院邵逸夫医院，肝脏疾病多组学精准诊治重点实验室，杭州市，浙江省，中国

3. 青岛市公共卫生临床中心，青岛市，山东省，中国；

4. 安徽医科大学第一附属医院，合肥市，安徽省，中国；

5. 中南大学湘雅二医院，代谢疾病国家临床研究中心，糖尿病免疫学教育部重点实验室，长沙市，湖南省，中国；

6. 南方医科大学顺德医院（顺德区第一人民医院），佛山市，广东省，中国；

7. 南京中医药大学附属医院，江苏省中医院，南京市，江苏省，中国；

8. 沈阳市第六人民医院，沈阳市，辽宁省，中国；

9. 温州医科大学附属第一医院MAFLD研究中心；浙江省慢性肝病诊疗重点实验室，温州市，浙江省，中国；

10. 上海交通大学电子信息与电气工程学院计算机科学与工程系，"一带一路"联合实验室；上海交通大学医学院附属第六人民医院内分泌与代谢科，上海市糖尿病研究所，上海市糖尿病临床医学中心，上海，中国;

11. 香港中文大学医学院医学数据分析中心；香港中文大学消化疾病国家重点实验室，香港特别行政区，中国；

12. 全球NASH理事会；肝病结局研究中心，华盛顿特区，美国；

13. 河北医科大学第三医院中西医结合肝病科，石家庄市，河北省，中国。

^& 共同第一作者。

^# 通讯作者: 祁小龙, Email: 101013436@seu.edu.cn; 南月敏, Email: nanyuemin@hebmu.edu.cn。

本文探讨肥胖的2型糖尿病（type 2 diabetes mellitus ,T2DM）患者中代谢相关脂肪性肝病（metabolic dysfunction-associated steatotic liver disease, MASLD）伴临床显著性肝纤维化的患病率。这项多中心研究于2017年至2024年期间从中国21个城市的三级医院和基层医疗卫生机构招募T2DM患者。临床显著性肝纤维化定义为瞬时弹性成像测得的肝脏硬度值≥8 kPa，或肝活检结果判定肝纤维化分期≥F2。本研究共纳入10,281例患者，其中瞬时弹性成像队列9,725例（门诊患者5,171例和基层医疗卫生机构患者4,554例），肝活检队列556例。肥胖患者占比为25.6%。肥胖T2DM患者中MASLD伴临床显著性肝纤维化的患病率为26.7%，显著高于非肥胖患者（8.4%）。随着身体质量指数升高，该患病率逐步增加，并与心脏代谢危险因素数量密切相关。此外，基于年龄、腰围、丙氨酸氨基转移酶、总胆红素及甘油三酯构建的无创模型在肥胖T2DM患者中对MASLD伴临床显著性肝纤维化风险的预测效能表现良好（AUC：0.799，95% CI：0.767-0.832）。肥胖的T2DM患者中MASLD伴临床显著性肝纤维化患病率较高，提示需加强风险分层及代谢因素的综合管理。

For more information: https://weekly.chinacdc.cn/en/article/doi/10.46234/ccdcw2025.247

Effectiveness and Acceptability of A Community-Based Comprehensive Smoking Cessation Intervention Incorporating Traditional Chinese Medicine Therapy — Qingdao City, Shandong Province, China, December 2023–December 2024

Yifan Yin¹; Yani Wang²; Jie Yang³; Haiyan Xu⁴; Kun Ma³; Hui Gong²; Fei Qi^2,#; Yi Nan^5,#

1.       School of Public Health, Qingdao University, Qingdao City, Shandong Province, China.

2.       Qingdao Municipal Center for Disease Control and Prevention, Qingdao City, Shandong Province, China;

3.       Community Health Service Center of Xuejiadao Street, Huangdao District, Qingdao City, Shandong Province, China;

4.       Community Health Service Center of Chengyang Street, Chengyang District, Qingdao City, Shandong Province, China;

5.      Tobacco Control Office, Chinese Center for Disease Control and Prevention, Beijing, China.

^# Corresponding authors: Fei Qi, CDCjkjy@qd.shandong.cn; Yi Nan, nanyi@chinacdc.cn.

Traditional Chinese Medicine (TCM) provides a practical and safe approach to smoking cessation. However, research examining its integration into community-based smoking cessation programs in mainland China remains limited. This cluster randomized controlled trial selected 20 matched communities in Qingdao and randomly assigned them in a 1:1 ratio to intervention or control groups, with 10 communities per group. Community health centers recruited voluntary smokers seeking cessation as study participants. The final sample comprised 239 participants in the intervention group and 250 in the control group, totaling 489 participants. The intervention group received a comprehensive TCM-based community intervention incorporating acupuncture and auricular acupressure, while the control group received standard self-help smoking cessation materials. Follow-up assessments were conducted at one, three, and six months post-enrollment. Logistic regression models were employed to evaluate the intervention's impact on smoking cessation outcomes. Logistic regression analysis adjusted for covariates demonstrated that the intervention group achieved significantly superior smoking cessation outcomes at all follow-up time points compared to the control group. At 6 months, participants in the intervention group showed significantly higher probabilities of achieving sustained cessation [adjusted odds ratio (aOR)=2.44, 95% confidence interval (CI): 1.08, 5.50], attempting cessation (aOR=5.01, 95% CI: 3.14, 7.99), reducing smoking consumption (aOR=2.99, 95% CI: 2.00, 4.45), and maintaining 7-day point prevalence abstinence (aOR=3.76, 95% CI: 2.04, 6.90). These findings provide compelling evidence supporting the integration of TCM smoking cessation therapies into community-based cessation services. The results offer innovative perspectives and empirical evidence for advancing smoking intervention models in public health practice.

基于中医治疗的社区综合戒烟干预措施的有效性和可接受性 — 青岛市，山东省，中国，2023年12月–2024年12月

尹亦凡¹，王亚妮²，杨杰³，徐海燕⁴，马坤³，宫晖²，綦斐^2,#，南奕^5,#

1. 公共卫生学院，青岛大学，青岛市，山东省，中国；

2. 青岛市疾病预防控制中心，青岛市，山东省，中国；

3. 青岛市黄岛区薛家道街道社区卫生服务中心，青岛市，山东省，中国；

4. 青岛市城阳区城阳街道社区卫生服务中心，青岛市，山东省，中国；

5. 控烟办公室，中国疾病预防控制中心，北京，中国。

^# 通信作者：綦斐, CDCjkjy@qd.shandong.cn; 南奕, nanyi@chinacdc.cn。

中医戒烟疗法是一种可行的、低风险的治疗方法。目前中国大陆鲜少有研究探索将中医戒烟疗法纳入社区戒烟服务的效果。本研究采用整群随机对照试验的方法，在青岛市选取了20个匹配社区，采用1∶1随机分配法将其分为干预组和对照组，每组包含10个社区。由各社区的卫生服务中心招募自愿戒烟者作为受试对象。最终干预组招募到239人，对照组招募到250人，共计489人。干预组接受了基于中医的社区综合干预，对照组发放自助戒烟材料。在受试对象入组后的第1、3、6个月进行随访，采用二元logistic回归模型来探索干预对戒烟结局的影响。调整协变量的二元logistic回归分析结果显示，各随访时间点，干预组的戒烟结局指标均显著优于对照组；与对照组相比，6个月后干预组实现持续戒烟的可能性显著提高(aOR=2.44，95%CI:1.08，5.50)，尝试戒烟的可能性显著提升(aOR=5.01，95%CI：3.14，7.99），实现减烟的可能性显著提高(aOR=2.99，95%CI：2.00，4.45），随访时七天内不吸烟的可能性明显提高(aOR=3.76，95%CI：2.04，6.90）。本研究结果为中医戒烟疗法纳入社区戒烟服务提供了重要的公共卫生参考，为进一步发展戒烟干预模式提供了创新的观点和实证证据。

For more information: https://weekly.chinacdc.cn/en/article/doi/10.46234/ccdcw2025.248