1 How to avoid premature death

The US traffic safety authority (NHTSA) estimates that seat belts cut the risk of fatal injury for front-seat car occupants by 45%. For front-seat occupants of light trucks, the cut is 60%. Of the people who died in passenger vehicles (cars that carry people) in the US in 2022 and whose belt use could be determined, 50% were not belted. The World Health Organization (WHO) figure is that seat belts reduce the risk of death for people in the vehicle by up to 50%. WHO estimates that 248,099 people died in road traffic crashes in China in 2021, equal to 17.4 deaths per 100,000 people. In the National Bureau of Statistics yearbook, road traffic deaths in 2021 were 62218

Cochrane pooled data from multiple studies. For motorcyclists wearing helmets, the risk of death fell by 42%. The original odds ratio was 0.58, with a 95% confidence interval ranging from 0.50 to 0.68. Head injuries were reduced by 69% (odds ratio 0.31; 95% CI 0.25–0.38).

A study in North Carolina examined homes that had experienced fires versus those that hadn’t. It found that having a working smoke alarm lowered the death risk by about 60%. The odds ratio was 0.39, with a 95% confidence interval ranging from 0.18 to 0.83. Between 2018 and 2020, of fatal fires in occupied homes in the US, 24% happened in homes without smoke alarms, and in 41% people were asleep when the fire started. In 2018, China reported 11,523 deaths from carbon monoxide poisoning; of these deaths, 72.59% of those in December, 67.42% of those in January and 66.48% of those in February happened at home.

The regulations designate “promptly replacing gas appliances and connecting hoses that have been phased out by the state or have exceeded their service life” as a user obligation; this means you must replace any stove or hose that has reached its expiration date or been discontinued. The same regulations also classify “unauthorized installation, modification, or removal of indoor gas facilities and metering devices” as prohibited actions, which includes any DIY attempts to alter piping or remove gas meters. Furthermore, the regulations explicitly forbid gas operators from requiring users to buy the products they designate or to accept the services they provide.

The China CDC investigated 828 mushroom poisoning incidents in 2025, involving 2,165 people, with 13 deaths. The case fatality rate was 0.6%, meaning 0.6% of poisoned people died. From 2019 to 2024 there were 276 to 676 incidents a year, with the case fatality rate between 0.87% and 2.86%. In 2025 alone, 138 poisonous mushroom species were identified, 34 of them recorded in China for the first time as causing poisoning. The China CDC’s public education material rejects the folk identification methods one by one. Only brightly colored ones are poisonous: wrong, whether a mushroom is poisonous has nothing to do with its color. Ones that insects have eaten or that have maggots are safe: wrong, many deadly mushrooms are also eaten by insects once mature. Ones that change color when boiled with silver or garlic are poisonous: wrong, mushroom toxins contain no sulfur, and a silver needle turns black because of sulfur. High-temperature frying removes the toxin: also unreliable. Its conclusion is “there is currently no simple, quick and effective way to tell whether a mushroom is poisonous”. The Beijing Municipal Market Regulation Administration’s 2026 notice says that if you feel unwell after eating one by mistake, “seek medical care immediately and do not treat yourself”, and keep the remaining mushrooms and food residue so that doctors can identify the poison

A Ministry of Emergency Management rule bans it in so many words: “It is forbidden to park electric bicycles, or charge them, in the public lobbies, evacuation corridors, stairwells and safety exits of high-rise civil buildings.” In the building lobby, corridor, stairwell and safety exit, you may neither park nor charge. Those who refuse to correct it are fined 500 to 1000 yuan if they are an individual or unit not in business, and 2000 to 10,000 yuan if in business. This rule does not cover elevators or the inside of the home. In a reply to a National People’s Congress delegate, the Ministry said that parking and charging e-bikes and batteries indoors in violation of the rules is listed as a focus of the clean-up of major fire hazards. What it tells the public about is the danger of “vehicles into buildings, cables out of homes, self-dismantling and modification”. Elevators are covered by local regulations: from 1 May 2025, Beijing bans taking e-bikes and charging batteries into elevator cars, and fines individuals 500 to 1000 yuan for refusing to correct it

Data from 123 clinical trials involving over 610,000 participants shows that a 10 mmHg reduction in systolic blood pressure lowers the incidence of major cardiovascular events by roughly 20%. The relative risk is 0.80, with a 95% confidence interval of 0.77–0.83. Systolic blood pressure is the higher of the two readings taken during a measurement. Stroke risk drops by 27% (RR 0.73), heart failure risk drops by 28% (RR 0.72), and overall mortality drops by 13% (RR 0.87, 95% CI 0.84–0.91). A screening program in China involving 1.7 million adults aged 35–75 found that 44.7% had hypertension; of these, 44.7% were aware of their condition, 30.1% were receiving treatment, and only 7.2% had their blood pressure under control.

The US Preventive Services Task Force is the US official body that gives screening recommendations. Its current recommendation is to screen adults aged 35 to 70 who are overweight or obese for prediabetes and type 2 diabetes, even if they have no symptoms at all. Overweight means a BMI of 25 or higher, and obesity means 30 or higher. For Asian Americans, it recommends lowering the threshold to a BMI of 23 or higher, because at the same BMI, Asians have a higher diabetes risk. China’s industry standard is that a BMI from 24.0 to 28.0 counts as overweight and 28.0 or higher counts as obese. The recommendation is rated B. It also states: “For adults with normal blood glucose, screening once every 3 years is a reasonable approach”

According to the World Health Organization (WHO), for each 1% rise in average speed, the risk of a fatal crash rises by 4%. The risk from drink-driving starts to rise from a very low blood alcohol concentration. WHO also says drivers who use a phone are about 4 times as likely to crash as those who do not, and using hands-free is not much safer. A US study fitted cameras in the cars of more than 3,500 drivers and recorded 905 crashes that injured people or damaged vehicles. The comparison was driving clips from when the driver was alert, attentive and not drinking. All the phone-handling actions combined gave 3.6 times the odds of a crash (OR 3.6). Dialing was 12.2 times, typing a message 6.1 times, reaching for the phone 4.8 times, browsing 2.7 times, and handheld talking 2.2 times. Clearly visible drowsiness on the video was 3.4 times (OR 3.4)

The U.S. National Highway Traffic Safety Administration (NHTSA) estimates that car seats lower the risk of fatal injury for infants under one year old in passenger cars by 71% and for children aged 1 to 4 by 54%. The World Health Organization reports a similar 71% reduction in infant deaths.

From 1972, New York City ran a program called “Kids Can’t Fly,” which distributes free window guards in high-risk neighborhoods and offers on-site safety guidance. Between 1973 and 1975, child fall incidents reported in the Bronx dropped by 50%. Afterwards, New York updated its health code to make it mandatory for landlords to install window guards in apartments housing children aged 10 or under.

A study using US Coast Guard data matched people in similar conditions and compared them. Among people who fell into the water from recreational boats, those wearing a life jacket had about half the risk of drowning. The figure is an adjusted RR of 0.51, 95% CI 0.35 to 0.74. In China, the drowning death rate for people under 20 fell from 6.60 per 100,000 in 2013 to 3.28 per 100,000 in 2021. The rural rate is about 2 times the urban rate. In 2021 it was 3.84 per 100,000 in rural areas and 2.01 in cities. Drowning is still the leading cause of death for children aged 1 to 14. In 2021 the drowning death rate for ages 1 to 14 was 3.23 per 100,000, which is 0.99 higher than road traffic injury in second place. In 2021, among injury deaths at ages 0 to 19, drowning accounted for 31.1% and road traffic for 27.9%. The 15 to 19 age group had the highest drowning death rate, 3.95 per 100,000, of which males were 5.99

Cochrane analyzed 108 separate trials involving 23,407 participants. Collectively, these studies show that regular exercise lowers fall rates among older adults by 23%. The fall rate ratio (RaR) was 0.77, with a 95% confidence interval ranging from 0.71 to 0.83. The proportion of individuals experiencing at least one fall also fell by 15% (relative risk 0.85). Having someone come to do a home safety assessment and modifications reduced fall rates by roughly 20% (RR 0.81; 95% CI 0.68–0.97). Practicing Tai Chi specifically lowered fall risk by about 29% (RR 0.71). In China, falls remain the top cause of injury-related mortality for seniors aged 65 or older; data from 2018 indicates that 55.97% of all falls among this age group occur at home.

The Qidong trial was randomized by group, not by individual, and followed people for 30 years. Vaccinating newborns against hepatitis B cut primary liver cancer by 84%. The 95% CI is 23% to 97%. The positive rate of hepatitis B surface antigen (HBsAg) fell by 72% (95% CI 68% to 75%); this positive rate is the share of people found to be carrying the virus. In the control group, 67.8% of people were vaccinated late, at ages 10 to 14. The efficacy of late vaccination against HBsAg positivity in early adulthood was only 21% (95% CI 10% to 30%), much weaker than vaccination at birth. In China’s whole population, the HBsAg positive share fell by 52% from 1992 to 2014, and by 97% in children 5 or younger. These numbers cannot be applied directly to catch-up vaccination in adults. People with a normal immune system who completed the full course and once produced protective antibodies still have immune memory after antibodies fall, and usually do not need a booster. Immune memory means that the body can quickly mobilize its defenses when it meets the virus again. Whether to catch up depends on the vaccination record, the surface antigen, the surface antibody and the core antibody. If the vaccination history is unclear, go to a vaccination clinic for assessment.

In the U.S., roughly 1 out of every 10 tetanus cases ends in death. Deep wounds and those exposed to dirt carry an even higher risk. China’s 2024 treatment guidelines classify wounds into two categories. Shallow wounds treated within 6 hours that have no soil, feces or animal saliva on them are considered low-risk. Wounds treated later, or those contaminated with such substances, as well as puncture wounds, avulsions, crush injuries, burns, frostbite, or wounds containing foreign bodies, are deemed high-risk. If you’ve received three or more tetanus shots and the most recent one was less than 5 years ago, no further dose is needed. For high-risk wounds, a booster is required if it’s been 5–10 years since your last shot; after 10 years, a booster is mandatory regardless of risk level. If you’ve never completed the three-dose series or can’t remember, you’ll need to finish the series and, for high-risk wounds, also receive passive immunization (an injection of immunoglobulin or antitoxin that delivers antibodies directly).

Swedish research on 1.67 million women found that vaccinated individuals have a lower incidence of invasive cervical cancer. For those vaccinated before age 17, the incidence was roughly 88% lower (IRR 0.12, 95% CI 0.00 to 0.34; the figures in brackets are the raw value and its credible range). Vaccination between 17 and 30 still lowers risk by about 53% (IRR 0.47, 95% CI 0.27 to 0.75). The World Health Organization sets girls aged 9 to 14 who have not had sex as the priority group for vaccination.

The US Preventive Services Task Force is the body that gives official US screening recommendations. Its current recommendation reads: “We recommend that women aged 40 to 74 have screening mammography every two years.” Mammography is what is usually called a mammogram (钼靶). The recommendation is rated B. For women aged 75 and over, and for adding ultrasound or MRI for dense breasts, it judged the evidence to be “insufficient”. China’s 2021 breast cancer screening guideline recommends that women at average risk start at 45 and be screened every 1 to 2 years. High-risk women start at 40 and are screened every year

This trial in rural India used group-level rather than individual randomization, involving women aged 30–59. A single HPV test cut the risk of death from cervical cancer by roughly 48% (hazard ratio 0.52; 95% CI 0.33–0.83). It also reduced the likelihood of detecting late-stage disease by about 53% (HR 0.47, 95% CI 0.32 to 0.69). For the interval between tests, see the 2018 recommendation of the US Preventive Services Task Force: for women aged 30 to 65 who have testing for high-risk HPV types alone, test every 5 years

Cochrane pooled data from multiple studies showing that individuals undergoing fecal occult blood screening have a roughly 16% lower risk of dying from colorectal cancer. The original RR was 0.84, with a 95% CI ranging from 0.78 to 0.90. For those who’ve had at least one screening round, this risk reduction reaches 25% (RR 0.75). The NordICC randomized trial likewise found that among participants invited to get a colonoscopy, colorectal cancer incidence dropped from 1.20% to 0.98% over 10 years; its RR was 0.82, with a 95% CI of 0.70–0.93.

This trial randomly assigned 2,571 participants to groups after a myocardial infarction; neither doctors nor patients knew who got the vaccine or the placebo. Over 12 months, the overall death rate was 2.9% in the vaccine group versus 4.9% in the placebo group. A placebo is a control shot with no active ingredient. The hazard ratio was 0.59, with a 95% confidence interval of 0.39 to 0.89. Cardiovascular death rates also showed a hazard ratio of 0.59. Another study pooled multiple studies and found that flu vaccination lowered the rate of major cardiovascular events to 3.6% from 5.4% in the control group; the relative risk was 0.66, with a 95% confidence interval of 0.53 to 0.83. Cardiovascular death risk showed a relative risk of 0.74, though this fell within the margin of error and was not statistically significant (95% CI 0.42 to 1.30).

This Phase 3 trial involved 15,400 participants from 18 countries. Participants were randomly assigned to receive either the vaccine or a placebo, with follow-up lasting an average of 3.2 years. Over that time, 6 cases of shingles occurred in the vaccine group versus 210 in the placebo group. Expressed per 1,000 person-years, these figures translate to 0.3 versus 9.1 cases. One thousand person-years represents the number of cases observed in a group of 1,000 people over one year. The original report states, “The overall vaccine efficacy against shingles is 97.2% (95% CI 93.7–99.0, P<0.001).” Efficacy ranged from 96.6% to 97.9% across all age brackets. Within 7 days after the injection, reactions at the injection site and throughout the body were more common in the vaccine group. Grade 3 symptoms (the most severe grade) were reported by 17.0% in the vaccine group and 3.2% in the placebo group. The proportions with serious adverse events and deaths were similar in the two groups

Researchers in the Netherlands randomly assigned 84,500 seniors aged 65 or older to two groups for comparison. They used the 13-valent pneumococcal conjugate vaccine. Its effectiveness against pneumonia caused by strains it targets was 45.6%, with a 95.2% confidence interval of 21.8–62.5. This figure refers to the specific bacterial strains the vaccine can protect against. For invasive pneumococcal disease, the effectiveness was 75.0% (95% CI 41.4–90.8). This is the most dangerous kind of infection. Against pneumonia from all causes added together, it had no effect.

This randomized trial in Linqu, Shandong, followed participants for 22 years. Those who underwent Helicobacter pylori eradication therapy saw their risk of gastric cancer drop by nearly half. The original odds ratio was 0.48, with a 95% confidence interval ranging from 0.32 to 0.71. Their risk of dying from gastric cancer also fell by roughly 38% (hazard ratio 0.62; 95% CI 0.39–0.99).

The NLST trial in the U.S. enrolled 53,454 participants aged 55–74 with at least 30 pack-years of smoking history and who had quit smoking no more than 15 years earlier. A pack-year is a unit for the amount smoked: one pack a day for one year is one pack-year. The results were as follows. Those who underwent low-dose CT had a 20.0% relative reduction in lung cancer deaths versus those who only got chest X-rays. The 95% confidence interval is 6.8–26.7. Overall mortality dropped by 6.7% relative to controls, with a 95% CI of 1.2–13.6. Each person was screened three years in a row. Across the three rounds combined, 24.2% of low-dose CT exams were suspicious. Of the suspicious results, 96.4% were false alarms (false positives)

A review that went systematically through nearly 10 years of research found that the evidence on limiting people’s access to lethal means has kept growing stronger. After painkillers were controlled, suicides linked to painkillers fell by 43%. Where people often jump from buildings, adding protection cut them by 86% (79% to 91%; the brackets give the credible range of this number). School-based cognitive programs lowered suicide attempts by about 55% (OR 0.45, 95% CI 0.24 to 0.85). Medicine and psychological treatment for depression are an important part of preventing suicide. From 1 May 2025, dialing 12356 anywhere in China connects to a psychological assistance hotline, open at least 18 hours every day

The Emergency Management Department’s “National Recommended List of Basic Household Emergency Supplies” contains 11 items in total. Among them, “fire extinguishers and fire blankets” are recommended for “putting out small fires at the initial stage”, and the list also notes that “fire blankets can be draped over the body to aid escape”. The “escape respirators” listed are “firefighting filtering self-rescue respirators designed for use during fire escapes”. “External medical supplies” refer to “hemostatic powder, adhesive bandages, gauze bandages, and other items used to treat wounds”. Cochrane analyzed 98 studies involving 2,605,044 participants in total. Home safety interventions lowered injury rates to an IRR of 0.89; the 95% confidence interval for this figure is 0.78 to 1.01. For interventions that included on-site guidance, injury rates dropped by around 25% (IRR 0.75, 95% CI 0.62 to 0.91).

A UK study analyzed electronic medical records from primary-care clinics, comparing 4,915 patients diagnosed with bladder cancer against 21,718 controls. Among patients with visible blood in urine, the proportion ultimately found to have bladder cancer was 2.8% for those aged 60+, with a 95% confidence interval of 2.5–3.1. For ages 40–59, the figure was 1.2%, with a 95% CI of 0.6–2.3. This proportion is called the positive predictive value. Blood in the urine that can be seen only under a microscope also matters. The odds ratio is 20, with a 95% CI of 12–33. For people aged 60 and over, this proportion is 1.6%, with a 95% CI of 1.2–2.1. The UK National Health Service (NHS) says that blood in the urine can be a sign of cancer and must be checked. Even with no other symptoms, a first occurrence or a small amount, make an appointment with a doctor as soon as possible

One meta-analysis combined data from 14 long-term studies involving 92,757 men, followed for an average of 6.1 years. Compared with men without erectile dysfunction, those with the condition faced higher risks as follows: overall cardiovascular events rose by roughly 44% (RR 1.44, 95% CI 1.27–1.63). Heart attacks increased by about 62% (RR 1.62, 95% CI 1.34–1.96). Cerebrovascular events rose by roughly 39% (RR 1.39, 95% CI 1.23–1.57). All-cause mortality went up by about 25% (RR 1.25, 95% CI 1.12–1.39). No significant difference appeared for cardiovascular-related deaths (RR 1.19, 95% CI 0.97–1.46). The risk elevation was greater in younger men and in those whose baseline cardiovascular risk was moderate. Studies that used questionnaire-based diagnosis reported an RR of 1.61 (95% CI 1.38–1.86), while studies asking just one question gave an RR of 1.27 (95% CI 1.18–1.37).

One meta-analysis evaluated six randomized controlled trials involving 740 men. Interventions included lifestyle changes or medication to control cardiovascular risk factors, with follow-ups lasting at least six weeks. Overall, erectile function scores on the IIEF-5 questionnaire rose by an average of 2.66 points (95% CI: 1.86–3.47). When two trials using statins (143 men) were excluded, the remaining four trials (597 men) relying solely on lifestyle changes still showed an average improvement of 2.40 points (95% CI: 1.19–3.61). The IIEF-5 consists of five questions scored from 5 to 25; the original text divides scores into five bands, where 22 to 25 points counts as no dysfunction and 5 to 7 points counts as severe.

One study pooled 25 studies and 10676 heterosexual couples. In each couple one partner had HIV and the other did not (formally called serodiscordant). Compared with people who never used condoms, people who used a condom every time had about 71% lower risk of HIV transmission. The raw figure is RR 0.29, 95% CI 0.20 to 0.43. Compared with people who used them on and off, the risk was about 77% lower (RR 0.23, 95% CI 0.13 to 0.40). The authors conclude that although condoms are not perfect, “consistent use can reduce HIV transmission by more than 70%”. The World Health Organization says that using condoms correctly and consistently is one of the most effective ways to prevent sexually transmitted infections, including HIV. But ulcers on places the condom does not cover, such as syphilis and genital herpes, are not blocked by a condom

Article 23 of the “Regulations on HIV/AIDS Prevention and Control” provides that health authorities of local governments at county level and above designate medical and health institutions, and that these “shall provide free counseling and initial screening tests to people who voluntarily seek HIV counseling and testing”. The point of early testing is not psychological comfort: modern antiretroviral therapy can drive the virus down to undetectable levels. The World Health Organization states that “people with HIV on antiretroviral treatment with an undetectable viral load do not pass HIV to their sexual partners”. The PARTNER study observed 782 same-sex couples (serodiscordant pairs) for a total of 1,593 couple-years (the years each couple was followed, added up); despite 76,088 unprotected encounters, only 15 new infections occurred, and genetic analysis proved none originated from the partner. Article 39 of the Regulations provides: “Without the consent of the person or their guardian, no organization or individual may make public the name, address, workplace, portrait or medical history of people living with HIV, AIDS patients or their family members, or other information from which their identity could be inferred.”

82 people who had attempted suicide were interviewed within 3 days of admission. 47.6% (39 people) said that from the first time the suicidal thought appeared on this occasion to actually acting, no more than 10 minutes passed. People whose process ran longer had clearly higher suicidal-intent scores. The score on the impulsivity scale had no relation to how long the process was. 76.8% (63 people) said that during this time they had some kind of contact with a partner, family member or friend. The authors conclude that the window in which one can intervene is usually very short, and that professionals have limited room to step in at this stage. They therefore argue for spreading the recognition of signals and the methods of intervention to ordinary people. Another systematic review pooled 90 follow-up studies. Among people seen for self-harm, the median proportion who harmed themselves again without dying within 1 year was 16%. The proportion who died by suicide at 1 year was 2%. In follow-up of 9 years or more, about 7% died by suicide

A systematic review of paraquat poisoning: the case fatality is extremely high, because the substance is itself very toxic and there is no effective treatment. It is actively carried into lung tissue against the concentration gradient (formally, active uptake against the concentration gradient), leading to pneumonitis and pulmonary fibrosis. It also causes kidney injury and liver injury. The review states that gastric lavage should not be done. Hemodialysis and hemoperfusion are unlikely to change the clinical course. The evidence for steroids and immunosuppressants is very weak. The review adds one sentence: “case fatality is high in all centers, although treatment differs widely”. Ten tertiary hospitals in Bangladesh took in 1420 cases from 2013 to 2024, of which 257 could be analyzed: the case fatality was 43.2%. Common presentations were leg swelling from acute kidney failure 71.2%, vomiting 65.8% and abdominal pain 58.0%. The trial in acute carbon monoxide poisoning was a double-blind randomized trial with 76 people in each of the two groups. Neither doctors nor patients knew which group they were in. At six weeks, the number left with cognitive sequelae was 19/76 (25.0%) in the hyperbaric oxygen group and 35/76 (46.1%) in the normobaric oxygen group, P=0.007. After adjusting for other factors, OR 0.45 (95% CI 0.22 to 0.92; the brackets give the credible range of this number). Another study followed 73 consecutive cases: 30% had cognitive sequelae and 12% showed white matter hyperintensities. China revoked the registration and production licence for paraquat aqueous solution from 1 July 2014 and stopped its production. From 1 July 2016, the aqueous solution has not been sold or used in China. From 26 September 2020, the sale and use of the soluble gel formulation within China is banned. The document states that “suicides by taking paraquat occur from time to time” was the direct reason for tighter regulation

A trauma ICU (intensive care unit) in southern Xinjiang compiled statistics. From April 2020 to July 2024 it took in 289 cases of falls from a height. The average age of this group was 40.3. The median fall height was 3 meters; 26.6% fell from 5 meters or more, and 11.4% from 10 meters or more. The median injury severity score (ISS) was 24; the higher this score, the more severe the injury, and 63.3% of patients had an ISS above 20. 47.1% had injuries to 3 or more parts, and 18.3% to 4 or more. 36% needed a ventilator (mechanical ventilation), for a median of 103.5 hours. The median stay in the ICU was 8 days, the shortest 1 day and the longest 132 days. In-hospital or 30-day mortality was 5.5% (16/289). A trauma center in Germany took in 84 multiple-trauma patients with an ISS of 25 or more (multiple trauma means injury to several parts at the same time). The proportion who returned to work during follow-up was 58%. Age, length of ICU treatment and self-rated health were the predictors. In 2024 the average cost per hospital stay nationwide (the average money spent per admission) was 9870.0 yuan, down 4.3% from the previous year at that year’s prices. In the same year, total national health expenditure was 9,089.55 billion yuan, of which out-of-pocket health spending was 2,500.75 billion yuan, or 27.5%

The US compared 96,217 living kidney donors with 20,024 healthy non-donors in similar condition. The latter came from the US National Health and Nutrition Examination Survey (NHANES III). Look at the estimated risk of reaching kidney failure 15 years after donation. For donors it is 30.8 per 10,000 people, 95% CI 24.3–38.5. For healthy non-donors it is 3.9 per 10,000 people, 95% CI 0.8–8.9, P<0.001. The formal name for kidney failure is end-stage renal disease (ESRD); at this stage one has to depend on dialysis or a transplant. Estimated lifetime risk of reaching ESRD: donors 90 per 10,000 people, the unscreened general population 326 per 10,000 people, and healthy non-donors 14 per 10,000 people. Norway also made a comparison. On one side were 1901 kidney donors, with a median follow-up of 15.1 years. On the other side were 32,621 controls who were eligible to donate, with a median follow-up of 24.9 years. All-cause death was about 30% higher in donors (HR 1.30, 95% CI 1.11–1.52). Cardiovascular death was about 40% higher (HR 1.40, 1.03–1.91). Reaching ESRD was around ten times higher (HR 11.38, 4.37–29.6). The overall incidence of ESRD in this donor group was 302 cases per million people. In the US there were another 3698 kidney donors, of whom 11 developed ESRD, which equals 180 cases per million people observed for one year, against 268 in the general population over the same period. In this group, 255 people came back for a check on average 12.2±9.2 years after donating. Of them, 85.5% had a kidney filtration rate (GFR) of ≥ 60 ml/min/1.73 m². 60 is the lower limit of clinically normal. 32.1% had high blood pressure. 12.7% had proteinuria (protein leaking into the urine). In Chennai, India, 305 people who had sold a kidney were surveyed, on average 6 years after the sale: 96% sold to pay off debts, and received on average 1070 US dollars. After the kidney was removed, average family income fell by one third (P<0.001), the number of people living below the poverty line rose, and three quarters were still in debt at the time of the survey. 86% reported that their health was worse than before the kidney was removed, and 79% would not advise others to sell a kidney

The public education material of the National Nuclear Safety Administration says that a radioactive source is solid radioactive material permanently sealed in a container or covered by a tight cladding. Industrial level gauges, flaw detectors and hospital gamma knives all use this kind. A Category III source, without protection, can cause permanent injury after a few hours of contact and can kill in days to weeks. X-rays cannot be seen, and gamma rays are electromagnetic waves like them. Protection against external exposure relies on three things: shorten the time, increase the distance, and add shielding. Gamma rays penetrate strongly, and only a thick concrete wall or lead can stop them. As of 2025, there are about 178,000 radioactive sources in use and 355,000 radiation devices (sets) nationwide. The annual rate of accidents with radioactive sources is stable at at most 1 per 10,000 sources. The classification is as follows. Loss, theft or loss of control of a Category I or II source makes a major radiation accident. Category III makes a relatively serious radiation accident. Loss or theft of a Category IV or V source, or exposure of people above the annual dose limit, makes a general radiation accident. Official case: in June 2020, the ironmaking plant of the Ningxia Iron and Steel Group was doing gamma-ray flaw detection on a blast furnace pipeline renovation project. A Category II iridium-192 source exposed three workers. Chen had Grade III acute radiation skin injury of the left hand. Liu had Grade IV in the left thumb and index finger, and Grade III in the middle, ring and little fingers. Fan had Grade I-II in the left hand. The doses to all three seriously exceeded the dose limits in the national standard. The two responsible units had their radiation safety licences revoked and were fined 70,000 yuan. International case: in 1987 in Goiânia, Brazil, a teletherapy machine in an abandoned clinic was taken apart. The cesium-137 source of 50.8 TBq inside was taken out, and the sealed capsule holding the source was broken. About 112,000 people were monitored. Of them, 249 were contaminated inside or outside the body. Of these 249, 129 were moderately to severely contaminated and 50 needed close medical monitoring. In the end 4 people died (national / international)

A nationwide Swedish registry study examined 2,099 individuals diagnosed with gambling disorder in specialist care between 2005 and 2016. Gambling disorder is defined as an inability to control gambling habits, which negatively impacts daily life. Compared to the general Swedish population aged 20–74, these individuals showed a 1.8-fold increase in overall mortality and a 15-fold increase in suicide mortality (these figures represent standardized mortality ratios). Over the follow-up period, 67 participants died, including 21 from suicide. What predicted death by suicide was depression. In a 2023 correction, researchers reported that the suicide risk was 12.1 times higher for men and 16.1 times higher for women. Starting May 1, 2025, China launched a nationwide mental health hotline at 12356, available at least 18 hours per day.

This medication is a fixed-dose combination of emtricitabine and tenofovir. In the iPrEx trial, 2,499 men who have sex with men and transgender women were assigned to either take this drug daily or receive a placebo. The group taking the medication saw a 44% reduction in infections (95% CI 15–63). Among participants whose blood tests detected the drug, the protective effect was much stronger. The UK’s PROUD trial involved 544 men who have sex with men; those who started treatment immediately had an 86% lower infection rate compared to those who delayed treatment for a year (90% CI 64–96, a 90% credible range). France’s IPERGAY trial evaluated on-demand dosing before and after sex; results showed an 86% drop in infections (95% CI 40–98). A meta-analysis used by WHO pooled the trials and found that overall, the relative risk of infection dropped to 0.49 (0.33–0.73, roughly a 51% reduction). In trials where adherence exceeded 70%, the relative risk fell to 0.30 (0.21–0.45, about a 70% reduction); when adherence stayed below 40%, the relative risk was 0.95, essentially indicating no effect. In August 2020, China’s National Medical Products Administration approved this drug for pre-exposure prophylaxis use in adults and adolescents weighing at least 35 kg (multi-country / China)

The U.S. Preventive Services Task Force 2025 recommendation is osteoporosis screening for women aged 65 and older (Grade B). Postmenopausal women under 65 at high fracture risk by assessment should also be screened (Grade B). Evidence for men is insufficient; no recommendation. The evidence review for that guidance pooled 3 randomized trials with 42,009 older European women. Screening meant assessing fracture risk first, measuring bone density in those at high risk, and treating those found high risk. Hip fractures in the screening group were about 17% lower (RR 0.83, 95% CI 0.73 to 0.93). In absolute terms, screening avoided 5 hip fractures per 1,000 people. In the UK SCOOP trial of 12,483 women aged 70 to 85, hip fractures in the screening group were about 28% lower (HR 0.72, 95% CI 0.59 to 0.89); mortality did not differ. The Chinese Medical Association 2017 guideline recommends DXA for women aged 65 and older and men aged 70 and older, and earlier when osteoporosis risk factors are present. In a 2017–2018 national survey, osteoporosis prevalence among adults aged 40 or older was 20.6% in women and 5.0% in men (China).

Fragility fracture means a fracture from minor trauma or everyday activity. The Chinese Medical Association 2017 guideline lists three groups for treatment: prior fragility fracture of spine or hip; bone density T-score −2.5 or lower regardless of prior fracture; or low bone mass plus fragility fracture of wrist, upper arm, or pelvis, or high calculated fracture risk. The guideline states: "There is currently insufficient evidence that calcium supplementation alone can replace other anti-osteoporosis drug therapy." Cochrane's 2025 update on alendronate in postmenopausal women with osteoporosis or prior fracture found hip fractures about 51% lower in the treated group (RR 0.49, 95% CI 0.25 to 0.96) and symptomatic vertebral fractures about 55% lower (RR 0.45, 95% CI 0.28 to 0.73). The HORIZON trial enrolled 2,127 people mean age 74.5 after hip-fracture surgery; yearly zoledronic acid starting within 90 days post-op, median follow-up 1.9 years. New fractures fell from 13.9% to 8.6% (about 35% relative reduction). Death fell from 13.3% to 9.6% (about 28% relative reduction). The guideline notes about 20% of people die from complications within one year after hip fracture. In the 2017–2018 national survey, only 1.4% of women and 0.3% of men with diagnosed osteoporosis or prior fracture were on medication (China).

The China Meteorological Administration’s public education says that when the ice is 15 cm thick, adults can skate on it. The ice of an open-air rink must also reach 15 cm before it opens. The Beijing Municipal Water Authority says that a regular natural ice rink needs 15 cm of ice, and then for the following week the temperature must stay between -8℃ and 1℃ with no strong wind before it can open. On wild ice there are often holes cut by anglers, and once cut they are hard to freeze solid again. The guidance of the Minnesota Department of Natural Resources covers only new clear ice: under 4 inches (about 10 cm), do not go on; 4 inches allows walking and ice fishing. White ice, formed when melted snow refreezes, is only about half as strong as clear ice, and its thickness must be counted double. On the same water, the ice may be a foot thick here and only one or two inches a few feet away. Ice over moving water is usually dangerous, especially near streams, bridges and culverts. Ice near the shore may also be thinner than farther out. The thresholds the US National Weather Service gives for walking, ice fishing and skating are also 4 inches. The Canadian Centre for Occupational Health and Safety relays the advice of the Canadian Red Cross. A few people skating or walking together need 15 cm, and a crowded skating party needs 20 cm. These are all safety guides, and no study has calculated how many deaths following them prevents (national / US, Canada)

The Canadian Centre for Occupational Health and Safety and a safety body in Queensland, Australia list the following practices. Check the guard and the disc before starting, and do not use a disc with cracks, chips or deformation. The maximum speed marked on the disc must not be lower than the speed marked on the machine, and the diameter and center hole must also fit the machine. Disconnect the power before changing the disc. Fix the thing to be ground or cut in place first. Wear safety glasses or goggles, with a face shield over them. Hold both handles with both hands and stand firmly. A cutting disc must not be used for grinding, because the disc then breaks more easily. Do not put the machine down until the disc has stopped completely. Point sparks and debris toward where no one is, and keep nothing flammable around. The Queensland notice says that the design speed at the edge of a cutting disc is about 70 meters per second. If a large 356 mm disc is fitted to a 230 mm machine, the edge speed reaches at least 120 meters per second, and the disc breaks easily. In February 2016, a local worker using a 230 mm angle grinder was hit in the chest by fragments and died of internal injuries. There are two accident investigation reports in China. In 2019 in Harbin, a worker changed the cutting disc for a toothed saw blade and went to cut a board without fitting the guard. The saw blade caught his trousers and cut the thigh artery, and he died of blood loss. In 2024 in Futian, Shenzhen, a worker used an angle grinder fitted with a wood saw blade, with no guard and no auxiliary handle, to cut a wooden door frame. The machine kicked back and cut the carotid artery, and he died. The national standard cited in the report says “do not attach saw chains, wood carving blades or toothed saw blades”. In South Korea’s emergency injury surveillance from 2011 to 2018, 8697 visits were for injuries from high-speed rotating cutting tools, of which 4603 involved grinder-type tools. Injuries to the hand were 46.4% and to the head 23.0%. Compared with other similar tools, a grinder injury was about twice as likely to become a serious injury (OR 2.07, 95% CI 1.88–2.29). A hospital in Mianyang, Sichuan, admitted 36 inpatients with eye injuries from angle grinders in two years. After surgery and with glasses on, 10 still had best vision below 0.05. Of 742 acute hand and forearm injuries in one year at a hospital in Turkey, angle grinders caused 82. Except for 8, none were injured at work, and 44% were retired people. Of 15 angle grinder injuries at a Japanese trauma center in 2017 to 2018, 9 were misuse such as fitting a saw blade to cut wood. Of these, 2 lost a whole finger and 1 lost a segment (Canada, Australia / China / South Korea, Turkey, Japan)

In New York State, 2,342 students in 6 high schools were randomly assigned by class to two groups. One group’s questionnaire included suicide questions; the other group’s did not. Distress did not differ between the groups right after completion or 2 days later (P = .66 and P = .41; a P above 0.05 means no detectable difference). At 2 days, the share who said they had thought about suicide was 4.7% in the asked group and 3.9% in the not-asked group, with no detectable difference (P = .49). Students with depressive symptoms were less distressed after being asked (P = .01). Students with a previous suicide attempt were less likely to have suicidal thoughts after being asked (P = .02). A 2022 meta-analysis assessed 17 studies and pooled 8 comparisons of “asked” versus “not asked”. After being asked, neither immediately nor later were suicidal thoughts and behaviors, non-suicidal self-harm, or psychological distress significantly increased. The strongest evidence is 8 randomized controlled trials, with low or unclear risk of bias. A 2014 literature review also states that no study found a significant increase in suicidal thoughts after asking

In atrial fibrillation the upper chambers of the heart quiver, and blood pools in them and easily forms clots. A clot that rushes into the blood vessels of the brain is a stroke. The most common symptoms are palpitations, getting tired on activity and discomfort in the chest; about 25% of people also say they have no symptoms. A single-lead ECG of 30 seconds or more, or an ordinary 12-lead ECG of 10 seconds or more, can confirm the diagnosis. A 2007 meta-analysis pooled 29 randomized trials with 28,044 people. Compared with no drug, dose-adjusted warfarin cut strokes by about 60% (by 64%, credible range 49% to 74%). Antiplatelet drugs such as aspirin cut them by only about 20% (by 22%, credible range 6% to 35%). Comparing the two kinds of drug directly, warfarin cut strokes a further 39% against antiplatelet drugs. The absolute yearly increase in major bleeding outside the brain was no more than 0.3%. A Cochrane review looked only at 2313 people who had not had a stroke. Warfarin lowered death by about 30% (OR 0.69, 95% CI 0.50 to 0.94). Four large trials with 71,683 people in all compared the new oral anticoagulants with warfarin. The new drugs cut stroke and embolism by a further 19% (RR 0.81) and death by 10% (RR 0.90). Intracranial bleeding was 52% lower (RR 0.48), but gastrointestinal bleeding was 25% higher (RR 1.25). Aspirin cannot replace an anticoagulant. Among 5599 people unsuitable for warfarin, apixaban cut stroke and embolism by 55% compared with aspirin (HR 0.45). Major bleeding was 1.4% against 1.2% a year, with no visible difference (HR 1.13, credible range 0.74 to 1.75). Another trial enrolled only 973 people aged 75 or older. For fatal or disabling stroke, intracranial bleeding and arterial embolism combined, warfarin was 52% lower than aspirin (RR 0.48). Bleeding outside the brain was 1.4% against 1.6% a year. China’s 2023 atrial fibrillation guideline uses the CHA2DS2-VASc-60 score. Heart failure, high blood pressure, diabetes, vascular disease, age 60 to 64, and being a woman are 1 point each. Age 65 or over and a previous stroke are 2 points each. For men with 2 points or more and women with 3 points or more, an oral anticoagulant is recommended. For men with 1 point and women with 2 points, consider it after weighing the bleeding risk and the person’s own wishes. The guideline does not recommend antiplatelet drugs to prevent strokes caused by atrial fibrillation. The 2023 US guideline states that whether to take one depends on stroke risk, and not on whether the atrial fibrillation comes in episodes or is continuous. It also states that a bleeding risk score must not be used alone to decide against taking one; it should be used to find bleeding factors that can be changed. In China’s 2014 to 2016 survey of people aged 45 and over, atrial fibrillation was found in 1.8%, about 7.9 million people. Those who knew they had atrial fibrillation were 78.3% in cities and only 35.3% in the countryside. Only 6.0% of high-risk people with atrial fibrillation were using an anticoagulant. In the 2020 to 2021 national survey, 43.8% of the atrial fibrillation found was discovered this time. Of those diagnosed before, 32.1% were using an anticoagulant, and in the countryside only 19.8%

Hepatitis C spreads through blood, and there is no vaccine. The World Health Organization says that chronic hepatitis C often has no symptoms for decades, and by the time symptoms appear the liver is already badly damaged. A positive antibody only shows past infection; the nucleic acid has to be tested to know whether the virus is still there. About 30% of people clear the virus on their own within 6 months of infection and need no treatment. WHO says that oral direct-acting antivirals taken for 8 to 12 weeks cure almost all patients. The evidence review done for the US Preventive Services Task Force pooled 49 treatment studies, and the cure rate was above 95% in every genotype. Cure means no virus found in the blood 12 weeks after stopping the drug. Serious adverse reactions were 1.9%, and stopping because of side effects 0.4%. The same review pooled follow-up record studies, with no grouped control. People who were cured had about 60% lower all-cause mortality than those not cured (HR 0.40, 95% CI 0.28–0.56, 13 studies). Liver cancer was about 71% lower (HR 0.29, 95% CI 0.23–0.38, 20 studies). France followed 9895 people with chronic hepatitis C for a median of 33.4 months. After removing the effect of age, degree of liver fibrosis, drinking and other factors, those who took the drug had about 52% lower all-cause mortality (HR 0.48, 95% CI 0.33–0.70). Liver cancer was about 34% lower (HR 0.66, 95% CI 0.46–0.93). Among US veterans, 15,059 people with hepatitis C and advanced liver disease took these drugs. Followed for about 1.6 years on average, 2.6 per 100 people followed for a year died among those cured, and 12.3 among those not cured. After removing other factors, the risk of death was about 74% lower (HR 0.26, 95% CI 0.22–0.31). In 2020 the US Preventive Services Task Force recommended that all adults aged 18 to 79 be tested (grade B recommendation). For most people one test in a lifetime is enough. China’s 2022 prevention and treatment guideline advises antibody screening for all adults, regular testing for those who are always at high risk, and a nucleic acid test for everyone with a positive antibody. In China’s 2006 national survey, the antibody-positive rate in people aged 1 to 59 was 0.43%. Pooling many studies, it is 0.60% in the general population, 48.67% in people who use drugs, and 6.59% in people on hemodialysis. The National Healthcare Security Administration says that before the negotiation, a course of hepatitis C drugs mostly cost more than 50,000 yuan. The three hepatitis C drugs that entered medical insurance through negotiation in 2019 had an average price cut of more than 85% (US, France / China)

A “confined space” means a place such as a septic tank, manhole, sewage pool, cellar or tank that is closed or semi-closed and not meant for people to stay in for long. The Ministry of Emergency Management analyzed the larger accidents in confined spaces in industrial and trade enterprises since 2013. Poisoning and suffocation make up 96.8% of the accident count and 96.9% of the deaths. The main killers are hydrogen sulfide, carbon monoxide, nitrogen and carbon dioxide. Accidents of blind rescue without proper protection make up 87.4% of the count and 86.8% of the deaths. The Ministry’s 2020 safety guidance manual says that in nearly 80% of accidents, blind rescue increased the casualties. More than 50% of the people who die in confined spaces are the rescuers. In 2018 the State Council Work Safety Committee Office reported 8 accidents. All 8 began with only 1 person in danger, and because of blind rescue, each ended with 3 to 4 dead. In 2019, at a paper mill in Dongguan cleaning a sewage pool, 3 people breathed in hydrogen sulfide and fainted. 6 people went down one after another to rescue them, and 7 died in the end. In 2020, at a flour products factory in Jiaozuo, 1 worker fell into a material tank in the fermentation workshop. Others rescued blindly, and 6 died in all. The US National Institute for Occupational Safety and Health investigated 70 confined-space fatal incidents from 1983 to 1993, with 109 deaths. Of these, 39 (36%) went in to rescue someone. Of these 39, only 4 were professional rescuers such as police or firefighters. Its 1986 alert said that about 60% of the dead were people who tried to rescue. The manual says that hydrogen sulfide smells like rotten eggs, but when the concentration is high the nose can no longer smell it. A concentration above 1000 milligrams per cubic meter can kill within seconds. When the carbon dioxide concentration is high, a person loses consciousness and collapses within seconds. The manual requires that where the site has no conditions to rescue yourself, you call 119 and 120 in time, and “forced rescue must never be allowed”. Pulling a person out from outside is possible only if the trapped person wears a full-body safety harness with the lifeline attached outside. Order No. 13 of the Ministry of Emergency Management requires industrial and trade enterprises to work by “ventilate first, test next, work last”. Enterprises must provide testing, ventilation, protective and rescue equipment according to risk, with a watcher present throughout. Ventilation and testing continue during the work, and if conditions do not meet the safety requirements one must not enter. The watcher must stop blind rescue without safety measures. The Anshun City health commission reminds that in a vegetable cellar that has been sealed for a long time, the vegetables use up oxygen and give off carbon dioxide. Before going down, open the vents and ventilate well. This ventilation reminder cannot replace gas testing, protection and a watcher (national / US).

The 2024 programme of the National Health Commission defines the high-risk group like this. First, aged 45 or over, and then meeting any one of the following. One, living in a county with a high rate of stomach or esophageal cancer. For stomach cancer that means an age-standardized incidence above 20 per 100,000 people, and for esophageal cancer above 15. Two, a parent, child, brother or sister has had this cancer. Three, a positive Helicobacter pylori test; this counts only for stomach cancer. Four, smoking, heavy drinking, eating salty food or a liking for pickled food, and for esophageal cancer also a liking for hot food. Five, having had diseases such as atrophic gastritis, gastric ulcer, gastric polyps, Barrett’s esophagus or reflux esophagitis. The screening age is generally 45 to 74, gastroscopy is the first choice, and in principle it is done once every 5 years. The 2022 national guideline expressly does not advise people outside the high-risk group to have stomach cancer screening. A study in 6 high-incidence areas of China followed about 637,500 people aged 40 to 69. People who had a gastroscopy once, compared with those who were not invited, had about 57% lower risk of dying of upper gastrointestinal cancer. The raw figure is RR 0.43, 95% CI 0.40 to 0.47. Incidence of upper gastrointestinal cancer was about 23% lower (RR 0.77). Only 33.53% of those invited actually went. Counting everyone who was invited, deaths were about 31% lower (RR 0.69, 95% CI 0.66 to 0.72). Another study was done in villages with a high rate of esophageal cancer, not randomized, and followed for 10 years. Cumulative deaths from esophageal squamous cell cancer were 3.35% in the screening group and 5.05% in the control group. In South Korea’s national screening programme, people who had a gastroscopy were about 47% less likely to die of stomach cancer. The raw figure is OR 0.53, 95% CI 0.51 to 0.56. For barium meal no difference was seen (OR 0.98). The more gastroscopies, the lower the risk. Pooling 10 studies from Asia, people who had a gastroscopy had about 40% lower stomach cancer deaths. The raw figure is RR 0.60, 95% CI 0.49 to 0.73. The number getting stomach cancer showed no change. In northern China, a trial randomized by village enrolled 33,800 people aged 45 to 69 and followed them for 9 years. People assigned to the screening group had about 18% lower esophageal cancer deaths (HR 0.82, 95% CI 0.53 to 1.26), which is still within the margin of error. Incidence was about 19% lower (HR 0.81, 95% CI 0.60 to 1.09), also not significant. A 2023 meta-analysis corrected for the bias that people who go for a check are healthier to begin with. For people who really had a gastroscopy, stomach cancer deaths were about 48% lower (RR 0.52, credible range 0.39 to 0.79). Counted by the whole screening programme, only RR 0.94 remained (credible range 0.71 to 1.28), with no visible effect (China / South Korea / Asia)

In national surveillance of foodborne disease outbreaks, 19 bongkrekic acid poisonings were reported from 2010 to 2020. 146 people fell ill and 43 died, a case fatality of 29.5% (meaning 29.5% of those who fell ill died). By food: home-fermented corn flour products 9 outbreaks, 33 deaths. Wet rice noodles 5 outbreaks, 7 deaths. Wood ear 3 outbreaks, 5 ill, 3 died. In 2020, the food poisoning deaths reported nationwide were 143, of which bongkrekic acid caused 12. Ahead of it were poisonous mushrooms (80) and methanol (14). The notice of the Beijing Municipal Market Regulation Administration states that bongkrekic acid is not destroyed by boiling at 100℃ or by pressure cooking, and that there is currently no specific antidote. From 2018 Guangdong has required wet rice noodles in small packs to be sealed with the shelf life clearly marked. Before and after, the province’s yearly cases fell from an average of 6.25 to 0.5