中华疾病控制杂志

Age-period-cohort analysis of incidence and mortality trends of nasopharyngeal carcinoma in the Chinese population, 1994-2019

ZHOU Zonglei, LI Kunpeng, LI Nannan, ZHOU Ruzhen

2023, 27(8): 869-876. doi: 10.16462/j.cnki.zhjbkz.2023.08.001

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Objective To understand the incidence and mortality trends of nasopharyngeal carcinoma among the Chinese population, and to evaluate the effect of age, period and birth cohort on the risk of nasopharyngeal carcinoma incidence and mortality. Methods Data on gender-specific incidence and mortality of nasopharyngeal carcinoma among the Chinese population between 1994 to 2014 were obtained through the Global Health Data Exchange Database. We described the temporal trend of nasopharyngeal carcinoma incidence and mortality, and the age effect, period effect, and cohort effect were estimated using an age-period-cohort (APC) model and intrinsic estimator method. Results The standardized incidence of nasopharyngeal carcinoma among Chinese male and female population increased from 4.16/100 000 and 2.26/100 000 in 1994 to 8.55/100 000 and 2.83/100 000 in 2019, while the standardized mortality of nasopharyngeal carcinoma decreased from 3.57/100 000 and 1.80/100 000 in 1994 to 2.20/100 000 and 0.72/100 000 in 2019. Results of APC analysis showed that during 1994-2019, age effect of nasopharyngeal carcinoma incidence in both Chinese male and female population increased first, then decreased and increased afterward with the increase of age [effect coefficient (male): -1.94-0.68 to 0.18-0.54, all P < 0.05; effect coefficient (female): -1.49-0.49 to 0.20-0.38, all P < 0.05]; period effect showed an increasing trend as year increased [effect coefficient (male): -0.44-0.53, all P < 0.05; effect coefficient (female): -0.12-0.24, all P < 0.05]; cohort effect decreased first, then increased and then decreased with the year of birth [effect coefficient (male): 0.82--0.36 to-0.05--0.36, all P < 0.05; effect coefficient (female): 0.63--0.17 to-0.01--0.57, all P < 0.05]. Age effect of nasopharyngeal carcinoma mortality in Chinese population exhibited an upward trend with the increase of age [effect coefficient (male): -2.08-1.04, all P < 0.05; effect coefficient (female): -1.75-1.08, all P < 0.05]; cohort effect of nasopharyngeal carcinoma mortality among Chinese male population decreased with year of birth (effect coefficient: 0.95--0.89, P < 0.05). However, significant period effect of nasopharyngeal carcinoma mortality in the whole population and cohort effect of nasopharyngeal carcinoma mortality among Chinese female population were not observed. Conclusions Age effect exerts impacts on the risk of nasopharyngeal carcinoma incidence in both Chinese male and female population to varying degrees. The risk of nasopharyngeal carcinoma mortality among Chinese male population is affected by age effect and cohort effect, while the risk of nasopharyngeal carcinoma mortality in Chinese female population is only affected by age effect. Health education and screening for nasopharyngeal cancer are suggested to be strengthened for individuals aged over 40 years, especially for males to reduce the risk of nasopharyngeal carcinoma incidence and mortality.

Association of urinary iron and arsenic levels with dyslipidemia in community-dwelling elderly in Yinchuan

HE Pei, WANG Rui, DUAN Siyu, WANG Yuhua, BAI Meili, SUN Jian, YANG Huifang

2023, 27(8): 877-882. doi: 10.16462/j.cnki.zhjbkz.2023.08.002

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Objective To explore the relationship between urinary iron and arsenic content and dyslipidemia in community-dwelling elderly people in Yinchuan City, and to provide scientific environmental epidemiological evidence for the formulation of dyslipidemia prevention strategies. Methods The baseline population of the Yinchuan Chronic Disease Cohort for the Elderly was selected as the study population. The general demographic information was collected through questionnaires, and blood lipids, blood pressure and liver function were measured through health checkups. We also collected 10 mL of morning urine at the baseline survey. The concentration of iron and arsenic in the urine of the study subjects was determined using an inductively coupled plasma- mass spectrometry and the anhydride was corrected with urine muscles. The association between urinary iron and arsenic levels and the prevalence of dyslipidemia was analyzed by conditional logistic regression. Results Urinary iron concentration in elderly people in the dyslipidemia group (115.97 μg/g creatinine) was lower than that in the healthy control group (139.11 μg/g creatinine), and the difference was statistically significant (Z=3.405, P < 0.001); urinary arsenic concentration in elderly people in the dyslipidemia group (77.25 μg/g creatinine) was higher than that in the healthy control group (67.45 μg/g creatinine), and the difference was statistically significant (Z=-3.269, P=0.001). Multiple logistic regression analysis showed that after adjusting for covariates, urinary Fe (OR=0.68, 95% CI: 0.57-0.82, P < 0.001) concentration was negatively associated with dyslipidemia in the elderly, and urinary As (OR=1.32, 95% CI: 1.09-1.59, P=0.001) concentration was positively associated with dyslipidemia in the elderly and showed a dose-response relationship (all P_trend≤0.001). Stratified analysis by gender found that in the male population, compared with the Q1 group, the ORs and their 95% CIs for dyslipidemia were 0.68 (0.52-0.88), 0.70 (0.54-0.92), and 0.59 (0.45-0.79) for urinary iron in the Q2, Q3, and Q4 groups, respectively, and urinary arsenic in the Q2, Q3, and Q4 groups ORs for dyslipidemia and their 95% CIs were 1.08 (0.84-1.40), 1.31 (1.01-1.71), and 1.85 (1.38-2.47), respectively. For the female population, the ORs for dyslipidemia and their 95% CIs were 0.76 (0.59-0.98) for the group with urinary iron at the Q4 group only compared with the Q1 group. Conclusions Higher urinary iron concentrations in community-dwelling older adults may reduce the risk of dyslipidemia in Yinchuan; higher urinary arsenic concentrations may increase the risk of dyslipidemia, and this association is more pronounced in the male population.

Study on the combined effects of sleep and obesity on functional loss in middle-aged and elderly people

WANG Yunyan, LI Li, SUN Donghan, WU Wenwen

2023, 27(8): 883-888. doi: 10.16462/j.cnki.zhjbkz.2023.08.003

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Objective The aim of this study was to investigate the combined effect of sleep and obesity on the prevalence of functional disability among middle-aged and older adults. Methods Data were collected from the 2015 China Health and Retirement Longitudinal Study (CHARLS). The logistic regression model was performed to estimate the combined effect of sleep and obesity on the prevalence of functional disability. Results Compared to participants with normal waist circumference (WC) and 6- < 8 hours of nocturnal sleep, those with abdominal obesity and 0- < 4 hours of nocturnal sleep exhibited an increased risk of functional disability (OR=1.655, P < 0.001). Similarly, participants with abdominal obesity and no afternoon nap, compared to those with normal WC and 0- < 30 minutes of afternoon nap, showed an elevated risk of functional disability (OR=3.360, P=0.008). When compared to non-systemically obese individuals with 6- < 8 hours of nocturnal sleep, those with systemic obesity and 4- < 6 hours of nocturnal sleep had an increased risk of functional disability (OR=2.359, P < 0.001). Additionally, systemically obese individuals with 30- < 90 minutes of afternoon nap, compared to non-systemically obese individuals with 0- < 30 minutes of afternoon nap, showed an increased risk of functional disability (OR=1.905, 95% CI: 1.237-2.933, P=0.003). Conclusions The concurrent presence of short nocturnal sleep duration, absence of an afternoon nap or extended afternoon nap duration, and either abdominal or systemic obesity, increases the risk of functional disability. This suggests that controlling body mass index (BMI) and WC among middle-aged and older adults with short nocturnal sleep duration, absence of an afternoon nap, or extended afternoon nap duration could be beneficial in preventing functional disability.

The relationship between biomass fuel use and all-cause mortality in older adults: a prospective cohort study

JIANG Lili, GAN Ting, DING Mingfeng, HAN Xuemei, GAO Yinyan

2023, 27(8): 889-894. doi: 10.16462/j.cnki.zhjbkz.2023.08.004

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Objective To evaluate the relationship between biomass fuel use and all-cause mortality in older adults. Methods This cohort study included participants aged 65 years and older from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) in 2011-2012 who were followed up until 2018. A total of 5 853 participants were included. The Weighted Cox regression model and robust inverse probability weighted Cox regression model were used to explore the association between biomass fuel use and all-cause mortality in older people. In addition, we examined the effect of switching cooking fuels on all-cause mortality during follow-up. Results Biomass fuel use increased the risk of all-cause mortality in older adults [average hazard ratio (AHR)=1.17, 95% CI: 1.08-1.28]. Older adults who switched to clean fuel had a lower risk of all-cause mortality compared with those who kept using biomass fuel (AHR=0.21, 95% CI: 0.18-0.24). Conclusions Biomass fuel use increases the risk of all-cause mortality in older adults, while switching to clean fuel could reduce the risk.

Association between socioeconomic status and mild cognitive impairment in community-living older adults

FAN Renjia, ZENG Yan, XU Lang, LIU Dan, CHENG Guirong

2023, 27(8): 895-900. doi: 10.16462/j.cnki.zhjbkz.2023.08.005

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Objective To explore the relationship between socioeconomic status (SES) and mild cognitive impairment (MCI) in older adults. Methods We utilzed the data from the Hubei Memory and Aging Cohort Study (HMACS). A total of 7 787 older adults ≥65 years old were included, who had completed a complete set of neuropsychological assessments and clinical physical examinations. SES was measured by factors such as education level, occupation, and monthly household income per capita. MCI was diagnosed by a panel of experts following Petersen′s MCI standard and Chinese Diagnostic guidelines for dementia and Cognitive impairment. A multivariate logistic regression was used to analyze the association between SES and MCI in older adults. Results Out of the 7 887 respondents (average age of 71.74±5.58 years), the prevalence of MCI was 23.00% (95% CI: 22.07%-23.93%). MCI prevalence was highest among the low SES group at 44.65%, followed by the middle SES group (16.89%) and the high SES group (9.18%); it was more prevalent among women than men, and more common in rural areas compared to urban ones. Stratified analysis revealed that, compared to their high SES counterparts, the risk of MCI was 6.276 times higher among low SES urban males (OR=6.276, 95% CI: 4.017-9.805) and 3.978 times higher among low SES urban females (OR=3.978, 95% CI: 2.943-5.376). Among rural female older adults, the distribution of SES was significantly uneven according to existing SES standards. Conclusions Older adults with lower SES have a higher prevalence of MCI. Therefore, MCI prevention strategies should particularly focus on community-dwelling older adults with lower income and educational attainment.

Association of dual olfactory and hearing impairment with cognitive impairment among community-dwelling adults aged 65 years and above

WAN Hong, XU Lang, LI Lin, CHENG Guirong, LIU Dan, YU Yafu, HAN Gangbin, HUANG Linya, ZHANG Jingjing, ZENG Yan

2023, 27(8): 901-906. doi: 10.16462/j.cnki.zhjbkz.2023.08.006

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Objective To investigate the association between dual olfactory and hearing impairment and cognitive impairment in community-dwelling adults aged ≥65 years. Methods A total of 8 370 elderly people aged ≥65 years from the Hubei Memory and Aging Cohort Study were included. The participants were grouped by no olfactory and hearing impairment (NOHI), olfactory impairment only (OI), hearing impairment only (HI), and dual olfactory and hearing impairment (DOHI). Cognitive impairment includes mild cognitive impairment and dementia. Logistic regression was used to analyze the association between cognitive impairment and sensory function. Results The prevalence of olfactory impairment, hearing impairment, DOHI and cognitive impairment were 24.1% (95% CI: 23.2%-25.0%), 44.5% (95% CI: 43.4%-45.5%), 20.0% (95% CI: 19.1%-20.8%) and 26.3% (95% CI: 25.4%-27.3%) respectively, in community-dwelling old adults. All sensory impairment groups had significantly higher rates of cognitive impairment than those without sensory loss, and the prevalence of cognitive impairment in DOHI group was significantly higher than that in the other three groups. The DOHI individuals had increased odds of cognitive impairment than NOHI (OR=1.402), OI (OR=1.437) and HI (OR=1.403), after adjusting for sociodemographic factors, lifestyle and chronic diseases. Conclusions The risk of cognitive impairment in older people with dual olfactory and hearing impairment in the Chinese community is significantly higher than that of people without sensory impairment, and also higher than those with only one sensory impairment. Dual sensory impairment is a high risk factor for cognitive impairment.

Prediction of early Alzheimer′s disease progression based on Lasso Cox regression model

HAN Hongjuan, QIN Yao, QIAO Guoguo, CHEN Durong, CUI Jing, MA Yifei, ZHANG Rong, YU Hongmei

2023, 27(8): 907-915. doi: 10.16462/j.cnki.zhjbkz.2023.08.007

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Objective The study aims to explore predictors related to the progression from normal cognition (NC) to mild cognitive impairment (MCI), the reversion from MCI to NC, and the progression from MCI to Alzheimer′s disease (AD), and to establish corresponding prediction models. Methods Based on the Alzheimer′s Disease Neuroimaging Initiative (ADNI) database, three Lasso Cox regression models were developed to predict the transition from NC to MCI, the reversion from MCI to NC, and the progression from MCI to AD. Results The study included 502 NC and 990 MCI patients, of which 104 NC progressed to MCI, 90 MCI reverted to NC, and 370 MCI progressed to AD. The covariate effects of the predictors showed that lower Rey′s auditory verbal learning test-learning (HR=0.884 0, 95% CI: 0.778 0-0.990 0), atrophy of the entorhinal cortex (HR=0.999 6, 95% CI: 0.999 2-0.999 9), higher functional activities questionary score (HR=1.552 0, 95% CI: 1.292 0-1.813 0) and Tau protein (HR=1.003 0, 95% CI: 1.001 0-1.006 0) were associated with the progression from NC to MCI. Lower scores of Alzheimer′s disease assessment scale-13 (HR=0.925 0, 95% CI: 0.857 0-0.993 0), functional activity scale scores (HR=0.826 0, 95% CI: 0.691 0-0.961 0) and lower concentrations of Tau protein (HR=0.997 0, 95% CI: 0.994 0-0.999 0) were all relevant factors for MCI reversal to NC. The apolipoprotein E4 (APOE4) gene (HR=1.304 0, 95% CI: 1.069 0-1.540 0), longer years of education (HR=1.055 0, 95% CI: 1.017 0-1.093 0), higher clinical dementia rating sum of boxes score (HR=1.192 0, 95% CI: 1.060 0-1.324 0), Alzheimer′s disease assessment scale-13 entries (HR=1.036 0, 95% CI: 1.011 0-1.061 0), Rey′s auditory verbal learning test-immediate (HR=0.973 0, 95% CI: 0.956 0-0.990 0), functional activities questionary score (HR=1.065 0, 95% CI: 1.039 0-1.091 0), and phosphorylation Tau (HR=1.018 0, 95% CI: 1.009 0-1.027 0), lower Rey′s auditory verbal learning test-immediate (HR=0.973 0, 95% CI: 0.956 0-0.990 0) and lower concentrations of Aβ amyloid (HR=0.999 2, 95% CI: 0.998 8-0.999 6) were associated with the progression from MCI to AD. Conclusions The transformation among different stages of AD are affected by multiple factors. Risk prediction of AD is beneficial to perform health management intervention and preventive care in key populations, thereby reducing the risk of future disease progression.

Establishment and verification of the diet balance index for midgestational women in Lanzhou City

HE Qin, LI Jing, LI Yanping, ZHANG Gexiang

2023, 27(8): 916-921. doi: 10.16462/j.cnki.zhjbkz.2023.08.008

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Objective This study aimed to develop and validate a Dietary Balance Index (DBI) that allows for a swift, precise, and user-friendly assessment of dietary quality among second-trimester pregnant women in Lanzhou. Methods The DBI for the second-trimester was formulated based on the Dietary Guidelines for Chinese Residents (2016) and the Dietary Guidelines for Women and Children in China (2016). The nutritional quality of diets among second-trimester women undergoing routine obstetric examinations in Lanzhou Maternal and Child Institutions was evaluated. This served to further assess the reliability and validity of the newly established DBI index system for the second-trimester. Results The DBI index system for second-trimester women aligns closely with the Diet Balance Index (DBI-16) system in China, with the addition of seaweed vegetables, processed vegetables, and animal blood/liver to the subgroup, reflecting the dietary structure characteristics of the regional population. Dietary energy and nutrient intake showed a significant negative correlation with the low bound score (LBS) and diet quality distance (DQD), but a positive correlation with the high bound score (HBS) (all P < 0.05). The HBS, LBS, and DQD of the recommended diet were all found to be appropriate. The mean dietary quality distance was calculated to be 34.08, with only 0.26% of pregnant women achieving a balanced dietary intake. Conclusions The initial development of the dietary balance index for second-trimester pregnant women in Lanzhou enables a rapid, accurate, and convenient evaluation of dietary quality in this population. Following further optimization, this method has potential for widespread application.

Risk prediction of small for gestational age birth based on machine learning algorithms

ZHANG Ruimin, WANG Keke, LI Jinbo, CHEN Zhuanzhuan, YANG Hailan, WU Weiwei, FENG Yongliang, WANG Suping, ZHANG Xinri

2023, 27(8): 922-927. doi: 10.16462/j.cnki.zhjbkz.2023.08.009

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Objective To evaluate the performance of risk prediction of five machine learning models and traditional logistic regression models, such as, extreme gradient boosting (XGBoost), support vector machine (SVM), and Naive Bayes, aimed at small for gestational age (SGA). Methods A total of 9 972 women who gave birth in the First Hospital of Shanxi Medical University from March 2012 to September 2016 were selected as the research subjects in this study. Their data was collected from the hospital information system and through questionnaire surveys. Based on delivery outcomes, each case was put into one of two categories: an SGA group (n=1 124) and a non-SGA group (n=8 848), with the trial set and test set according to the ratio of 7.50∶2.50. Multivariate logistic regression model were used to screen the influencing factors. To establish predictive models, XGBoost, SVM, Naive Bayes, gradient boosting decision tree (GBDT) and k-nearest neighbor (KNN) algorithms were used. Furthermore, their predictive performance was measured with metrics such as the area under the curve (AUC), accuracy, and precision. Results Logistic regression analysis showed that gestational hypertension and eclampsia were among the seven variables related to the occurrence of SGA. By incorporating such variables into the machine learning algorithms and traditional logistic regression, the SVM model achieved the best performance with the highest AUC of 0.72 and 71% accuracy. Comparatively, compared to the SVM model, the logistic regression-based model was under performing, with an AUC of 0.71 and 66% accuracy. Conclusions Machine learning models, especially SVM, are capable of more accurately evaluating the risk of the occurrence of SGA in Shanxi Province, and can provide a reference for the primary prevention of SGA.

Correlation between serum 25(OH)D₃ levels and alcoholic fatty liver disease in adult males in Hefei

WANG Xiaoyu, WANG Huihui, ZENG Li, GONG Weiyi, YANG Bingbing, XU Dexiang, HU Chunqiu

2023, 27(8): 928-932. doi: 10.16462/j.cnki.zhjbkz.2023.08.010

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Objective To explore the correlation between 25-hydroxy vitamin D₃ [25(OH)D₃] level and alcoholic fatty liver disease (AFLD) of adult males in Hefei. Methods A total of 90 patients with AFLD and 90 healthy controls were collected according to the inclusion criteria. General information of study subjects were collected through questionnaires, electronic medical records were consulted and clinical examination data were collected. Serum 25(OH)D₃ levels were detected by radioimmunoassay. The correlation between serum 25(OH)D₃ levels and AFLD was analyzed by logistic regression model. Results Mann-Whitney U test showed that serum 25(OH)D₃ [49.15(39.08, 71.09)] in patients with AFLD were significantly lower than the control group [67.04(51.03, 76.84)] (Z=-4.088, P < 0.001). Trending χ² test showed that the prevalence of AFLD increases with increasing 25(OH)D₃ levels (χ² _trend=13.13, P < 0.001). Mann-Whitney U test showed that the level of 25(OH)D₃ [38.46(30.22, 42.41)] in the moderate to severe AFLD group was significantly lower than that in the mild AFLD group [52.70(42.41, 73.13)], and the difference was statistically significant (Z=-3.172, P=0.001). The logistic regression analysis showed that men with insufficient and adequate serum 25(OH)D₃ had a reduced risk of AFLD when compared with men with serum 25(OH)D₃ deficiency after adjusting for confounders (OR=0.085, OR=0.827). Conclusion The serum 25(OH)D₃ level of adult men in Hefei was associated with the risk and severity of AFLD.

The correlation analysis between the fibrinogen-albumin ratio and renal damage and disease activity of systemic lupus erythematosus

ZHANG Xiangxiang, PAN Haifeng, WANG Deguang

2023, 27(8): 933-939. doi: 10.16462/j.cnki.zhjbkz.2023.08.011

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Objective To explore the relationship between the fibrinogen-albumin ratio (FAR) and renal damage and disease activity in newly diagnosed patients with systemic lupus erythematosus (SLE). Methods The medical records of relevant clinical data of 156 newly diagnosed SLE patients and 159 healthy controls were retrospectively analyzed. Results The FAR of SLE patients was significantly higher than that of healthy controls (Z=-10.390, P < 0.001). The FAR of SLE patients in the moderate and severe disease activity group was higher than that in the mild disease activity group (Z=-4.703, P < 0.001). The FAR in lupus nephritis group was significantly higher than that in non-lupus nephritis group (Z=-6.312, P < 0.001). The FAR of SLE patients was negatively correlated with complement 3 (r=-0.249, P=0.002), serum total protein (r=-0.474, P < 0.001), and positively correlated with erythrocyte sedimentation rete (r=0.383, P < 0.001), C-reactive protein (r=0.293, P < 0.001), blood urea nitrogen (r=0.220, P=0.006), uric acid (r=0.296, P < 0.001), creatinine (r=0.180, P=0.025), 24-hour urine protein (r=0.588, P < 0.001) and SLE disease activity index (r=0.430, P < 0.001). Multivariate logistic regression analysis showed that FAR was an independent risk factor for moderate to severe SLE activity and renal damage. According to receiver operating characteristic curve, the areas under the curve of FAR for diagnosis of SLE, prediction of moderate to severe SLE activity and renal damage were 0.84(95% CI: 0.79-0.88), 0.72(95% CI: 0.64-0.80), 0.80(95% CI: 0.72-0.87), respectively. Conclusions FAR is associated with disease activity and renal damage in SLE patients, and has certain clinical significance for assessing SLE disease activity and renal damage.

Road traffic injuries of takeout couriers in Hefei and their influencing factors

QI Liangwei, GAO Peng, CHEN Haifeng, WU Qing, CAI Yuyu, FANG Xinyu, YE Dongqing

2023, 27(8): 940-945. doi: 10.16462/j.cnki.zhjbkz.2023.08.012

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Objective To research the existing environment and factors affecting road traffic injuries (RTIs) among takeout couriers in Hefei City, to provide solid evidence for reducing RTIs in this population. Methods A random sampling method was used to survey takeout couriers in Hefei City. The survey covered basic information, self-assessed anxiety and social support, frequency of traffic injuries, and safety-related driving behavior. Multivariate logistic regression models were employed to examine the factors influencing RTIs among this population. Results A total of 463 takeout couriers were interviewed, 42 of whom were wounded (9.1%). Most injuries occurred in non-motor vehicle lanes (76.2%), between April and June (69.0%), and from 16:00 to 19:59 (45.2%). The upper (35.7%) and lower (33.3%) limbs were the most severely affected body parts, with contusions/abrasions being the most common type of injury (57.1%). Outpatient treatment was the most common form of post-injury care (45.2%). Multivariate logistic regression analysis showed that the length of employment ≥ 1 year (OR=0.41, 95% CI: 0.18-0.91, P=0.029), no retrograde distribution (OR=0.45, 95% CI: 0.22-0.94, P=0.033), and high social support scores (OR=0.39, 95% CI: 0.16-0.97, P=0.042) were protective factors for RTIs among online distribution personnel. However, being married /remarriage (OR=2.18, 95% CI: 1.07-4.42, P=0.031) was identified as a risk factor. Conclusions The incidence of RTIs among takeout couriers is relatively high. To address this, it is essential to strengthen emotional support for takeout couriers, enhance their traffic safety awareness training, and capitalize on their work experience.

A comparative analysis of comparison of latent variables, manifest variables and Bayesian mediation effect models

XU Honglyu, SU Yingzhen, TAO Jian, GUO Jichang, TAO Fangbiao

2023, 27(8): 946-954. doi: 10.16462/j.cnki.zhjbkz.2023.08.013

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Objective The study aimed to compare the mediating effects and model fitting of the latent variable, the manifest variable and the Bayesian mediating effect model. Methods Data from a previous specialized survey on college students′ behavior and health were utilized. Six beverage consumption scores served as independent variables, seven dimensions of the Pittsburgh Sleep Quality Index Scale were mediating variables, and nine patient health questionnaire assessment depressive symptom scores were dependent variables. The mediating effects of sleep quality on the association between beverage consumption and depressive symptoms were analyzed using latent variable, manifest variable, and Bayesian mediation effect models. Results The mediating effect values of the above three models were 0.12, 0.06, and 0.06, respectively. The mediating effect accounted for 71%, 43%, and 43% of the total effect, and the ratio of the mediating effect to the direct effect were 2.49, 0.76, and 0.76, respectively. The mediating effects of the manifest variable mediation effect model and the Bayesian mediation effect model were nearly identical. The estimated value of the mediating effect, the ratio of the mediating effect to the total effect, and the ratio of the mediating effect to the direct effect of the latent variable mediation effect model were 2.00 times, 1.65 times, and 3.27 times those of the other two models, respectively. Conclusions While the mediating effects of the three models were consistent, the latent variable mediation effect model estimated a higher mediating effect value, and the Bayesian mediation effect model provided a more comprehensive evaluation index for model fitting.

Progress in global COVID-19 vaccine development and vaccination strategies

WU Yu, LIU Jue, LIU Min, LIANG Wannian

2023, 27(8): 955-962. doi: 10.16462/j.cnki.zhjbkz.2023.08.014

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On May 5, 2023, the World Health Organization declared that the outbreak of COVID-19 no longer constitutes a public health emergency of international concern. The global epidemic is relatively stable, but countries should not relax their vigilance against the novel coronavirus. Vaccination against COVID-19 remains an effective means of prevention. This study mainly makes a comparative analysis of the current progress of global COVID-19 vaccine research and development and the adjustment of vaccination strategies in different countries, combined with the latest guidance recommended by the World Health Organization on COVID-19 vaccine vaccination strategies, analyzes and discusses the inspiration of global COVID-19 vaccine research and development and national vaccination strategies for China, and puts forward targeted vaccination recommendations suitable for China's national conditions.

Analysis for the time trends of hepatoma mortality in China from 2004 to 2020

DING Shushu, GUO Haoyang, CHEN Hao, SUN Shu, SHI Wei, YUAN Hui

2023, 27(8): 963-967. doi: 10.16462/j.cnki.zhjbkz.2023.08.015

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Objective To analyze the standardized mortality rate of hepatoma and its trend variation among the Chinese population from 2004 to 2020, in order to provide a basis for formulating prevention and treatment strategies of hepatoma. Methods Mortality data were obtained from the the statistical information center of the National Health Commission. We extracted the mortality data of hepatoma from 2004 to 2020 and calculated the standardized mortality. The trend variation of standardized mortality of hepatoma in different regions and different age groups was compared by joinpoint model regression analysis. Results The standardized mortality rate of hepatoma among Chinese residents from 2004 to 2020 revealed that the rate was higher among rural residents compared to urban residents, and higher in males compared to females. The results of joinpoint regression showed that the standardized mortality of hepatoma in urban residents [average annual percent change(AAPC)=-2.38%, P < 0.001] was lower than that in rural residents (AAPC=-2.41%, P < 0.001); The annual decline rate of males was lower than that of females. The standardized mortality rate of hepatoma among urban residents aged 20- < 50, 55- < 60 and 70- < 85 showed a year-on-year decrease. In contrast, the standardized mortality rate of liver cancer among rural residents aged 25- < 50, 60- < 65 and 70- < 80 decreased year-on-year. Conclusions The overall mortality rate of liver cancer in China showed a downward trend from 2004 to 2020. However, disparities persist across gender, age, and region.

Relationship between hypertriglyceridemic-waist phenotype and clustering of cardiovascular risk factors among residents aged 40 and above in Dehui City, Jilin Province

REN Yuan, QIU Zihan, ZHANG Fuliang, GUO Zhenni, ZHANG Peng, SUN Xin, JIN Hang, LI Feng′e

2023, 27(8): 968-973. doi: 10.16462/j.cnki.zhjbkz.2023.08.016

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Objective This study aimed to explore the relationship between hypertriglyceridemic-waist phenotype (HTWP) and clustering of cardiovascular risk factors (CRFs) among residents aged 40 and above in Dehui City, Jilin Province. Methods A cross-sectional survey was conducted among residents aged 40 and above in Dehui City, Jilin Province, from January to March 2016, using a multistage stratified, random cluster sampling method. The HTWP was defined by serum triglyceride (TG) levels of ≥1.7 mmol/L and waist circumference (WC) of ≥90 cm in males or ≥80 cm in females. The logistic regression model was conducted to assess the relationship between the HTWP and the clustering of CRFs. Results The prevalence of HTWP was 33.98% among residents aged 40 and above in Dehui City, Jilin Province. The detection rates of CRFs clustering in the HTWP group and normal waist-normal triglycerides (NWNT) group were 71.68% and 20.90%, respectively. The multivariate logistic regression analysis indicated that the risk of detecting CRFs clustering in the HTWP group was 12.01 times greater than that in the NWNT group (OR=12.01, 95% CI: 9.83-14.67, P < 0.001). Conclusions The HTWP is strongly correlated with the clustering of CRFs, making it a convenient tool for screening CRFs clustering in residents aged 40 and above.

Impact of social activity participation on the health of the elderly: based on propensity score matching method

ZHAO Chuangyi, YANG Yuan, YUAN Kongjun, ZHOU Guangqing, LI Haiyan

2023, 27(8): 974-978. doi: 10.16462/j.cnki.zhjbkz.2023.08.017

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Objective This study aimed to explore the impact of social participation on the health of the elderly. Methods Data of the 2018 China Health and Retirement Longitudinal Survey (CHARLS) was obtained and studied with propensity score matching method (PSM), logistic regression model and instrumental variables regression. Results The logistic regression showed that the effect of social activity participation on depression in the elderly before PSM was not statistically significant. The risk of impaired activities of daily living of the elderly who participated in social activities was 0.795 times higher than that of the elderly who did not participate in social activities (OR=0.795, 95% CI: 0.712-0.889, P < 0.001). After PSM, the elderly who participated in social activities were less likely to suffer from depression or impaired activities of daily living than the elderly who did not participate in social activities (OR=0.971, 95% CI: 0.964-0.978, P < 0.001; OR=0.689, 95% CI: 0.628-0.889, P < 0.001). The results of two-stage least squares (2SLS) regression showed that social activity participation had an inhibitory effect on depression and impairment of activities of daily living in the elderly (β=-19.622, P < 0.001; β=-3.999, P < 0.001). Conclusions Social activity participation can improve the activities of daily living of the elderly and reduce depression. Measures should be taken to improve the participation of the elderly in social activities and to promote healthy aging.

The mediation analysis of homocysteine in the realtionship between oral health status and carotid intima-media thickness

LUO Lingfeng, HUANG Qiumin, SUN Zhonghan, MEI Zhendong, ZHENG Yan, ZHANG Zengli, SHI Limiao

2023, 27(8): 979-982. doi: 10.16462/j.cnki.zhjbkz.2023.08.018

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Objective The objective of this study was to explore the associations between oral health status and carotid intima-media thickness (cIMT), as well as to discern the potential mediating role of homocysteine (HCY) in these associations. Methods A total of 691 participants were included in the study, all aged 50 years and above, who underwent physical examinations in a hospital in Shaoxing City, Zhejiang Province, between June 15, 2019, and January 12, 2020. These participants provided complete oral and cIMT examination data. The associations between oral health status and cIMT were analyzed using multivariate logistic regression models. Bootstrap methods were utilized to assess the mediating effect of serum HCY levels on the relationship between oral health status and cIMT. Results After adjusting potential covariates by logistic regression models, it was found that the odds of abnormal cIMT was 2.04 times higher in the group with poor oral health, compared with the group exhibiting good oral health (OR=2.04, 95% CI: 1.48-2.81). The mediating analysis results showed that the serum HCY levels played a mediating role in the association between oral health status and cIMT (indirect effect=0.04, 95% CI: 0.01-0.06, P < 0.001), accounting for 21.89% of the total effect (P < 0.001). Conclusions Poor oral health may increase the probability of cIMT thickening, with higher serum HCY levels partially mediating this association.

Epidemiological characteristics and spatial clustering analysis of hepatitis C in Shaanxi Province from 2015 to 2021

NING Shaoqi, LIU Chenyue, HU Danni, CAO Lei, CHEN Sa, ZHANG Luqian, NIAN Yunpeng, ZHANG Yi

2023, 27(8): 983-988. doi: 10.16462/j.cnki.zhjbkz.2023.08.019

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Objective To analyze the epidemic characteristics and spatial aggregation of the hepatitis C virus in Shaanxi Province, thereby offering scientific evidence for the prevention and control. Methods We collected data on Hepatitis C virus infection cases in Shaanxi Province from 2015 to 2021, eliminating duplicate cases. The distribution characteristics were analyzed by descriptive epidemiological study, R 4.0.4 and GeoDa 1.6 software was used to conduct spatial statistical analyses.Results The reported incidence in Shaanxi Province from 2015 to 2021 showed an overall downward trend (χ²=590.919, P < 0.001). The male-to-female ratio was 1.06∶1, with the majority of reported cases found in the 40- < 70 age group. The primary occupations of these infected were farmers, housework, unemployed individuals and retirees. Global autocorrelation analysis found positive Moran's I coefficients in 2016, 2017, 2018, 2019, and 2021 (all P < 0.05). Hot Spot analysis identified high concentration areas of hepatitis C virus in 2016 (12), 2017 (14), 2018 (12), 2019 (9), 2021 (8), which were mainly concentrated in the central and eastern regions of Guanzhong. Conclusions The incidence of Hepatitis C virus in Shaanxi Province displays distinct population characteristics and regional clustering. Therefore, we should enhance epidemic surveillance and health education among high-risk populations and key regions, improve overall protective awareness, and provide medical assistance to control the infection source as early as possible.

Random sampling: a causal perspective

MU Yutong, GUO Yang, LI Qing, ZHANG Miao, SUO Chen, LI Yaxin, LIU Haiyan, HU Anqun, ZHENG Yingjie

2023, 27(8): 989-992. doi: 10.16462/j.cnki.zhjbkz.2023.08.020

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This article explained the structure and principle of simple random sampling, cluster sampling, and stratification sampling from the perspective of causal graphs. The process of generation and adjustment of sampling bias was clearly presented. We found that: when the target attribute of the study was related to other attributes which affected the selection of the samples, the representative of the sample would be biased. In other words, the sampling bias or the systematic error of sampling would appear. When selecting sampling methods, cluster sampling requires heterogeneity within clusters but homogeneity among clusters. In contrast, stratified sampling requires the opposite way. Finally, this paper provides a route for the selection of sampling methods in practical research work, which can help readers to improve the acknowledgment of random sampling and consider the best sampling method.

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2023 Vol. 27, No. 8

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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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