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CN 34-1304/R ISSN 1674-3679

2021 Vol. 25, No. 10

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Literature Review
Promoting research on air pollution, climate change and population health under the goal of carbon neutrality and at the peak carbon dioxide emissions
SHI Xiao-ming
2021, 25(10): 1117-1119, 1225. doi: 10.16462/j.cnki.zhjbkz.2021.10.001
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Abstract:
Air pollution and climate change are the most important environmental health problems that threaten human health globally. These challenges have become more prominent in China. This issue present new findings in air pollution control, health risk assessment, temperature threshold identification, aiming to offer the latest evidences in the field of air pollution, climate change and health. At the same time, under the goal of carbon peak and carbon neutrality, some suggestions to promote research on air pollution, climate change and health are put forward in this study.
Climate Change, Air Pollution and Health
Impact of persistent high ambient fine particulate matters exposure on cardiometabolic risk factors among middle-aged and elderly people
SHI Wan-ying, CHEN Chen, CAO Ya-qiang, ZHANG Yi, CUI Qian, ZHAO Feng, WANG Jiao-nan, FANG Jian-long, TANG Song, LI Tian-tian, SHI Xiao-ming
2021, 25(10): 1120-1125, 1168. doi: 10.16462/j.cnki.zhjbkz.2021.10.002
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  Objective  To explore the effects of persistent high exposure of fine particulate matters (PM2.5) on cardiometabolic risk factors among middle-aged and older people in Beijing-Tianjin-Hebei and surrounding regions.  Methods  A cross-sectional survey was conducted from April 9th, 2017 to March 31st, 2019 in 6 Provinces in Beijing-Tianjin-Hebei and the surrounding areas. A total of 2 415 middle-aged and elderly people aged 40 to 89 years were recruited as the research participants. Questionnaire survey was conducted to obtain the basic information, socioeconomic and lifestyle of the participants. Physical examination was carried out to obtain waist circumference, levels of fasting blood glucose, blood pressure, triglycerides and high-density lipoprotein cholesterol. According to the consensus statement from the International Diabetes Federation in 2005, the co-prevalence of cardiometabolic risk factors was defined. Daily mean PM2.5 concentrations ≥75 μg/m3, ≥90th percentile of daily mean PM2.5 concentrations in each County during the survey year and various durations (≥2 d or ≥3 d) were used to define PM2.5 high exposure scenarios and persistent states. Logistic regression model was used to analyze the effects of persistent high exposure of PM2.5 on co-prevalence of cardiometabolic risk factors.  Results  Persistent high exposure of PM2.5 was significantly associated with the co-prevalence of cardiometabolic factors, especially when extreme pollution scenario was defined by P90 and lasted for more than 2 days and 3 days, OR value (95% CI) of elevated risk of co-prevalence of cardiometabolic factors were 1.58 (1.00-2.50) and 2.57 (1.27-5.22), respectively. The increase of blood glucose and triglyceride level were more sensitive metabolic risk factors. Moreover, subgroup analysis showed that persistent high PM2.5 exposure had a more substantial impact on cardiometabolic risks in males and people under 65 years.  Conclusions  Persistent high exposure of PM2.5 in Beijing-Tianjin-Hebei and surrounding regions in China can significantly increase cardiometabolic risks in middle-aged and older people.
Chronic ozone exposure and depression among middle-aged and elderly people in China
DU Peng, ZHANG Wen-jing, ZHANG Yi, CHEN Chen, FANG Jian-long, LI Tian-tian, SHI Xiao-ming
2021, 25(10): 1126-1132, 1138. doi: 10.16462/j.cnki.zhjbkz.2021.10.003
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  Objective  To investigate the association between chronic ozone (O3) exposure and depression among middle-aged and elderly people in China, in order to provide guidance for prevention and intervention of depression.  Methods  Among key areas for air pollution control in China, according to strict inclusion criteria for study sites and population, 8 584 participates aged 40~ < 90 from 45 districts/counties in 16 provinces were randomly selected and recruited using a stratified random sampling method. The demographic characteristics, socioeconomic factors, disease and symptom information were obtained through face-to-face questionnaire survey, and the depression was measured by Patient Health Questionnaire 9 (PHQ-9). One- and two-year moving average concentrations of air pollutant prior to the survey were calculated, referring to the data from the closest environmental monitoring station. The multivariate Logistic regression model was constructed to analyze the association between chronic O3 exposure and depression.  Results  The prevalence of depression was 6.79% (n=583) among the selected 8 584 participates. Statistically significant association between chronic O3 exposure and depression was not found from Logistic regression analysis model. The maximum OR value was 1.04 (95% CI: 0.96-1.13, P=0.326) for each 10 μg/m3 increase of two-year moving average concentrations of O3. In subgroup analysis, the stronger associations were observed in male and current smoking participants compared with female and never smoking individuals, and these differences were statistically significant (all P < 0.05). Moreover, modification effects of particulate matter smaller than 2.5 μm in aerodynamic diameter (PM2.5) and annual temperature were found on the O3-depression associations. Low PM2.5 concentrations (≤25th percentile in all districts/counties) and high temperature (≥75th percentile in all districts/counties) conditions enhanced the effects of O3 on depression.  Conclusion  Our findings indicated statistically positive association of O3 exposure and depression among male, current smoking individuals, population in low PM2.5 concentration and high temperature conditions.
The spatio-temporal variation of heavy air pollution in typical regions of China from 2017 to 2020
CHU Yang-xi, YIN Li-na, SHAO Pan-yang, HU Jing-nan
2021, 25(10): 1133-1138. doi: 10.16462/j.cnki.zhjbkz.2021.10.004
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  Objective  Heavy air pollution (HAP) is harmful to human health. Based on the characteristics of HAP from 2017 to 2020, we aimed to summarize the cause of HAP and provide a scientific basis for the formulation of air pollution prevention and control policies in "the Fourteenth Five-Year Plan" period.  Methods  The national air quality monitoring data during 2017-2020 were collected to analyze the spatio-temporal HAP distribution patterns.  Results  Spatially, 54.7% of HAP days in China occurred in key regions, including Beijing-Tianjin-Hebei (BTH) and surrounding region, Fen-Wei River Plain and Yangtze River Delta, which accounted for 36.3%, 11.1% and 7.3%, respectively. Among non-key regions, the Urumqi-Changji-Shihezi City cluster (UCS) accounted for 8.7% of nationwide HAP days. Temporally, HAP days in key regions decreased by 49.4%-61.5% from 2017 to 2020, while those in UCS only decreased by 4.6%, much smaller than in key regions. Fine particulate matter (PM2.5) HAP days normally occur from November to February, those due to inhalable particles (PM10) frequently happen from April to May and from October to November, and those due to ozone (O3) mostly take place from May to July. PM2.5 accounted for 87.0%-96.0% of HAP days in the studied regions, followed by PM10 and O3, waking up 3.0%-12.0% and < 3.0%, respectively.  Conclusions  The number of HAP days from 2017 to 2020 generally decreased. Still, the HAP situation in some regions and cities remains challenging. Continuous reduction of PM2.5 HAP days in autumn and winter should be the focus of air pollution prevention and control, with enhanced measures in BTH and surrounding region, Fen-Wei River Plain and UCS to effectively reduce air pollutant emissions and improve the public health benefits.
A study on the thresholds of temperature for early warning in different temperature zones of China based on the temperature-mortality relationships
WU Jun-le, YU Min, ZHOU Mai-geng, ZHOU Chun-liang, XIAO Yi-ze, HUANG Biao, XU Yan-jun, MENG Rui-lin, ZHAO Liang, HU Jian-xiong, HE Guan-hao, XU Xiao-jun, LIU Tao, XIAO Jian-peng, ZENG Wei-lin, GUO Ling-chuan, LI Xing, MA Wen-jun
2021, 25(10): 1139-1146. doi: 10.16462/j.cnki.zhjbkz.2021.10.005
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  Objective  To estimate the thresholds of temperature for health early warning in different temperature zones in China, our study aims to provide support for developing health early warning system of temperature.  Methods  Daily mortality and meteorological data were collected from 364 Chinese locations during 2006-2017. Distribution lag non-linear model (DLNM) and multivariate Meta analyses were applied to estimate the association between temperature and mortality, and identified the thresholds of temperature.  Results  Mean of daily temperature was 16.0 ℃. Mean of daily relative humidity was 73.0%. Mean of daily non-accidental mortality was 8.3 cases. The relationships of daily average temperature with mortality in different climate zones were inverted "J" type. For cold effect, the temperature ranges of low risk in the temperate zone, warm temperate or north subtropics, middle subtropics and south subtropics were 9.1-13.8 ℃, 0.1-19.3 ℃, 8.8-24.3 ℃ and 9.9-25.3 ℃, respectively; and they were 1.8-9.1 ℃, -6.1-0.1 ℃, 1.5-8.8 ℃ and 4.8-9.9 ℃ for medium risks of cold temperature, respectively; and they were < 1.8 ℃, < -6.1 ℃, < 1.5 ℃ and < 4.8 ℃ for high risk of cold temperature, respectively. For heat effect, the temperature ranges of low risk were 23.4-24.8 ℃, 28.6-29.3 ℃, 27.2-29.5 ℃ and 28.2-28.6 ℃, respectively; and they were 24.8-26.1 ℃, 29.3-30.1 ℃, 29.5-31.0 ℃ and 28.6-29.0 ℃ for medium risk of hot temperature, respectively; and they were > 26.1 ℃, > 30.1 ℃, > 31.0℃ and > 29.0 ℃ for high risk of hot temperature, respectively. For heat effect in all climate zones, the average daily mortality increased with the increase of risk grade, For cold effect, the average daily mortality increased with the increase of risk grade in other three climate zones, except in warm temperate zone and northern subtropical zone.  Conclusion  Based on the temperature-mortality relationship, we identified the thresholds of temperature for health early warning, and the effectiveness of the early warning based on the thresholds is well.
Association of ambient coarse particulate matter with hospital admissions, related expenditures and stays for depression in China: a multicity study
MA Ya-ting, XU Zhou-yang, NI Xiao-li, GUO Xin-biao, WU Shao-wei
2021, 25(10): 1147-1153. doi: 10.16462/j.cnki.zhjbkz.2021.10.006
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  Objective  Based on China's urban employee basic medical insurance and urban residents' basic medical insurance database, this study aims to investigate the associations between short-term exposure to ambient coarse particulate matter (PM2.5-10) and risk of hospital admissions, related expenditures and stays (counted as days in hospital) for depression.  Methods  A two-stage time-series study was conducted using the daily data in ambient PM2.5-10 and hospital admissions for depression in 56 prefecture-level or above cities in China from 2013 to 2017. The generalized additive model (GAM) with adjustment for day-of-week effect, holiday effect, secular trend, and meteorological variables was used to investigate the city-specific associations between short-term exposure to PM2.5-10 and risk of hospital admissions for depression, and a random-effects model was used to pool the city-specific associations to generate an overall association over different cities. Attributable numbers and fractions of hospital admissions, related expenditures and stays associated with short-term exposure to ambient PM2.5-10 were also calculated based on the results of the two-stage time-series analyses.  Results  A total of 82 708 hospital admissions for depression were identified in the urban medical insurance schemes in 56 Chinese cities during the study period. Short-term exposure to ambient PM2.5-10 was associated with increased hospital admissions, related expenditures and stays. For each 10 μg/m3 increase in lag0, lag02, and lag03, there were significant increases of 0.58% (95% CI: 0.04%-1.12%), 1.20% (95% CI: 0.10%-2.29%) and 1.20% (95% CI: 0.01%-2.39%) in hospital admissions for depression, respectively. The attributable fractions of hospital admissions, related expenditures and stays associated with ambient PM2.5-10 reached maximum values at lag03, and were 4.14% (95% CI: 0.04%-8.03%), 3.67% (95% CI: 0.03%-7.14%) and 3.89% (95% CI: 0.04%-7.54%), respectively; and the average hospitalization expenditure and stay per patient due to short-term exposure to PM2.5-10 were 483.77 (95% CI: 4.49-940.63) yuan and 1.03 (95% CI: 0.01-1.99) d, respectively.  Conclusion  Short-term exposure to ambient PM2.5-10 is associated with increased risk of hospital admissions, expenditures and stays for depression in the general urban population in China.
Research on public risk perception of air pollution in Tianjin and Shijiazhuang
YANG Wen-jing, FAN Lin, LI Xu, WANG Jiao, YE Dan, HAN Xu, WANG Xian-liang
2021, 25(10): 1154-1158. doi: 10.16462/j.cnki.zhjbkz.2021.10.007
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  Objective  To explore the determining factors influencing public risk perception of air pollution in Tianjin and Shijiazhuang, and to identify the relationship between risk perception and fine particulate matter (PM2.5) daily average exposure.  Methods  A questionnaire survey was conducted in Tianjin and Shijiazhuang by cluster sampling method. T-test was conducted for comparison analysis of the risk perception in different cities. Linear regression model and Logistic regression model were employed to explore the determining factors of public perception and preventive actions of air pollution respectively.  Results  A total of 3 902 valid questionnaires were screened out. The public with higher education and income in Tianjin were more familiar with air pollution, while the young women with higher education and income were more sensitive to the health impact caused by air pollution. There were geographical differences in the correlation between PM2.5 average daily doses and public risk perception. The more the public in Tianjin trust the government, the more familiar they are with the risk of air pollution, the younger the public, the more likely it is to take measures towards air pollution. For the public in Shijiazhuang, the higher the level of education and the younger the population, the higher the willingness to take countermeasures.  Conclusions  The risk perception of air pollution was influenced by age, education level, and income level to a certain extent, and is related to the pollution prevention and control measures taken. The Tianjin public's risk perception was positively correlated with the average daily doses and concentration of PM2.5.
Association between sulfur dioxide air pollution and daily hospital emergency and outpatient visits: a multi-city time-series study
ZHOU Lu, KAN Hai-dong, CHEN Ren-jie
2021, 25(10): 1159-1163. doi: 10.16462/j.cnki.zhjbkz.2021.10.008
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  Objective  To assess the effects of sulfur dioxide (SO2) air pollution on daily hospital emergency and outpatient visits in Beijing, Xian, Wuhan, and Guangzhou.  Methods  The daily data on emergency and outpatient visits, ambient air pollutants, and weather conditions of 5 hospitals in Beijing, Xian, Wuhan, and Guangzhou were collected from January 1, 2013 to December 31, 2015. Generalized additive models were applied to analyze the effects of SO2 exposure on daily hospital emergency and outpatient visits. Random-effects meta-analyses were used to obtain the combined effect values.  Results  The included emergency and outpatient visits of 5 hospitals were 411 277 and 4 935 282, respectively. The average annual SO2 levels of Beijing, Xian, Wuhan, and Guangzhou were 16.5, 30.1, 30.5, and 15.0 μg/m3, respectively. The lag effects of SO2 exposure on emergency and outpatient visits were observed in our study. For the single-day lag periods, the estimated effect of the same-day exposure was the largest. Afterward, the effect decreased and lost statistical significance in the lag 3 d. Our results showed that the lag 0-2 d concentrations of SO2 had the largest effect on emergency and outpatient visits. And a 10 μg/m3 increment in SO2 concentrations was associated with excess risks of 3.44% (95% CI: 1.65%-5.26%) and 1.32% (95% CI: 0.45%-2.20%) for daily emergency and outpatient visits, respectively. The exposure-response curves between SO2 exposure and daily emergency and outpatient visits were nearly linear, but the curves turned to level off at higher concentrations. Besides, SO2-related population attributable fractions were 3.33% (95% CI: 1.63%-4.99%) and 1.31% (95% CI: 0.45%-2.16%) for daily emergency and outpatient visits, respectively.  Conclusions  Short-term exposure to SO2 can increase the risk of hospital emergency and outpatient visits in Chinese cities, suggesting that the prevention and control of SO2 pollution should be further strengthened, and the corresponding air pollution standard should be tightened.
Original Articles
Prevalence and influencing factors of microalbuminuria among general population aged from 18 to 75 years old in 6 provinces of China
XU Jian-wei, LIU Min, WANG Si-qi, LI Yuan, ZHANG Pu-hong, BAI Ya-min, JI Ning, WU Jing
2021, 25(10): 1164-1168. doi: 10.16462/j.cnki.zhjbkz.2021.10.009
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  Objective  To investigate the prevalence and influencing factors of microalbuminuria (MAU) among a general Chinese population aged from 18 to 75 years old in 6 Provinces of China.  Methods  The multi-stage stratified cluster random sampling method was used in this study in 2018. A total 2 693 18-75-year-old subjects were selected from 12 districts of 6 Provinces. Questionnaire survey, physical measurement and 24 h urine collection were conducted. Univariate and multivariate Logistic regression analysis were used.  Results  A total of2 607 subjects were finally included in the analysis, a total of 234 MAU were detected and the detection rate of MAU was 8.98%(95% CI: 7.91%~10.14%). The detection rate of MAU in male, 50 years and above, smoking, obesity, hypertension and diabetes population were 10.48%、11.91%、10.94%、14.82%、16.85%、23.21%, respectively, which were significantly higher than the corresponding population (all P < 0.05). Compared with non-hypertension, non-diabetes, normal body weight people, hypertension(OR=2.843, 95% CI: 2.093~3.862, P < 0.001), diabetes(OR=2.453, 95% CI: 1.626~3.702, P < 0.001)and obesity(OR=1.941, 95%CI: 1.338~2.815, P < 0.001)would increase the risk of MAU.  Conclusions  Hypertension, diabetes and obesity were related to the occurrence of MAU. Early MAU screening should be carried out in these population, so as to prevent and delay the occurrence and development of kidney damage.
Status of physical activity and leisure sit-in time among the high-risk population of cardiovascular disease in Jiangsu Province
DONG Hui-bin, SU Jian, CUI Lan, CHEN Lu-lu, QIN Yu, TAO Ran
2021, 25(10): 1169-1174. doi: 10.16462/j.cnki.zhjbkz.2021.10.010
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  Objective  To investigate the status of physical activity and leisure sit-in time among the high-risk population of cardiovascular disease (CVD) in Jiangsu Province, and provide basis data for the formulation of strategies to improve the physical activity of residents.  Methods  From September 1, 2015 to June 30, 2017, 16 066 high-risk groups of CVD aged 35-75 years from 6 project sites in Jiangsu Province were included in this study. Specifically designed questionnaires were used to collect basic personal information and physical activity data, and the physical activity and leisure sit-in time status with different characteristics was analyzed.  Results  The value of physical activity intensity is expressed in metabolic equivalent (MET), the median total physical activity was 11.94 MET-h/d, the proportion of physical activities related to work and housework was 87.90%, and the physical activity patterns of people with different characteristics were different. The median daily leisure sit-in time was 1.71 h/d, 49.00% of individuals spend more than 2.00 h/d in leisure sit-in every day, the proportion of men who spend more than 2.00 h/d of leisure sit-in per day was higher than that of women (χ2 =122.30, P < 0.001).  Conclusion  The physical activities of the high-risk population of CVD in Jiangsu Province are mainly work and housework, and the proportion of CVD who spend more than 2.00 h/d in leisure sit-in is high, targeted health education should be carried out according to the specific conditions of different groups.
The prevalence of the metabolic associated fatty liver disease among residents aged 30 to 79 in Dongguan City of Guangdong Province
YANG Jia-lu, LUO Yan-fang, SHAN Ren-hu, ZUO Zhi-gang, YU Zhen, CHEN Wu-nong, ZHU Yao-wen, LI Liu-qing, LUO Shi-yun, YE Yong-xin, ZHANG Zhuo-yu, LI Rui, JU Jing-meng, ZHU Shan-shan, FAN Jia-hua, XIA Min
2021, 25(10): 1175-1179, 1230. doi: 10.16462/j.cnki.zhjbkz.2021.10.011
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  Objective  To explore the prevalence of metabolic associated fatty liver disease (MAFLD) and the impact of different characteristics among residents aged 30 to 79 in Dongguan City of Guangdong Province.  Methods  Baseline data were collected in Dongguan City, Guangdong Province of South China Cohort, including physical examination, ultrasound, and laboratory tests. According to the inclusion and exclusion criteria, we included 8 670 participants and defined the status of MAFLD referred to the consensus statement of international experts. Multivariate Logistic regression analysis model was used to analyze the factors according to gender.  Results  The prevalence of MAFLD was 31.85% among residents aged 30 to 79 in Dongguan City. The prevalence was similar among males in different age groups (χ2 =2.958, P=0.565), while it linearly increased with age in females (χtrend2=81.429, P < 0.001). The prevalence showed a linear increase with BMI, FPG, ALT, TG, TC, uric acid (UA) while a linear decrease with HDL-C. The results of multivariate Logistic regression analysis model showed that females ≥50 years old had a higher risk of MAFLD (OR=2.37, 95% CI: 1.74~3.23, P < 0.001).  Conclusions  The prevalence of MAFLD was 31.85% among residents aged 30 to 79 in Dongguan City, and there was a linear association between the prevalence of MAFLD and various metabolic indices including BMI, FPG, TG, and TC. Age ≥50 years old may be a risk factor of MAFLD in females.
Exploration of the association between meteorological factors and positive rate of norovirus infectious diarrhea based on the distributed lag non-linear model in Shanghai
ZHOU Shi-xia, ZHANG Hai-yang, WANG Li-ping, LIU Wei, FANG Li-qun, National Science and Technology Major Project Etiology of Diarrhea Surveillance Study Team
2021, 25(10): 1180-1185, 1193. doi: 10.16462/j.cnki.zhjbkz.2021.10.012
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  Objective  To explore the association between norovirus among diarrheal patients and meteorological factors in Shanghai, and to provide a scientific basis for the prevention and control of norovirus infectious diarrhea.  Methods  We collected the data of diarrhea in Shanghai from 2012 to 2019 and the daily meteorological data of all meteorological monitoring points in Shanghai. A distributed lag non-linear model (DLNM) was constructed to analyze the relationship between norovirus infections diarrhea and meteorological factors.  Results  18.75% of the 21 148 diarrheal patients were found norovirus. Age group of 45~ < 60 years old patients were found with the highest positive percentage (22.72%). Compared with the daily average temperature of 18 ℃ (P50), the daily average temperature of -6 ℃ had the greatest impact on norovirus infection (RR=3.06, 95% CI: 1.49-6.30); the average daily temperature lagging by 2 days has a maximum impact on norovirus infection (RR=1.15, 95% CI: 1.02-1.29). Compared with the daily precipitation of 0mm (P50), the highest negative effect was associated with daily precipitation of 195 mm (RR=0.31, 95% CI: 0.06-1.66).  Conclusions  The rate of norovirus infection in patients in Shanghai is high, and low temperature increases the risk of norovirus infectious diarrhea. Targeted prevention and control work should be carried out according to the characteristics of norovirus epidemic.
The relationship between incidence of pulmonary tuberculosis and meteorological factors in Qinghai Province and multivariate time series analysis
LIANG Da, SHANG Yue, WANG Zhao-fen, MA Bin-zhong
2021, 25(10): 1186-1193. doi: 10.16462/j.cnki.zhjbkz.2021.10.013
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  Objective  To explore the relationship between meteorological factors and the incidence of pulmonary tuberculosis (PTB) in Qinghai Province, and establish a autoregressive integrated moving average model-X (ARIMAX) model to make a short-term prediction of the number of PTB cases.  Methods  Geographically weighted regression (GWR) was applied to analyze the influence of meteorological factors on the incidence of PTB. The monthly number of PTB cases in Qinghai Province from 2014 to 2018 was used as the response sequence and meteorological factors as the input sequence, the meteorological factors related to the incidence of PTB were determined by the cross-correlation function (CCF) diagram. The ARIMAX model was established to fit and predict the monthly number of PTB cases from 2014 to 2018 and 2019 respectively, and compared with the actual monthly cases.  Results  Precipitation and relative humidity had a positive effect on the incidence of PTB, air pressure, temperature and sunshine hours had a negative effect, while the wind speed had both positive and negative effects. The correlation between the average temperature, wind speed and the incidence of PTB was determined by CCF diagram. The optimal model established was ARIMAX(0, 1, 2)×(0, 1, 0)12 with two covariables (the third order lag of average temperature and the second order lag of average wind speed). The model has a goodness of fit (R2) of 0.71 and mean absolute percentage error (MAPE) was 24.91%.  Conclusions  Meteorological factors affected the incidence of PTB to different degrees. An optimal ARIMAX model was established to predict the incidence of PTB.
A study of the polymorphisms of XPC rs2279017 and susceptibility of esophageal cancer
DUAN Pei-fen, ZHOU Yan, FENG Xiang-xian
2021, 25(10): 1194-1197. doi: 10.16462/j.cnki.zhjbkz.2021.10.014
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  Objective  To investigate the relationship between the polymorphisms of xeroderma pigmentosum group C (XPC) rs2279017 and the susceptibility of esophageal cancer in Changzhi area and its interaction with major risk factors.  Methods  In this study, 150 cases of esophageal cancer and 176 cases of control were selected to participate in the questionnaire survey, and the group case-control study was conducted. Then, the genotype of XPC rs2279017 was detected by quantitatire real-time PCR. The results were analyzed by SPSS 20.0.  Results  In the control group, the frequencies of XPC genotype (GG, GT, TT) were 48.86%, 42.05%, 9.09%, respectively. Among the esophageal cancer group, the rates were 29.33%, 46.00% and 24.67%, respectively, and the difference was statistically significant (χ2 =20.12, P < 0.001). The risk of esophageal cancer with allele T was 2.11 times that with allele G (OR=2.11, 95% CI: 1.53-2.92, P < 0.001). In addition, interaction analysis showed that XPC mutant T had a synergistic effect on alcohol consumption (RERI=1.26, S=1.91, API=0.35).  Conclusions  Polymorphism of XPC rs2279017 may be related to the occurrence of esophageal cancer in Changzhi City.
Establishment of technical specifications for data sharing in esophageal cancer screening cohort based on FHIR model and CDASH model
YUE He-xin, GUI Lu-ting, ZHAN Yong-le, LIU Xuan, ZHANG Yi-fang, BIAN Feng, JIANG Yu
2021, 25(10): 1198-1205, 1219. doi: 10.16462/j.cnki.zhjbkz.2021.10.015
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  Objective  To promote the data integration, sharing and utilization of esophageal cancer screening cohorts by establishing a data standard.  Methods  We systematically and comprehensively retrieved relative databases and selected representative esophageal cancer screening cohorts with high-quality. Relevant information were extracted from these studies, then we have referenced the fast healthcare interoperability resources (FHIR) model and clinical data acquisition standards harmonization (CDASH) model to define variables and establish the data standard.  Results  In this study, eight high-quality esophageal cancer screening cohorts were included. Their data matched well with the FHIR and CDASH models, which proves that the newly established data standard was feasible.  Conclusion  The establishment of the data standard of esophageal cancer screening cohorts helps with future cohort design and data collection.
Analysis of cervical lesion screening of rural women in Hebei Province from 2015 to 2017
LI Na, ZHENG Zhen-ru, ZHANG Xian-bo, QIAN Li-jie, LI Jin-hua
2021, 25(10): 1206-1209. doi: 10.16462/j.cnki.zhjbkz.2021.10.016
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  Objective  To analyze the data of rural women's cervical disease screening project in Hebei Province from 2015-2017, and to evaluate the implementation condition of the project.  Methods  Gynecological examination and cervical cytology examination were conducted on married women aged 35-64 years in rural regions of 66 prefectures/counties during 2015-2017. Colposcopy was performed among the examinees with abnormal cervical cytology and multiple biopsy was subsequently carried out among the examinees with suspicious cervical lesions. We collected the data onto each monitoring point. SPSS 22.0 system software has used for statistical analysis.  Results  From 2015 to 2017, the proportion of descriptive reports using the Bethesda system (TBS) classification in Hebei Province was 95.26%, 95.23% and 96.66%, respectively. The abnormal detection rate of colposcopy discreased from 19.62% (n=2 040) in 2015 to 17.45% (n=1 968) in 2017 (χ2 =16.84, P < 0.001). The abnormality rate of histopathology increased from 26.87% (n=588) in 2015 to 38.41% (n=822) in 2017 (χ2 =65.56, P < 0.001). The detection rate of cervical precancerous lesions increased from 75.27/100 000 in 2015 to 105.91/100 000 in 2017(χ2 =23.86, P < 0.001). The detection rate of cervical invasive cancer increased from 17.28/100 000 in 2015 to 21.07/100 000 in 2017 (χ2 =2.77, P=0.251). The early diagnosis rate increased from 84.94% in 2015 to 86.80% in 2017(χ2 =0.57, P=0.751).  Conclusions  The cervical cancer screening project of Hebei Province has achieved certain screening effect, especially in the screening of precancerous lesions. However, the quality of colposcope and histopathology need to be optimized.
The value of liquid-based thinprep cytologic test and high-risk human papillomavirus test in the screening of cervical cancer and precancerous lesions
LU Ya-ling, ZHANG Jin-ling, XU Tan, OUYANG Cheng-xin, ZHANG Li-jie
2021, 25(10): 1210-1213. doi: 10.16462/j.cnki.zhjbkz.2021.10.017
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Abstract:
  Objective  To evaluate and compare the value of liquid-based thinprep cytologic test (TCT) and high-risk human papillomavirus (HR-HPV) test in the screening of cervical cancer and precancerous lesions, and provide the preliminary basis for the selection of single screening method for cervical cancer and precancerous lesions.  Methods  The data of 5 657 women who underwent TCT, HR-HPV test, colposcopy and histopathological examinations for health examination in the gynecological outpatient department of Shenzhen People's Hospital from February 25, 2006 to October 15, 2019 were collected. Cytological positive results included atypical squamous cells of undetermined significance (ASC-US) and above lesions. Count data were compared using χ2 test, and the Logistic regression analysis model was performed to analyze the relationship between HR-HPV infection, TCT positive and cervical cancer and precancerous lesions (low-grade cervical intraepithelial neoplasia and above lesions), respectively.  Results  The number of HR-HPV positive women (the positive rate) was 3 857 (68.18%). The sensitivity, positive predictive value, and negative predictive value of HR-HPV test in the screening of cervical cancer and precancerous lesions were all higher than TCT (82.39% vs. 55.34%, 51.80% vs. 47.35%, 76.28% vs. 61.64%; all P < 0.001), but its specificity was lower than TCT (42.48% vs. 53.84%, P < 0.001). Logistic regression analysis model showed that the risk of cervical cancer and precancerous lesions for HR-HPV positive women (OR=3.42, 95% CI: 3.02-3.88, P < 0.001) was higher than that for TCT positive women (OR=1.48, 95% CI: 1.33-1.65, P < 0.001).  Conclusion  The value of HR-HPV test in screening cervical cancer and precancerous lesions is higher than that of TCT.
Association between maternal exposure to phosphate fertilizers during pregnancy and the risk of preterm birth
ZHANG Yuan, LI Jia-jia, LIN Shi-qi, WU Ji-lei, PEI Li-jun
2021, 25(10): 1214-1219. doi: 10.16462/j.cnki.zhjbkz.2021.10.018
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Abstract:
  Objective  To explore the association between consumption of chemical fertilizers and the risk of preterm birth, to provide references for improvement of birth outcomes.  Methods  Using the birth population monitoring data from October 1, 2007 to September 30, 2012 in Pingding County, Shanxi Province, 155 cases of preterm birth were followed up, and 204 newborns with normal birth weight (2 500~4 000 g) born at the same time without any surface defects and gestational age ≥37 weeks were randomly selected as the control group. Stratified multivariate Logistic regression model and structural equation model were used to investigate the associations between the risk of preterm birth and maternal exposure to chemical fertilizers during pregnancy.  Results  The results of the stratified multivariate Logistic regression analysis model showed that after adjusting for confounding factors, women exposed to village-level fertilizer application ≥100 t had a higher risk of preterm birth than women who had village-level fertilizer application < 50 t (aOR=2.51, 95% CI: 1.23-5.12). Household consumption of phosphorus fertilizer was a risk factor for premature birth (aOR=2.54, 95% CI: 1.23-5.22). The findings of structural equation model indicated that maternal exposure to phosphate fertilizer during pregnancy may be an important environmental factor for the risk of premature birth.  Conclusions  Women's exposure to chemical fertilizers during pregnancy, especially phosphate fertilizers, is associated with the risk of preterm birth, so it is recommended that rural women should try to avoid exposure to chemical fertilizers during pregnancy.
A study on the relationship between the number of prenatal visits and low birth weight infants
LIAO Fang, TIAN Mei-ling, WANG Shuo, SHI Zi-jia, YUAN Hui-qing, WANG Li
2021, 25(10): 1220-1225. doi: 10.16462/j.cnki.zhjbkz.2021.10.019
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Abstract:
  Objective  To understand the prenatal healthcare examination status of pregnant women in Hebei Province, and to explore the relationship between the frequency of prenatal visits and low birth weight infants.  Methods  The data of 263 171 singleton pregnant women aged 18-≤55 and their newborns who were delivered for more or equal to 28 weeks and were hospitalized in 22 monitoring hospitals in Hebei Province, from January 2013 to December 2017 were analyzed.They were divided into three groups based on the number of prenatal visits, including 0-≤3, 4-≤7 and≥8. The relationship between the number of prenatal visits and low birth weight children was analyzed.  Results  With the increase in the number of prenatal visits, the prevalance of low birth weight infants tend to decrease. Multivariate Logistic regression analysis showed that the incidence of low birth weight infants in pregnant women with 0-≤3 prenatal visits was 1.802 times that of pregnant women who had equal to or more than 8 prenatal visits comparatively; The incidence of low birth weight infants in pregnant women with 4-≤7 prenatal visits was 1.268 times than that of pregnant women with more or equal to 8 prenatal visits. Multivariate Logistic regression analysis showed that the advanced age of pregnant women, multiple births and small gestational age were the independent risk factors for the number of prenatal visits.The high educational level of pregnant women, the number of pregnancies and pregnancy complications were the protective factors for the number of prenatal visits.  Conclusions  The more the frequency of prenatal visits, the lower the risk of low birth weight infants.Hence we should strengthen the health education and prenatal care for pregnant women with low educational level, multiple childbirths and advanced age, so as to promote the health of mothers and infants.
Incidence of birth defects during different surveillance ranges in Shanghai from 2016 to 2018
LI Wen-xian, DU Li, LI Min-ming, ZHU Li-ping
2021, 25(10): 1226-1230. doi: 10.16462/j.cnki.zhjbkz.2021.10.020
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Abstract:
  Objective  To compare the incidence and composition of birth defects in children under 18 years old in Shanghai during prenatal and postpartum monitoring periods, in order to explore more appropriate time period of birth defects surveillance.  Methods  The hospital-based monitoring data from 2016 to 2018 were retrived from Shanghai birth defects surveillance network, in which all defects cases were reported from any gestational week to age of 18. The cumulative incidencece and proportion were respectively analyzed before 28 gestational weeks, 28 gestational weeks to postpartum 7 days, postpartum 8 to 42 days, postpartum 43 days to 1 years old, 1 to 2 years after birth, 2 to 3 years after birth, and 3 to 18 years old.  Results  The incidences were respectively 16.31, 15.34 and 22.05 per 1000 births below 18 years of age in Shanghai, 2016-2018. Congenital heart disease was the top kind of birth defects within all years. The cumulative incidences were 4.49 and 14.44 per 1000 births before 28 gestational weeks and perinatal period. The cumulative incidences turned respectively 15.18, 16.90, 17.05, 17.11 and 17.35 per 1000 births when the monitoring range was prolonged to postpartum 42 days, 1, 2, 3 and 18 years after birth. A total of 83.21% and 97.38% of birth defects were diagnosed, and the cumulative incidences increased to 1.45 and 1.7 times high, when defects identified at any gestational weeks and before 1 years of age were included.  Conclusions  It is suggested that the surveillance period of birth defects should be extended from any gestational weeks to 1 year after birth within hospital-based monitoring mode.
Short Report
Analysis of incidence and trend of stroke in Shenzhen from 2008 to 2018
WANG Yi-rong, CAI Wei-cong, PENG Ji, LEI Lin
2021, 25(10): 1231-1234, 1240. doi: 10.16462/j.cnki.zhjbkz.2021.10.021
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Abstract:
  Objective  To analyze the incidence and trend of stroke in Shenzhen from 2008 to 2018, in order to provide evidence for formulating and evaluating prevention strategy of stroke in Shenzhen.  Methods  According to stroke monitoring data, the temporal trends of stroke in Shenzhen was analyzed by trend test and annual percentage change (APC).  Results  From 2008 to 2018, the incidence rate of stroke was 215.48/100 000, with 1.12% APC, and there was no statistical difference in incidence rate of stroke in each year(t=2.07, P=0.07). The incidence rate of male (237.89/100 000) was higher than that of female (191.30/100 000). The incidence rate of age 0-45 group was low, but it increased dramatically after age of 45. The incidence rate rose with age and especially for 75 age groups, with 2.75% APC, which has statistical significance(t=4.65, P < 0.001).  Conclusion  In 2008 to 2018, the incidence of stroke in Shenzhen was relatively stuble, but the incidence of the high age group showed a significant increase, so it is necessary to pay more attention to the elderly.
Expression and clinical significance of PLOD3 in gastric adenocarcinoma, an analysis from TCGA data bank
CHEN Qiang, ZHANG Tao, WANG Zi-ran, WU Zheng-sheng, DU Wei-dong
2021, 25(10): 1235-1240. doi: 10.16462/j.cnki.zhjbkz.2021.10.022
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Abstract:
  Objective  To analyze the expression of procollagen-lysine, 2-oxoglutarate 5-dioxygenase (PLOD3) and its clinical significance in gastric adenocarcinoma by means of the cancer genome atlas (TCGA) database.  Methods  The UALCAN database (http://ualcan.path.uab.edu/) was used to analyze differentiated expression of PLOD3 gene in gastric adenocarcinoma tissues and normal gastric tissues in TCGA database. Kaplan-Meier model was designed to analyze the correlation between the prognosis of patients with gastric adenocarcinoma and the expression of PLOD3. LinkedOmics database was implemented to analyze the genes related to PLOD3. Immunohistochemistry was carried out to verify the expression difference of PLOD3 in gastric adenocarcinoma and adjacent normal gastric tissues.  Results  The database analysis revealed that the expression level of PLOD3 gene in gastric cancer tissues was higher than that in normal gastric tissues (P < 0.001). Expression of PLOD3 gene in gastric adenocarcinoma with p53 mutation was higher than the cases without p53 mutation (P < 0.001). PLOD3 gene expression was significantly correlated with the survival of patients with gastric adenocarcinoma (HR=1.360, 95% CI: 1.150-1.610, P < 0.001). PLOD3 expression was positively correlated with the genes, such as AP1S1, LRWD1, and SLC12A9 (all P < 0.001), and negatively correlated with the genes, such as CGGBP1, ZNF561 and MIER1 (all P < 0.001). The immunohistochemical observation further demonstrated that more PLOD3 protein was expressed in gastric adenocarcinoma tissues than the adjacent noncancerous gastric tissues (P=0.031).  Conclusion  PLOD3 would become a valuable biomarker for evaluating the prognosis and targeted therapy for patients with gastric adenocarcinoma.

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