中华流行病学杂志最新文献

Objective: To investigate the influencing factors of progression and regression of carotid intima-media thickening and carotid plaques in a Chinese population, and to provide evidence for the early prevention and intervention of atherosclerosis. Methods: Based on data from 11 416 participants in the second resurvey (August 2013 to September 2014) and the third resurvey (August 2020 to December 2021) of China Kadoorie Biobank Study, combined with questionnaire data, physical measurements, and blood biomarker measurements, multivariable logistic regression models were used to identify factors associated with the progression, persistence, or regression of carotid intima-media thickening and carotid plaque through stratified analyses. Results: It was found that older age was significantly associated with an elevated risk of new carotid intima-media thickening (P<0.001) and new carotid plaque (P<0.001). Being man (OR=1.37, 95%CI: 1.15-1.62), current smoking or smoking cessation due to illness (OR=1.26, 95%CI: 1.04-1.51), higher LDL-C levels (OR=1.31, 95%CI: 1.22-1.40), and hypertension (OR=1.18, 95%CI: 1.05-1.34) were significantly associated with an increased risk of incident carotid intima-media thickening, while higher HDL-C levels were significantly associated with a reduced risk of incident carotid intima-media thickening (OR=0.78, 95%CI: 0.66-0.91). Among participants with existing carotid intima-media thickening, men (OR=0.53, 95%CI: 0.37-0.76), those with higher LDL-C levels (OR=0.74, 95%CI: 0.64-0.87), and hypertension (OR=0.66, 95%CI: 0.50-0.86) were less likely to have the regression of carotid intima-media thickening. Current smoking or smoking cessation due to illness (OR=1.28, 95%CI: 1.05-1.55), daily excessive alcohol consumption (OR=1.35, 95%CI: 1.05-1.72), low body weight (OR=1.72, 95%CI: 1.25-2.37), higher LDL-C levels (OR=1.20, 95%CI: 1.11-1.29), hypertension (OR=1.54, 95%CI: 1.35-1.75), and diabetes (OR=1.39, 95%CI: 1.10-1.75) were associated with an increased risk of new carotid plaque. In individuals with existing carotid plaques, older adults (age ≥60: OR=0.28, 95%CI: 0.18-0.42) and those with elevated LDL-C levels (OR=0.83, 95%CI: 0.72-0.95) were less likely to have carotid plaque regression. Conclusions: Atherosclerosis is modifiable. Effective management of blood lipids, smoking cessation, limiting alcohol intake, and the effective control of blood pressure, blood glucose and body weight are clinically important strategies for the prevention and regression of atherosclerosis, potentially delaying or even reversing disease progression.

The "Medicine+X" interdisciplinary integration talents cultivation is an important measure to implement the national strategy of "Education Power" and "Healthy China" and to promote the construction of new medicine. Taking the mandatory graduate course of "Fundamentals of Medical Statistics" at Peking University Health Science Center as an example, this paper systematically elaborates on the instructional design and implementation steps of the integrated medical statistics curriculum, and evaluates the effectiveness of the curriculum reform by analyzing the results of a questionnaire survey. The results indicated that after the teaching reform, the post-class test scores, learning benefit scores, and satisfaction scores of the students all significantly increased compared with the scores before the reform [(15.4±2.9) vs. (10.6±5.3), (91.2±9.1) vs. (80.3±29.0), and (99.5±0.6) vs. (97.3±1.9)], the differences were significant (all P<0.05). However, no significant differences were observed among the final exam scores (P=0.973). The teaching practice proved that, compared with traditional teaching modes, the integrated teaching curriculum showed superior effects on improving students' clinical parctice capability and strengthening the application of scientific research methods, providing robust support to the training of new-type medical talents who can have the performance inviolving the medical treatment, disease prevention and healthcare and further promote the in-depth development of medical science.

Objective: To analyze the search and identification data of HIV/AIDS related topics of public concern on TikTok platform to provide evidence for optimizing public health education strategies. Methods: Based on search data for "HIV" and "AIDS" from TikTok platform from January 2023 to December 2024, the latent dirichlet allocation (LDA) model was employed for topic extraction and evolution analysis. Results: Four search peaks were observed in March and June 2023, and February and December 2024. The LDA model analysis identified eight core themes: expert-led science communication, visualized explanation of viral mechanisms, treatment and patient support, sexual and reproductive health, antiviral treatment and HIV/AIDS prevention campaigns, prenatal HIV screening, public awareness activities, and HIV/AIDS related film and television narratives. Thematic evolution followed two primary pathways: HIV prevention and prenatal cultural representation. Conclusions: Public concern to AIDS on TikTok platform is primarily driven by three factors: public health campaigns, societal activity cycles and social media-amplified events. The users exhibit dual demands for scientifically rigorous yet visually accessible content and thematic shifts are largely shaped by policy-driven agenda setting. It is recommended that future HIV/AIDS health communication strategies be optimized across multiple dimensions, including message source credibility, content creation, communication formats, and strategic timing, to enhance public engagement and health literacy.

Objective: To understand the association between plasma 25-hydroxyvitamin D [25(OH)D] level and depressive symptom in older adults aged ≥65 years in 18 longevity areas in China. Methods: Based on cross-sectional data from the 2021 China Healthy Ageing and Biomarkers Cohort Study. The information about the demographic characteristics, lifestyles, cognitive function, and disease history of the older adults were collected through face-to-face interviews. Fasting venous blood samples were taken to measure plasma 25(OH)D level. The risk for depressive symptom was evaluated by using the Patient Health Questionnaire-9 (PHQ-9), with score ≥10 indicating positive result. Multivariable logistic regression, multiple linear regression, and restricted cubic spline models were used to evaluate the relationship of plasma 25(OH)D level with the risk for depressive symptom and PHQ-9 score. Results: A total of 4 882 participants were included, with the mean age of (83.79±11.23) years and women accounting for 55.1%, and the detection rate of depressive symptom was 6.7% (329/4 882). The study participants were stratified into three tertile groups (T₁-T₃) based on plasma 25(OH)D level. Multivariable logistic regression analysis revealed a significant inverse association between plasma 25(OH)D level and depressive symptom. Compared with the T₁ group, the T₃ group had significantly lower risk for depressive symptom (OR=0.678, 95%CI: 0.493-0.928, P=0.016). Multiple linear regression analysis showed that higher plasma 25(OH)D level was negatively associated with PHQ-9 score (T₂: β=-0.426, 95%CI: -0.701 - -0.151, P=0.002; T₃: β=-0.705, 95%CI: -0.983 - -0.428, P<0.001). Restricted cubic spline models indicated a monotonically decreasing dose-response relationship between plasma 25(OH)D level and risk for depressive symptom (P for linear=0.010). Conclusion: In older adults aged ≥65 years from 18 longevity areas in China, plasma 25(OH)D level was significantly associated with the risk for depressive symptom.

Objective: To establish a reproductive decision-making indicator system for families affected by HIV, and provide theoretical evidence for the scientifical assessment of their reproductive risk and development of precise intervention strategies. Methods: An indicator framework was developed through literature review and expert panel discussions. Fuzzy analytic hierarchy process was employed for expert consultation to determine the weights of indicators in the reproductive decision-making system for families affected by HIV. Results: A total of 13 experts participated in this study. A decision-making assessment system was established, comprising 4 criterion-level indicators and 19 index-level indicators. At the criteria level, the weights of self-status, medical staff capability, medical institutional status, and family status indicators were 0.279, 0.255, 0.235 and 0.230, respectively. At the index level, the top three indicators with combined weights were the capability of providing reproduction guidance,preconception/pregnancy/postpartum consultation and guidance, and the provision of AIDS counseling service, with weights of 0.066, 0.066, and 0.065, respectively. Conclusion: The reproductive decision-making indicator system established in this study can be used in the assessment of the reproductive risk for families affected by HIV to provide reference for precise interventions and public health decision-making.

The Healthy China 2030 blueprint identifies health promotion and chronic disease prevention as national strategic priorities. Focusing on the role of health promotion in the prevention and control of chronic diseases, this paper first summarizes the concept of health and its evolution process, then introduces the global and national strategies for chronic disease prevention and control. Based on the evidence both at home and abroad, this paper systematically explains the appilication of health promotion strategies in chronic disease prevention and control and introduces recommendations for health promotion and indicators for chronic disease prevention and control developed in Healthy China Initiative. This study may provide insights and guidance for future research and practice of health promotion for chronic disease prevention and control.

Objective: To evaluate the performance of blocking the mother to child transmission of HBV in Jiangsu Province, to standardize the practice of blocking the mother to child transmission of HBV. Methods: Five counties (districts) were selected in northern, central and southern Jiangsu; the local data of maternal HBV screening and blocking mother to child transmission of HBV during 2021-2023 were extracted from relevant information systems. Chi-square test, Cochran-Armitage test and Firth's penalized likelihood logistic regression model were used for statistical analyses. Results: From 2021 to 2023, a total of 63 805 pregnant women were surveyed in HBV screening, the HBsAg positive rate was 4.46%. In the positive women, 18.46% were at high-risk for mother to child transmission of HBV indicated by HBeAg or HBV-DNA levels; the rate of antiviral therapy during pregnancy increased from 33.78% in 2021 to 82.20% in 2023 (P<0.001). In 2 844 HBV-exposed live-born infants, the annual timely injection rates of hepatitis B immune globulin exceeded 98.30% each year (P=0.627), and the annual timely injection rate of hepetitis B vaccine birth dose increased from 95.25% in 2021 to 99.12% in 2023 (P<0.001). The annual post-vaccination serological test rate in HBV-exposed infants increased from 68.83% in 2021 to 92.82% in 2023 (P<0.001). In the post-vaccination serological test of 2 343 children, the annual HBsAb negative rate fell from 18.59% in 2021 to 6.92% in 2023 (P<0.001). Eight cases of blocking failure were identified (0.34%), the blocking failure rate in the pregnant women at high risk was 1.65%. Multivariate analysis revealed that the risk for blocking failure was 6.75 times (aOR=6.75,95%CI: 1.46-64.47) higher in high-risk pregnant women who received no antiviral therapy than in those who received antiviral therapy during pregnancy. Conclusions: From 2021 to 2023, the measures of blocking the mother to child transmission of HBV in Jiangsu is effective. Antiviral therapy for pregnant women at high risk is the key determinant of success. In the blocking transmission practice, it is necessary to increase the antiviral treatment rate in pregnant women at high-risk, further standardize the post-vaccination serological test procedures and strengthen the booster vaccination in HBsAb-negative children.

Transgender women (TGW) are individuals whose birth sex is male but whose gender identify is female. They are usually simply classified as men who have sex with men, resulting in their specific needs being overlooked. TGW is a key population affecting the spread of AIDS. Global epidemiological data show that the HIV/AIDS prevalence and new infection rates are significantly higher in TGW than in general population. The prevalence of HIV infection in TGW remains at a high level in different areas of China , with higher infection risks compared with cisgender men who have sex with men. This paper summarizes the factors influencing HIV infection in TGW from multiple dimensions, including personal characteristics, social factors, and healthcare service, to provide references for the research and development of intervention measures in this population.

Objective: To describe the incidence of tuberculosis (TB) in 10 areas where China Kadoorie Biobank (CKB) Study was conducted between 2009 and 2018 and explore the influencing factors. Methods: To comprehensively obtain the incidence data of TB, the CKB cohort was linked with the TB cases registered in the China Information System for Disease Control and Prevention. Poisson regression models were used to analyze the temporal, area, and population distributions of TB incidence and estimate RR of the factors associated with TB. Joinpoint regression model was used to detect temporal trends. Results: The TB incidence rate varied significantly with area, which was highest in the project area in Hunan [167.3 per 100 000 person-years (95%CI: 157.0 per 100 000 person-years-177.7 per 100 000 person-years)] and lowest in the project area in Zhejiang [33.3 per 100 000 person-years (95%CI: 28.6 per 100 000 person-years-38.0 per 100 000 person-years)]. The risk for TB increased with age, and the RRs were 1.39 (95%CI: 1.29-1.50) and 1.50 (95%CI:1.38-1.63), respectively, in age groups 60- years and ≥70 years. Smoking, alcohol consumption, BMI, and diabetes were associated with an elevated risk for TB (RR=1.28, 95%CI: 1.17-1.40), 1.11 (95%CI:1.03-1.20), 2.62 (95%CI: 2.40-2.86), and 1.67 (95%CI: 1.50-1.86), respectively. Women had lower risk for TB (RR=0.55, 95%CI: 0.50-0.60). Overweight (RR=0.57, 95%CI: 0.53-0.62) and obesity (RR=0.48, 95%CI: 0.42-0.55) were also associated with lower risk for TB. Higher education level was associated with reduced risk for TB. For participants with education levels of junior and senior high school, college or university, the RRs were 0.85 (95%CI: 0.79-0.92) and 0.63 (95%CI: 0.54-0.74). Similarly, higher annual household income was associated with lower TB risk, the RR were 0.88 (95%CI: 0.81-0.96) in 10 000- Yuan group and 0.77 (95%CI: 0.71-0.84) in ≥20 000 Yuan group. After adjusting for age, sex, and area, the TB incidence rate initially increased and peaked in 2013 [101.3 per 100 000 person-years (96.8 per 100 000 person-years-105.8 per 100 000 person-years)], then declined [annual percentage change (APC): 5.06% during 2009-2013; APC=-6.71% during 2013-2018]. Conclusions: The incidence of TB was high in adults in the 10 study areas of CKB, the risk was influenced by sociodemographic characteristics, lifestyles and BMI.

Objective: To investigate the liver function and the distribution characteristics of liver fibrosis in older adults aged ≥65 years in 18 longevity areas in China. Methods: Based on cross-sectional data from the 2021 China Healthy Ageing and Biomarkers Cohort Study. The information about the demographic characteristics, lifestyles, cognitive function, and disease history of the older adults were collected through face-to-face interviews. Fasting blood samples were taken from the older adults for routine blood tests and liver function tests, including AST, ALT, AST/ALT, total protein (TP), albumin (ALB), globulin (GLOB) tests, and the ratio of ALB to GLOB (A/G) and the Fibrosis-4 index for liver fibrosis were calculated. The skewness-median-coefficient of variation method was used to describe the liver function and the distribution of liver fibrosis of the older adults. The abnormal liver function status of older adults with different risks for advanced liver fibrosis was explored. Results: The study included 5 403 participants with an average age of (85.2±11.6) years, of whom 2 365 (43.8%) were men. In the older adults, the AST, ALT, ALB, TP, and A/G levels showed downward trends with age, while AST/ALT and GLOB levels increased with age. The older adults at high-risk for progressive liver fibrosis accounted for 49.7%. The proportions of those at high risk were 50.0% in men and 49.4% in women. Men aged 65-79, 80-89, and ≥100 years showed higher high risk rates compared with women in same age groups (42.0% vs. 36.9%, 50.0% vs. 45.2% and 69.1% vs. 60.9%). Men had more abnormal liver damage indicators compared with women, such as low AST (9.9% vs. 4.3%) and low ALT (55.7% vs. 51.2%), while women had more abnormal liver synthesis indicators compared with men, including low ALB (25.2% vs. 29.2%) and low A/G (9.2% vs. 11.1%). Conclusions: The risk for advanced liver fibrosis was relatively high in older adults in China, showing an upward trend with age and being higher in men than in women. The abnormality of liver function was characterized by lower level than reference range in older adults. Men showed more liver damage indicators (low AST and low ALT) compared with women, whereas women showed more abnormal liver synthesis indicators (low ALB and low A/G) compared with men.