Pub Date : 2025-02-01DOI: 10.1016/j.lanwpc.2024.101377
Lingling Yu, Peng Yin
<div><h3>Background</h3><div>Colorectal cancer (CRC) is the second leading cause of cancer-related deaths worldwide in 2022. Triglyceride glucose (TyG) index, as a more convenient and reliable predictor of insulin resistance, is associated with cardiometabolic diseases, but its relationship with CRC remains unclear. Although evidence from previous prospective cohort studies indicated that people with higher baseline TyG index were associated with onset of CRC, most of these studies have focused on elevated baseline TyG index levels rather than its dynamic changes over time. This study aimed to evaluate the long-term trajectories of the TyG index and the mortality due to CRC.</div></div><div><h3>Methods</h3><div>We used data from a Multi-center Elderly Health Management Cohort Study in Luzhou and Zunyi, China. Participants aged ≥65 years were enrolled from January 2017 and followed up until December 2021. Baseline data came from annual health examinations from the health management programs for the elderly in basic public health services including standardized questionnaires and laboratory tests. Demographic information, lifestyles, and health conditions were collected. TyG index was calculated by fasting blood glucose and triglycerides. Deaths from all-cause and CRC were obtained from linkage with China's national death registration system. CRC death as underlying cause of death was defined as International Classification of Diseases, 10th revision codes C18-C20. The latent class trajectory modeling method was used to analyze the 5-year TyG index trajectories from registration and the Cox proportional hazards regression model was utilized to examine the relationship between baseline TyG index level, the trajectory of TyG index, and CRC mortality.</div></div><div><h3>Findings</h3><div>Among 767,483 older adults, 52.9% were females; the mean age at baseline was 70.4 years. A total of 39,738 deaths (including 700 from CRC) were recorded in a median follow-up of 3.8 years [IQR 2.4-5.2]). Three longitudinal patterns based on the 5-year TyG index were identified: “medium-stable trajectory” (n=374,345, 48.8%), “low-stable trajectory” (n=334,645, 43.6%), and “high-stable trajectory” (n=58,493, 7.6%). Compared with the lowest quartile TyG index in the baseline, there was a borderline significant higher risk of CRC mortality for the highest quartile (hazard ratio 1.23, 95% confidence interval 0.98-1.54, p=0.07) after adjustment for age, sex, years of schooling, alcohol consumption, smoking, exercise frequency, diabetes, hypertension, cardiovascular and cerebrovascular diseases. Compared with medium-stable TyG index pattern, individuals with a high-stable TyG index had lower CRC mortality, with a crude hazard ratio (95% CI) of 0.71 (0.50-0.99). In the fully adjusted model, neither low-stable trajectory group nor high-stable trajectory group showed any significant association with CRC mortality (low-stable trajectory hazard ratio: 0.96 (95% CI: 0.82-1.13); h
{"title":"Longitudinal trajectories of triglyceride glucose index and colorectal cancer mortality in Chinese older adults: a large prospective cohort study","authors":"Lingling Yu, Peng Yin","doi":"10.1016/j.lanwpc.2024.101377","DOIUrl":"10.1016/j.lanwpc.2024.101377","url":null,"abstract":"<div><h3>Background</h3><div>Colorectal cancer (CRC) is the second leading cause of cancer-related deaths worldwide in 2022. Triglyceride glucose (TyG) index, as a more convenient and reliable predictor of insulin resistance, is associated with cardiometabolic diseases, but its relationship with CRC remains unclear. Although evidence from previous prospective cohort studies indicated that people with higher baseline TyG index were associated with onset of CRC, most of these studies have focused on elevated baseline TyG index levels rather than its dynamic changes over time. This study aimed to evaluate the long-term trajectories of the TyG index and the mortality due to CRC.</div></div><div><h3>Methods</h3><div>We used data from a Multi-center Elderly Health Management Cohort Study in Luzhou and Zunyi, China. Participants aged ≥65 years were enrolled from January 2017 and followed up until December 2021. Baseline data came from annual health examinations from the health management programs for the elderly in basic public health services including standardized questionnaires and laboratory tests. Demographic information, lifestyles, and health conditions were collected. TyG index was calculated by fasting blood glucose and triglycerides. Deaths from all-cause and CRC were obtained from linkage with China's national death registration system. CRC death as underlying cause of death was defined as International Classification of Diseases, 10th revision codes C18-C20. The latent class trajectory modeling method was used to analyze the 5-year TyG index trajectories from registration and the Cox proportional hazards regression model was utilized to examine the relationship between baseline TyG index level, the trajectory of TyG index, and CRC mortality.</div></div><div><h3>Findings</h3><div>Among 767,483 older adults, 52.9% were females; the mean age at baseline was 70.4 years. A total of 39,738 deaths (including 700 from CRC) were recorded in a median follow-up of 3.8 years [IQR 2.4-5.2]). Three longitudinal patterns based on the 5-year TyG index were identified: “medium-stable trajectory” (n=374,345, 48.8%), “low-stable trajectory” (n=334,645, 43.6%), and “high-stable trajectory” (n=58,493, 7.6%). Compared with the lowest quartile TyG index in the baseline, there was a borderline significant higher risk of CRC mortality for the highest quartile (hazard ratio 1.23, 95% confidence interval 0.98-1.54, p=0.07) after adjustment for age, sex, years of schooling, alcohol consumption, smoking, exercise frequency, diabetes, hypertension, cardiovascular and cerebrovascular diseases. Compared with medium-stable TyG index pattern, individuals with a high-stable TyG index had lower CRC mortality, with a crude hazard ratio (95% CI) of 0.71 (0.50-0.99). In the fully adjusted model, neither low-stable trajectory group nor high-stable trajectory group showed any significant association with CRC mortality (low-stable trajectory hazard ratio: 0.96 (95% CI: 0.82-1.13); h","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"55 ","pages":"Article 101377"},"PeriodicalIF":7.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143427968","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.lanwpc.2024.101324
Gaoyuan Yang , Zhicheng Yao
<div><h3>Background</h3><div>The adoption of targeted and immunotherapeutic drugs in the management of hepatocellular carcinoma (HCC) signifies a pivotal modern therapeutic approach. Nevertheless, a conspicuous gap exists in exhaustive research regarding the adverse effects of these medications in relation to their efficacy and influence on survival outcomes. This systematic review and network meta-analysis aim to assess the diverse frequencies and severities of specific adverse reactions induced by different targeted and immunotherapy interventions.</div></div><div><h3>Methods</h3><div>Clinical studies on targeted therapies and immunotherapeutic approaches in hepatocellular carcinoma (HCC) patients were selected from reputable databases including PubMed, Embase, Web of Science, and the Cochrane Library, covering the period from 2008 to 2023. These chosen studies encompassed a variety of treatment regimens. Data processing and evaluation adhered to PRISMA guidelines, utilizing a random-effects model for data synthesis. As all included studies were randomized controlled trials (RCTs), bias assessment followed the Cochrane Risk of Bias Assessment Tool and was assessed using Revman 5.3 software. The Relative Risk (RR) was selected as the effect measure over Odds Ratio (OR) to enable a risk probability analysis that better suited the characteristics of the research findings. To ensure model convergence, researchers generated trajectory plots, density plots, and Brooks-Gelman-Rubin diagnostic plots, and calculated the Potential Scale Reduction Factor (PSRF). Heterogeneity was evaluated by determining the I2 for both direct and indirect comparisons within the network model.</div></div><div><h3>Findings</h3><div>A meticulous review of pertinent literature was conducted, identifying 13 Randomized Controlled Trials (RCTs) covering 13 treatment protocols for hepatocellular carcinoma (HCC), including first-line and select second-line therapies. This study encompassed a total of 10,760 patients. Initially, adverse events within the same category were consolidated, followed by the sequential construction of a network model to evaluate the risk probabilities associated with various adverse events of different targeted immunotherapy regimens and establish priority rankings. The primary outcomes of the systematic evaluation included 38 types of adverse reactions, graded for severity based on the National Cancer Institute Common Terminology Criteria for Adverse Events 5.0 (CTCAE 5.0). Additionally, statistical analysis was conducted on adverse events related to 28 immune checkpoint inhibitors, with each analyzed comprehensively to assess the risk probability of the corresponding drugs.</div></div><div><h3>Interpretation</h3><div>Cabozantinib, camrelizumab, and their combination therapy for hepatocellular carcinoma (HCC) are linked to an elevated occurrence of prevalent adverse reactions. These reactions encompass elevated aminotransferase levels, fatigue, diarrhe
{"title":"Post-treatment adverse events ranking in targeted immunotherapy for hepatocellular carcinoma: a network meta-analysis based on risk probability assessment","authors":"Gaoyuan Yang , Zhicheng Yao","doi":"10.1016/j.lanwpc.2024.101324","DOIUrl":"10.1016/j.lanwpc.2024.101324","url":null,"abstract":"<div><h3>Background</h3><div>The adoption of targeted and immunotherapeutic drugs in the management of hepatocellular carcinoma (HCC) signifies a pivotal modern therapeutic approach. Nevertheless, a conspicuous gap exists in exhaustive research regarding the adverse effects of these medications in relation to their efficacy and influence on survival outcomes. This systematic review and network meta-analysis aim to assess the diverse frequencies and severities of specific adverse reactions induced by different targeted and immunotherapy interventions.</div></div><div><h3>Methods</h3><div>Clinical studies on targeted therapies and immunotherapeutic approaches in hepatocellular carcinoma (HCC) patients were selected from reputable databases including PubMed, Embase, Web of Science, and the Cochrane Library, covering the period from 2008 to 2023. These chosen studies encompassed a variety of treatment regimens. Data processing and evaluation adhered to PRISMA guidelines, utilizing a random-effects model for data synthesis. As all included studies were randomized controlled trials (RCTs), bias assessment followed the Cochrane Risk of Bias Assessment Tool and was assessed using Revman 5.3 software. The Relative Risk (RR) was selected as the effect measure over Odds Ratio (OR) to enable a risk probability analysis that better suited the characteristics of the research findings. To ensure model convergence, researchers generated trajectory plots, density plots, and Brooks-Gelman-Rubin diagnostic plots, and calculated the Potential Scale Reduction Factor (PSRF). Heterogeneity was evaluated by determining the I2 for both direct and indirect comparisons within the network model.</div></div><div><h3>Findings</h3><div>A meticulous review of pertinent literature was conducted, identifying 13 Randomized Controlled Trials (RCTs) covering 13 treatment protocols for hepatocellular carcinoma (HCC), including first-line and select second-line therapies. This study encompassed a total of 10,760 patients. Initially, adverse events within the same category were consolidated, followed by the sequential construction of a network model to evaluate the risk probabilities associated with various adverse events of different targeted immunotherapy regimens and establish priority rankings. The primary outcomes of the systematic evaluation included 38 types of adverse reactions, graded for severity based on the National Cancer Institute Common Terminology Criteria for Adverse Events 5.0 (CTCAE 5.0). Additionally, statistical analysis was conducted on adverse events related to 28 immune checkpoint inhibitors, with each analyzed comprehensively to assess the risk probability of the corresponding drugs.</div></div><div><h3>Interpretation</h3><div>Cabozantinib, camrelizumab, and their combination therapy for hepatocellular carcinoma (HCC) are linked to an elevated occurrence of prevalent adverse reactions. These reactions encompass elevated aminotransferase levels, fatigue, diarrhe","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"55 ","pages":"Article 101324"},"PeriodicalIF":7.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143427970","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.lanwpc.2024.101418
Ming Liu , Chuan Liu , Tsz Ngai Mok , Xiaolong Qi , Wai-Kit Ming
Background
Cirrhosis and other chronic liver diseases (CLD), along with liver cancer, present significant health challenges in the East Asia Pacific (EAP) region. This study evaluates the burden of CLD and its progression to hepatocellular carcinoma (HCC) from 1990 to 2021.
Methods
Data from the Global Burden of Disease Study 2021 were analyzed to examine trends in CLD burden and annual transition rates to HCC across different etiologies and sociodemographic index (SDI) regions. The estimated annual percentage change (EAPC) was used to assess trends in age-standardized rates (ASR). Correlations between age-standardized DALY rates (ASDR), annual transition rates, and SDI were determined using Spearman’s rank correlation. Risk factors, such as high alcohol and drug use, were also evaluated.
Findings
The prevalence of CLD in EAP increased significantly by 43.80% (95% UI: 38.23% to 48.77%) from 1990 to 2021, while the ASDR decreased (EAPC: -2.42% [95% CI: -2.48% to -2.36%]), notably in high and high-middle SDI regions. HBV and HCV remained the leading causes of CLD across all SDI regions, with alcohol use and NAFLD increasingly contributing, particularly in high SDI regions. A significant negative correlation was observed between ASDR and SDI in high (ρ=-0.20, p<0.01), middle (ρ=-0.49, p<0.001), and low-middle (ρ=-0.63, p<0.001) SDI regions. Despite this, high alcohol use and drug use contributed more to DALYs across all SDI regions, and the annual transition rate to HCC was rising (1.09% [0.89% to 1.28%]), with the highest rates in high SDI regions. The transition rate from CLD to HCC is rising in EAP, much exceeding the global rate. High SDI regions showed higher transition rates, particularly among those with chronic hepatitis B, C, and NAFLD including cirrhosis. A significant positive relationship was found between the transition rate from CLD to HCC and SDI in high (ρ=0.60, p<0.001) and low-middle (ρ=0.34, p<0.001) SDI regions.
Interpretation
While the EAP region has made progress in reducing the burden of CLD, greater attention is needed for alcohol use and NAFLD. The progression from CLD to HCC warrants increased focus, especially in high SDI regions. Enhanced surveillance for HCC in patients with chronic hepatitis is crucial.
{"title":"Burden of cirrhosis and other chronic liver diseases and their progression to hepatocellular carcinoma in East Asia Pacific: 1990 to 2021","authors":"Ming Liu , Chuan Liu , Tsz Ngai Mok , Xiaolong Qi , Wai-Kit Ming","doi":"10.1016/j.lanwpc.2024.101418","DOIUrl":"10.1016/j.lanwpc.2024.101418","url":null,"abstract":"<div><h3>Background</h3><div>Cirrhosis and other chronic liver diseases (CLD), along with liver cancer, present significant health challenges in the East Asia Pacific (EAP) region. This study evaluates the burden of CLD and its progression to hepatocellular carcinoma (HCC) from 1990 to 2021.</div></div><div><h3>Methods</h3><div>Data from the Global Burden of Disease Study 2021 were analyzed to examine trends in CLD burden and annual transition rates to HCC across different etiologies and sociodemographic index (SDI) regions. The estimated annual percentage change (EAPC) was used to assess trends in age-standardized rates (ASR). Correlations between age-standardized DALY rates (ASDR), annual transition rates, and SDI were determined using Spearman’s rank correlation. Risk factors, such as high alcohol and drug use, were also evaluated.</div></div><div><h3>Findings</h3><div>The prevalence of CLD in EAP increased significantly by 43.80% (95% UI: 38.23% to 48.77%) from 1990 to 2021, while the ASDR decreased (EAPC: -2.42% [95% CI: -2.48% to -2.36%]), notably in high and high-middle SDI regions. HBV and HCV remained the leading causes of CLD across all SDI regions, with alcohol use and NAFLD increasingly contributing, particularly in high SDI regions. A significant negative correlation was observed between ASDR and SDI in high (ρ=-0.20, p<0.01), middle (ρ=-0.49, p<0.001), and low-middle (ρ=-0.63, p<0.001) SDI regions. Despite this, high alcohol use and drug use contributed more to DALYs across all SDI regions, and the annual transition rate to HCC was rising (1.09% [0.89% to 1.28%]), with the highest rates in high SDI regions. The transition rate from CLD to HCC is rising in EAP, much exceeding the global rate. High SDI regions showed higher transition rates, particularly among those with chronic hepatitis B, C, and NAFLD including cirrhosis. A significant positive relationship was found between the transition rate from CLD to HCC and SDI in high (ρ=0.60, p<0.001) and low-middle (ρ=0.34, p<0.001) SDI regions.</div></div><div><h3>Interpretation</h3><div>While the EAP region has made progress in reducing the burden of CLD, greater attention is needed for alcohol use and NAFLD. The progression from CLD to HCC warrants increased focus, especially in high SDI regions. Enhanced surveillance for HCC in patients with chronic hepatitis is crucial.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"55 ","pages":"Article 101418"},"PeriodicalIF":7.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143427605","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.lanwpc.2024.101304
Ran Li , Therese Hesketh
<div><h3>Background</h3><div>The increasing incidence and survival rates of cancers, driven by an ageing population, present a significant challenge to China’s healthcare system. Patients with cancer are managed and followed-up almost exclusively within tertiary care with resulting overburdened services. Recent policy directives recommend that primary healthcare adopt an expanded role in cancer care, especially in follow-up and aftercare. Advantages include easier access and lower out-of-pocket costs compared to tertiary hospitals, but effective coordination between tertiary hospitals and primary healthcare centres (PHCs) for post-discharge cancer care remains limited. We conducted a pragmatic trial integrating PHCs into aftercare of older cancer patients.</div></div><div><h3>Methods</h3><div>This pragmatic controlled trial was centred at a tertiary oncology hospital in Nantong, Jiangsu province, China, which treats over 80% of local cancer patients, and involved six PHCs —one urban PHC and five township hospitals—serving as step-down facilities. Patients aged 60 and older with lung, breast, colorectal, or prostate cancer were identified by tertiary physicians after hospitalization for surgery, chemotherapy, or radiotherapy. Participants were assigned according to their preference, to either the usual care group, with aftercare from the tertiary hospital, or the intervention group, where the follow-up and aftercare plan was developed and monitored by tertiary physicians, but delivered by PHC doctors. Outcomes measured were hospital admissions within three months, length of hospital stay, and the mean difference in health-related quality of life (HRQoL) at one - and three - months. Subgroup analyses investigated differential effects by treatment types. This trial was registered (ChiCTR2300073108).</div></div><div><h3>Findings</h3><div>Of the 1,722 individuals screened, 755 patients (mean age 70.2years, SD 6.40, 276 females [37%] and 479 males [63%]) were enrolled between May 2023 and April 2024. Ninety participants were assigned to the intervention group and 665 to the usual care group. Patients in the intervention group had significantly lower household incomes. Intervention group patients had 43% fewer admissions to tertiary hospital at one-month (IRR = 0.57, 95% CI: 0.41–0.81, p = 0.001), with no significant difference at three months (IRR = 0.96, 95% CI: 0.78–1.18, p = 0.705). Patients who underwent surgery in the intervention group, had an 83% reduction in hospitalizations at one-month (IRR = 0.17, 95% CI: 0.04–0.76, p = 0.020) and a 61% reduction at three months (IRR = 0.39, 95% CI: 0.18–0.82, p = 0.014), compared to control patients who received surgery. Patients in the intervention group had 4.68 fewer admission days within one-month (95% CI: -7.92 to -1.44, p = 0.005) and 4.26 fewer days within three months (95% CI: -8.47 to -0.06, p = 0.047) compared to the control group. Intervention group patients showed better HRQoL, at one month and
{"title":"Integrating primary healthcare into cancer aftercare for older patients post discharge – a pragmatic non-randomized controlled trial","authors":"Ran Li , Therese Hesketh","doi":"10.1016/j.lanwpc.2024.101304","DOIUrl":"10.1016/j.lanwpc.2024.101304","url":null,"abstract":"<div><h3>Background</h3><div>The increasing incidence and survival rates of cancers, driven by an ageing population, present a significant challenge to China’s healthcare system. Patients with cancer are managed and followed-up almost exclusively within tertiary care with resulting overburdened services. Recent policy directives recommend that primary healthcare adopt an expanded role in cancer care, especially in follow-up and aftercare. Advantages include easier access and lower out-of-pocket costs compared to tertiary hospitals, but effective coordination between tertiary hospitals and primary healthcare centres (PHCs) for post-discharge cancer care remains limited. We conducted a pragmatic trial integrating PHCs into aftercare of older cancer patients.</div></div><div><h3>Methods</h3><div>This pragmatic controlled trial was centred at a tertiary oncology hospital in Nantong, Jiangsu province, China, which treats over 80% of local cancer patients, and involved six PHCs —one urban PHC and five township hospitals—serving as step-down facilities. Patients aged 60 and older with lung, breast, colorectal, or prostate cancer were identified by tertiary physicians after hospitalization for surgery, chemotherapy, or radiotherapy. Participants were assigned according to their preference, to either the usual care group, with aftercare from the tertiary hospital, or the intervention group, where the follow-up and aftercare plan was developed and monitored by tertiary physicians, but delivered by PHC doctors. Outcomes measured were hospital admissions within three months, length of hospital stay, and the mean difference in health-related quality of life (HRQoL) at one - and three - months. Subgroup analyses investigated differential effects by treatment types. This trial was registered (ChiCTR2300073108).</div></div><div><h3>Findings</h3><div>Of the 1,722 individuals screened, 755 patients (mean age 70.2years, SD 6.40, 276 females [37%] and 479 males [63%]) were enrolled between May 2023 and April 2024. Ninety participants were assigned to the intervention group and 665 to the usual care group. Patients in the intervention group had significantly lower household incomes. Intervention group patients had 43% fewer admissions to tertiary hospital at one-month (IRR = 0.57, 95% CI: 0.41–0.81, p = 0.001), with no significant difference at three months (IRR = 0.96, 95% CI: 0.78–1.18, p = 0.705). Patients who underwent surgery in the intervention group, had an 83% reduction in hospitalizations at one-month (IRR = 0.17, 95% CI: 0.04–0.76, p = 0.020) and a 61% reduction at three months (IRR = 0.39, 95% CI: 0.18–0.82, p = 0.014), compared to control patients who received surgery. Patients in the intervention group had 4.68 fewer admission days within one-month (95% CI: -7.92 to -1.44, p = 0.005) and 4.26 fewer days within three months (95% CI: -8.47 to -0.06, p = 0.047) compared to the control group. Intervention group patients showed better HRQoL, at one month and ","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"55 ","pages":"Article 101304"},"PeriodicalIF":7.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143427731","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.lanwpc.2024.101397
Kui Sun, Junwei Wang, Xin Zhou, Wei Fu
Background
Colorectal cancer (CRC) with benign lymph node enlargement (BLNE) (>1 cm) is often associated with better long-term prognosis and favorable outcomes in immunotherapy. However, lymph node enlargement (LNE) can mislead clinicians into considering metastatic lymph node enlargement (MLNE), potentially resulting in misguided therapeutic decisions in unnecessary neoadjuvant therapy and extended lymphadenectomy. This, ultimately, can lead to overtreatment, increasing the risk of postoperative complications and tumor recurrence. Thus, developing a pre-treatment multimodal CT radiomics-based model to assess LNE status is essential.
Methods
A total of 319 pre-treatment multimodal CT images of CRC patients with LNE were retrospectively collected from 2015 to 2020 as a development cohort. Additionally, 111 multimodal CT images from 2020 to 2022 were prospectively collected as a validation cohort. Tumor and LNE regions of interest were manually segmented, and 40 patients were randomly re-outlined by another radiologist to extract radiomics features. The intragroup correlation coefficient was calculated to assess the reproducibility of the radiomics features. Following feature screening, multiple predictive models were constructed, including tumor and lymph node models for individual modalities (TumorN, A, V; LnN, A, V; Ln, lymph node; N, non-contrast phase; A, arterial phase; V, venous phase), along with 15 models combining multiple modalities. The predictive performance of these models was assessed using area under the receiver operating characteristic curve (AUROC) and precision-recall curve (AUPRC), along with sensitivity, specificity, and accuracy.
Findings
After validation with the prospective cohort, TumorN and LnA demonstrated the best predictive performance among single modalities, with AUROC values of 0.626 and 0.781, respectively. Among all models, LnNAV exhibited the highest predictive performance, achieving AUROC and AUPRC values of 0.820 and 0.883, respectively, with a sensitivity of 0.708, specificity of 0.848, and overall accuracy of 0.766.
Interpretation
Radiomics, as a non-invasive and quantitative approach, can reflect underlying physiopathological information. The incorporation of a multimodal radiomics model yielded excellent performance in predicting pre-treatment LNE status, particularly for BLNE, with a specificity of 0.848. This approach can provide valuable guidance for clinical treatment strategies.
{"title":"A non-invasive multi-phase CT classifier for predicting pre-treatment enlarged lymph node types in colorectal cancer","authors":"Kui Sun, Junwei Wang, Xin Zhou, Wei Fu","doi":"10.1016/j.lanwpc.2024.101397","DOIUrl":"10.1016/j.lanwpc.2024.101397","url":null,"abstract":"<div><h3>Background</h3><div>Colorectal cancer (CRC) with benign lymph node enlargement (BLNE) (>1 cm) is often associated with better long-term prognosis and favorable outcomes in immunotherapy. However, lymph node enlargement (LNE) can mislead clinicians into considering metastatic lymph node enlargement (MLNE), potentially resulting in misguided therapeutic decisions in unnecessary neoadjuvant therapy and extended lymphadenectomy. This, ultimately, can lead to overtreatment, increasing the risk of postoperative complications and tumor recurrence. Thus, developing a pre-treatment multimodal CT radiomics-based model to assess LNE status is essential.</div></div><div><h3>Methods</h3><div>A total of 319 pre-treatment multimodal CT images of CRC patients with LNE were retrospectively collected from 2015 to 2020 as a development cohort. Additionally, 111 multimodal CT images from 2020 to 2022 were prospectively collected as a validation cohort. Tumor and LNE regions of interest were manually segmented, and 40 patients were randomly re-outlined by another radiologist to extract radiomics features. The intragroup correlation coefficient was calculated to assess the reproducibility of the radiomics features. Following feature screening, multiple predictive models were constructed, including tumor and lymph node models for individual modalities (Tumor<em><sub>N</sub>, <sub>A</sub>, <sub>V</sub>;</em> Ln<em><sub>N, A, V</sub>;</em> Ln, lymph node; N, non-contrast phase; A, arterial phase; V, venous phase), along with 15 models combining multiple modalities. The predictive performance of these models was assessed using area under the receiver operating characteristic curve (AUROC) and precision-recall curve (AUPRC), along with sensitivity, specificity, and accuracy.</div></div><div><h3>Findings</h3><div>After validation with the prospective cohort, Tumor<em><sub>N</sub></em> and Ln<em><sub>A</sub></em> demonstrated the best predictive performance among single modalities, with AUROC values of 0.626 and 0.781, respectively. Among all models, Ln<em><sub>NAV</sub></em> exhibited the highest predictive performance, achieving AUROC and AUPRC values of 0.820 and 0.883, respectively, with a sensitivity of 0.708, specificity of 0.848, and overall accuracy of 0.766.</div></div><div><h3>Interpretation</h3><div>Radiomics, as a non-invasive and quantitative approach, can reflect underlying physiopathological information. The incorporation of a multimodal radiomics model yielded excellent performance in predicting pre-treatment LNE status, particularly for BLNE, with a specificity of 0.848. This approach can provide valuable guidance for clinical treatment strategies.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"55 ","pages":"Article 101397"},"PeriodicalIF":7.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143427816","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.lanwpc.2024.101374
Ang Zheng , Junlin He , Xin Qin , Xin Wang
<div><h3>Background</h3><div>As breast cancer continues to present a growing global burden, particularly in China, understanding the factors that drive healthcare costs is crucial for informed policy-making and resource allocation. The primary objective was to identify the key predictors of total hospitalisation costs in breast cancer patients undergoing surgery, using machine learning models. A secondary objective was to explore the influence of different treatment types, patient demographics, and hospital characteristics on total expenses.</div></div><div><h3>Methods</h3><div>We conducted a multicenter, retrospective study utilising an anonymised healthcare dataset collected from 2016 to 2020 across three provinces of Shanxi, Hainan and Liaoning in China. The study included 19,094 breast cancer patients who underwent surgery, identified using the International Classification of Diseases (ICD-10) codes from C50.0 to C50.9 and corresponding mastectomy procedure codes (19301 to 19307). The analysis incorporated a variety of patient characteristics, comorbidities, and hospital attributes. We applied several ensemble machine learning techniques, including gradient boosting algorithms, to assess the contributions of each variable to total costs, both with and without length of stay (LOS). Permutation importance analysis was performed to rank the key cost drivers. A sensitivity analysis using propensity score matching (PSM) adjusted for age, length of stay, insurance type, admission year (2016–2020), week of admission, hospital level (provincial, municipal, district, or other), hospital location, drug fee, and surgery fee was conducted to validate the robustness of the findings, focusing on variables such as drug ratio and tumor surgery admissions.</div></div><div><h3>Findings</h3><div>The average total hospitalisation cost per admission was 2,649.60 USD, with a standard deviation of 2,110.95 USD. LOS was the most significant predictor, with an approximate increase of 150.00 USD per additional hospital day. Other important factors included hospital location, number of beds, and drug ratio. After excluding LOS, the top cost drivers were drug ratio, number of beds, general hospital admissions, tumor surgery admissions, and radiotherapy. Breast cancer patients with longer lengths of stay, admissions to general hospitals in Northern China, a history of radiotherapy, and a lower drug ratio were associated with the highest total costs. The model demonstrated robust performance, with a root mean squared logarithmic error (RMSLE) of 0.474. In the PSM analysis, patients with a drug ratio exceeding 30% had significantly lower average total costs (1,681.65 USD) compared to those with a drug ratio of 30% or lower, who incurred substantially higher costs (2,696.40 USD, P < 0.001).</div></div><div><h3>Interpretation</h3><div>This study underscores the critical role of managing key cost drivers such as LOS and drug ratios in breast cancer surgery. Our results sug
{"title":"Predicting total costs and key drivers in breast cancer surgery patients: ensemble machine learning analyses","authors":"Ang Zheng , Junlin He , Xin Qin , Xin Wang","doi":"10.1016/j.lanwpc.2024.101374","DOIUrl":"10.1016/j.lanwpc.2024.101374","url":null,"abstract":"<div><h3>Background</h3><div>As breast cancer continues to present a growing global burden, particularly in China, understanding the factors that drive healthcare costs is crucial for informed policy-making and resource allocation. The primary objective was to identify the key predictors of total hospitalisation costs in breast cancer patients undergoing surgery, using machine learning models. A secondary objective was to explore the influence of different treatment types, patient demographics, and hospital characteristics on total expenses.</div></div><div><h3>Methods</h3><div>We conducted a multicenter, retrospective study utilising an anonymised healthcare dataset collected from 2016 to 2020 across three provinces of Shanxi, Hainan and Liaoning in China. The study included 19,094 breast cancer patients who underwent surgery, identified using the International Classification of Diseases (ICD-10) codes from C50.0 to C50.9 and corresponding mastectomy procedure codes (19301 to 19307). The analysis incorporated a variety of patient characteristics, comorbidities, and hospital attributes. We applied several ensemble machine learning techniques, including gradient boosting algorithms, to assess the contributions of each variable to total costs, both with and without length of stay (LOS). Permutation importance analysis was performed to rank the key cost drivers. A sensitivity analysis using propensity score matching (PSM) adjusted for age, length of stay, insurance type, admission year (2016–2020), week of admission, hospital level (provincial, municipal, district, or other), hospital location, drug fee, and surgery fee was conducted to validate the robustness of the findings, focusing on variables such as drug ratio and tumor surgery admissions.</div></div><div><h3>Findings</h3><div>The average total hospitalisation cost per admission was 2,649.60 USD, with a standard deviation of 2,110.95 USD. LOS was the most significant predictor, with an approximate increase of 150.00 USD per additional hospital day. Other important factors included hospital location, number of beds, and drug ratio. After excluding LOS, the top cost drivers were drug ratio, number of beds, general hospital admissions, tumor surgery admissions, and radiotherapy. Breast cancer patients with longer lengths of stay, admissions to general hospitals in Northern China, a history of radiotherapy, and a lower drug ratio were associated with the highest total costs. The model demonstrated robust performance, with a root mean squared logarithmic error (RMSLE) of 0.474. In the PSM analysis, patients with a drug ratio exceeding 30% had significantly lower average total costs (1,681.65 USD) compared to those with a drug ratio of 30% or lower, who incurred substantially higher costs (2,696.40 USD, P < 0.001).</div></div><div><h3>Interpretation</h3><div>This study underscores the critical role of managing key cost drivers such as LOS and drug ratios in breast cancer surgery. Our results sug","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"55 ","pages":"Article 101374"},"PeriodicalIF":7.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143427989","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.lanwpc.2025.101492
Rebekah M. Ahmed , Olivier Piguet , Catherine J. Mummery , Sharon L. Naismith , Muireann Irish
In the last 5 years significant progress has been made in potential dementia treatments, yet many of these treatments come with significant burdens on the healthcare system that may limit access to treatment and care for patients. Often patients in remote and rural regions and those in low income regions are disadvantaged. Many clinical trials for dementia patients are biased to recruiting a homogenous group of patients that does not represent cultural and linguistic diversity, meaning the generalisability of trials is limited. This viewpoint discusses the barriers to access to early treatments and clinical trials for patients with dementia and offers a potential framework to address these including provision of infrastructure, regulatory change and patient education.
{"title":"The Holy Grail: highlighting the need for equitable access to dementia treatments and clinical trials","authors":"Rebekah M. Ahmed , Olivier Piguet , Catherine J. Mummery , Sharon L. Naismith , Muireann Irish","doi":"10.1016/j.lanwpc.2025.101492","DOIUrl":"10.1016/j.lanwpc.2025.101492","url":null,"abstract":"<div><div>In the last 5 years significant progress has been made in potential dementia treatments, yet many of these treatments come with significant burdens on the healthcare system that may limit access to treatment and care for patients. Often patients in remote and rural regions and those in low income regions are disadvantaged. Many clinical trials for dementia patients are biased to recruiting a homogenous group of patients that does not represent cultural and linguistic diversity, meaning the generalisability of trials is limited. This viewpoint discusses the barriers to access to early treatments and clinical trials for patients with dementia and offers a potential framework to address these including provision of infrastructure, regulatory change and patient education.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"55 ","pages":"Article 101492"},"PeriodicalIF":7.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143349327","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.lanwpc.2025.101486
Wanyue Dong , Yunning Liu , Ruhai Bai , Lei Zhang , Maigeng Zhou
Background
Understanding the disease burden of mental disorders in children and adolescents in China, especially at the sub-national level, is important for effective prevention and intervention. This study aims to assess the prevalence and related health burden of mental disorders in children and adolescents in China.
Methods
Following the same approach as the Global Burden of Disease Study 2021, we systematically analyze epidemiological and demographic information for mental disorders, and assess the prevalence, disability-adjusted life-years (DALYs), and years lived with disability (YLDs) in the children and adolescents for mental disorders and their ten subtypes across national and provinces in China from 1990 to 2021.
Findings
In 2021, the age-standardized prevalence of mental disorders in children and adolescents was 8.9% (uncertainty intervals [UI]: 8.1, 9.8) in China, accounting for 30.8 million cases (26.0, 36.3) and 2.8 million DALYs (2.0, 3.7). Among mental disorders, attention-deficit/hyperactivity disorder had the highest age-standardized prevalence, at 3.6% (3.0, 4.5). From 1990 to 2021, the age-standardized prevalence increased by 4.8%, but the number of mental disorders cases decreased by 21.9%. DALYs for mental disorders are higher in boys than in girls across all age groups. At the provincial level, the age-standardized prevalence of mental disorders in some provinces was much greater than that in other provinces (e.g., bipolar disorder in Hebei was more than two times greater than that in other provinces). Although disparities in the distribution of mental disorder burden were observed across provinces, there was a reduction in income-related inequality, where the gap in the age-standardized DALY rates between the highest and lowest income provinces decreased by 61.7% between 1990 and 2021. In 2021, among 22 health condition groups in China, mental disorders accounted for the largest proportion of health life lost.
Interpretation
Mental disorders are the leading causes of disability in children and adolescents in China, and the disease burden varies geographically. Careful planning of health services, including consideration of the local situation, is needed.
Funding
China National Natural Science Foundation (Grant No. 72104113, 72204112), Social Science Fund of Jiangsu Province (Grant No. 21GLD008), ShuangChuang Doctor Program of Jiangsu Province (Grant No. JSSCBS20210359), and the Fundamental Research Funds for the Central Universities (Grant No. 30923011101).
{"title":"The prevalence and associated disability burden of mental disorders in children and adolescents in China: a systematic analysis of data from the Global Burden of Disease Study","authors":"Wanyue Dong , Yunning Liu , Ruhai Bai , Lei Zhang , Maigeng Zhou","doi":"10.1016/j.lanwpc.2025.101486","DOIUrl":"10.1016/j.lanwpc.2025.101486","url":null,"abstract":"<div><h3>Background</h3><div>Understanding the disease burden of mental disorders in children and adolescents in China, especially at the sub-national level, is important for effective prevention and intervention. This study aims to assess the prevalence and related health burden of mental disorders in children and adolescents in China.</div></div><div><h3>Methods</h3><div>Following the same approach as the Global Burden of Disease Study 2021, we systematically analyze epidemiological and demographic information for mental disorders, and assess the prevalence, disability-adjusted life-years (DALYs), and years lived with disability (YLDs) in the children and adolescents for mental disorders and their ten subtypes across national and provinces in China from 1990 to 2021.</div></div><div><h3>Findings</h3><div>In 2021, the age-standardized prevalence of mental disorders in children and adolescents was 8.9% (uncertainty intervals [UI]: 8.1, 9.8) in China, accounting for 30.8 million cases (26.0, 36.3) and 2.8 million DALYs (2.0, 3.7). Among mental disorders, attention-deficit/hyperactivity disorder had the highest age-standardized prevalence, at 3.6% (3.0, 4.5). From 1990 to 2021, the age-standardized prevalence increased by 4.8%, but the number of mental disorders cases decreased by 21.9%. DALYs for mental disorders are higher in boys than in girls across all age groups. At the provincial level, the age-standardized prevalence of mental disorders in some provinces was much greater than that in other provinces (e.g., bipolar disorder in Hebei was more than two times greater than that in other provinces). Although disparities in the distribution of mental disorder burden were observed across provinces, there was a reduction in income-related inequality, where the gap in the age-standardized DALY rates between the highest and lowest income provinces decreased by 61.7% between 1990 and 2021. In 2021, among 22 health condition groups in China, mental disorders accounted for the largest proportion of health life lost.</div></div><div><h3>Interpretation</h3><div>Mental disorders are the leading causes of disability in children and adolescents in China, and the disease burden varies geographically. Careful planning of health services, including consideration of the local situation, is needed.</div></div><div><h3>Funding</h3><div><span>China National Natural Science Foundation</span> (Grant No. 72104113, <span><span>72204112</span></span>), <span>Social Science Fund of Jiangsu Province</span> (Grant No. <span><span>21GLD008</span></span>), ShuangChuang Doctor Program of Jiangsu Province (Grant No. JSSCBS20210359), and the <span>Fundamental Research Funds for the Central Universities</span> (Grant No. <span><span>30923011101</span></span>).</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"55 ","pages":"Article 101486"},"PeriodicalIF":7.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143349804","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.lanwpc.2024.101384
Menglong Li , Jinlei Qi , Yaqi Ma , Wen Shu , Huidi Xiao , Lijun Wang , Peng Yin , Haoyan Guo , Sten H. Vermund , Maigeng Zhou , Yifei Hu
<div><h3>Background</h3><div>Breast cancer is the fifth leading cancer-related cause of death among women in China. With the advent of the “Two cancers screening” national health plan from 2009, we aim to present the change and rural-urban differences in age-specific mortality rates during 2009-2021.</div></div><div><h3>Methods</h3><div>We extracted age-specific mortality data of breast cancer by rural-urban residence for Chinese women aged 20-84 years from 2009 to 2021 from China’s National Disease Surveillance Points system. The population data covering 166.1 million of women were grouped as 20-34 years, 35-64 years, and 65-84 years. We used negative binomial regression models to assess mortality rate ratios between urban and rural (reference) by time-periods. We assessed temporal trends in age-specific mortality rates for breast cancer using log-linear Joinpoint models.</div></div><div><h3>Findings</h3><div>From 2009 to 2021, the mortality rates of breast cancer changed from 13.73 per 100,000 women to 10.08 per 100,000 women in urban women aged 35-64 years with an average annual percent change (AAPC) of − 2.7% (95% CI − 4.6 to − 0.7, P = 0.007) and from 10.81 per 100,000 women to 10.91 per 100,000 women in rural women aged 35-64 years with an AAPC of 0.3%, (95% CI: − 0.3 to 0.9, P = 0.28). We identified comparatively minimal mortality disparities of breast cancer between urban and rural areas in the 35-64 age group (rate ratio: 1.12), compared to differences noted in younger (20-34 years, rate ratio: 0.82) and older groups (65-84 years, rate ratio: 1.64). The results among women aged 20-84 showed that the breast cancer mortality is significantly higher in urban than in rural areas, stratifying by time-period (rate ratio: 1.32 in 2009-2013, 1.23 in 2013-2017, and 1.11 in 2017-2021) and region (rate ratio: 1.27 in Central, 1.15 in Western, and 1.14 in Eastern). The results in the screening age of 35-64 group showed similar trends with overall population stratified by time-period (rate ratio: 1.20 in 2009-2013, 1.18 in 2013-2017, and 1.05 in 2017-2021) and region (rate ratio: 1.20 in Central, 1.07 in Western, and 1.08 in Eastern).</div></div><div><h3>Interpretation</h3><div>We found that breast cancer mortality in urban women was higher than that of rural women, with a decreasing temporal trend in rural-urban difference. The narrowing gap in breast cancer mortality rates between urban and rural areas may be related to the convergence of lifestyles in terms of reproduction, hormones, and other breast cancer risk factors among urban and rural residents. As socio-economic development and urbanization progress, differences in risk factors such as dietary patterns, lifestyles, and physical activity have become less pronounced nationwide, leading to a gradual reduction in the gap of breast cancer mortality rates between urban and rural women. This study provides insights into the changing landscape of breast cancer mortality in China, highlighting the
{"title":"Urban-rural differences in age-specific mortality rates for breast cancer in China from 2009 to 2021","authors":"Menglong Li , Jinlei Qi , Yaqi Ma , Wen Shu , Huidi Xiao , Lijun Wang , Peng Yin , Haoyan Guo , Sten H. Vermund , Maigeng Zhou , Yifei Hu","doi":"10.1016/j.lanwpc.2024.101384","DOIUrl":"10.1016/j.lanwpc.2024.101384","url":null,"abstract":"<div><h3>Background</h3><div>Breast cancer is the fifth leading cancer-related cause of death among women in China. With the advent of the “Two cancers screening” national health plan from 2009, we aim to present the change and rural-urban differences in age-specific mortality rates during 2009-2021.</div></div><div><h3>Methods</h3><div>We extracted age-specific mortality data of breast cancer by rural-urban residence for Chinese women aged 20-84 years from 2009 to 2021 from China’s National Disease Surveillance Points system. The population data covering 166.1 million of women were grouped as 20-34 years, 35-64 years, and 65-84 years. We used negative binomial regression models to assess mortality rate ratios between urban and rural (reference) by time-periods. We assessed temporal trends in age-specific mortality rates for breast cancer using log-linear Joinpoint models.</div></div><div><h3>Findings</h3><div>From 2009 to 2021, the mortality rates of breast cancer changed from 13.73 per 100,000 women to 10.08 per 100,000 women in urban women aged 35-64 years with an average annual percent change (AAPC) of − 2.7% (95% CI − 4.6 to − 0.7, P = 0.007) and from 10.81 per 100,000 women to 10.91 per 100,000 women in rural women aged 35-64 years with an AAPC of 0.3%, (95% CI: − 0.3 to 0.9, P = 0.28). We identified comparatively minimal mortality disparities of breast cancer between urban and rural areas in the 35-64 age group (rate ratio: 1.12), compared to differences noted in younger (20-34 years, rate ratio: 0.82) and older groups (65-84 years, rate ratio: 1.64). The results among women aged 20-84 showed that the breast cancer mortality is significantly higher in urban than in rural areas, stratifying by time-period (rate ratio: 1.32 in 2009-2013, 1.23 in 2013-2017, and 1.11 in 2017-2021) and region (rate ratio: 1.27 in Central, 1.15 in Western, and 1.14 in Eastern). The results in the screening age of 35-64 group showed similar trends with overall population stratified by time-period (rate ratio: 1.20 in 2009-2013, 1.18 in 2013-2017, and 1.05 in 2017-2021) and region (rate ratio: 1.20 in Central, 1.07 in Western, and 1.08 in Eastern).</div></div><div><h3>Interpretation</h3><div>We found that breast cancer mortality in urban women was higher than that of rural women, with a decreasing temporal trend in rural-urban difference. The narrowing gap in breast cancer mortality rates between urban and rural areas may be related to the convergence of lifestyles in terms of reproduction, hormones, and other breast cancer risk factors among urban and rural residents. As socio-economic development and urbanization progress, differences in risk factors such as dietary patterns, lifestyles, and physical activity have become less pronounced nationwide, leading to a gradual reduction in the gap of breast cancer mortality rates between urban and rural women. This study provides insights into the changing landscape of breast cancer mortality in China, highlighting the ","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"55 ","pages":"Article 101384"},"PeriodicalIF":7.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143427860","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.lanwpc.2024.101389
Lin Yang, Zhe Liu, Zifang Zhou, Peng Yin
<div><h3>Background</h3><div>The health significance of remnant cholesterol (RC) has been increasingly recognized. However, data are scarce with respect to their associations with lung cancer mortality in China, where lung cancer is a major public health issue among the elderly due to its increasing incidence and high mortality. Therefore, this study aimed to examine the association of RC with lung cancer mortality in Chinese individuals aged 65 years and over.</div></div><div><h3>Methods</h3><div>A total of 1,841,003 participants over 65 years were recruited in Zunyi, Luzhou and Shenzhen, China from January 1, 2017, to December 31, 2021. During baseline visits, questionnaire interviews were conducted to collect information on socioeconomic status (sex, age, education) and lifestyles (current smoking, exercising frequency, and alcohol drinking status). Vital status for each participant was obtained through linkage with China national death registration system up to December 2021. After excluding 575,456 participants with incomplete information, 1,265,547 participants remained for analysis. Baseline blood pressure, fasting blood glucose and blood lipids levels were measured, and participants were stratified into quartiles for RC, with quartile 1 representing the lowest levels (<0.46 mmol/L) and quartile 4 the highest (≥1.20 mmol/L). We considered lung cancer mortality (the International Classification of Diseases–10th Revision: C33–C34) as the underlying cause of death as the primary outcome. The Cox proportionate hazard models were used to estimate hazard ratios (HRs) with 95% confidence intervals (CIs) between RC categories and lung cancer mortality. Stratified analyses were performed to further explore association in various subgroups.</div></div><div><h3>Findings</h3><div>Among the 1,265,547 eligible participants included, the mean age was 71.43 ± 5.95 years, and 673,746 (53.2%) were female. During a mean follow-up of 2.91 years, 85,374 participants died, including 6,330 from lung cancer. In the full cohort, higher levels of RC were associated with decreased risks of lung cancer mortality. Compared with participants with RC in quartile 1, crude HRs (95% CI) were 0.89 (0.83-0.99) and 0.82 (0.76-0.88) for those with RC in quartile 3 and quartile 4 respectively. After adjustment for baseline sex, age, education, current smoking, drinking status, systolic blood pressure, exercise frequency, fasting blood glucose, the observed HRs (95% CI) was 0.90 (0.84-0.96) for those with RC in quartile 4. Subgroup analyses showed consistent results for both men and women.</div></div><div><h3>Interpretation</h3><div>Higher remnant cholesterol was associated with a lower mortality risk of lung cancer. Although the associations were robust in our analysis, it is still unclear whether this is because cholesterol is one of the protective factors against the occurrence and mortality of lung cancer, or due to a greater competing risk of death among patients with hi
{"title":"Remnant cholesterol and lung cancer mortality in Chinese older adults: a large prospective cohort study","authors":"Lin Yang, Zhe Liu, Zifang Zhou, Peng Yin","doi":"10.1016/j.lanwpc.2024.101389","DOIUrl":"10.1016/j.lanwpc.2024.101389","url":null,"abstract":"<div><h3>Background</h3><div>The health significance of remnant cholesterol (RC) has been increasingly recognized. However, data are scarce with respect to their associations with lung cancer mortality in China, where lung cancer is a major public health issue among the elderly due to its increasing incidence and high mortality. Therefore, this study aimed to examine the association of RC with lung cancer mortality in Chinese individuals aged 65 years and over.</div></div><div><h3>Methods</h3><div>A total of 1,841,003 participants over 65 years were recruited in Zunyi, Luzhou and Shenzhen, China from January 1, 2017, to December 31, 2021. During baseline visits, questionnaire interviews were conducted to collect information on socioeconomic status (sex, age, education) and lifestyles (current smoking, exercising frequency, and alcohol drinking status). Vital status for each participant was obtained through linkage with China national death registration system up to December 2021. After excluding 575,456 participants with incomplete information, 1,265,547 participants remained for analysis. Baseline blood pressure, fasting blood glucose and blood lipids levels were measured, and participants were stratified into quartiles for RC, with quartile 1 representing the lowest levels (<0.46 mmol/L) and quartile 4 the highest (≥1.20 mmol/L). We considered lung cancer mortality (the International Classification of Diseases–10th Revision: C33–C34) as the underlying cause of death as the primary outcome. The Cox proportionate hazard models were used to estimate hazard ratios (HRs) with 95% confidence intervals (CIs) between RC categories and lung cancer mortality. Stratified analyses were performed to further explore association in various subgroups.</div></div><div><h3>Findings</h3><div>Among the 1,265,547 eligible participants included, the mean age was 71.43 ± 5.95 years, and 673,746 (53.2%) were female. During a mean follow-up of 2.91 years, 85,374 participants died, including 6,330 from lung cancer. In the full cohort, higher levels of RC were associated with decreased risks of lung cancer mortality. Compared with participants with RC in quartile 1, crude HRs (95% CI) were 0.89 (0.83-0.99) and 0.82 (0.76-0.88) for those with RC in quartile 3 and quartile 4 respectively. After adjustment for baseline sex, age, education, current smoking, drinking status, systolic blood pressure, exercise frequency, fasting blood glucose, the observed HRs (95% CI) was 0.90 (0.84-0.96) for those with RC in quartile 4. Subgroup analyses showed consistent results for both men and women.</div></div><div><h3>Interpretation</h3><div>Higher remnant cholesterol was associated with a lower mortality risk of lung cancer. Although the associations were robust in our analysis, it is still unclear whether this is because cholesterol is one of the protective factors against the occurrence and mortality of lung cancer, or due to a greater competing risk of death among patients with hi","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"55 ","pages":"Article 101389"},"PeriodicalIF":7.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143427901","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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