Cancer incidence and mortality in Zhejiang Province, Southeast China, 2016: a population-based study / 中华医学杂志(英文版)

BACKGROUNDS@#Cancer is one of the main causes of death worldwide, seriously threatening human health and life expectancy. We aimed to analyze the cancer incidence and mortality rates during 2016 in Zhejiang Province, Southeast China.@*METHODS@#Data were collected from 14 population-based cancer registries across Zhejiang Province of China. Cancer incidence and mortality rates stratified by sex and region were analyzed. The crude rate, age-standardized rate, age-specific and region-specific rate, and cumulative rate were calculated. The proportions of 10 common cancers in different groups and the incidence and mortality rates of the top five cancers in different age groups were also calculated. The Chinese national census of 2000 and the world Segi population was used for calculating the age-standardized incidence and mortality rates.@*RESULTS@#The 14 cancer registries covered a population of 14,250,844 individuals, accounting for 29.13% of the population of Zhejiang Province. The total reported cancer cases and deaths were 55,835 and 27,013, respectively. The proportion of morphological verification (MV%) was 78.95% of the population, and percentage of incident cases identified through death certificates only (DCO%) was 1.23% with a mortality-to-incidence ratio (M/I ratio) of 0.48. The crude incidence rate in Zhejiang cancer registration areas was 391.80/105; the age-standardized incidence rate of the Chinese standard population (ASIRC) and the age-standardized incidence rate of the world standard population (ASIRW) were 229.76/105 and 220.96/105, respectively. The incidence rate in men was higher than that in women. The incidence rate increased rapidly after 45 years of age and peaked in individuals aged 80 to 84 years. The top 10 incidence rates of cancers were lung cancer, female breast cancer, thyroid cancer, colorectal cancer, stomach cancer, liver cancer, prostate cancer, cervical cancer, esophageal cancer, and pancreatic cancer (from highest to lowest). The crude mortality rate in Zhejiang cancer registration areas was 189.55/105; the age-standardized mortality rate of the Chinese standard population (ASMRC) and the age-standardized mortality rate of the world standard population (ASMRW) were 94.46/105 and 93.42/105, respectively. The mortality rate in men was higher than that in women, and the male population in rural areas was higher than that in urban areas. The cancer mortality rate increased rapidly after 50 years of age and peaked in individuals aged 85+ years. The top 10 mortality rates of cancers were lung cancer, liver cancer, stomach cancer, colorectal cancer, pancreatic cancer, esophageal cancer, female breast cancer, prostate cancer, lymphoma, and leukemia (from highest to lowest).@*CONCLUSIONS@#Lung cancer, female breast cancer, thyroid cancer, colorectal cancer, prostate cancer, liver cancer, and stomach cancer were the most common cancers in Zhejiang Province. Effective prevention and control measures should be established after considering the different characteristics of cancers in urban and rural areas.

An analysis on health life expectancy of adult residents in Zhejiang Province / 预防医学

Objective To analyze the health life expectancy (HALE) of the residents aged 15 years and above in Zhejiang Province and to evaluate the health level among adults. Methods The study was based the mortality data collected from Zhejiang Chronic Disease Surveillance Information and Management System, and the mortality rates were from the Under-Reporting Survey and the sample data in Zhejiang from the 5th National Health Service Survey in 2013. A Sullivan' s method was used to calculate the HALE. Results The life expectancy and self-evaluated HALE were 63.62 years, 55.80 years, respectively, and the difference was 7.82 years (61.49 years VS 55.13 years in males and 66.10 years VS 56.57 years in females) . The self-evaluated HALE 55.89 years in urban and 55.54 years in rural residents aged 15 years and above. The proportion of self-evaluated HALE in the total life expectancy was 87.70%, and it decreased with age, and the proportion has dropped to 67.31% in ≥65 age group. Life expectancy without chronic morbidity was 46.68 years (46.35 years in males and 47.01 years in females; 44.03 years in urban and 47.15 years in rural areas) among residents aged 15 years and above, and the proportion of self-evaluated HALE without chronic morbidity in the total life expectancy without chronic morbidity was 73.37%. Conclusion In general the proportion of self-evaluated HALE in the total life expectancy was small , and males had a greater proportion than female, and adults in rural areas had a greater proportion than that in urban areas. We should consider NCDS management for the elderly residents and to improve the life quality among the elderly residents.

Status and home environment-related risk factors for falls among older adults living in the urban community / 预防医学

Objective To study the status and environment-related risk factors for falls among older adults in the urban community,and to provide evidences for the development of specific interventions.Methods A total of 993 older adults aged ≥60 years old from 2 communities in Cixi City were selected by stratified cluster sampling. Face-to-face interview and field investigation were carried out to collect participants' basic information,the situation and environment-related risk factors for falls occurred to them from November 2012 to October 2013.Results The overall incidence of falls was 14.90%,and it was significantly higher in wowen (17.19%) than in men(12.47%)(P<0.05). There were 109 participants reported to have fall-related injury with an incidence of 10.98%(109/993). Moreover,the incidence of fall-related injury for women(13.87%) was significantly higher than that for men(7.69%)(P<0.05). Among them, 35.14% falls occurred in home,the washroom(93.62%)and drawing room(85.02%) had higher proportion of having falling-related environmental risk factors. The multivariate logistic analysis showed that uneven carpet in aisle (OR=3. 542,95% CI:1.235-10.161)and having clutters beside the bed (OR=8.611,95% CI:2.051-36.574) were two main environmental risk factors for elder falls in home.Conclusion The incidence of falls of older adult in Cixi was 14.90%. Uneven carpet in aisle and having clutters beside the bed were two main environmental risk factors for falls among the elderly at home.

An analysis on factors influencing salt - restriction behavior of hypertension in rural communities / 预防医学

Objective To learn the salt intake level of residents with hypertension in rural community and the influencing factors of salt restriction behavior. Methods We used random cluster sampling method to extract two rural communities. A total of 200 residents with hypertension or high - risk of hypertension were selected as the subjects. We conducted general information questionnaire,hypertension knowledge,attitudes and behavior questionnaire,3 - day salt intake survey and urine sodium detection to evaluate the level of sodium intake. We used multivariate logistic regression equation modeling to predict influencing factors of salt restriction behavior. Results After the completion of the investigation,M (QR )for daily sodium intake of 173 cases in the intervention group was 6. 72(5. 18)g,and the main route were through the salt,monosodium glutamate ,soy sauce,pickles. Daily 24 hours urinary sodium excretion amount was 90. 10(62. 28) mmol / 24 h and 152 cases(87. 86% )of respondents had salt - restriction - spoon,and 108 cases(71. 05% )use the salt- restriction - spoon,but only 53 cases(49. 07% )used the spoon correctly. The frequency of spoon for salt restriction and sodium intake was negatively correlated(P ﹤ 0. 05),whether spoon for salt restriction was used correctly and 24 - hour urinary sodium excretion was negatively correlated( P ﹤ 0 . 0 5 ). By multivariate logistic regression analysis ,those people who had high level of the average annual household income(OR = 2. 75,95% CI:1. 16 - 6. 53),identified 6 g of salt a day(OR = 5. 43,95% CI:1. 22 - 24. 07),regular consumption of vegetables(OR = 9. 35,95% CI:1. 16 - 75. 01) and initiative to take measures to control salt( OR = 5. 05,95% CI:1. 19 - 21. 45)were more likely to use salt -restricted spoons. Residents of drinking(OR = 0. 13,95% CI:0. 02 - 0. 84)did not tend to use salt - restricted spoons. Conclusion For people with high NaCl intake and no restriction behavior,the level of health knowledge,especially the knowledge of sodium salt,should be improved and the good dietary habits including salt - limited support tools and correct methods should be promoted .

An investigation on the awareness of osteoporosis among community doctors / 预防医学

Objective To analysis the awareness of community doctors on the knowledge of osteoporosis and to provide suggestions for conducting pertinent training for community doctors.Methods The design of questionnaire was based on the Osteoporosis Knowledge Questionnaire (OKT)and the Guideline of Diagnosis and Treatment of Osteoporosis in 2011.A total of 170 community doctors were investigated.Results The score of community doctors about osteoporosis was 29. There was 83.80% of community doctors who knew osteoporosis related knowledge well.However,there was 15.49% of community doctors'knowledge about osteoporosis that was not good enough.The most of community doctors got full score in the part of prevention knowledge with 52.82%.The most of community doctors failed in the part of treatment knowledge with 12.68%.The score of osteoporosis knowledge in different gender and title had no statistical significance (P >0.05). Conclusion It is necessary to strengthen community doctors's awareness about osteoporosis.

Circulating MicroRNA-21 is Downregulated in Patients with Metabolic Syndrome / 生物医学与环境科学（英文）

The microRNA-21 (miR-21) is known to play a major role in cancer progression; however, its function in the cardiovascular system appears to be even more complex and conflicting. To characterize miR-21 expression in the plasma of individuals with or without metabolic syndrome (MetS), 58 MetS cases and 96 non-MetS controls were investigated. Expression levels of miR-21 were significantly decreased in the circulation of MetS subjects (OR=0.52, 95% CI: 0.29-0.92) compared with that of non-MetS subjects. Body mass index (BMI) and the number of MetS components had a negative correlation with the level of miR-21, whereas age was inversely related to the level of miR-21. No significant difference was detected in miR-21 levels between the sexes (P=0.056). MiR-21 might be a negative regulating factor in MetS.

A case -case control study on risk factors of the re -treatment multidrug resistant pulmonary tuberculosis / 预防医学

Objective To explore the risk factors of patients with re -treatment multidrug resistant pulmonary tuberculosis (MDR -TB)and to provide suggestions for intervention.Methods A case -case control study was carried out between patients with or without re -treatment MDR -TB,with a questionnaire interview and multivariate logistic regression analysis to explore the risk factors of re -treatment MDR -TB.Results A total of 172 patients were enrolled in this study including 99 re -treatment MDR -TB patients and 73 re -treatment non -MDR -TB patients(P >0.05).There was no significant difference between case group and control group in gender,age,residence and marital status.The sick time,the anti -tuberculosis treatment time,the number of anti -tuberculosis treatments,the rate of adverse reactions,history of taking isoniazid or rifampicin and the number of treatment interruption were higher in cases than those in control group(P <0.05),while the months of first -treatment were lower than those in control group(P <0.05).The number of anti -tuberculosis treatments(≥3),adverse reactions during treatment,the months of first -treatment were significant risk factors by the multivariable regression model,with the adjusted ORs and 95%CIs of 5.07 (1.89,13.64),4.27 (2.04, 8.94)and 2.35(1.06,5.22),respectively.Conclusion The number of anti -tuberculosis treatments,adverse reactions during treatment,the months of first -treatment were risk factors of patients with re -treatment MDR -TB.

A study on patients’negative emotional reactions and its influencing factors at the diagnosis of pulmonary tuberculosis / 预防医学

Objective To investigate patients’negative emotional reactions and its influencing factors when pulmonary tuberculosis (PTB ) was diagnosed, and to provide evidence for health education and intervention. Methods A questionnaire survey was conducted among 440 PTB patients who were treated at the designated clinics of two counties in Zhejiang Province.Twenty patients at one clinic were randomly selected for a semi-structured interview.Results A total of 437 qualified questionnaires were collected and 19 patients were successfully interviewed.When they were told the result of diagnosis,58.58% patients felt worried,29.75% were shocked,20.37% tended to blame themselves,10.98% felt helpless and 35.70%had a sense of shame.In the semi-structured interview,the main reasons for negative emotions told by the patients were disbelieving the fact of getting the disease and misunderstanding TB was incurable.Old people felt more shocked (40.26%),worried (58.44%)and self-blaming (38.96%)about the diagnosis of TB.The divorced and widowed expressed more reactions of worry (95.24%), shock (6 1.09%), self -blame (6 1.09%), helpless (42.86%).Farmers had higher rate of shock (48.89%),worry (70.37%),and self-blame (43.70%).Conclusion Negative emotions or feelings were popular among TB patients when the disease was diagnosed.The elders,divorced or widowed people and farmers need to be attached more importance during the process of health education or intervention.

Medical cost analysis of initially-treated patients with tuberculosis under designated hospital mode / 预防医学

Objective To explore the direct medical cost of tuberculosis patients and its components under designated hospital mode,and to provide evidence for configuration optimization of tuberculosis prevention and control funds in Zhejiang Province.Methods A total of 7 counties including Cixi,were selected as study spots,and 50 initially-treated tuberculosis patients who completed treatment from each county were continually enrolled as study objects.Questionnaire survey and outpatient and inpatient medical records survey were carried out for each object.Results Average medical cost of initially-treated tuberculosis patients was 4 086 Yuan (RMB)which was 12.69% of their total yearly family income and 20.17% of patients occurred in debt.Average medical cost in designated hospital was 3 020 Yuan (RMB),of which 78.31% (2 365 Yuan)was used for DOT treatment in outpatient clinic.Examination cost of the outpatient constituted 25.24% (CT cost constituted 8.57%),and non -free medicine constituted 74.76% (hepatic protector medicine cost constituted 41.94%).Conclusion Tuberculosis patients suffered heavy economic burden because of self -paying auxiliary examination and drugs.To adjust existing funds usage of tuberculosis prevention and resource configuration is needed.

Investigation analysis on public awareness of tuberculosis knowledge in Zhejiang province, 2010 / 中华预防医学杂志

<p><b>OBJECTIVE</b>To investigate the status of awareness on tuberculosis (TB) in the public and its impact factors in Zhejiang province.</p><p><b>METHODS</b>A multi-stage sampling was applied. Around 6600 subjects were enrolled for questionnaire survey from December 2010 to January 2011 in Zhejiang province. Survey data were input by EpiData 3.0 software, and the the status of awareness on tuberculosis (TB) in the public and impact factors were analyzed by SPSS 13.0 software package.</p><p><b>RESULTS</b>A total of 6546 subjects were investigated, the response rate was 99.18% (6546/6600), 3306 were male and 3240 were female, the age of subjects was (44.90 ± 12.40) year-old. The total key information awareness rate of TB was 45.66% (14 944/32 730). 65.70% (4301/6546) knowing the transmission route, 33.30% (2180/6546) knowing the symptom of TB, 39.21% (2567/6546) knowing where to go when suspected suffering TB, 38.28% (2506, 6546) knowing national free anti-TB drug supply and examination of infectious TB patients, 51.79% (3390/6546) knowing TB is curable in most case. As for the the key information awareness rate, among senior high school or above, primary high school, primary school or below were 57.19% (3257/5695), 52.07% (6 066/11 650), 36.54% (5 621/15 385), respectively; among birthplace in city, rural areas were 54.70 (1745/3190), 44.68% (13 199/29 540), respectively; Amone male, female were 47.11% (7 788/16 530), 44.17% (7 156/16 200); among different occupations, cadre or staff was highest (59.43%, 1 563/2 630), whereas students was lowest (40.33%, 492/1220); among different age groups, subjects aged beyond 50 years was lowest (39.75%, 5 189/13 055). The total key information awareness rate among above different population groups showed statistically difference (all P values < 0.01).</p><p><b>CONCLUSION</b>Awareness of knowledge for prevention and therapy of tuberculosis in Zhejiang public was insufficient and imbalanced among subjects with different social demographic characteristics.</p>

Cross-sectional study on falls in residents of four communities in Zhejiang Province, China / 中华预防医学杂志

<p><b>OBJECTIVE</b>To understand the incidence of falls in different residents of four communities in Zhejiang Province to provide a basis for their prevention and control.</p><p><b>METHODS</b>A household questionnaire survey on falls was conducted in 16 899 residents of two urban and two rural communities during November 2000 to October 2001.</p><p><b>RESULTS</b>Standardized incidence rate of falls was 5.07%, higher in rural areas (5.23%) than that in urban areas (4.95%) and showing no significant differences by gender. Falls occurred in September and October accounted for 11.68% and 19.22% and those occurred in pre-school children and the elderly accounted for 22.94% and 19.46% of the total episodes, respectively. Leading causes of falls varied in different population, from falls during their play (7.65%) and sports (4.06%) in young people and pre-school children (19.12%), slipping down when walking in adult (1.21%) and elderly (4.28%) men, and slipping down when up and down stairs in adult and elderly women. Burden and severity of injury caused by falls were increased with age.</p><p><b>CONCLUSIONS</b>Incidence of falls in pre-school children and the elderly was higher in local residents of communities in Zhejiang Province, causing heavy burden to the society and their families. Varied relevant measures should be taken to prevent and control for falls in different subgroups of population.</p>

A cross-sectional study on injuries in residents at the community level of Zhejiang / 中华流行病学杂志

<p><b>OBJECTIVE</b>To study the incidence of injuries among residents living in the communities in Zhejiang.</p><p><b>METHODS</b>A household questionnaire survey was conducted to 16 899 residents in four communities.</p><p><b>RESULTS</b>The incidence of injuries was 16.11% in total, higher in urban area than in rural area and higher in men than in women. The leading causes of injuries were falls (4.80%), knife-cutting or by sharp articles (3.86%), traffic accident (2.07%), collision (1.99%), scalds (1.13%) and animal bites (1.06%). Peak incidence of age group was different in different injuries, such as traffic accident was high in 45 - 60 age group and falls was high in 5 and 60 age group. Direct economic loss for each case with injury would cost 324.21 RMB yuan.</p><p><b>CONCLUSION</b>Injury was common and frequently occurred among residents at the community level which seriously on danger their health and families.</p>