Geographic study of mortality,
biochemistry,
diet and lifestyle in rural China
(Surveys in 1983, 1989 and 1993 of
biochemistry, diet and lifestyle in 69 nationally representative rural
counties, and correlations with cause-specific death rates in those counties in
1973-75 and 1986-88)
Principal investigators: Chen Junshi (Chinese Academy of Preventive Medicine),
Liu Boqi (Chinese Academy of Medical Sciences), Pan Wenharn (Academia Sinica),
Colin Campbell (Cornell University) and Richard Peto (University of Oxford)
Objectives: To describe the wide variation across 69 rural
Chinese counties in diet, lifestyle, blood and urine biochemistry and mortality
rates, characterising each county by the average of the characteristics of
those living there (so the chief comparisons are between counties, not between
individuals).
Design: (i) Surveys in 1983 and 1989 of individuals and
households in two randomly chosen villages in each of 69 rural Chinese
counties; and (ii) determination of cause-specific mortality rates in the whole
of each of those counties for 1973-75 and 1986-88.
Techniques: (i) 8000 adults (60 per village x 2 villages x 69
counties) were interviewed at length and provided blood and urine samples, and
a 3-day weighed dietary survey was completed for 4000 households (30 per
village x 2 x 69). The whole survey was performed twice, in 1983 [1] and in
1989, allowing reproducibility to be assessed, and in 13 of the counties it was
repeated again 4 years later. (ii) The 1973-75 county-specific mortality rates
were obtained from another study [2,3], and the 1986-88 mortality rates from a
review of 300,000 individual death records [4]. Several hundred descriptive
variables have been constructed and the mean values of them for each county
have been tabulated, correlated and plotted.
Measurements: (i) Six interviewer-administered questionnaires
recorded individual characteristics (social factors, diet, health, smoking,
alcohol consumption, other aspects of lifestyle, height, weight, blood
pressure, lung function, etc), household characteristics (family structure,
physical characteristics of the house, income, amenities, 3-day food
consumption, cooking and heating fuel, etc), and village and county
characteristics (location, climate, economic level, etc). Special surveys were
done in each county of maternal education, infant feeding patterns, and height
for age in schoolchildren. Laboratory measurements were made of various blood
lipids, proteins, trace elements, antibodies (and, for hepatitis B, the surface
antigen), cotinine and fatty acid profile (from red blood cell membranes).
Among men, urinary cotinine, electrolytes and aflatoxin metabolites were also
measured, and proline load tests were done to assess ascorbate-inhibitable
gastric nitrosation rates. (ii) Age-standardised cause-specific mortality rates
(1973-75, 1986-88) were calculated for each county.
Implications: The chief purpose is to describe the wide range of
differences between different counties in lifestyles and disease-specific
mortality rates in rural China, rather than to analyse differences between
counties in search of direct evidence of causes. A few of the
"ecological" (i.e. geographic) correlations of particular factors
with particular diseases do yield good evidence of causality, but the real
importance of this study is purely descriptive: better appreciation of the
extraordinarily wide range of lifestyles and of disease rates across different
Chinese counties will lead to more specific studies.
- Chen J, Campbell TC, Li J, Peto R. Diet,
lifestyle and mortality in China. Oxford University Press, Oxford, Cornell
University Press, Ithaca, and People's Publishing House, Beijing, 1990
- Editorial Committee for the Atlas of Cancer
Mortality. Atlas of Cancer Mortality in the People's Republic of China.
China Map Press, 1979
- Zhou Y (chief editor). Atlas of mortality from
main death causes in China. China cartographic publishing house. Tongji
Medical University, Wuhan 1990
- Liu B, Peto R, Chen Z, Boreham J, Wu Y, Li J,
Campbell TC, Chen J. Emerging tobacco hazards in China: 1. Retrospective
proportional mortality study of one million deaths. Br Med J 1998; 317:
1411-22
Return back to Monograph of the
1989 results | CTSU home