中华流行病学杂志最新文献

Extremely unbalanced data refers to datasets with independent or dependent variables showing severe imbalances in proportions, which might lead to deviation of classical test statistics from theoretical distribution and difficulties in controlling type Ⅰ error. The increased availability of genome-wide resources from large population cohorts has highlighted the growing demand for efficient and accurate statistical methods for the process of extremely unbalanced data to improve the development of genetic statistical methods. This paper introduces two widely used correction methods in current genome-wide association study for extremely unbalanced data, i.e. Firth correction and saddle point approximation, describes their effectiveness in controlling type Ⅰ errors confirmed by simulation experiments, finally, and summarizes the commonly used software for extremely unbalanced genomic data to provide theoretical reference and suggestion for its application for the statistical analysis on extremely unbalanced data in future.

Objective: To analyze premature deaths from malignant tumors among Chinese residents from 1990 to 2021, and to quantify the extent to which changes in premature mortality from malignant tumors affect life expectancy among people aged 30 to 69 years. Methods: Using the Global Burden of Disease 2021 data on selected causes of death in China, the malignant tumor mortality rate was estimated for Chinese residents aged 30-69 years from 1990 to 2021, and life expectancy and de-malignant cause-of-death life expectancy were calculated based on the abridged life table for the Chinese population. Arriaga's decomposition method was used to assess the extent to which changes in malignant tumors mortality contributed to changes in life expectancy for people aged 30-69 years and Potential gains in life expectancy (PGLEs) for people aged 30- 69 years. Results: From 1990 to 2021, the standardized mortality rate of malignant tumors among Chinese people aged 30-69 years decreased from 154.29/100 000 to 98.58/100 000, and the change in the mortality rate of malignant tumors among people aged 30-69 years contributed to the increase of life expectancy of about 0.78 years, and the largest contribution was made by the age group aged 55-59 years, which was about 0.17 years. Among the top 10 malignant tumors, the largest "positive contributions" are stomach cancer, esophageal cancer, and liver cancer, with a cumulative contribution of 0.55 years, while pancreatic cancer hurts the increase of overall life expectancy. The PGLEs of malignant tumors for the population aged 30-69 years will be 1.69 years in 2021, which is higher for men (1.97 years) than for women (1.32 years). The top 5 malignant tumors causing loss of life expectancy in the population were tracheal, bronchus, and lung cancer, stomach cancer, esophageal cancer, colorectal cancer, and liver cancer, in that order. Compared with 1990, in 2021, PGLEs for malignant tumors among people aged 30-69 years increased in seven provinces (autonomous regions and municipalities), including Yunnan and Guizhou, and the rest saw a decline, with the largest decrease in Anhui Province. Conclusions: The standardized mortality rate of malignant tumors among Chinese residents aged 30-69 years declined from 1990 to 2021;the change in mortality rate of malignant tumors showed a positive effect on the growth of life expectancy, the change in PGLEs of malignant tumors varied among provinces (autonomous regions and municipalities), and premature deaths from tracheal, bronchus, and lung cancer and gastrointestinal malignant tumors still need to be paid attention to.

Objective: To analyze change trend of disease burden of chronic kidney disease (CKD) mortality between 2012 and 2023 in Chongqing, and provide suggestion for CKD prevention. Methods: The mortality data of CKD were collected from Chongqing death registration between 2012 and 2023 according to International Classification of Diseases 10^th. The data were analyzed to calculate mortality rate, standardized mortality rate, age specific mortality rate, and the rate of years of life lost (YLL) and proportion by using software SPSS 26.0. The mortality rate of CKD between men and women, urban area and rural area were compared by χ² test. The change trend was described by average annual percent of change (AAPC). Results: The mortality rate and standardized mortality rate of CKD were 7.94/100 000 and 4.63/100 000 respectively in 2012 and 6.70/100 000 and 2.79/100 000 respectively in 2023 in Chongqing. The difference in change of CKD mortality rate was not significant (AAPC=-0.79%, t=-1.60, P=0.273). However, the standardized mortality rate of CKD decreased by 3.59% (t=-3.98, P=0.003) from 2012 to 2023. The mortality rate of CKD was higher in men than in women in 2014 and 2022, the differences were significant (all P<0.05). The standardized mortality rate of CKD in men and women decreased by 3.17% and 4.11% respectively between 2012 and 2023, the difference was significant (all P<0.05). The mortality rate of CKD had been higher in urban area than in rural area since 2016 (all P<0.05). During this period, the mortality rate and standardized mortality rate of CKD in urban area remained stable, but the mortality rate and standardized mortality rate of CKD in rural area showed average annual decreases of 2.21% and 4.90%, the differences were significant (all P<0.05). The proportion of CKD due to hypertension decreased, but the proportion of CKD due to diabetes and other causes increased. The rate of age standardized YLL of CKD showed an average annual decrease of 2.83%, the differences were significant (P=0.011). Conclusions: The standardized mortality rate and age standardized YLL of CKD decreased from 2012 to 2023 in Chongqing. Men, urban residents and the elderly are key populations in CKD prevention.

Objective: To investigate the prevalence of baseline dyslipidemia in HIV-infected people before starting antiviral therapy (ART) in China. Methods: The data were collected from HIV/AIDS ART database of Chinese Disease Prevention and Control Information System. A national sample of HIV- infected people who initiated ART from 2018 to 2023 was used to collect baseline information, including sociodemographic characteristics and laboratory test results. According to the Chinese Lipid Management Guidelines (2023) and the National Cholesterol Education Program Adult Treatment Panel Ⅲ guidelines, triglyceride (TG) ≥1.7 mmol/L or total cholesterol (TC) ≥5.2 mmol/L were identified as dyslipidemia. Statistical analysis was performed with software SAS 9.4. An unconditional logistic regression model was used to analyze the factors influencing TG and TC abnormalities in HIV-infected patients before ART. Results: A total of 359 952 adults infected with HIV were included in this study, the prevalence rate of dyslipidemia was 38.41% (138 263/359 952). The abnormal rates of TG and TC were 31.40% (113 041/359 952) and 13.75% (49 494/359 952), respectively. In all age groups except for the 25-44 age groups, the abnormal rates of TG and TC were higher in HIV-infected women than in HIV-infected men. In HIV-infected patients, women, those aged 45-64 years, those lived in northeast region, those had heterosexual transmission, and those with BMI ≥28.0 kg/m², CD4⁺T lymphocytes counts ≥500 cells/µl had higher rates of baseline dyslipidemia (all P<0.05). Conclusions: The abnormal rate of TG in HIV-infected people before ART was higher in China from 2018 to 2023, especially in HIV-infected women, and the abnormal rate of TG and TC increased with age. Attention should be paid to the clinical diagnosis and ART selection in the treatment of HIV infection.

Objective: To understand the incidence of adverse pregnancy outcome in HIV-infected pregnant women and influencing factors in China and provide reference for the improvement of the health status of HIV-infected pregnant women and their newborns. Methods: Based on a mother-child cohort of HIV-infected pregnant women and children (PMTCT-MC-2005) established in Guangxi Zhuang Autonomous Region, Yunnan Province and Xinjiang Uygur Autonomous Region, this study enrolled pregnant women with or without HIV infection as study subjects from January 2017 to June 2023, a total of 1 646 pregnant women (558 HIV-infected and 1 088 HIV-uninfected) were included, and 34 cases with missing data were excluded. The χ² test was used to analyze the difference in the incidence adverse pregnancy outcome between two groups, and used logistic regression model to identify the influencing factors of adverse pregnancy outcome in HIV-infected pregnant women. Results: A total of 1 612 pregnant women were included in the study, in whom 541 were infected with HIV and 1 071 were not infected with HIV. The incidence of adverse pregnancy outcome was 18.8% (303/1 612), the incidence of adverse pregnancy outcome was 33.1% (179/541) in the HIV-infected pregnant women and 11.6% (124/1 071) in the pregnant women without HIV infection. The results of multivariable logistic regression analysis showed that the influencing factors of adverse pregnancy outcome were age <35 years at delivery (aOR=0.64, 95%CI: 0.43-0.95) compared with the age ≥35 years and the duration of antiviral treatment over 10 years (aOR=0.43, 95%CI: 0.23-0.79) compared with less than one year. Conclusions: The incidence of adverse pregnancy outcome in HIV-infected pregnant women was high in some regions of China during 2017-2023. It is necessary for HIV-infected women to get pregnancy at appropriate time based on antiretroviral treatment effect and strengthen self-care to reduce the incidence of adverse pregnancy outcome.

Objective: To assess the association between short-term ambient air pollution exposure and arterial stiffness and whether obesity modifies these associations. Methods: A cross-sectional study was conducted based on Fangshan family cohort in Beijing. The 24 hours average air pollutant levels on the day cohort participants took baseline survey were calculated as short-term air pollution. A generalized additive model (GAM) with Gaussian links was used to estimate changes in typical carotid artery intima-media thickness (CIMT), brachial-ankle pulse wave velocity (BAPWV), pulse pressure (PP) and ankle-branchial index (ABI) after short-term exposure to each air pollution (PM_2.5, PM₁₀, SO₂, NO₂, CO). The cross-product terms of each air pollution, body mass index (BMI), and waist-to-hip ratio were included in the GAM model to test the interaction. Further, they conducted a stratified analysis to test their effects on the relationship between short-term exposure to each air pollution and the arterial stiffness indicators. Results: A total of 4 211 individuals were included in the analysis. Individuals' age was (58.9±8.7) years, of which 2 268 (53.9%) were female. Several covariates, including sociodemographic factors, lifestyle behaviors, and history of drugs, were included in the analysis. The results of the GAM analysis showed that an increase in PM_2.5 (β=2.912×10^-4, 95%CI: 1.424×10^-4-4.400×10^-4, P<0.001), CO (β=0.027, 95%CI: 0.011-0.043, P<0.001), SO₂ (β=2.070×10^-3, 95%CI: 7.060×10^-4-3.430×10^-3, P=0.003), and NO₂ (β=3.650×10^-4, 95%CI: 2.340×10^-5-7.060×10^-4, P=0.036) were associated with an increase in CIMT, while an increase in PM₁₀ (β=0.018, 95%CI: 0.002-0.033, P=0.028) was associated with an increase in PP in the study population. Besides, the waist-to-hip ratio had an effect-modification on the correlation of short-term exposure of PM_2.5 (interaction P=0.015), NO₂ (interaction P=0.008), and CO (interaction P=0.044) with CIMT, and the correlation between short-term exposure of PM_2.5 (interaction P=0.002), NO₂ (interaction P=0.010), CO (interaction P=0.029), PM₁₀ (interaction P<0.001) with PP. The significant association between CIMT, PP, and air pollution concentrations was more visible in people with lower waist-to-hip ratios. Conclusions: Short-term ambient air pollution exposure was associated with arterial stiffness indicators, and there was an effect modification of waist-to-hip ratio on these associations, and lower waist-to-hip ratios may enhance the association between air pollution exposure and indicators.

Objective: To understand the interaction effect of general obesity, central obesity, and dyslipidemia on the risk of hypertension to provide scientific evidence for the early prevention and control of hypertension. Methods: From 2019 to 2023, 10 of the 16 districts in Tianjin were selected as project sites. A community and a natural village were selected as monitoring sites in each project site using a multi-stage cluster random sampling method. A questionnaire, physical, and biochemical examination were conducted on permanent residents aged 35-75 who had lived in the surveillance sites for more than half a year. The chi-square test univariate and multivariate logistic regression were used for statistical analysis. The multiplicative and additive models were used to calculate the interaction between general obesity and dyslipidemia, as well as central obesity and dyslipidemia, respectively. Results: A total of 177 160 subjects were included in the study, with an age of (56.44±8.62) years old. There were 29 535 (16.67%) patients with general obesity, 67 338 (38.01%) patients with central obesity, 64 906 (36.64%) patients with dyslipidemia, and 90 266 (50.95%) patients with hypertension. Multiplication interaction analysis results showed that, after adjusting for gender, age, culture level, marriage status, drinking, smoking, and diabetes, the multiplicative interactions between general obesity and dyslipidemia, and central obesity and dyslipidemia on hypertension were statistically significant (all P<0.001), and the adjusted OR and 95%CI were 2.57 (2.47-2.68) and 2.14 (2.08-2.20), respectively. The results of the additive interaction analysis demonstrated that after adjusting for relevant variables, the relative excess risk of interaction (RERI), the attributable proportion of interaction (API), and the synergy index (SI) of the interaction between generalized obesity and dyslipidemia were 0.48 (95%CI: 0.33-0.63), 0.15 (95%CI: 0.11-0.19), and 1.27 (95%CI: 1.18-1.36), respectively; the RERI, API, and SI of the interaction between central obesity and dyslipidemia were 0.37 (95%CI: 0.28-0.46), 0.13 (95%CI: 0.10-0.16), and 1.25 (95%CI: 1.18-1.32), respectively. Conclusions: There might be multiplicative and additive interactions between general obesity, central obesity, and dyslipidemia on the risk of hypertension. Simultaneous control of BMI, waist circumference, and blood lipid levels may effectively reduce the risk of hypertension.

Objective: To analyze awareness, willingness, the status of using, and related factors of HIV pre-exposure prophylaxis (PrEP) in men who have sex with men (MSM) in Shaanxi Province to provide a reference for the next step of HIV prevention and control strategy. Methods: Using a cross-sectional study design from March to May 2022, with the assistance of MSM social organizations in Xi'an, relying on the network platform and MSM Social organizations, a convenient sampling method was used to recruit MSM with an estimated sample size of 900. The inclusion criteria were male aged ≥18, having had same-sex sexual intercourse in the last twelve months, HIV-negative or unknown status of infection. An electronic questionnaire was made with the help of questionnaire-star and an anonymous self-administered questionnaire was used to collect information on socio-demographic characteristics, sexual behavior, awareness and using of PrEP, etc. A logistic regression model was used to analyze related factors of PrEP awareness and use in MSM. SPSS 25.0 software was used for statistical analysis. Results: Among 981 MSM subjects, 76.55% (751/981) had heard of PrEP, and 42.51% (417/981) were aware of PrEP. Among those who knew about PrEP, 74.34% (310/417) had homosexual sexual activity in the last six months, 99.03% (307/310) were willing to use PrEP, and 40.97% (127/310) were using PrEP. The multivariate logistic regression analysis model results showed that nationality (other ethnic groups:aOR=4.48,95%CI:1.28-15.68),education level (high school or technical secondary school: aOR=3.01,95%CI:1.49-6.07; universities or colleges: aOR=2.86,95%CI:1.47-5.57; master degree: aOR=5.10,95%CI:2.37-10.98), monthly income 5 000-10 000 yuan (aOR=1.70,95%CI: 1.00-2.88), tested for HIV in the past 12 months (aOR=1.87,95%CI:1.34-2.61) were related factors of PrEP knowledge awareness. Singlehood (aOR=0.46,95%CI:0.26-0.81) and consulted professionals about PrEP (aOR=9.56,95%CI:4.58-19.96) were related factors of PrEP use. Conclusions: The proportion of willingness to use PrEP was higher among MSM in Shaanxi Province, but the awareness rate and utilization rate of MSM for PrEP were low. The cognition of PrEP should be further improved to promote the correct use of PrEP among MSM.

Objective: To analyze the epidemic characteristics and trends of newly reported HIV-infected people among Chinese and Burmese in Dehong Dai and Jingpo Autonomous Prefecture (Dehong Prefecture) of Yunnan Province, China, from 2000 to 2023, and provide evidence for formµlating AIDS prevention and control measures for the Burmese living in Dehong. Methods: The data were obtained from the Chinese Disease Control and Prevention Information System. The distribution of HIV-infected people with different population characteristics was analyzed, and the Joinpoint regression model was used to analyze the temporal trend of crude detection rate in different genders, ethnicities, and ages. Results: From 2000 to 2023, 24 989 newly HIV infections were reported in Dehong Prefecture, of which 14 594 (58.4%) were Chinese and 10 395 (41.6%) were Burmese. Compared with Chinese, Burmese women (32.9%, 3 416/10 395), those aged 20-29 (40.9%, 4 248/10 395), and Jingpo people (26.7%, 2 773/10 395) accounted for a higher proportion. The new diagnosis rate of Chinese nationals increased from 1.0/10 000 in 2000 to 15.4/10 000 in 2004, and then showed a downward trend, falling to 1.2/10 000 in 2023. Among them, compared with other age groups, Dai and other ethnic groups and women, the new diagnosis rate among 20-49 age group, Jingpo and men were relatively higher, at 1.7/10 000, 2.3/10 000 and 1.3/10 000 respectively. Regarding the method of detection, the Chinese HIV-infected people were mainly detected by key population testing (35.7%), while the Burmese HIV-infected people by key population testing (28.9%) and physical examination for entry-exit personnel (25.3%). The transmission routes of both nationalities were mainly heterosexual transmission, but compared with Chinese HIV-infected persons, the proportion of Burmese infected persons through non-marital non-commercial transmission was relatively higher (66.4% vs. 60.6%). The proportion of Chinese nationals with a first CD4⁺T lymphocyte (CD4) counts of <200 cells/µl (28.9%) was higher than that of Burmese nationals (19.8%). Conclusions: The rising trend of HIV infection among Chinese and Burmese people in Dehong Prefecture from 2000 to 2023 slowed down. The new diagnosis rate was higher in the 20-49 age group, Jingpo and men. Compared with Burmese HIV-infected people, the proportion of Chinese HIV-infected people with first CD4 counts <200 cells/µl was relatively higher. Comprehensive interventions should be further carried out for Myanmar nationals, and efforts should be made to expand testing for Chinese nationals.

Objective: To identify the spatial clustering and its temporal trends among newly reported HIV/AIDS cases in Henan Province during 1995-2020, and to provide evidence for strategies on prevention and control of the disease. Methods: Information about newly reported HIV/AIDS cases in Henan between 1995 and 2020 were obtained from China Information System for Disease Control and Prevention and to describe their demographic characteristics, spatial autocorrelation and changing trends. This program was conducted at county level, using the ArcGIS 10.2. Results: A total of 96 528 HIV/AIDS cases with complete current address information in counties (districts) were newly reported during 1995-2020 in Henan, and the spatial autocorrelation analysis showed that Global Moran's I index was 0.249, Z_G value of the Global Getis-Ord G coefficient was 6.472 (all P<0.001), indicating that there was a high clustered positive spatial autocorrelation of HIV/AIDS. The newly reported HIV/AIDS cases from 1995 to 2000, 2001 to 2005, 2006 to 2010, 2011 to 2015, and 2016 to 2020 in Henan Province all exhibited high values of global spatial clustering. Their Moran's I indices were 0.197, 0.103, 0.491, 0.411 and 0.383, respectively. The Z_G values of the Global Getis-Ord G coefficient were 4.580, 3.386, 10.246, 8.378 and 8.093, respectively. All of global spatial correlation were statistically significant (all P<0.001). The results of local spatial autocorrelation analysis showed that newly reported HIV/AIDS cases in Henan Province had high-high clustering areas at each time stage mentioned above. The number of high-high clustering counties/districts gradually increased from 6 in 2001-2005 to 21 in 2016-2020, spreading from Zhumadian City and Zhoukou City in southeast Henan to Nanyang City in southwest Henan, Zhengzhou City and its surrounding counties/districts in central Henan. Conclusions: In Henan Province, an increasing trend of clusters appeared on HIV epidemic among newly reported HIV/AIDS cases from 1995 to 2020, and high-high clustering areas gradually expanded from Zhumadian City and Zhoukou City to Nanyang City, Zhengzhou City and its surrounding counties/districts, indicating that it is necessary to strengthen the AIDS prevention and control programs in these areas in Henan.