中华流行病学杂志最新文献

For most cancers, clear intervention targets for primary prevention are lacking, due to unidentified high-risk causal factors. Consequently, the focus of cancer prevention and control in China has shifted towards early screening and treatment within the general population. This review outlines the significant challenges in research and practice of cancer prevention and control in China, including: ①inadequate understanding of the natural history of cancer; ② limited high-level evidence supporting cancer screening effectiveness and value; ③compromised efficiency and accuracy in current screening modality; and ④ insufficient universality and sustainability of the current screening practices, taking esophageal cancer as an example. To address these challenges, we propose potential coping strategies: ① establishing tailored technologies and pathways for cancer prevention and control based on population-based and clinical epidemiological studies using high-quality designs; ②breaking conventional constraints to establish a novel, efficient, and precision cancer screening strategy and modality that aligned with the frontline needs of cancer prevention and control; and ③establishing enhanced communication platforms among government policymaking departments, scientific research teams, and industrial institutions to foster collaboration and translation in the field of cancer prevention and control. Ultimately, through the collaboration of multiple disciplines and departments, we will jointly achieve the long-term goal of cancer prevention and treatment.

Objective: Diabetic retinopathy (DR) has been reported as the leading cause of blindness among diabetic adults, which is closely related to poor quality of life and increased burden of disability. This study aimed to aggregate the optimally available evidence on modifiable risks of DR. Methods: Until June 2023, PubMed, Cochrane Library, CNKI, and Wanfang databases were used to retrieve Meta-analysis about various risk factors for DR, and Meta-analysis were analyzed and summarized. R 4.3.2 software was used for each Meta-analytic association to calculate the effect size, 95%CI, heterogeneity, small-study effects, excess significance bias, and 95% prediction intervals. The credibility of significant evidence was graded. Results: We captured 23 eligible papers (72 associations) covering a wide range of medication use, concomitant diseases, daily intervention, biomarkers, lifestyle, and physical measurement index. Among them, higher HbA1c variability (RR=1.45, 95%CI: 1.26-1.66) and urine microalbumin positive (OR=2.44, 95%CI: 1.99-2.97) were convincing (grade Ⅰ) evidence, and insulin use (RR=3.48, 95%CI: 2.14-5.67) was highly suggestive (grade Ⅱ) evidence. Moreover, hypertension (OR=2.03, 95%CI: 1.06-3.97), poor glycemic control (OR=4.35, 95%CI: 1.47-12.85), positive macroalbuminuria (OR=8.42, 95%CI: 3.52-20.15), long sleep duration (OR=2.05, 95%CI: 1.37-3.05), vitamin D deficiency (OR=2.02, 95%CI: 1.17-3.50), periodontitis (OR=4.51, 95%CI: 1.76-11.55) were the main risk factors for DR. Intensive blood pressure intervention (RR=0.78, 95%CI: 0.65-0.94), dietary control (OR=0.64, 95%CI: 0.47-0.89) and moderate intensity physical activity (RR=0.76, 95%CI: 0.59-0.97) yielded significant protective associations with DR. Conclusions: Intensive blood pressure glycemic control, and a healthy lifestyle pattern could reduce the risk of DR. This study provides the evidence to identify high-risk populations and recommends rational treatment options and healthy living interventions.

Diagnostic tests are indispensable tools in clinical practice and are rigorously evaluated through scientifically designed accuracy studies before the clinical practice. The accuracy of these tests directly affects the correctness of the diagnosis and the rationality of treatment decisions. This article introduces the types of designs and their characteristics used in diagnostic test accuracy studies, including single-group studies, diagnostic case-control studies, single-group paired studies, and parallel-group studies. It recommends appropriate design types based on the research question stage, the diagnostic test's role in the clinical diagnostic pathway, and the actual clinical application scenario to provide suggestions for further standardizing the design of current clinical diagnostic test accuracy research. This article may help clinical researchers better understand and choose the appropriate type of diagnostic test accuracy study design to improve diagnostic test accuracy research quality.

In the context of delayed marriage and parenthood, decreased willingness in having children, and population aging in China, maternal and child health has become an important and urgent issue. Being essential platforms for research in maternal and child health, the importance of birth cohorts has been widely recognized. In the past 20 years, tens of birth cohorts have been established in major cities and regions of China, with cohorts ranging from thousands to hundreds of thousands. These cohorts, particularly those large ones launched in recent years, have collected a wide spectrum of data and biological samples from mothers and children. Although they have made considerable preliminary achievements, there remain difficulties and challenges. The significant challenges include small and medium-sized cohorts' lacking of clear research themes; insufficient recognition of and emphasis on behavioral and social determinants of health while emphasizing biological determinants of health; variations in types of variables and quality of data collected, which make it difficult for cohorts to be merged and shared; lack of and difficulties in long-term follow-up; significant uncertainties in resources for long-term sustention of the cohorts, and so on. So, we argue that birth cohorts should focus on essential and urgent issues in maternal and child health in the country and seek recognition and support from the government and the entire society. Last but not least, the overall success of birth cohorts in the country requires scientists to be not only academically capable, but also realistic, persistent, altruistic, and collaborative.

Objective: To assess the influence of extreme temperature events on the mortality risk of nervous system diseases in residents of Jiangsu Province and identify patients with nervous system diseases who are susceptible to extreme temperature events. Methods: Acase-crossover design was used to investigate the cumulative lagged effects of extreme temperature events on the mortality risk of nervous system disease in local residents by using the data on causes of death from nervous system diseases in Jiangsu from 2014 to 2020 with conditional logistic regression model. The final definition of extreme temperature events was established using Akaike information criterion. The heat wave was defined as 4 or more consecutive days with daily mean temperatures above the 92.5^th percentile of annual daily mean temperatures, and the cold spell was defined as 2 or more consecutive days with daily mean temperatures below the 10^th percentile of annual daily mean temperatures. Furthermore, stratified analyses was conducted to compare the effects of extreme temperature events on mortality risk in populations in different gender, age and marital status groups to identify susceptible populations to extreme temperature event. Results: Statistical results showed that the effect values of heat wave and cold spell on the mortality risk of nervous system diseases all peaked at the 7^th day of the cumulative lag, with OR of 1.60 (95%CI: 1.44-1.76) and 1.33 (95%CI: 1.13-1.56), respectively. Heat wave exposure increased mortality risk for individuals with Alzheimer's and Parkinson's diseases, while cold spell exposure increased the mortality risk for those with Alzheimer's disease. Stratified analyses showed that the mortality risk for nervous system disease and Alzheimer's disease was higher in partnerless population after heat wave exposure. Conclusions: Heat wave and cold spell were associated with increased mortality risks for nervous system disease, highlighting the need for improved early warning systems for extreme temperature event. In the context of heat wave, interventions to protect individuals with nervous system disease should prioritize partnerless population.

The development of longitudinal cohorts has made the identification and surveillance of multiple biological markers and behavioral factors which influence disease course or health status become possible. However, traditional statistical methods typically use univariate longitudinal data for research, failing to fully exploit the information from multivariate longitudinal data. The group-based multi-trajectory model (GBMTM) emerged as a method to study the developmental trajectory of multivariate data in recent years. GBMTM has distinct advantages in analyzing multivariate longitudinal data by identifying potential subgroups of populations following similar trajectories by multiple indicators that influence the outcome of interest. In this study, we introduced the application of GBMTM by explaining the fundamental principles and using the data from a health management study in the elderly by using smart wearing equipment to investigate the relationship between multiple life-related variables and hypertension to promote the wider use of GBMTM in longitudinal cohort studies.

Non-neonatal tetanus is an acute, specific, toxic disease in patients over 28 days of age, characterized by continuous rigidity and paroxysmal spasms of the skeletal muscles throughout the body caused by the intrusion of Clostridium tetani through skin or mucosal membrane into the body and reproducing in anaerobic environments to produce exotoxins. The mortality rate of severe patients is close to 100% without medical intervention. Even with aggressive comprehensive treatment, the global mortality rate remains at 30%-50%, making it a potentially fatal disease. In order to standardize the diagnosis, treatment and prevention of non-neonatal tetanus, based on "Regulation for Diagnosis and Treatment of Non-neonatal Tetanus (2019 Edition)", experts have revised this regulation according to clinical practice and recent research progress in this field to guide medical institutions in the prevention and control of non-neonatal tetanus. This article interprets the key points and basis for updating the 2024 edition regulation to guide clinical implementation and application.

Objective: To explore the correlation between fasting plasma glucose (FPG) trajectory and new-onset chronic kidney disease (CKD) in elderly population (≥65 years old) in Nanjing. Methods: The study cohort was composed of 14 763 subjects who met the inclusion criteria in the population in elderly health examination in Nanjing. Based on the FPG levels detected in health examination from 2018 to 2021 (logarithm was used for normal distribution), three different FPG trajectory groups were determined using the SAS Proc Traj program, i.e. low-stable group, medium-stable group, and high-stable group. The incidence of CKD in 2022 was analyzed, and log-rank test was performed to compare the differences of cumulative incidence of new-onset CKD among different trajectory groups. Cox proportional hazards regression model was used to analyze the correlation between different FPG trajectories and new-onset CKD. Results: The mean follow-up time was (416.09±81.96) days. The follow-up time of the 500^th day was selected to analyze the cumulative incidence rate of CKD in different FPG trajectory groups, and the cumulative incidence rate of CKD in the low-stable group, the medium-stable group, and the high-stable group of FPG increased with elevated trajectory, which was 15.3%, 21.8%, and 29.3%, respectively (log-rank test χ²=151.16, P<0.001). Cox proportional hazards regression model analysis showed that compared with the low-stable group, the medium-stable group and the high-stable group were all at risk for new-onset CKD. After adjusting for multiple confounding factors, the analysis by Cox proportional hazards regression model 4 indicated that the risk for CKD in medium-stable and high-stable groups were still 1.676 (95%CI: 1.462-1.921) times and 2.007 (95%CI: 1.562-2.579) times higher than that in low-stable group. Conclusions: Elevated FPG change trajectory level is a risk factor for new-onset CKD, and persistently high level of FPG increase the risk for CKD. FPG should be monitored in elderly population by follow up, and individualized prevention and control measures for CKD should be developed for different trajectory groups.

Objective: To analyze the relationship between body mass index (BMI) and fat mass percentage (FMP) in children aged 3-17 years in China. Methods: The BMI and FMP data of children aged 3-17 years from the National Nutrition and Health Systematic Survey in 0-18 years old children in China was analyzed. BMI-Z score/BMI and FMP were used to classify the subjects, respectively. Spearman correlation was used to analyze the correlation between BMI and FMP. The consistency between BMI-Z score/BMI and FMP in classifying the subjects was measured using Kappa coefficient. Results: The FMP of malnutrition, normal and overweight/obesity in boys was higher in age group 10-13-year than in other age groups (all P<0.001). The FMP of all nutritional status in girls increased with age (all P<0.05). The BMI of boys in all the FMP levels increased with age (all P<0.05). When the FMP of girls was 25%- or ≥30%, BMI increased with age (all P<0.001). The relationship between BMI and FMP was strong (r=0.705, P<0.001), with r of 0.618 in boys and 0.884 in girls. The consistency between BMI-Z score/BMI and FMP in classifying the subjects was found to be moderate (Kappa=0.574, P<0.001). Conclusions: There was a strong relationship between BMI and FMP. The consistency between BMI-Z score/BMI and FMP in classifying the subjects was moderate.

Objective: To analyze epidemiological characteristics and spatiotemporal clustering of hepatitis A in China from 2005 to 2023. Methods: The incidence data of hepatitis A in China during 2005-2023 were collected from the China Disease Control and Prevention Information System . Results: From 2005 to 2023, a total of 605 509 cases of hepatitis A were reported in China. The average annual reported incidence rate was 2.32/100 000, the incidence was 2.85/100 000 in men and 1.81/100 000 in women, and the incidence was 3.25/100 000 in age group 0-14 years, 2.10/100 000 in age group 15-64 years and 2.49/100 000 in age group ≥65 years , respectively. The case count in farmers was highest (40.57%, 245 639/605 509). The proportion of the cases in jobless or the unemployed increased most obviously (347.32%), and the proportion of the cases in students decreased most significantly (90.27%). The average annual reported incidence rate in the western China was highest (4.45/100 000), followed by that in northeastern China (2.02/100 000), central China (1.89/100 000) and eastern China (1.16/100 000). From 2020 to 2023, the incidence of hepatitis A showed no spatial clustering. From 2005 to 2019, the obvious hot spots and high-high clustering areas mainly distributed in provinces, such as, Sichuan, Qinghai, Xinjiang, Xizang and Gansu. The low-low clustering areas were mainly distributed in Beijing, Tianjin, Hebei, Shandong, Jiangsu, Shanghai, Zhejiang, Fujian, Henan, Anhui, Jiangxi, Jilin and Liaoning. An independent high-low clustering was found in Shanxi during 2014-2019. A total of 5 high incidence clustering areas were detected through spatiotemporal scanning analysis. Conclusions: The incidence rate of hepatitis A in China declined significantly from 2005 to 2023. The reported incidence rate in the elderly showed no obvious decrease, and the reported cases accounted for the highest proportion in the whole population. Before 2020, the reported incidence rate of hepatitis A showed high-high clustering in western China, the spatiotemporal clustering disappeared from 2020 to 2023, but the reported incidence rate of hepatitis A in western China was still high. It is suggested to pay attention to the prevention and control of hepatitis A in populations at high risk and areas with high incidence of hepatitis A.