中华疾病控制杂志

Challenge and opportunity of real world research

WANG Tong

2021, 25(6): 621-624. doi: 10.16462/j.cnki.zhjbkz.2021.06.001

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As a supplement to randomized controlled trial, real-world research has received increasing attention recently. There are opportunities and challenges in how to effectively apply high-quality real-world data effectively to generate reliable real-world evidence. This article reviews the relevant issues regarding data management and utilization and the methodology of evidence confirming to provide references for real-world research and applications.

G-methods in the existence of time varying confounding

QIU Qin-xiao, YOU Dong-fang, ZHAO Yang

2021, 25(6): 625-631. doi: 10.16462/j.cnki.zhjbkz.2021.06.002

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Objective To introduce and compare different G-methods which can deal with time varying confounding. Methods The simulation experiments of four scenarios were carried out to verify the effects of different G-methods on time varying confounding in different situations. Dataset from UK Biobank was then analyzed using different G-methods. Results All three G methods can effectively deal with time varying confounding with similar performance, while G-computation was vulnerable to G-null paradox. However, with the increasing number of time varying confounders, the estimated effects of inverse probability of treatment weighting (IPTW) were more variable. Conclusion All of the three G-methods can remove the bias resulted from time varying confounding appropriately.

Efficacy evaluation of hypertensive drugs based on targeted maximum likelihood estimation

PAN Feng-ming, ZHAO Hong-yu, WU Xin-ying, FENG Yi-ping, HOU Qing-zhen, WANG Shu-kang, JI Xiao-kang, ZHANG Zhen-tang, WANG Qing, XUE Fu-zhong

2021, 25(6): 632-636,643. doi: 10.16462/j.cnki.zhjbkz.2021.06.003

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Objective To facilitate precision medicine design and hypertension disease control by the usage of big data, the targeted maximum likelihood estimation (TMLE) model was implemented to evaluate the average treatment effect and individualized treatment effect of captopril or nitrendipine on hypertension control based on the project named "Comprehensive Prevention and Control Project of Hypertension and Diabetes for All Populations" in Jiaonan, Shandong Province. Methods We first selected hypertension patients taking captopril or nitrendipine in the cohort as a starting point. The outcomes of these patients were defined as whether their blood pressure was controlled at the first follow-up. Age, gender, occupation, BMI, smoke, drink and exercise were then included as confounders. After that, we applied targeted maximum likelihood estimation inset with Super Learner combination prediction algorithm to fluctuate the initial estimate of the conditional expectation of the outcome. Based on the initial estimate, the optimization model was built until the best balance of deviation and variance was reached in the model. Finally, the average treatment effect and individualized treatment effect were calculated based on the model. Results In the selected 13 676 hypertensive patients, nitrendipine was better for blood pressure control than captopril (OR=1.24, 95% CI: 1.13-1.35, P=0.004). In terms of individual net effect, 98.65% of patients had better blood pressure control with nitrendipine. Conclusion TMLE can be used to analyze the average treatment effect and individualized treatment effect, which provides proof of concept for the causal inference in the real world study.

Application of Bayesian additive regression tree model in the evaluation of individualized efficacy of hypertension drugs

ZHAO Hong-yu, FENG Yi-ping, MA Xiao-tian, PAN Feng-ming, WU Xin-ying, WANG Shu-kang, JI Xiao-kang, ZHANG Zhen-tang, WANG Qing, XUE Fu-zhong

2021, 25(6): 637-643. doi: 10.16462/j.cnki.zhjbkz.2021.06.004

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Objective To evaluate the personalized efficacy of captopril and its drug combination with nitrendipine on blood pressure control by Bayesian additive regression tree (BART) model, and to identify subgroup characteristics of high-yield patients, taking people with hypertension and diabetes as samples. Methods According to different medication modes, the patients with hypertension and diabetes who were included in the "Comprehensive Prevention and Control Project of Hypertension and Diabetes for All Populations" in Jiaonan, Shandong Province from January 2011 to July 2015 were divided into three groups. The propensity score was used to randomize the matching formation and to get comparable samples, then BART model was established to explore the personalized efficacy of medication. Results In the comparison between captopril alone and no medication, combination medication and no medication, combined medication and captopril alone, the area under curre (AUC) of the three groups of models and their 95% CI were 0.710 (0.686-0.734), 0.796 (0.754-0.838) and 0.768 (0.725-0.812), respectively. And for most patients, the combined medication effect was better than the single captopril and no medicine. Among them, lower systolic blood pressure and good exercise habits were the common characteristics of those who used captopril alone and combination drugs that had better efficacy compared with those who did not use drugs. Conclusion The constructed BART model is used to predict the personalized efficacy of hypertension drugs in patients with hypertension and diabetes, which can be used to summarize the characteristics of high-yield subgroups, and also provide the basis for the practice of precision medicine in the treatment of hypertension.

Assessment of individualized treatment effect of antidiabetic prescriptions for type 2 diabetes based on uplift model

WU Xin-ying, LIU Xiao-juan, PAN Feng-ming, ZHAO Hong-yu, FENG Yi-ping, WANG Shu-kang, JI Xiao-kang, ZHANG Zhen-tang, WANG Qing, XUE Fu-zhong

2021, 25(6): 644-649, 678. doi: 10.16462/j.cnki.zhjbkz.2021.06.005

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Objective To evaluate the individualized treatment effect of antidiabetic medications for type 2 diabetes in the real world and to identify the benefited individuals from each prescription as well as their characteristics by uplift modeling. Methods Data was collected from the Comprehensive Intervention Program of Chronic Diseases in Jiaonan, Shandong Province from Jannary 1, 2012 to Delember 31, 2018. Patients with type 2 diabetes were included in this study. The intervention groups were given three prescriptions, including metformin, glipizide and metformin combined with glipizide, while the control group was given no medication. The outcome was whether the last FPG measured during the observation period reached standard. According to the propensity score matching method with a match ratio of 1∶1, the simulated randomized controlled trial was conducted to evaluate the average effect of three prescriptions. The uplift model was used to evaluate the individual treatment effect and to identify the characteristics of the individuals who benefit from treatment. Results A total of 5 652 people were included in the cohort, with an average age of (64.20±11.48) years old, 2 239 males (39.61%). There were 1 707 patients in the metformin group, 321 patients in the glipizide group, 535 patients in the metformin combined with glipizide group, and 3 089 patients in the non-treatment group. The propensity scores of the three hypoglycemic prescriptions groups and the control group were basically balanced after matching. There were no statistical difference in blood glucose control rate between the three groups and the control group. However, the individual treatment effect evaluation based on the uplift model showed that all of the three drug prescriptions were more effective in some patients, with a ratio of 68.59%, 65.37% and 51.89%, respectively. What's more, three hypoglycemic prescriptions had a cumulative incremental effect of over 8.24%, 9.60% and 10.53% compared with random intervention, respectively. Conclusion According to the uplift model, the personalized effect can be evaluated, which is helpful to provide reference for the characteristic identification of personalized medication for type 2 diabetes.

DNA methylation mediates the effect of BMI on insulin-treated gestational diabetes mellitus

WANG Ting-ting, SU Ping, SUN Xiao-ru, YU Yuan-yuan, LI Hong-kai, XUE Fu-zhong

2021, 25(6): 650-655. doi: 10.16462/j.cnki.zhjbkz.2021.06.006

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Objective To explore the mediate role of DNA methylation between body mass index (BMI) and insulin-treated gestational diabetes mellitus (I-GDM) and further estimate its mediation effect. Methods Based on Gene Expression Omnibus (GEO) data repository (accession number GSE88929), obstetricians collected 44 I-GDM and 64 controls, which included a total of 212 991 cytosine-phosphate-guanine pairs of nucleotides (CpG) sites. A causal inference test (CIT) was used to select potential mediator of CpG sites. Furthermore, after adjusting for confounding factors including maternal age, fetal sex, and gestational age, we estimated the mediation effect of BMI on I-GDM by CpG sites. Results In CIT process, step 1 results showed that BMI was associated with I-GDM (OR=1.057, 95% CI: 1.014-1.105, P=0.010). Step 2 results indicated that 6 348 CpG after adopting FDR correction were associated with I-GDM conditional on BMI. Step 3 results manifested that 529 CpG were associated with BMI adjusting for I-GDM. Step 4 results showed that I-GDM was independent of BMI after adjusting 6 CpG. Therefore, CIT detected 6 CpG sites (cg00542041, cg08589721, cg25775742, cg15819225, cg26824326, cg15110463) as mediators between BMI and I-GDM. The above 6 CpG showed significant mediation effects by a causal inference model of mediation analysis. Conclusion Our research identified 6 DNA methylation CpG sites, which represent a potential mediation relationship between BMI and I-GDM. These findings suggest that the 6 CpG may serve as novel biomarkers and provide an essential reference for studying the complex biological mechanism between BMI and I-GDM.

The effect of mis-adjusting instrumental variables on the estimation of causal effect in Logistic regression analysis model

SU Ping, WANG Ting-ting, YU Yuan-yuan, SUN Xiao-ru, LI Hong-kai, XUE Fu-zhong

2021, 25(6): 656-662. doi: 10.16462/j.cnki.zhjbkz.2021.06.007

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Objective To explore the effects of adjusting for instrumental variables (Ⅳs) in a Logistic regression model through statistical simulation and real data analysis while there were unmeasured confounding factors. Methods Simulations were carried out by traversing the value of parameters in the Logistic regression model, and variables were all binomial distribution. Bias and standard error were used to evaluate the performance of estimators. As for the real data analysis, a longitudinal hypertension cohort was constructed based on the multi-center health management cohort of Shandong Province, and single nucleotide polymorphism (SNP) rs12149832 was selected as the Ⅳ. Logistic regression models with and without adjusting Ⅳ(rs12149832) were used to estimate the effect of body mass index (BMI) on hypertension. Results The statistical simulation results showed that adjusting for Ⅳs in a Logistic regression model would increase the confounding bias and the standard error of effect estimation, but these increases were generally small. As for the real data analysis, a total of 1 240 women were included in the Hypertension cohort. The baseline age was (37.7±10.5) years and the BMI was (22.1±3.1) kg/m². The estimated value with adjusting for Ⅳ (0.225, P < 0.001) was slightly less than the estimated value without adjusting for the Ⅳ (0.228, P < 0.001), which basically verified the statistical simulation results about adjusting Ⅳs. Conclusion In observational epidemiological studies, the mistaken inclusion of Ⅳs in the Logistic regression model has an impact on both the bias and standard error of the effect estimates.

The trend and burden of cardiovascular death in Anhui Province from 2013 to 2018

XING Xiu-ya, HE Qin, CHEN Ye-ji, ZHANG Luan, LIU Zhi-rong

2021, 25(6): 663-667. doi: 10.16462/j.cnki.zhjbkz.2021.06.008

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Objective To understand the characteristics and life loss of cardiovascular diseases (CVDs) death among residents in Anhui Province. Methods The data of 24 death surveillance points in Anhui Province from 2013 to 2018 in the national "death information registration management system" was collected. The mortality of CVDs was analyzed, and the change trend of CVDs mortality was tested by annual percent change (APC). Potential years of life lost (PYLL), potential years of life lost rate (PYLLR) and average years of life lost (AYLL) were used for disease burden assessment. Results From 2013 to 2018, the standardized mortality rate of CVDs in Anhui Province was 260.36/100 000, showing a decreasing trend year by year (APC%=-2.53%). The CVDs mortality rate was higher in men than in women, and higher in rural areas than in urban. And it is the highest in Northern Anhui, followed by central Anhui, and the lowest in southern Anhui. CVDs were the first cause of death in the whole population (48.58%), with PYLLR of 12.86‰ and AYLL of 11.13 years. PYLLR was the highest in cerebral hemorrhage (4.69 ‰) and ischemic heart disease (4.28 ‰). AYLL ranked the top three in chronic rheumatic heart disease, cerebral hemorrhage and ischemic heart disease. Conclusion The prevention and control of CVDs in Anhui Province has received some achievement, but the burden of disease is still heavy, the prevention and control of high-risk groups should be strengthened.

Association between resting heart rate and metabolic syndrome in adults in Dalian

CHEN Ze-kun, WANG Ying, YU Xue, DOU Yu-Qi, MA De-fu

2021, 25(6): 668-672, 697. doi: 10.16462/j.cnki.zhjbkz.2021.06.009

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Objective Investigate the intrinsic relationship between resting heart rate (RHR) and metabolic syndrome (MS). Methods In this study, people who had physical examination in the Physical Examination Center of Dalian Medical University Affiliated Hospital of Dalian City, Liaoning Province from January 1, 2015 to December 31, 2017 were selected as the study subjects. The prevalence of MS among groups with different heart rates was compared by chi-square test. Binary Logistic regression analysis model was used to analyze the relationship between RHR and MS. Results 65 745 subjects were included in the study, including 36 356 males (55.3%) and 29 389 females(44.7%). Logistic regression analysis showed that after adjusting for age, height and weight, the risk of MS increased by 16% for every 10 increase in RHR per minute (OR=1.16, 95% CI: 1.13-1.20). Compared with subjects with a RHR of < 70 bpm, subjects with a RHR of ≥90 bpm had higher odds of MS: 1.51(OR=1.51, 95% CI: 1.34-1.71) in males and 1.89 (OR=1.89, 95% CI: 1.49-2.40) in females. In addition, compared with subjects with normal body mass index (BMI) (< 24 kg/m²) and normal RHR (< 80 bpm), subjects with high BMI and high RHR had higher odds of MS: 14.87 (OR=14.87, 95% CI: 11.18-19.77) in females and 6.22(OR=6.22, 95% CI: 5.40-7.17) in males. Conclusion In this study, the prevalence of metabolic syndrome was found to increase with increased resting heart rate. In addition, combining RHR and BMI can increase the efficacy of RHR as a marker of metabolic syndrome, and RHR can be combined with BMI as a potential clinical measure indicator.

Prevalence and related factors of diabetic retinopathy in Liuzhou

LIU Jin-ji, WANG Huan, LONG Zhi-gang, YANG Qiao-sheng, MO Xiong-jun, HUANG Li, WEI Suo-su, CHEN Qiu-ju

2021, 25(6): 673-678. doi: 10.16462/j.cnki.zhjbkz.2021.06.010

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Objective To estimate the prevalence and related factors of diabetic retinopathy(DR) in patients with diabetes mellitus (DM) in Liuzhou, Guangxi Zhuang Autonomous Region. Methods A stratified cluster random sampling method was used to select patients who diagnosed with DM from 12 community health service centers and township health centers in Liuzhou as the research objects. Questionnaire survey, physical examination, laboratory tests and fundus examination were performed to them. Unconditional two classification Logistic stepwise regression analysis model was used to analyze the relationship between DR and various factors. Results A total of 3 017 DM were included, and 898 of them presented with DR at a morbidity rate of 29.8%. Among DR patients, the number of mild, moderate, severe non-proliferative DR patients and proliferative DR patients were 736(82.0%), 103(11.5%), 23(2.5%) and 36(4.0%), respectively. The unconditional two classification Logistic stepwise regression analysis demonstrated, the younger people (OR=0.628, 95% CI: 0.531-0.744), history of systemic disease (OR=0.812, 95% CI: 0.684-0.963) were protective factors for DR. The history of eye surgery (OR=2.096, 95% CI: 1.632-2.693), higher fasting glucose (OR=1.103, 95% CI: 1.071-1.135), higher urinary albumin (OR=1.001, 95% CI: 1.000-1.001), higher systolic pressure (OR=1.011, 95% CI: 1.006-1.016), faster heart rate (OR=1.009, 95% CI: 1.001-1.017), farmer and freelance occupation (OR=1.207, 95% CI: 1.002-1.453) were the independent risk factors for DR occurrence. Conclusions The prevalence of DR is medium in the DM patients in Liuzhou, Guangxi Zhuang Autonomous Region, mainly with mild non-proliferative DR patients. Ages, history of systemic disease, eye surgery, urinary albumin, fasting glucose, blood pressure, heart rate and occupation are the independent risk factors for DR occurrence.The publicity and education of DR and disease screening for DM patients should be strengthened.

Current status and influencing factors of healthy fitness of the elderly in Hefei City

YANG Xiu-lan, SHAO Ming, CUI Meng-jie, XU Jun, Hu Meng-zhi, LIU Yun-xiao

2021, 25(6): 679-685,715. doi: 10.16462/j.cnki.zhjbkz.2021.06.011

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Objective To investigate the status and influencing factors of healthy fitness among elderly population in Hefei City, and to provide data reference for the formulation of health policies and measures. Methods A multi-stage random sampling method was used to select 967 elderly people who met the inclusion criteria. The uniformly trained investigators used questionnaires to conduct face-to-face surveys of the survey subjects. The SPSS 23.0 software was used to conduct single factor analysis and multiple linear regression analysis of related factors affecting the healthy fitness of the elderly. Results There were significant differences in healthy fitness (physiological, psychological and social) among the elderly in Hefei, which were related to gender, age, marital status, sleep duration and quality, chronic disease, personality, frequency of meeting children, experience of major life events, etc. The differences were statistically significant (all P < 0.05). The results of multiple linear regression analysis showed that gender, age, sleep, chronic disease, meeting frequency of children, personality, experience of major life events, etc. were influencing factors of the differences in healthy fitness of the elderly (all P < 0.05). In addition, the random forest regression model showed that education level, age and personal monthly income were the three most important influencing factors. Conclusions The healthy fitness of the elderly in Hefei was at a general level. The education level, sleep condition, economic income and pension mode of the elderly are the focus of attention, so targeted intervention measures should be taken to improve the health level of the elderly.

The association between metabolic syndrome and the risk of gallstones among premenopausal and postmenopausal women

WU Shui-lin, QIN Jia-li, LI Yong, MAO Xue-qian, ZHOU Yue, YANG Jing-li, BAI Ya-na

2021, 25(6): 686-691. doi: 10.16462/j.cnki.zhjbkz.2021.06.012

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Objective To analysis the incidence of gallstones among women in Jingchang cohort, and explore the relationship of metabolic syndrome and its components with the risk of gallstones among premenopausal and postmenopausal women. Methods A prospective cohort study was conducted to investigate the effects of metabolic syndrome and its components on the incidence of gallstones in women who did not have gallstones from baseline data. Results A total of 4 196 women were included in this study, and 195 (4.65%) had gallstones in follow-up. The incidence of gallstones in postmenopausal women with metabolic syndrome (10.91%) was higher than that in women without metabolic syndrome (5.68%, χ² ＝19.982, P < 0.001). With the increase of the number of abnormal components, the incidence of gallstones gradually increased (χ² _trend＝30.340, P < 0.001), and reached the maximum when multiple metabolic components were abnormal (12.24%). After adjusting for confounding factors, the risk of gallstones in postmenopausal women with multiple metabolic abnormalities was 6.839 times higher than that in the normal population (95% CI: 1.665-28.084, P＝0.008). The incidence of gallstones in people with abnormal waist circumference, TG, HDL-C, FPG were higher than those in normal subjects among postmenopausal women (all P < 0.05). After adjusting for confounding factors, the risk of gallstones in postmenopausal women with abnormal waist circumference (HR=1.805, 95% CI: 1.204-2.704, P＝0.004) and HDL-C (HR=1.451, 95%CI: 1.071-1.965, P＝0.016) were still higher than that in the normal population. In the grouping of metabolic syndrome, the abnormal number of metabolic syndrome and the normal or abnormal grouping of each component, the incidence of gallstones in postmenopausal women was higher than that in premenopausal women (all P < 0.05). Conclusion The incidence of gallstones in postmenopausal women is related to metabolic syndrome, and the incidence of gallstones in women is affected by menopausal status.

Association between dietary fatty acid patterns and risk of oral cancer by principal component analysis

LI Yan-ni, CHEN Qing, LIN Jing, CHEN Lin, QIAN Jia-wen, ZHUANG Zhao-cheng, HONG Yi-hong, YAN Ling-jun, SHI Bin, QIU Yu, LIN Li-song, ZHENG Xiao-yan, PAN Li-zhen, CHEN Fa, WANG Jing, HE Bao-chang, LIU Feng-qiong

2021, 25(6): 692-697. doi: 10.16462/j.cnki.zhjbkz.2021.06.013

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Objective To explore the relationship between dietary fatty acid patterns and the risk of oral cancer. Methods A case-control study including 225 cases newly diagnosed as primary oral cancer was performed at the First Affiliated Hospital of Fujian Medical University from November 14 2013 to March 21 2019. At the same time, 524 controls were recruited from the same hospital. Principal component analysis was utilized to construct the main dietary fatty acid patterns of local residents. Unconditional Logistic regression analysis model was used to explore the association between dietary fatty acid patterns and oral cancer. Adjusted odds ratio (OR) and corresponding 95% confidence interval (CI) were calculated. Results Six dietary fatty acid patterns were extracted by principal component analysis. Pattern 6 (characterized by hexaoic acid and tridecanoic acid), which accounts for the largest proportion of the population, was used as the reference group. Compared with pattern 6, the adjusted OR (95% CI) values of pattern 1 (characterized by long-chain saturated fatty acids and monounsaturated fatty acids) and pattern 2 (characterized by medium-chain saturated fatty acids and polyunsaturated fatty acids) were 0.47 (95% CI: 0.25-0.86) and 0.45(95% CI: 0.21-0.98), respectively. No statistically significant associations were observed between other patterns and the risk of oral cancer (all P>0.05). Conclusions Compared with pattern 6 (characterized by hexaoic acid, tridecanoic acid and eicotrienoic acid), pattern 1 (characterized by long-chain saturated fatty acids and monounsaturated fatty acids) and pattern 2 (characterized by medium-chain saturated fatty acids and polyunsaturated fatty acids) are negatively correlated with the risk of oral cancer, which suggest some particular dietary fatty acids patterns may reduce the risk of oral cancer.

The influence of childhood family relations on depression of middle-aged and elderly people

DU Chun-jing, PANG Yue, SUN Ju-mei, XIE Rui-rui, WANG Qiong, LIU Jun, WU Bing-yi

2021, 25(6): 698-702. doi: 10.16462/j.cnki.zhjbkz.2021.06.014

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Objective Through quantitative analysis of the influence of childhood family relationship on depression in middle-aged and elderly people, this paper aims to provide a life-cycle perspective for the promotion strategies of mental health in middle-aged and elderly people. Methods Based on the data of the China Health and Retirement Longitudinal Study(CHARLS) (2013, 2014, and 2015), Logistic regression model were used to evaluate the relationship between childhood family relationship and mental health in the middle and later stages of life. Results The incidence of depression in middle-aged and older people was 31.2%. Univarriate Logistic regression analysis showed that factors including age, gender, marital status, education level, parents' education level, birthplace, childhood family economic status, health status, relationship with parents of different genders, and the relationship between parents were risk factors for depression in middle-aged and older people (all P<0.05). The binary Logistic regression results showed that poor relationships with caregivers and poor relationships between parents in childhood were risk factors for depression in middle-aged and older people. Specifically, the risk of depression in middle-aged and older people who have a "poor relationship" with a male caregiver during childhood was 1.58 times that of a "good relationship, " and this risk increased to 1.95 times when they have a "poor relationship" with a female caregiver during childhood.In addition, the risk of depression in middle-aged and older people with "poor relationship" between parents in childhood was 1.40 times that of a "good relationship". Conclusion Family relationship in childhood plays a vital role in mental health in the middle and later life. In childhood, the bad inter-generations, especially the bad mother-child relationship, are the risk factors of depression for middle-aged and older people. We should understand and formulate health promotion strategies for middle-aged and older adults from the whole life cycle perspective.

Frailty subtypes among people living with HIV and HIV-negative individuals in Taizhou, Zhejiang: a cluster analysis

LI Jing, YUAN Shi-ying, CHEN Xiao-xiao, LIN Hai-jiang, HE Na, DING Ying-ying

2021, 25(6): 703-708. doi: 10.16462/j.cnki.zhjbkz.2021.06.015

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Objective To identify the frailty subtypes and investigate their differences in distribution and epidemiological characteristics between people living with HIV (PLWH) and HIV-negative individuals, to provide evidence for conducting intervention on frail PLWH. Methods PLWH and HIV-negative individuals who met the Fried's frailty phenotype criteria were selected from the baseline survey of the comparative HIV and aging research in Taizhou cohort (CHART) from February 2017 to January 2020. Latent cluster analysis was conducted to identify the frailty subtypes based on five Fried frailty components. Results Among 83 frail PLWH and 101 frail HIV-negative individuals included, three frailty clusters were identified. Cluster 1 was characterized by weakness with low physical activity, exhaustion and weak grip strength, which was defined as weakness group; cluster 2 was characterized by 5 poor items with slow walking pace as prominent feature, which was defined as slow walking pace group; cluster 3 was characterized by weight loss and mild weakness, which was defined as emaciation group. Proportion of frail PLWH was the highest in slow walking pace group (54.2%), but proportion of frail HIV-negative individuals was the highest in weakness group(35.6%). Frail PLWH in slow walking pace group were more likely to be current smokers compared with those in emaciation group(χ² =10.889, P=0.004). Frail PLWH in weakness group were more likely to be current smokers compared with those in emaciation group(χ² =7.909, P=0.019). Frail PLWH in emaciation group were more likely to be underweight compared to those in weakness group(χ² =9.309, P=0.009). Frail HIV-negative individuals in weakness group were more likely to be aged over 60 years old compared to those in emaciation group(χ² =10.502, P=0.001), but less likely to have sleep disorders than those in emaciation group(χ² =6.541, P=0.011). Frail HIV-negative individuals in slow walking pace group were more likely to be aged over 60 years old compared to those in emaciation group(χ² =6.232, P=0.013). Conclusions Distribution of frailty subtypes are different between frail PLWH and HIV-negative individuals. Frail PLWH have more frailty subtype characterized by 5 poor components with slow walking pace as the prominent feature. Screening and intervention should be actively carried out considering frailty subtypes and their characteristics in PLWH.

Analysis of HIV/AIDS drug resistance mutations in Wuxi City from 2014 to 2016

CHEN Jian-shuang, YIN Yue-qi, CHENG Hao, ZHANG Xuan, YUAN De-fu, ZHANG Xiao-xuan, WANG Xiao-min, WEI Qian-kun, WANG Bei

2021, 25(6): 709-715. doi: 10.16462/j.cnki.zhjbkz.2021.06.016

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Objective To investigate the characteristics of HIV gene drug resistance changes among human immunodeficiency virus infected person /acquired immune deficiency syndrome patients (HIV/AIDS) in Wuxi City, Jiangsu Province from 2014 to 2016. Methods The HIV/ AIDS population in Wuxi City in 2014 was used as the research object to carry out HIV molecular epidemiological investigation and follow-up research. Basic information of the infected persons were collected, and DNA was extracted from their blood samples. The pol gene fragment was amplified by nest-PCR and sequenced. The sequence was then submitted to the HIV drug resistance database for drug resistance mutation analysis. In 2016, the same population was followed up. The HIV-1 drug resistance mutation was tested again, and the change of drug resistance during two years was analyzed. Results A total of 612 HIV/AIDS cases from 2014 to 2016 were collected. Most of them were aged 30 or above, accounting for 85.46% (523/612), among which the proportion of people aged 50 or older was higher, accounting for 37.25% (228/612). The main route of transmission was homosexual transmission, accounting for 49.67% (304/612). A total of 1 224 samples were tested and 811 pol sequences were successfully obtained. The total resistance rate was 10.11% (82/811). The drug resistance rates to non-nucleoside reverse transcriptase inhibitors, nucleoside reverse transcriptase inhibitors and protease inhibitors were 7.77% (63/ 811), 5.30% (43 /811) and 1.23% (10/811), respectively. The most common mutations were K103N/S and M184V/I. A total of 38 cases of HIV/AIDS had changes in drug resistance before and after follow-up. Conclusion The drug resistance of human immunodeficiency virus-1 (HIV-1) gene level of HIV/AIDS patients in Wuxi was diverse and complex, and the drug resistance changed greatly. Therefore, the monitoring of drug-resistant mutations and the management of antiviral treatment should be strengthened.

Development of a shortened version of the chronic hepatitis B virus infection-related stigma scale

WUERKEN Zhu-ma-jiang, LIN Xiao, WANG Ying, HAO Yuan-tao

2021, 25(6): 716-721. doi: 10.16462/j.cnki.zhjbkz.2021.06.017

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Objective To develop and evaluate a shortened version of the chronic hepatitis B virus infection-related stigma scale (HBVSS). Methods A total of 1 058 people with chronic HBV-infections were administered by convenient sampling method in this study. The data of 529 subjects were randomly selected as a training sample for item screening by classical test theory and item response theory (IRT). The data of the remaining 529 subjects were used as a validation sample to evaluate the psychometric properties of the shortened version scale. Results 2 better items remained within each dimension (perceived stigma dimension remained 4 items) of the original HBVSS, a shortened version HBVSS-12 was formed. Cronbach'α of HBVSS-12 was 0.670-0.856 for each dimension and 0.903 for the total scale. Confirmatory factor analysis showed acceptable goodness-of-fit (standardized root mean square residual=0.038, root mean square error of approximation=0.074, comparative fit index=0.958 and Tucker-Lewis index=0.937). IRT discrimination parameters were estimated to be 1.22-2.71 and difficulty parameters, -3.24-3.15. Average item information ranged from 0.413-1.711. Compared with the original scale, the average information of HBVSS-12 was reserved from 56.23%-82.72% for each dimension and 73.20% for the total scale. Conclusion The HBVSS-12 showed good reliability, validity, and item quality, making it simple and effective for assessing chronic HBV infection-related stigma.

Quality assessment of cohort studies literature on Chinese smoking by using Newcastle-Ottawa-Scale

AI Fei-ling, HU Kui-ru, SHI Yu-lin, WANG Yu-tong, ZHAO Jian, WANG Xue-wei, WAN Xia

2021, 25(6): 722-729. doi: 10.16462/j.cnki.zhjbkz.2021.06.018

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Abstract:
Objective To evaluate the quality of published cohort studies of smoking for Chinese population. Methods Cohort studies on the relationship between smoking and disease occurrence/mortality for Chinese population among English and Chinese databases were searched, including PubMed, Embase, Cochrane Library, CNKI, WanFang and VIP, respectively. The Newcastle-Ottawa-Scale (NOS) was used to assess the quality of literature, as well as compared the difference between Chinese and English literature. The change of NOS scores was compared before and after the release of the guide of reporting observational research - "Strengthening the Reporting of Observational Studies in Epidemiology" (STROBE). Results Among 99 records of NOS, 75.76% of the studies were published in English, and the quantity of literature increased year by year. The median and quartile of the total NOS scores were 8.0(7.0, 9.0), respectively. Three items got lower scores, which were representativeness of exposed cohort, follow-up duration, and adequacy of follow-up. The quality of English literature was relatively high, especially in the comparability between two groups and adequacy of follow-up. After STROBE statement released, the total NOS score increased, especially in the comparability. In addition, both Chinese and English literature significantly improved in the assessment of outcomes and representativeness of the exposed cohorts. Conclusions The quantity of publications on the relationship between smoking and diseases for Chinese population is on the rise, especially for English literature. The quality of literature is improving, but some information on cohort studies is not fully reported. Therefore, the quality of publications needs to be strengthened in the future.

The study on the relationship between herpes zoster and depression based on Health Big Data—Real world research examples

DING Xiong, JIANG Wei, JIANG Jing, HU Yue-hua, WU Ying, LI Yun, ZHAO Dan-dan, YIN Da-peng

2021, 25(6): 730-733. doi: 10.16462/j.cnki.zhjbkz.2021.06.019

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Objective The aim of our study was to explore the relationship between depression and the risk of herpes zoster in Yichang City. Methods With use of the Health Big Data of Yichang City, China, patients who were diagnosed with herpes zoster by clinicians between September 1, 2018 to September 30, 2019 were included. For each patient with herpes zoster, 4 matched controls were identified, matched for age (class interval: 10 years old) and sex. Controls took the index date of their matched case, and conditional Logistic regression analysis model was used to evaluate the relationship between depression and the risk of herpes zoster. Results In age was 56 (43, 67) years old, a total of 5 370 cases were included and 21 480 controls were matched. There were 2 533 males (47.17%) in the case group and 10 132 males (47.17%) in the control group. After adjusting for potential confounding factors, patients with depression had the 1.697 times risk of shingles as those without depression, the OR (odds ratio, OR) for case group was 1.697, (95% CI: 1.089-2.643, P=0.019), compared with matched controls. This relationship also observed in female (OR=1.983, 95% CI: 1.124-3.498, P=0.018), age under 50 years old (OR=2.213, 95% CI: 1.059-4.629, P=0.035) and older than 70 years old (OR=2.738, 95% CI: 1.264-5.929, P=0.011). Conclusion The recent study suggested that depression may be a risk factor for herpes zoster, especially in females, individuals under 50 years old and older than 70 years old.

Influential factors of overweight and obesity in young adults aged 20 to 39 in Guangxi based on random forest algorithm

PENG Ying-chun, MO Hai-juan, LAI Yin-juan, HUANG Zhi-bi, LUO Qian-qian, WEI Yu-qun

2021, 25(6): 734-738. doi: 10.16462/j.cnki.zhjbkz.2021.06.020

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Objective To explore the influence of transportation mode, working status, and leisure time activity on overweight and obesity among young adults aged 20 to 39 in Guangxi, so as to provide a reference for improving the physical fitness level of the whole population. Methods A randomized whole-group sample of young adults aged 20-39 years from institutions in cities of Guangxi was conducted, with a total of 7 534 cases. The data were divided into 20- < 30 and 30-39 ages groups, and a random forest classification model were constructed after over-sampling a random forest classification model. Results According to the decline of the Gini index, we ranked the importance of the variables. The main influencing factors of overweight and obesity for young people aged 20- < 30 were the time spent riding motorcycles, electric bicycles, reading and using computers, the time spent watching TV and listening to the radio, mainly sitting at a desk, and light housework. As for 30-39 age group, the influencing factors of overweight and obesity were, in order, the length of time riding a motorcycle or electric vehicle; the length of watching TV and listening to the radio; the length of reading and using the computer; the length of light housework; the length of sitting mainly at the desk. Conclusions People should try to shorten the duration of sedentary behavior. In a short distance, try to choose cycling and walking, avoid sedentary work style and leisure activities, and increase scientific and regular physical exercise will be good choices.

Evaluation of simplified methods based on 2018 Chinese guidelines for the management of hypertension for screening high blood pressure among children and adolescents in Suzhou

HU Jia, HAN Di, HAI Bo, DING Zi-yao, YIN Jie-yun, YANG Hai-bing, SHEN Hui

2021, 25(6): 739-744. doi: 10.16462/j.cnki.zhjbkz.2021.06.021

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Objective To evaluate the validation of various simplified methods for screening high blood pressure (HBP) among children and adolescents in Suzhou. Methods 7 340 children and adolescents aged 6 to 17 years were enrolled by stratified cluster random sampling method. Height, weight and blood pressure were measured. Considering 2018 Chinese guidelines for the management of hypertension as gold standard, the validation of 4 simplified methods (formula method, height-specific method, age group-specific method, sex- and age-specific method) for screening HBP were assessed. Results According to gold standard and 4 simplified methods, the prevalence of HBP were 17.3%, 17.9%, 17.5%, 18.5%, 17.1%, respectively. There was no significant difference between the prevalence of HBP identified by height-specific method (χ² =0.593, P=0.477), sex- and age-specific method (χ² =0.865, P=0.383) and gold standard method. Kappa values of formula method, height-specific method, sex- and age-specific method were 0.818, 0.865, 0.858, respectively, higher than that of age group-specific method (0.670). Area under the curve (95% confidence interval) of height-specific method and sex- and age-specific method were 0.934 (95% CI: 0.924-0.944) and 0.927 (95% CI: 0.916-0.938), respectively, higher than that of formula method [0.915 (95% CI: 0.904-0.926)]. The age group-specific method had the lowest area under the curve[0.844 (95% CI: 0.829-0.858)] was the lowest. When stratified by age, sex and height, screening effects of 4 simplified methods among different subgroups were similar with total population. Height-specific method and sex-and age-specific method had different screening strengthens among different groups. Conclusion All 4 simplified methods performed well for screening HBP. Considering the convenience of using, height-specific method would be proper for early HBP screening.

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2021 Vol. 25, No. 6

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Editor

Editor-in-Chief Ye Dongqing M.D.

Assistant editor Fan Yinguang M.D.

Assistant editor Pan Haifeng M.D.

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