Study on Environmental and Lifestyle Factors for the North–South Differential of Cardiovascular Disease in China

Abstract

Human death and life span are closely related to the geographical environment and regional lifestyle. These factors considerably vary among counties and regions, leading to the geographical disparity of disease. Quantitative studies on this phenomenon are insufficient. Cerebrovascular and heart diseases are the leading causes of death. The mortality rate of cerebrovascular and heart diseases is statistically higher in northern China than in southern China; the p-value of t-test for cerebrovascular and heart diseases was 0.047 and 0.000, respectively. The population attribution fraction of 12 major risk factors for cardiovascular disease (CVD) in each province was calculated based on their exposure and relative risk. The results found that residents in northern China consume high sodium-containing food, fewer vegetables, and less sea food products, and tend to be overweight. Fine particulate matter is higher in northern China than in southern China. Cold temperatures also cause a greater number of deaths than hot temperatures. All these factors have resulted in a higher CVD mortality rate in northern China. The attributive differential for sodium, vegetable, fruit, smoking, PM2.5, omega-3, obesity, low temperature, and high temperature of heart disease between the two parts of China is 9.1, 0.7, −2.5, 0.1, 1.4, 1.3, 2.0, 4.7, and −2.1%, respectively. Furthermore, the attributive differential for the above factors of cerebrovascular disease between the two parts of China is 8.7, 0.0, −5.2, 0.1, 1.0, 0.0, 2.4, 4.7, and −2.1%. Diet high in sodium is the leading cause of the north–south differential in CVD, resulting in 0.71 less years of life expectancy in northern compared with that in southern China.

The prevalence of MAFLD and its association with atrial fibrillation in a nationwide health check-up population in China

“…In an effort to mitigate the risk and reduce the burden of disease in such a vast country, it is important to understand that the population risk varies geographically. First, geographical differences could be explained by temperature related different agricultural patterns (e.g., more maize, beans, and livestock in northern China) and associated socioeconomic structures and dietary patterns (northern China had lower vegetable intake, lower intake of seafood products and higher obesity and overweight rate), which lead to more general metabolic disturbances ( 40 , 41 ). Next, compared with Han residents, NAFLD were more prevalent in the Hui, Uygur populations, Taiwan and the northwest region of mainland in China ( 9 ).…”

Age, sex, residence, and region-specific differences in prevalence and patterns of multimorbidity among older Chinese: evidence from Chinese Longitudinal Healthy Longevity Survey

“…This may be due to the high-sodium diet, geographic and environmental factors affecting older people in the North. The higher number of high-income households in the northern region of this study may also have a more disruptive lifestyle [ 35 , 36 ]. Severe air pollution and malnutrition in the population have contributed to a pattern of cardiopulmonary disease that is more common in the West [ 37 ].…”

Prevalence of hypertension in endemic and non-endemic areas of Keshan disease: A cross-sectional study in rural areas of China

“…When the temperature dropped by 1°C, the SBP and DBP for the total population rose by 0.55 and 0.26 mmHg, respectively ( 37 ). Moreover, residents in the north of China had 2.32 g more sodium daily than those in the south of China ( 38 ). One study reported that individuals with hypertension or normal blood pressure could lower their blood pressure by moderately reducing their salt intake for 4 weeks or more ( 39 ).…”