中华疾病控制杂志

Prevalence of myopia and associated factors among fourth-grade students in China

ZHANG Xian, LI Tianhao, WANG Weidong, HU Yisong, MAO Yanxin

2024, 28(8): 869-875. doi: 10.16462/j.cnki.zhjbkz.2024.08.001

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Objective To analyze the screening nearsightedness of the fourth grade students in China and discuss the factors affecting the students′ myopia. Methods A total of 26 373 students were selected from the fourth grade primary school cohort of China education panel survey (CEPS) in 2018. χ² test was used to compare the prevalence of myopia among students with different characteristics, and multi-level logistic regression model was used to analyze the factors affecting the detection rate of myopia. Results The prevalence rate of screening myopia was 52.11%, with girls (56.38%) higher than boys (48.20%) (χ²=176.597, P < 0.001). The myopia rate of urban registered students was 55.71%, which is 7.12% higher than that of rural registered students (48.59%) (χ²=133.790, P < 0.001). Multilevel logistic regression analysis showed that there were different factors affecting the risk of myopia among urban and rural students. Whether they participated in sports interest classes (OR=0.83, 95% CI: 0.74-0.93, P=0.001) and living with parents (OR=1.21, 95% CI: 1.07-1.38, P=0.002) had a significant effect on the risk of myopia among rural students. Age (OR=0.91, 95% CI: 0.84-0.98, P=0.014), only child or not (OR=1.09, 95% CI: 1.01-1.18, P=0.030), cognitive level or not (OR=1.09, 95% CI: 1.01-1.18, P=0.032), family economic conditions (OR=1.23, 95% CI: 1.03-1.47, P=0.020) had significant effect on myopia risk of urban students. Conclusions It is necessary to take reasonable intervention measures according to local conditions and the difference between urban and rural areas to control the prevalence of myopia in students scientifically.

Depression of Chinese fourth graders and its influencing factors

WANG Weidong, MA Ruize, TANG Lina, MAO Yanxin, HU Yisong

2024, 28(8): 876-883. doi: 10.16462/j.cnki.zhjbkz.2024.08.002

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Objective Utilizing baseline survey data from the primary school cohort of the China education panel survey (CEPS), this study aims to examine the prevalence of depression among fourth-grade students in China and its influencing factors, using the epidemiological center depression scale as a measurement tool. Methods The study uses Stata 18.0 software and employs the chi-square test to compare the differences in depression in fourth-grade students with different characteristics. Logistic regression models are used to analyze the impact of various factors on students′ risk of depression. Results The depression detection rate among fourth-grade students was 15.23%. Specifically, student′s cognitive individual ability level (Middle ∶ Low, OR=0.71, 95% CI: 0.61-0.83, P < 0.001; High ∶ Low, OR=0.65, 95% CI: 0.52-0.81, P < 0.001), academic performance(Middle ∶ Low, OR=0.77, 95% CI: 0.66-0.88, P < 0.001; High ∶ Low, OR=0.61, 95% CI: 0.51-0.74, P < 0.001), and academic pressure(Middle ∶ Low, OR=1.33, 95% CI: 1.15-1.53, P < 0.001; High ∶ Low, OR=1.78, 95% CI: 1.47-2.14, P < 0.001) significantly affect the risk of developing depression. At the school and family levels, positive parental relationships(Bad ∶ Good, OR=1.53, 95% CI: 1.32-1.78, P < 0.001), teacher-student relationships (Good ∶ Bad, OR=0.81, 95% CI: 0.71-0.93, P=0.002), and peer relationships (Good ∶ Bad, OR=0.78, 95% CI: 0.68-0.89, P < 0.001) can reduce the depression risk independently. Conclusions Factors including personal attributes, family environment, school, and peers all have varying degrees of influence on their depressive states. In light of these findings, concerted efforts should be made from the individual, family, and school perspectives in order to alleviate the level of depression in primary school students and promote their mental health.

Analysis of the prevalence and risk factors of overweight and obesity in fourth grade students in China

SHEN Yanfang, HU Chenle, WANG Weidon, MAO Yanxin, HU Yisong, TANG Lina

2024, 28(8): 884-889. doi: 10.16462/j.cnki.zhjbkz.2024.08.003

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Objective To analyze the prevalence of overweight and obesity and their risk factors among fourth grade students in China. Methods A total of 29 996 students were selected from the fourth grade primary school cohort of China education panel survey (CEPS) in 2018-2019 school year. Chi-square test was used to examine the differences in the prevalence of overweight and obesity among different groups and logistic regression models were used to analyze the factors related to overweight or obesity. Results The prevalence of overweight/obesity among fourth-grade elementary school students was 22.4%. The prevalence of overweight and obesity was 12.3% and 10.1% respectively. Logistic regression analysis indicated that the rate of overweight/obesity among boys was higher than girls (OR=2.60, 95% CI: 2.43-2.78, P < 0.001), with respective rates of 29.2% and 14.6%. The rate of overweight/obesity among students in the 11-year-old group was lower than that in the 10-year-old group (OR=0.81, 95% CI: 0.76-0.87, P < 0.001), with respective rates of 20.9% and 23.8%. The rate of overweight/obesity among students attending urban schools was higher than students attending rural schools (OR=1.45, 95% CI: 1.31-1.60, P < 0.001), with respective rates of 23.7% and 15.3%. The rate of overweight/obesity among only children was higher than non-only children (OR=1.42, 95% CI: 1.33-1.52, P < 0.001). The rate of overweight/obesity among students with a sports hobby was lower than students without a sports hobby (OR=0.74, 95% CI: 0.69-0.79, P < 0.001). Besides, our results found that the higher the frequency of skipping breakfast, the greater the risk of overweight/obesity for students; the higher the frequency of consuming fried/grilled/puffed foods, the greater the risk of overweight/obesity for students. Conclusions Schools should scientifically guide fourth-grade students to reasonably combine meals, maintain a healthy diet, and encourage students to actively increase their sports time. Attention and precise prevention should be strengthened for high-risk groups such as male students, urban students, and only children.

Hemoglobin levels and anemia prevalence among Chinese students aged 10-11: evidence from the 2018 China education panel study primary school cohort

HU Yisong, LI Jiatong, HAN Jiayu, WANG Yuan, WANG Weidong

2024, 28(8): 890-895. doi: 10.16462/j.cnki.zhjbkz.2024.08.004

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Objective To analyze the hemoglobin level and anemia prevalence in Chinese 10-11 years old children and to explore possible socio-economic factors. Methods Grade 4 students data from China education panel survey (CEPS) was used and there are 17 695 students with hemoglobin data. The anemia status was diagnosed by using hemoglobin of fingertip blood and adjusted with altitude of each school. All socio-economic factors were collected from questionnaire survey. Multiple logistic regression analysis model was used to analyze the influencing factors of anemia prevalence. Results The mean concentrations of hemoglobin were (130.61±11.32) g/L and (131.88±11.85) g/L, and the anemia prevalence was 6.78% and 6.28% respectively in 10 and 11 years old students. The mean concentrations of hemoglobin were (131.52±11.62) g/L and (130.96±11.60) g/L, and the anemia prevalence was 6.41% and 6.64% respectively in male and female students. The students with urban Hukou had higher mean concentrations of hemoglobin than that of students with rural Hukou, the mean concentrations of hemoglobin were (132.02±11.32) g/L and (130.70±11.78) g/L, and the anemia prevalence was 5.04% and 7.59% respectively. Multivariate logistic regression analysis showed that primary school students with rural household registration had a higher risk of anemia [OR(95% CI)=1.26(1.09~1.46), P=0.002], while that of 11-year-old students [OR(95% CI)=0.85(0.75~0.96), P=0.010], Primary school students with medium or higher family economic status and parents with the highest education in high school or above had a lower risk of anemia (all OR < 1.00, P < 0.05). Conclusions The anemia is still a public health issue worthy of attention in 10 and 11 years old students and the anemia prevalence is different in different socio-economic students. The prevention and control of anemia should be focused on fragile population distribution and more targeted strategies are needed.

Sleep status of Chinese fourth-grade primary school students and its physical and psychological factors

TANG Lina, LIU Jinbao, SHI Jiahao, LI Jiarui, GAI Qinbao, HU Yisong, WANG Yuan

2024, 28(8): 896-902. doi: 10.16462/j.cnki.zhjbkz.2024.08.005

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Objective To understand the status and group differences in sleep quantity and quality among fourth-grade primary school students in China, and to explore its physical and psychological factors. Methods Total of 23 717 school students between the ages of 10 and 11 with complete important variables in the 2018 China Education Panel Survey (CEPS) data were selected as research subjects. A multiple linear regression model was used to analyze factors affecting their sleep duration, and a multifactor logistic regression model was used to analyze factors affecting their sleep quality. Results The average sleep duration of fourth-grade school students nationwide was 9.26 hours, and the proportion of subjects with self-rated good sleep quality was 88.56%. BMI classification, frequency of illness, depression score, smoking, alcohol consumption, consumption of barbecued/puffed/and western fast food, consumption of sugary/carbonated beverages, and the frequency of not eating breakfast were the factors affecting their sleep duration (all P < 0.05). Gender, self-rated health rating, frequency of illness, depressed psychology, alcohol consumption, consumption of barbecued, puffed, and western fast food, and consumption of sugary or carbonated beverages and habits of not eating breakfast were the factors affecting their sleep quality (all P < 0.05). Conclusions The average length of sleep of Chinese fourth-grade primary school students has not reached 10 hours, but the self-assessed sleep quality is good. Different physical and mental factors and health behaviors have different effects on the duration and quality of sleep.

The impact of peak and duration of intrapartum fever on adverse perinatal maternal and neonatal outcomes

ZHANG Peili, HU Peng, GUO Jingyi, LIN Hualiang

2024, 28(8): 903-908. doi: 10.16462/j.cnki.zhjbkz.2024.08.006

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Objective To explore the impact of maternal intrapartum fever′s peak and duration on perinatal outcomes. Methods This study included primiparas who delivered at term with a singleton fetus in the Shantou Central Hospital from 2020 to 2022. The exposure factor was intrapartum fever (the maternal body temperature ≥37.5 ℃). The participants were grouped based on different fever peak (Tmax, the highest recorded body temperature during labor), fever duration (t, the time from the first recorded fever to the first recorded normal body temperature or delivery), and fever composite variable v, $ \[\left[ {v = \frac{{{T_{max}} - 37℃}}{{100}} \times t} \right]\]$. The study compared the differences in neonatal outcomes (including neonatal asphyxia, neonatal infections, hypoxic-ischemic encephalopathy, seizures, intracranial hemorrhage, etc.) and adverse perinatal outcomes of pregnant women (including maternal operative delivery, postpartum hemorrhage, incision infection, puerperal sepsis). Logistic regression analysis was conducted to assess the association between the peak and duration of intrapartum fever and adverse perinatal outcomes. Results A total of 2 197 parturients were included in the study, and 307 (13.9%) of them had intrapartum fever. Compared with afebrile parturients, febrile parturients had higher rates of neonatal adverse outcomes and maternal operative delivery. After adjusting for confounding factors, for every 1 ℃ increase in fever peak, the risk of adverse neonatal outcomes increased by 1.204 times (OR =2.204, 95% CI: 1.691-2.423), and the risk of maternal operative delivery increased by 88.3% (OR =1.883, 95% CI: 1.581-2.242);for every 60-minute increase in the duration of fever, the risk of adverse neonatal outcomes increased by 28.4% (OR =1.284, 95% CI: 1.178-1.400), and the risk of maternal operative delivery increased by 29.4% (OR =1.294, 95% CI: 1.183-1.414);for every 1 unit increase in the composite variable of fever, the risk of adverse neonatal outcomes increased by 55.4% (OR =1.554, 95% CI: 1.359-1.777), and the risk of maternal operative delivery increased by 49.4% (OR =1.494, 95% CI: 1.298-1.720). Conclusions Increased peak fever, increased duration of fever, and increased composite fever variables were associated with higher risk of adverse neonatal outcomes and maternal operative delivery.

Application of logistic regression and decision tree model on influencing factors of the comorbidity of depression and anxiety symptoms in adolescents

YE Sheng, YANG Yue, LU Xuelei, LIU Hui, LI Juntong, LIU Li

2024, 28(8): 909-916. doi: 10.16462/j.cnki.zhjbkz.2024.08.007

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Objective To analyze the influencing factors of the comorbidity of depression and anxiety symptoms among adolescents by using logistic regression and decision tree model, and to provide basis for relevant intervention. Methods In October 2022, a combination of purposive sampling and stratified random cluster sampling method was employed to recruit 10 178 adolescents across eight districts in Nanjing. Data were collected through a questionnaire assessing the comorbidity of depression and anxiety symptoms and potential influencing factors. Logistic regression and decision tree analyses were conducted to identify key predictors, with model performance evaluated using the receiver operating characteristic (ROC) area under curve (AUC). Results The prevalence of the comorbidity of depression and anxiety symptoms was 16.63% among adolescents. Both analytical models highlighted self-harm behavior, academic satisfaction, school bullying, educational phase and drinking history as significant influencing factors of these comorbid symptoms (all P < 0.05). The area under ROC curve of logistic regression model was larger than that of decision tree model (0.828 ∶ 0.787, Z=11.153, P < 0.01). Conclusions The predictive ability of the logistic regression model is better than that of the decision tree model. More attention should be paid to the influence of self-harm, academic satisfaction and school bullying on the comorbidity of depression and anxiety symptoms. Additionally, efforts should be made to help adolescents develop healthy behaviors, thereby promoting their physical and mental well-being.

Influencing factors of thyroid volume in children aged 6-12 years in Gansu Province and comparison of different thyroid volume correction methods

XU Lihua, FEI Xiulan, CHEN Faqing, LI Qinglin, SUN Wei, WANG Tao, WANG Yanling

2024, 28(8): 917-921. doi: 10.16462/j.cnki.zhjbkz.2024.08.008

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Objective To analyze the influencing factors of thyroid volume at children aged 6-12 years in Gansu Province, and to explore the appropriate correction method of thyroid volume. Methods Based on the results of the 2019 iodine deficiency disease monitoring in Gansu Province, Liangzhou District of Wuwei City and Kongtong District of Pingliang City, where iodine nutrition is appropriate, were selected as survey sites. A multi-stage stratified sampling method was used to extract non-residential children aged 6-12 years (with balanced regional and gender ratio). The height, weight, thyroid volume, urinary iodine and salt iodine in their families were measured. The influencing factors of thyroid volume in children were analyzed. The thyroid volume correction effects of body mass volume index (BMIV), body surface area volume index (BSAV), weight height volume index (WHVI), height volume index (WHVI), height volume index1 (HVI1) and height volume index2 (HVI2) were compared. Results Thyroid volume was not statistically significant when children of different genders (Z=-0.837, P=0.403). Spearman rank correlation analysis showed that height, body weight, BMI, body surface area (BSA), age, urinary iodine were positively correlated with thyroid volume (P < 0.001). Among them, BSA had the strongest correlation with thyroid volume (r=0.787). Quantile regression analysis showed that age and BSA had significant effects on the overall distribution of thyroid volume. Spearman rank correlation analysis of height, weight and corrected thyroid volume showed that BSAV could eliminate the influence of height and weight on thyroid volume to the greatest extent. Conclusions Age and BSA significantly affected thyroid volume. BSAV has a good correction effect on children′s thyroid volume, and it is recommended to be used as an evaluation index of children′s thyroid volume.

Comparative analysis of blood pressure distribution and prevalence in different altitudes regions between Tibetan and other ethnicities in Yunnan Province

YANG Li, XIA Yu, TANG Mingjing, HE Liping, ZHU Qiuyan, WANG Huadan, MA Min, HE Jie, DUO Lin, PANG Linhong

2024, 28(8): 922-928. doi: 10.16462/j.cnki.zhjbkz.2024.08.009

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Objective This study aims to comparatively analyse the risk of hypertension in Tibetans and other ethnicities at different altitudes regions in Yunnan Province, and to provide a scientific basis for the control of hypertension among people living at high altitudes. Methods During 2020-2021, a multistage stratified cluster random sampling method was used to select four townships in the Diqing Tibetan Autonomous Prefecture, Shangri-La City, Yunnan Province as survey points. These included Jiantang Town and Xiaozhongdian Town at altitudes ≥ 2500 meters, and Wujing Township and Jinjiang Town at altitudes < 2500 meters. A total of 1 549 permanent residents aged 18 years and above were sampled for questionnaire survey, physical examination and blood biochemistry tests. Theχ² test was used to analyse the distribution of blood pressure levels and the prevalence of hypertension in different ethnic groups at different altitudes, and multifactorial logistic regression was used to analyse the factors affecting the prevalence of hypertension in people at different altitudes. Results The prevalence of hypertension was higher in the group with an altitude of ≥2 500 m than in the group with an altitude of < 2 500 m (P=0.002). The average systolic blood pressure of Tibetan nationality was 5.29 mmHg higher than that of Han nationality (P < 0.001). The prevalence of hypertension was higher among Tibetans than among other ethnic living at the same altitude in the altitude < 2 500 m group (P < 0.017), but lower among Tibetans than among Han Chinese and other ethnic groups living at the same altitude in the altitude ≥2 500 m group (P < 0.017).There were no significant differences in the hypertension prevalence and mean systolic and diastolic blood pressure among Tibetan populations at different altitudes (all P>0.05). There was a negative interaction between Tibetan ethnicity and altitude on the risk of developing hypertension. People living at ≥2 500 m altitude have more risk factors for hypertension compared to those at < 2 500 m altitude. Conclusions The hypertension prevalence among Han and other people increased as the altitude increased. Tibetans seem to show greater adaptation to plateaus and changes in blood pressure at different altitudes.

Association between urinary sodium and potassium excretion and blood pressure among adults in Shandong Province, China

GUO Rui, ZHANG Bingyin, XU Chunxiao, DONG Jing, REN Jie, LIU Danru, LU Zilong, GUO Xiaolei

2024, 28(8): 929-936. doi: 10.16462/j.cnki.zhjbkz.2024.08.010

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Objective To analyze the association between urinary sodium and potassium excretion with the risk of hypertension and blood pressure levels among adults in Shandong Province, China. Methods Residents aged 18-69 years were selected for questionnaire survey, physical examination, and random spot urine collection in Shandong Province in 2019. The 24 hour urinary sodium and potassium excretion was estimated by spot urine through the Tanaka formula. Dose-response relationship and association of 24 hour urinary sodium and potassium excretion with the risk of hypertension and blood pressure levels using restricted cubic spline, logistic regression models, and linear regression models. Subgroup analyses were conducted according to different ages, genders, and antihypertensive drug usage. Results A total of 3 280 subjects were included, 24 hour urinary sodium, urinary potassium and urinary sodium-potassium ratios were (4.12±0.95) g/d, (1.70±0.39) g/d and (2.51±0.69). For every 1g/d increase in sodium excretion, systolic blood pressure increases by 1.221 mmHg (95% CI: 0.611-1.830, P < 0.001), and diastolic blood pressure increases by 0.612 mmHg (95% CI: 0.201-1.023, P=0.004). For every 1g/d increase in potassium excretion, systolic blood pressure decreases by 2.297 mmHg (95% CI: -3.797--0.796, P=0.003) and diastolic blood pressure decreases by 1.159 mmHg (95% CI: -2.171--0.147, P=0.025). Compared with the group with a urinary sodium-potassium ratio of < 2.0, the ≥2.9 group increases the risk of hypertension by 37% (95% CI: 1.062-1.769, P=0.015), with an increase in systolic blood pressure of 3.047 mmHg (95% CI: 1.470-4.624, P < 0.001) and diastolic blood pressure of 1.796 mmHg (95% CI: 0.734-2.859, P=0.001). There was no interaction for any of the metrics except for a multiplicative interaction for gender and urinary potassium in the association with systolic blood pressure (P=0.015). Conclusions With the increase of urinary sodium and the decrease of urinary potassium, the risk of hypertension, systolic blood pressure and diastolic blood pressure all increase, and the use of random spot urine for assessing the risk of hypertension in large epidemiological surveys is scientifically valid.

Relationship between body fat percentage and conventional obesity indicators and its cut-off values in Guangxi Zhuang population

LYU Fangfang, MO Caimei, LEI Lidi, LI Jinxiu, WEI Gangjie, LU Peini, XU Xuemei, HUANG Xuanqian, ZENG Xiaoyun, QIU Xiaoqiang, LIU Shun

2024, 28(8): 937-943. doi: 10.16462/j.cnki.zhjbkz.2024.08.011

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Objective To investigate the association of body fat percentage (BFP) with body mass index (BMI) and waist circumference (WC) in Zhuang people aged 35- < 75 years in Guangxi, and to explore the cut-off values of obesity. Methods A total of 12 311 participants were selected from the baseline survey of the Prospective Cohort study of Chronic Diseases in Natural Minority Populations in Guangxi Zhuang Autonomous Region in 2018-2019. First, the relationship between BFP and BMI and WC was determined by curve fitting. Then, multiple linear regression model was used to analyze the main influencing factors of BFP, and regression equations for BMI and WC to predict BPF were constructed to calculate the overweight and obesity cut-off values of BPF. Finally, using BMI and WC criteria as the gold standard, the sensitivity, specificity and the area under curve (AUC) the receiver operating characteristic (ROC) of BFP corresponding cut-off values were calculated to evaluate its diagnostic value. Results BMI was superior to WC in predicting BFP. Based on the Chinese standard BMI of 28 kg/m², the BFP obesity cut-off values was 23.4% in men and 35.6% in women, and the AUC was 0.732 and 0.847, respectively. The corresponding sensitivity and specificity were 0.581 and 0.882 in males, and 0.818 and 0.876 in females. Conclusions In Guangxi Zhuang population, the BFP cut-off values calculated based on the Chinese obesity standard should be referred to BMI. The calculated obesity cut-off value for males is lower than the international standard. However, the cut-off values calculated with BMI≥30 kg/m² are higher than the international standard. The rationality of the BFP cut-off values needs to be further verified by considering the positive predictive value and the risk of obesity-related diseases in the future.

A case-control study of empirical dietary index for insulin resistance and risk of gastric precancerous lesions

SHU Xing, LI Bin, JIANG Haoqi, TANG Jinzhi, SHI Chang′e, ZHAO Qihong, YANG Wanshui, TANG Min, U Anla

2024, 28(8): 944-949. doi: 10.16462/j.cnki.zhjbkz.2024.08.012

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Objective To explore the relationship between empirical dietary index for insulin resistance (EDIR) and the risk of gastric precancerous lesions (GPL) and provide epidemiological basis for dietary prevention and control of GPL. Methods From September 2021 to July 2022, 102 patients with GPL, 204 with non-atrophic gastritis (NAG) or normal gastric mucosa patients were selected for a non-matched case-control study in the First Affiliated Hospital of Anhui Medical University. Then EDIR were applied to unmatched cases-control studies. Results The EDIR score of the case group was higher than that of the control group, and the difference was statistically significant (Z=-2.141, P=0.032); Compared with the control group, the refined grain intake (Z=-2.475, P=0.013) was higher in the case group; After adjustment for confounders, the higher EDIR[Quartile 2: OR(95% CI): 4.36(1.61~11.84), P=0.003] was positively associated with an increased risk of GPL. Conclusions Higher EDIR scores and high intake of refined grains increase the risk of developing GPL.

Epidemiological characteristics and spatial-temporal clustering of scarlet fever in Hangzhou from 2010 to 2023

WANG Yi, WANG Zhe, JIN Xinye, TAO Mingyong, DUAN Xiaojian, ZHU Yi, HE Zhaokai, SUN Zhou

2024, 28(8): 950-955. doi: 10.16462/j.cnki.zhjbkz.2024.08.013

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Objective This study aims to explore the epidemiology and spatial-temporal clustering characteristics of scarlet fever in Hangzhou from 2010 to 2023, providing a scientific basis for the formulation of prevention and control strategies for scarlet fever as well as the rational allocation of health resources in Hangzhou. Methods The incidence data of scarlet fever in Hangzhou from 2010 to 2023 came from China Disease Prevention and Control Information System. Joinpoint 5.1.0 software was used to analyze the trend of scarlet fever incidence data, and ArcGIS 10.8 software was used to carry out spatial autocorrelation analysis. SaTScan 10.1.2 was used to perform spatio-temporal scan analysis. Results The average annual incidence of scarlet fever in Hangzhou from 2010 to 2023 was 5.06 per 100 000 population. Joinpoint regression analysis revealed a decreasing trend in the incidence of scarlet fever in Hangzhou from 2015 to 2023. The distribution of cases exhibited distinct seasonal patterns, peaking in late spring to early summer (April to June) and late autumn to early winter (November to January of the following year). The majority of cases were among children aged 3~9 years (85.79%), males (61.00%), and preschool children (47.09%). Gongshu District and Shangcheng District were identified as high-incidence areas, accounting for 35.73% (2 459/6 882) of all reported cases. The global autocorrelation analysis showed that the incidence of scarlet fever was spatially correlated in all years except 2011, 2013 and 2014 (P<0.05). Local spatial autocorrelation analysis indicated the presence of hotspots ("high-high" clusters) of scarlet fever incidence in Hangzhou from 2010 to 2023, relatively concentrated in the northeastern and central regions. Spatiotemporal scan analysis detected three clusters, of which the primary cluster encompassed 13 neighborhoods in Shangcheng and Gongshu Districts, spanning from March 2014 to June 2016. Conclusions From 2010 to 2023, the epidemic of scarlet fever in Hangzhou initially shows a fluctuating upward trend, followed by a fluctuating downward trend after 2015. There is a significant spatial-temporal clustering in the city, primarily concentrated in the northeastern and central regions of Hangzhou. Enhanced health education and disease surveillance efforts should be implemented in high-incidence areas and populations.

A bidirectional two-sample mendelian randomization analysis of the relationship between mild to moderate depression and the risk of knee osteoarthritis

LEI Xuefeng, ZHANG Wenzheng, TU Yihui, XUE Huaming

2024, 28(8): 956-960. doi: 10.16462/j.cnki.zhjbkz.2024.08.014

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Objective To utilize a bidirectional Mendelian randomization(MR) analysis to examine the causal link between mild-to-moderate depression and knee osteoarthritis (KOA), offering novel perspectives for the prevention, management, and prognostic evaluation of KOA. Methods Genome-wide association study (GWAS) data were utilized, genetic loci closely associated with mild-to-moderate depression and KOA were selected as instrumental variables. The inverse variance weighted(IVW) was employed as the primary analytical approach to assess causal effects, supplemented by methods such as weighted median (WM), simple median (SM), weighted mode, and MR-Egger regression for two-sample MR analysis. The causal relationship between mild-to-moderate depression and KOA was evaluated using OR, with tests for heterogeneity, genetic pleiotropy, and sensitivity analysis to assess the stability and reliability of the results. Results MR analysis indicated that patients with mild-to-moderate depression had a 1.64-fold increased risk of KOA compared to the healthy population (OR=1.64, 95% CI: 1.34-2.02; P < 0.001). External validation confirmed that mild-to-moderate depression indeed increases the risk of KOA. Conclusions A potential causal association may exist between mild-to-moderate depression and KOA, with mild-to-moderate depression possibly serving as a risk factor for KOA.

A neural network risk prediction model of coal workers′ pneumoconiosis-a hospital-based case-control study

YANG Yutong, TIAN Qinghua, AN Qi, HAO Jianguang, WANG Jianru, WU Jiao, LI Yichun, LI Yang, WANG Qingyao, LI Yuxing, LEI Lijian, LUO Mingzhong

2024, 28(8): 961-968. doi: 10.16462/j.cnki.zhjbkz.2024.08.015

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Objective This study aims to construct a high-efficiency coal workers′ pneumoconiosis (CWP) risk prediction model to promote early prevention of CWP. Methods We conducted a case-control study based on hospital records, collected case data of coal workers diagnosed with CWP and non-CWP in an occupational disease hospital in Shanxi Province from 2017 to 2022 and established a database of CWP. Random forest method was used to screen the characteristic variables. The CWP prediction model was constructed based on back propagation (BP) neural network and Logistic regression respectively, and the CWP prediction ability of the two models was evaluated by receiver operating characteristic (ROC). Results The BP neural network model demonstrated a sensitivity of 88.6%, a specificity of 87.6%, and an accuracy rate of 87.12%. Based on variable normalization importance analysis, the most influential factors for CWP prevalence in coal workers were forceful expiratory volume in 1 second/ forceful vital capacity (FEV1/FVC), working age and work type. The logistic regression model showed a sensitivity of 80.7%, a specificity of 84.1%, and an accuracy rate of 82.7%. The BP neural network model exhibited a higher area under the curve (AUC) value (AUC=0.918, 95% CI: 0.903-0.964) compared to the logistic regression model (AUC=0.802, 95% CI: 0.750-0.850), indicating superior predictive performance. Conclusions The BP neural network model provides better predictive performance compared to the logistic regression model, and applying the BP neural network to CWP prediction has higher accuracy. FEV1/FVC, working age and work type are identified as significant factors influencing the occurrence of CWP in coal workers.

Methodological research progress on the trajectory of chronic disease multimorbidity

WEI Conghan, LIANG Lizhong, ZENG Zhirong

2024, 28(8): 969-975. doi: 10.16462/j.cnki.zhjbkz.2024.08.016

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As the aging of the population intensifies and the spectrum of diseases in the population changes, the complexity of multimorbidities of chronic diseases is increasing. Clarifying the progression patterns of multimorbidities over time will provide points for further research. This study analyzes the concepts related to chronic disease multimorbidity trajectories, systematically reviews the literature visualization, and summarizes the methodological advances and research findings from three research perspectives: variable-centered, individual-centered, and disease diagnosis-centered. The development of chronic disease multimorbidity trajectory research will provide evidence to early detect disease risks, implement interventions, delay and control disease progression, and have important reference significance in identifying the mechanisms of multimorbidity occurrence and optimizing health resource allocation.

Health economics evaluation of co-administration of oral rotavirus vaccine in children under 5 years old in China

WANG Rui, SUN Xinrui, YANG Fan, WANG Qi, WANG Lei, WEI Sheng

2024, 28(8): 976-981. doi: 10.16462/j.cnki.zhjbkz.2024.08.017

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Objective To analyze the cost-effectiveness and cost-utility of the strategy of co-administration of oral rotavirus vaccine (ORV) and immunizing vaccines. Methods A decision tree-Markov model was developed to evaluate 100 000 newborns to assess the cost-effectiveness and cos-utility of co-administration of ORV versus the single administration of ORV at the age of 0-5years. And the sensitivity analysis of the model was carried out. According to the hypothesis of study, the ORV full-dose rate under the strategy of co-administration would be 46% and 91%. Since the full vaccination rate of diphtheria, tetanus and acellular pertussis combined vaccine (DTaP) vaccine was more than 90%, which was much higher than that of ORV, with the implementation of the strategy of co-administration, the vaccination rate of ORV might gradually approach the vaccination rate of DTaP vaccine, so the median and maximum values are taken. Results When the strategy of co-administration of ORV and DTaP combined vaccine was implemented and the coverage rate of full dose reached 46%, the cost of reducing 1 RVGE case, the cost of reducing 1 RVGE death, and the incremental cost-utility ratio (ICUR) were 1 856.4 yuan, 3.395 million yuan and 6 401.7 yuan per quality-adjusted life year (QALY), respectively. When the coverage rate of full dose reached 91%, the cost of reducing 1 RVGE case, the cost of reducing 1 RVGE death, and the ICUR were 1 398.2 yuan, 2.559 million yuan, and 5 044.6 yuan per QALY, respectively. Sensitivity analysis showed that the co-administration vaccine strategy of ORV had good cost-utility in increasing QALY. Conclusions Implementing the strategy of co-administration of ORV and immunizing vaccines have good cost-effectiveness and cost-utility in children.

Association between perceived teacher caring behaviors and depression among students

ZHU Yu, LI Jing, LIU Fang, WU Yangpei, CHEN Shujun, LI Baikun

2024, 28(8): 982-987. doi: 10.16462/j.cnki.zhjbkz.2024.08.018

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Objective To investigate the degree of association between students′ perceived teacher caring behaviors and depression, and to provide strategies for the formulation of mental health policies in higher education environments. Methods This study employed a multi-level random sampling approach to recruit 9 389 students across 10 universities. A survey was administered to evaluate the students′ perceived teacher caring behaviors as well as their depression status. Subsequently, a 1∶1 individual matching was implemented, taking into account school, grade, and gender, to identify healthy controls for the students exhibiting signs of depression. Spearman rank correlation analysis and Conditional logistic regression analysis model were used to analyze association between students′ perceived teacher caring behaviors and the risk of mild depression and moderate depression. Results Among the 2 192 pairs of students with mild depression and healthy control, 555 pairs (25.3%) were male; among the 635 pairs with moderate depression and healthy control, 147 pairs (23.1%) were male. Students with depression reported lower levels of perceived teacher caring behaviors compared to their healthy controls (Z_mild=-13.497, Z_moderate = -12.598, P < 0.001). Conditional logistic regression analysis revealed that perceived teacher caring behaviors were protective factors against mild depression (OR=0.810, 95% CI: 0.752-0.873) and moderate depression (OR=0.603, 95% CI: 0.490-0.742). Conclusions High levels of students′ perceived teacher caring behaviors contribute to reducing depression among students. Universities should actively develop and implement targeted public health strategies to promote students′ mental health.

Analysis of the prevalence characteristics of stroke in Longhua District, Shenzhen City from 2016 to 2022

ZHAO Shaojuan, YAN Xinfeng, YU Chuanning, PENG Ji, LEI Lin

2024, 28(8): 988-992. doi: 10.16462/j.cnki.zhjbkz.2024.08.019

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Objective To understand the prevalence characteristics of stroke incidence among residents of Longhua District, Shenzhen, China, from 2016 to 2022, and to provide a basis for the the formulation of policies related to the prevention and control of chronic diseases in the region. Methods The data for this study were obtained from the stroke incidence surveillance data of the permanent residents of Longhua District, Shenzhen, China, in the Chronic Non-communicable Disease Surveillance Reporting Network Information System, Shenzhen, China, from 2016 to 2022. SPSS 23.0 was used to calculate the status of incidence rate, standardized incidence rate and age-specific incidence rate and incidence type of stroke, and Joinpoint 4.3.1.0 was used to calculate the annual percentage change (APC). Results The average annual incidence rate in Longhua District, Shenzhen, China, from 2016 to 2022 was 166.45/100 000, and the change in the annual incidence rate was not significant (t=0.460, P=0.665). The incidence rate of stroke was higher in males than in females (2016 yearχ²=14.851, P < 0.001;2017 yearχ²=29.848, P < 0.001;2018 yearχ²=34.468, P < 0.001;2019 yearχ²=82.447, P < 0.001;2020 yearχ²=113.310, P < 0.001;2021 yearχ²=107.890, P < 0.001;2022 yearχ²=119.740, P < 0.001). The incidence of stroke increased with age, and the mean age of onset of stroke was earlier in men than in women in different years. Among the risk factors for stroke, the proportion of confirmed concomitant hypertension was the highest. Conclusions The incidence of stroke in Longhua District, Shenzhen City, is still serious, and the incidence rate is significantly increasing, comprehensive interventions should be implemented to effectively control various risk factors, especially the effective management and control of hypertension.

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2024 Vol. 28, 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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