The Consequences of Industrialization: Evidence from Water Pollution and Digestive Cancers in China

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A Survey of Weak Instruments and Weak Identification in Generalized Method of Moments

James H Stock, Jonathan Wright, Motohiro Yogo (2002)

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Mortality registration and surveillance in China: History, current situation and challenges

Gonghuan Yang, Jianping Hu, Ke Rao … (2005)

Background Mortality statistics are key inputs for evidence based health policy at national level. Little is known of the empirical basis for mortality statistics in China, which accounts for roughly one-fifth of the world's population. An adequate description of the evolution of mortality registration in China and its current situation is important to evaluate the usability of the statistics derived from it for international epidemiology and health policy. Current situation The Chinese vital registration system currently covers 41 urban and 85 rural centres, accounting for roughly 8 % of the national population. Quality of registration is better in urban than in rural areas, and eastern than in western regions, resulting in significant biases in the overall statistics. The Ministry of Health introduced the Disease Surveillance Point System in 1980, to generate cause specific mortality statistics from a nationally representative sample of sites. Currently, the sample consists of 145 urban and rural sites, covering populations from 30,000 – 70,000, and a total of about 1 % of the national population. Causes of death are derived through a mix of medical certification and 'verbal autopsy' procedures, applied according to standard guidelines in all sites. Periodic evaluations for completeness of registration are conducted, with subsequent corrections for under reporting of deaths. Conclusion Results from the DSP have been used to inform health policy at national, regional and global levels. There remains a need to critically validate the information on causes of death, and a detailed validation exercise on these aspects is currently underway. In general, such sample based mortality registration systems hold much promise as models for rapidly improving knowledge about levels and causes of mortality in other low-income populations.

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Spatial analysis of air pollution and mortality in Los Angeles.

Daniel Krewski, Richard Burnett, Yuanli Shi … (2005)

The assessment of air pollution exposure using only community average concentrations may lead to measurement error that lowers estimates of the health burden attributable to poor air quality. To test this hypothesis, we modeled the association between air pollution and mortality using small-area exposure measures in Los Angeles, California. Data on 22,905 subjects were extracted from the American Cancer Society cohort for the period 1982-2000 (5,856 deaths). Pollution exposures were interpolated from 23 fine particle (PM2.5) and 42 ozone (O3) fixed-site monitors. Proximity to expressways was tested as a measure of traffic pollution. We assessed associations in standard and spatial multilevel Cox regression models. After controlling for 44 individual covariates, all-cause mortality had a relative risk (RR) of 1.17 (95% confidence interval=1.05-1.30) for an increase of 10 mug/m PM2.5 and a RR of 1.11 (0.99-1.25) with maximal control for both individual and contextual confounders. The RRs for mortality resulting from ischemic heart disease and lung cancer deaths were elevated, in the range of 1.24-1.6, depending on the model used. These PM results were robust to adjustments for O3 and expressway exposure. Our results suggest the chronic health effects associated with within-city gradients in exposure to PM2.5 may be even larger than previously reported across metropolitan areas. We observed effects nearly 3 times greater than in models relying on comparisons between communities. We also found specificity in cause of death, with PM2.5 associated more strongly with ischemic heart disease than with cardiopulmonary or all-cause mortality.