中华流行病学杂志最新文献

Objective: To understand the association between body composition and elevated high-sensitivity C-reactive protein (hs-CRP) 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. Body composition indicators (muscle mass, fat mass, body fat percentage, and visceral fat level) were measured using bioelectrical impedance analysis. Plasma hs-CRP levels were detected by immunoturbidimetry, with >3.0 mg/L indicating elevated hs-CRP. Multivariable logistic regression model was used to analyze associations between four body composition indicators and elevated hs-CRP, and restricted cubic spline models were used to evaluate dose-response relationships. Results: A total of 4 596 older adults aged (82.61±10.55) years, in whom 2 185 (47.5%) were men, were included in the study, and elevated hs-CRP was detected in 1 287 older adults (28.0%). After adjustment for confounders, Q₄ group showed 32.8% lower risk of elevated hs-CRP compared with Q₁ group in terms of muscle mass (OR=0.672, 95%CI: 0.518-0.869). In contrast, Q₄ group showed 54.7% (OR=1.547, 95%CI: 1.189-2.012), 43.2% (OR=1.432, 95%CI: 1.141-1.799), and 73.8% (OR=1.738, 95%CI: 1.358-2.226) higher risks for elevated hs-CRP compared with Q₁ group in terms of fat mass, body fat percentage and visceral fat level. Restricted cubic spline models revealed significant nonlinear relationships between four body composition indicatos and risk for elevated hs-CRP (all P<0.05). Subgroup analysis indicated sex-specific associations: in men, Q₄ group showed reduced hs-CRP elevation risk by 43.7% in terms of muscle mass (OR=0.563, 95%CI: 0.408-0.774) with no significant association in terms of fat mass, and in women, Q₄ group showed increased risk by 82.5% in terms of fat mass (OR=1.825, 95%CI: 1.243-2.678) with no significant association in terms of muscle mass. Conclusions: Higher muscle mass might mitigate inflammation risk, while increased fat mass, body fat percentage, and visceral fat level might exacerbate the risk in older adults. Better body composition could help reduce systemic inflammation risk, but sex-specific difference exists.

Objective: To investigate the expression changes of chemokines in the peripheral blood of hepatitis B surface antigen (HBsAg)-positive pregnant women and umbilical cord blood of their newborns in relation to hepatitis B virus (HBV) placental transmission (BPT), to identify factors influencing chemokines, and to evaluate their predictive value for BPT. Methods: From April 2024 to April 2025, an epidemiological survey was conducted among HBsAg-positive pregnant women delivering at Longyan First Hospital, Fujian Province. ELISA and real-time fluorescence quantitative PCR were used to detect HBV serological markers and HBV DNA levels in maternal peripheral blood and neonatal umbilical cord blood. Nested PCR was performed to amplify the HBV S region in maternal peripheral blood to determine HBV genotypes. Chemokine levels in maternal peripheral blood and umbilical cord blood were measured using a flow cytometric bead array. Multivariate analysis was performed using a binary logistic regression model, and receiver operating characteristic curves were used to assess the predictive value of chemokines for BPT. Results: The incidence of BPT among HBsAg-positive pregnant women was 47.22% (34/72). The expression levels of CXC chemokine ligands (CXCL) 1, CXCL10, and CXCL13 were significantly higher in maternal peripheral blood than in umbilical cord blood, whereas CXCL16 was significantly lower in peripheral blood than in umbilical cord blood. These trends were consistent across different HBeAg statuses and HBV DNA loads. C-C motif chemokine ligand (CCL)2 levels in both maternal peripheral blood and umbilical cord blood were significantly higher in the non-BPT (NBPT) group than in the BPT group. Conversely, CXCL10 levels were significantly higher in the BPT group than in the NBPT group, while umbilical cord blood CXCL13 and maternal peripheral blood CXCL8 were also significantly higher in the BPT group. Logistic regression analysis revealed that umbilical cord blood CCL2 was a protective factor against BPT (OR=0.97, 95%CI: 0.94-0.99). Conclusions: CXCL16 appears to be predominantly secreted by the placenta, and umbilical cord blood CCL2 serves as a protective factor against BPT. Peripheral blood chemokines showed lower predictive value for BPT compared with the classical predictor, HBV DNA. Larger sample sizes and multicenter studies are needed to explore further the potential role of chemokines in predicting BPT.

Objective: To describe the knowledge structure, collaboration patterns, and thematic evolution of complex networks in HIV intervention research from 2015 to 2024 using bibliometric methods. The study aims to identify high-impact entities and emerging hotspots, revealing the research dynamics and collaboration characteristics in the field of complex networks and HIV interventions. Methods: Relevant English literature published between 2015 and 2024 was retrieved from the Web of Science Core Collection, resulting in a total of 1 068 papers. CiteSpace software was used to construct networks of countries/regions, institutions, authors, and keywords, analyzing global research output, collaboration relationships, and the evolution of research themes. Results: The research output on complex network technologies in HIV preventive interventions showed a fluctuating upward trend, peaking at 149 papers in 2024. Original research accounted for 93.4%, while reviews made up 6.6%. The United States (586 papers) and China (223 papers) were the leading contributors. South Africa had the highest average citation per paper, at 41.5 citations. The international collaboration network density was 0.103, showing a "core-periphery" structure. Universities like the University of California and Johns Hopkins University were at the core of the collaboration network, with active interdisciplinary collaboration between public health and computer science, advancing directions such as "AI-driven transmission prediction." Burst keyword analysis revealed that research topics shifted from focusing on "antiviral treatment and drug-using populations" (2015-2016), to "high-burden regions and epidemic response" (2016-2018), and then to "behavioral interventions for specific populations and immune network dynamics" (2019-2020). In recent years, the research frontier further developed into "MSM health management", "mental health associations" and "innovations in network analysis methods and cross-disease research" (2021-2024), with "network analysis" (burst strength=5.81) emerging as the most influential new hotspot. Conclusions: From 2015 to 2024, research on complex network technologies in HIV preventive interventions showed overall growth, with a predominant focus on original research. Knowledge production and collaboration displayed significant centralization and a "core-periphery" pattern. Cross-disciplinary collaboration has driven intelligent methods to become a major growth area, with research topics shifting from individual treatment modeling to population-level interventions and the integration of technological and social perspectives.

Objective: To evaluate the incidence and overdiagnosis of thyroid cancer and related socioeconomic burden in China, from 2025 to 2034, estimate the direct and indirect economic burdens, and provide evidence for public health policy development. Methods: The morbidity and mortality data of thyroid cancer in China during 2009-2018 and the estimated data of the United Nations were used to predict the disease burden of thyroid cancer in China from 2025 to 2034 with Bayesian age-period-cohort model. Publicly available data of average hospitalization cost, per capita gross domestic product, productivity growth rate, employment rate, and amount of consumer price index increase were used to predict the economic burden by using cost-of-illness method and friction cost method. A one-way sensitivity analysis was conducted to evaluate the robustness of the results. Results: From 2025 to 2034, the newly diagnosed thyroid cancer case count would increase from 529 656 to 1 619 485, with overdiagnosed case count rising from 431 336 to 1 312 720. The death count would increase from 14 366 to 32 644. The direct economic burden of thyroid cancer would indrease from 8.04 billion Yuan to 24.58 billion Yuan, while the total economic burden would increase from 8.67 billion Yuan to 27.11 billion Yuan. In 2025, the economic burden attributed to overdiagnosis was estimated to be 7.00 billion Yuan, accounting for approximately 80.73% of the total annual burden. The sensitivity analysis indicated that hospitalization cost and the discount rate had substantial impacts on the results. Conclusion: Thyroid cancer would continue to cause substantial health and economic burdens in China between 2025 and 2034.

Objective: To estimate the incidence of type 2 diabetes among adults in China, evaluate the influence of data from different sources on incidence estimation, and analyze the consistency of such differences across population subgroups. Methods: Based on participants in the second (August 2013 to September 2014, n=23 438) and third (August 2020 to December 2021, n=23 326) resurveys of the China Kadoorie Biobank, new-onset type 2 diabetes cases during follow-up were identified separately through three approaches: field survey (combining questionnaire-based self-report and blood glucose testing), questionnaire-based self-report, and follow-up monitoring through linkage to multiple healthcare databases. Age-standardized incidence rates were calculated using the direct standardization method. Generalized linear mixed-effects models were used to estimate incidence rate ratios (IRRs) and 95%CIs comparing incidence ascertained through field survey versus follow-up monitoring. Results: Among participants in the second resurvey, the crude incidence rates (/1 000 person-years) estimated using field survey, questionnaire-based self-report, and follow-up monitoring were 8.4 (95%CI: 7.9-8.9), 4.3 (95%CI: 3.9-4.6), and 2.8 (95%CI: 2.5-3.1), respectively. The corresponding crude incidence rates(/1 000 person-years) in the third resurvey were 8.3 (95%CI: 7.9-8.6), 6.2 (95%CI: 5.9-6.5), and 5.8 (95%CI:5.5-6.1), respectively. The age-standardized incidence rate (/1 000 person-years) was 7.6 (95%CI: 7.1-8.2) in the second resurvey and 7.4 (95%CI:7.0-7.8) in the third resurvey based on field survey results. The IRR comparing field survey with follow-up monitoring was 3.27 (95%CI: 2.90-3.70) in the second resurvey and declined to 1.46 (95%CI: 1.37-1.56) in the third resurvey, with this trend being observed consistently across subgroups. In both resurveys, participants with an education level of middle school or above, those with annual household income <20 000 Yuan, those with central obesity, and those without coronary heart disease or stroke showed relatively higher IRRs, indicating that incidence was more markedly underestimated by follow-up monitoring in these subgroups compared with field survey. Conclusion: This study indicated that in large population-based cohorts, integrating multi-source health care data could substantially improve the identification of new type 2 diabetes cases compared with relying on a single data source.

Objective: To understand the molecular epidemiological characteristics and influencing factors of natural scavengers of hepatitis B surface antigen (HBsAg) in the community population. Methods: From 2010 to 2015, people from the Wuwei Hepatitis B Prevention and Treatment Demonstration Zone were used as the research object to conduct health examinations and follow-up visits. Using the nested case-control study method, 99 HBsAg natural clearancers during the follow-up period were selected as the case group, and 316 HBsAg natural clearancers who did not have HBsAg natural clearance were selected as the control group. Data were collected using questionnaires, serology, and single-nucleotide polymorphism detection. Results: Among the 99 HBsAg natural clearance cases, 45 cases were male (45.45%) and 54 cases were female (54.55%); among the 316 control cases, 156 cases were male (49.37%) and 160 cases were female (50.63%); the genotypes of Notch3 gene rs1043994 loci CC, CT and TT genotypes accounted for 63.64%, 32.95% and 3.41%, respectively, and the frequency in the control group was 77.21%, 21.84% and 0.95%, respectively. The difference in genotype distribution between the two groups was statistically significant (P=0.014). The distribution frequencies of the Notch4 gene rs367398 AA, AG, and GG genotypes in the case group were 11.36%, 50.00% and 38.64%, respectively. In the control group, the frequencies were 5.38%, 43.99% and 50.63%, respectively. The genotype distribution difference between the two groups was statistically significant (P=0.043). Analysis of multivariate logistic regression model showed that factors related to the natural clearance of HBsAg include age ≥60 years old (OR=3.14, 95%CI: 1.33-7.41, P=0.009), Notch3 gene rs1043994 locus CT genotype (OR=1.82, 95%CI: 1.06-3.13, P=0.031), and TT genotype (OR=5.58, 95%CI: 1.05-29.59, P=0.044), Notch4 gene rs367398 locus AA genotype (OR=2.89, 95%CI: 1.17-7.13, P=0.021). Conclusion: In a community-based population of HBsAg carriers, individuals aged ≥60 years, those with the Notch3 gene rs1043994 locus (CT, TT) and the Notch4 gene rs367398 locus (AA) were more likely to experience natural clearance of HBsAg.

Objective: To investigate the association between diet-exercise patterns and central obesity in primary and secondary school students in China. Methods: The data from the 2023 "Nutrition Improvement Program for Students Compulsory Educationin Rural Area" Nutritional Health Monitoring, which was conducted in 121 912 students aged 8-15 years in primary and secondary schools (grade 3-9) in 115 counties in China. Standardized procudures were used to measure students' fasting height, weight, and waist circumference in the morning. The information about dietary intake and physical activity levels of the students were collected by using questionnaires. Latent class analysis was conducted based on the selection of variables with strong associations to extract students' diet-exercise patterns. The associations between diet-exercise patterns and central obesity were examined with both binary logistic regression and generalized ordered logistic regression models. Results: The prevalence of central obesity was 16.6% in students with normal waist circumference and 17.2% in students with high waist circumference when defined by waist circumference, while 20.6% when defined by waist-to-height ratio (WHtR). Five distinct diet-exercise patterns were identified: low food intake & low activity, frequent beverage/fried food intakes & high activity, infrequent beverage/fried food intakes & high activity, frequent beverage/fried food intakes & low activity, and infrequent beverage/fried food intakes & low activity. After adjusting for confounding factors, both logistic regression models consistently showed that frequent beverage/fried food intakes & high activity pattern was positively associated with central obesity risk compared with infrequent beverage/fried food intakes & high activity pattern (OR=1.142, 95%CI: 1.095-1.192; OR=1.125, 95%CI: 1.075-1.177). The low food intake & low activity pattern was negatively associated with central obesity risk (OR=0.889, 95%CI: 0.849-0.931; OR=0.865, 95%CI: 0.824-0.909). Additionally, high meat intake and daily frequent food intake patterns were negatively associated with central obesity risk (both P<0.001). Conclusions: Regular food intake and high meat intake patterns showed negative associations with central obesity. The frequent beverage/fried food intakes & low activity patterns were positively associated with central obesity risk in primary and secondary school students in rural area in China. It is suggested to conduct interventions, such as nutritional health education, with emphasis on post-exercise dietary choice to reduce central obesity risk in this population.

Objective: To explore the epidemiological characteristics of chronic pain and influencing factors in old 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. The study participants were divided into two groups (pain group and non-pain group) by using numerical rating scale. The area, population and age specific epidemiological characteristics of chronic pain were described. Unconditional logistic regression model was used to analyze the influencing factors of chronic pain. Results: A total of 5 874 old adults were included in the study, with an average age of (85.59±11.65) years. The prevalence of chronic pain was 61.25% (3 598/5 874). The prevalence of chronic pain was higher in central China (66.40%) than in eastern China (58.91%) and western China (58.88%), higher in southern China (63.34%) than in northern China (58.49%) and higher in women (65.63%) than in men (55.38%). Lower back was the most common site for severe pain (32.46%), followed by knee (31.75%) and shoulder/neck/back (9.89%). Logistic regression model results showed that living in central China (OR=1.31, 95%CI: 1.09-1.59), being women (OR=1.71, 95%CI: 1.46-2.00), moderate/inferior financial status (OR=1.21, 95%CI: 1.02-1.45), being overweight (OR=1.32, 95%CI: 1.09-1.59) and obese (OR=1.68, 95%CI: 1.33-2.13), suffering from five or more chronic diseases (OR=1.33, 95%CI: 1.08-1.63), depression (OR=2.25, 95%CI: 1.89-2.67), and hypertension (OR=1.29, 95%CI: 1.13-1.46) were risk factors for chronic pain in the pld adults, while self-assessed good health status (OR=0.44, 95%CI: 0.36-0.55) was a protective factor (all P<0.05). Conclusions: The prevalence of chronic pain was relatively high in old adults aged ≥65 years in China, and there were significant area, age and gender specific differences. Many factors influencing chronic pain existed. It is necessary to strengthen pain intervention and management in women, those with poor economic conditions, poor health status and depression.

Objective: To understand the association of thyroid hormone level with body mass index (BMI), waist circumference and body composition 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, 4 566 older adults aged ≥65 years were included in this study. Multiple linear regression and restricted cubic spline models was used to analyze the associations of thyroid hormone level with BMI, waist circumference, muscle mass, and fat mass. Stratified analyses were performed according to gender, age, and fish intake of the older adults. Results: The mean age of the older adults was (82.6±10.5) years, 47.5% of them were men, the free triiodothyronine (FT3) and free thyroxine (FT4) levels were (4.2±0.6) pmol/L and (15.4±2.2) pmol/L respectively. After controlling confounding factors, the results of the multiple linear regression model showed that for each increment of 1 pmol/L in FT3 level, the mean levels β (95%CI) of change in BMI, waist circumference, muscle mass, and fat mass was 0.64(0.44-0.83), 1.21(0.66-1.76), 0.22(0.03-0.41), and 1.44(1.05-1.84) respectively. The mean change in muscle mass for each increment of 1 pmol/L in FT4 level was -0.15 (-0.19--0.10). The restricted cubic spline analysis showed that positive nonlinear associations of FT3 with BMI, waist circumference, muscle mass, and fat mass (all P for nonlinear <0.05) and negative linear association between FT4 and muscle mass (P for linear <0.001). Conclusions: In the older adults aged ≥65 years in 18 longevity areas in China, FT3 level was positively associated with the changes of BMI, waist circumference and body composition. FT4 level was negatively correlated with muscle mass.

Objective: To investigate the association between sarcopenic obesity (SO) phenotype and mild cognitive impairment (MCI) in community-dwelling old adults. Methods: The base line data from Hubei Memory and Aging Cohort Study during 2018-2023 were used in this study. Old adults aged ≥65 years, including those from 4 urban communities in Wuhan and 48 rural villages in Dawu, Hubei Province, were recruited through cluster random sampling. They were divided into four groups: control (without sarcopenia or obesity), obesity only, sarcopenia only, and SO. MCI was diagnosed by using Peterson criteria. The associations of obesity only, sarcopenia only, SO with MCI risk were evaluated by binary logistic regression analysis, then stratified analyses was conducted. Results: A total of 2 738 old adults aged ≥65 years [(72.59±5.36) years] were included in this study, in whom 53.98% were women.The crude prevalence rates of obesity, sarcopenia, and SO were 50.62%, 18.37%, and 10.01%, respectively. The prevalence of MCI was 22.62% in the control, 24.46% in the obesity only, 43.67% in the sarcopenia only, 43.43% in the SO. After adjusting for all variables. The risk for MCI increased by 71% (OR=1.71, 95%CI: 1.24-2.37) in sarcopenia only group and 60% (OR=1.60, 95%CI: 1.18-2.16) in SO group compared with the control. In subgroup analysis, the moderation effect of age and residence were statistically significant (all P interactions <0.05). In the rural old adults, compared with control, obesity only group showed a 28% (OR=0.72, 95%CI: 0.54-0.97) lower risk for MCI, while the sarcopenia only group showed a 53% (OR=1.53, 95%CI: 1.07-2.20). In the urban adults, compared with control, SO group showed a 116% (OR=2.16, 95%CI: 1.11-4.19) higher risk for MCI. Conclusion: Both sarcopenia only and SO are the potential risk factors for MCI in community-dwelling old adults aged ≥65 years with heterogeneity across populations.