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Growing evidences showed that heavy metals exposure may be associated with metabolic diseases. Nevertheless, the mechanism underlying arsenic (As) exposure and metabolic syndrome (MetS) risk has not been fully elucidated. So we aimed to prospectively investigate the role of serum uric acid (SUA) on the association between blood As exposure and incident MetS. A sample of 1045 older participants in a community in China was analyzed. We determined As at baseline and SUA concentration at follow-up in the Yiwu Elderly Cohort. MetS events were defined according to the criteria of the International Diabetes Federation (IDF). Generalized linear model with log-binominal regression model was applied to estimate the association of As with incident MetS. To investigate the role of SUA in the association between As and MetS, a mediation analysis was conducted. In the fully adjusted log-binominal model, per interquartile range increment of As, the risk of MetS increased 1.25-fold. Compared with the lowest quartile of As, the adjusted relative risk (RR) of MetS in the highest quartile was 1.42 (95% confidence interval, CI: 1.03, 2.00). Additionally, blood As was positively associated with SUA, while SUA had significant association with MetS risk. Further mediation analysis demonstrated that the association of As and MetS risk was mediated by SUA, with the proportion of 15.7%. Our study found higher As was remarkably associated with the elevated risk of MetS in the Chinese older adults population. Mediation analysis indicated that SUA might be a mediator in the association between As exposure and MetS.
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Arsênio , Exposição Ambiental , Síndrome Metabólica , Ácido Úrico , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Arsênio/sangue , Arsênio/toxicidade , China/epidemiologia , População do Leste Asiático , Exposição Ambiental/efeitos adversos , Síndrome Metabólica/epidemiologia , Síndrome Metabólica/induzido quimicamente , Síndrome Metabólica/sangue , Ácido Úrico/sangueRESUMO
Previous studies on temperature and infectious diseases primarily focused on individual disease types, yielding inconsistent conclusions. This study collected monthly data on notifiable infectious disease cases and meteorological variables across 7 provinces in China from 2011 to 2019. A distributed lag nonlinear model was used to evaluate the association between ambient temperature and infectious diseases within each province, and random meta-analysis was applied to evaluate the pooled effect. Extreme hot temperature (the 97.5th percentile) was positively associated with the risk of respiratory infectious diseases with the relative risk (RR) of 1.45 (95%CI: 1.01-2.08). Conversely, extreme cold temperature (the 2.5th percentile) was negatively associated with intestinal infectious diseases and zoonotic diseases and vector-borne diseases, reporting RRs of 0.43 (95%CI: 0.30-0.60) and 0.46 (95%CI: 0.38-0.57), respectively. This study described the nonlinear association between ambient temperature and infectious diseases with different transmission routes, informing comprehensive prevention and control strategies for temperature-related infectious diseases.
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Lead poisoning is globally concerning, yet limited testing hinders effective interventions in most countries. We aimed to create annual maps of county-specific blood lead levels in China from 1980 to 2040 using a machine learning model. Blood lead data from China were sourced from 1180 surveys published between 1980 and 2022. Additionally, regional statistical figures for 15 natural and socioeconomic variables were obtained or estimated as predictors. A machine learning model, using the random forest algorithm and 2973 generated samples, was created to predict county-specific blood lead levels in China from 1980 to 2040. Geometric mean blood lead levels in children (i.e., age 14 and under) decreased significantly from 104.4 µg/L in 1993 to an anticipated 40.3 µg/L by 2040. The number exceeding 100 µg/L declined dramatically, yet South Central China remains a hotspot. Lead exposure is similar among different groups, but overall adults and adolescents (i.e., age over 14), females, and rural residents exhibit slightly lower exposure compared to that of children, males, and urban residents, respectively. Our predictions indicated that despite the general reduction, one-fourth of Chinese counties rebounded during 2015-2020. This slower decline might be due to emerging lead sources like smelting and coal combustion; however, the primary factor driving the decline should be the reduction of a persistent source, legacy gasoline-derived lead. Our approach innovatively maps lead exposure without comprehensive surveys.
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Chumbo , Aprendizado de Máquina , Chumbo/sangue , China , Humanos , Feminino , Masculino , Criança , Adolescente , Exposição Ambiental , Intoxicação por Chumbo/epidemiologia , Intoxicação por Chumbo/sangueRESUMO
BACKGROUND: We sought to explore the associations of outdoor light at night (LAN) and air pollution with the risk of cerebrovascular disease (CeVD). METHODS: We included a total of 28â 302 participants enrolled in Ningbo, China from 2015 to 2018. Outdoor LAN and air pollution were assessed by Satellite-derived images and land-use regression models. CeVD cases were confirmed by medical records and death certificates and further subdivided into ischemic and hemorrhagic stroke. Cox proportional hazard models were used to estimate hazard ratios and 95% CIs. RESULTS: A total of 1278 CeVD cases (including 777 ischemic and 133 hemorrhagic stroke cases) were identified during 127â 877 person-years of follow-up. In the single-exposure models, the hazard ratios for CeVD were 1.17 (95% CI, 1.06-1.29) for outdoor LAN, 1.25 (1.12-1.39) for particulate matter with an aerodynamic diameter ≤2.5 µm, 1.14 (1.06-1.22) for particulate matter with aerodynamic diameter ≤10 µm, and 1.21 (1.06-1.38) for NO2 in every interquartile range increase. The results were similar for ischemic stroke, whereas no association was observed for hemorrhagic stroke. In the multiple-exposure models, the associations of outdoor LAN and PM with CeVD persisted but not for ischemic stroke. Furthermore, no interaction was observed between outdoor LAN and air pollution. CONCLUSIONS: Levels of exposure to outdoor LAN and air pollution were positively associated with the risk of CeVD. Furthermore, the detrimental effects of outdoor LAN and air pollution might be mutually independent.
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Poluentes Atmosféricos , Poluição do Ar , Transtornos Cerebrovasculares , Acidente Vascular Cerebral Hemorrágico , AVC Isquêmico , Humanos , Estudos de Coortes , Poluentes Atmosféricos/efeitos adversos , Poluentes Atmosféricos/análise , Exposição Ambiental/efeitos adversos , Poluição do Ar/efeitos adversos , Poluição do Ar/análise , Material Particulado/efeitos adversos , Material Particulado/análise , Transtornos Cerebrovasculares/epidemiologia , Transtornos Cerebrovasculares/etiologia , China/epidemiologiaRESUMO
AIMS: To explore the associations between visit-to-visit lipid variability and risk of ischemic heart disease (IHD) in a population-based cohort in China. METHODS: We evaluated lipid variability in 30,217 individuals from the Yinzhou Health Information System who had ≥3 recorded lipid measurements during 2010-2014. We used various indicators including standard deviation (SD), coefficient of variation (CV), variability independent of the mean (VIM), and average real variability (ARV) to quantify the variability in triglycerides, total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C). We used Cox proportional hazards models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). RESULTS: Overall, a total of 1305 participants with IHD were identified during the follow-up of 194,421 person-years. Subjects in Q4 had a 21% elevated risk of IHD (HR = 1.21, 95% CI: 1.03-1.41) for LDL-C variability (CV) compared with the reference (Q1). The HRs for Q4 vs Q1 were 1.21 (95% CI: 1.04-1.42) for HDL-C variability, and 1.28 (95% CI: 1.10-1.50) for TC variability. However, no association was observed between triglycerides variability and risk of IHD. CONCLUSIONS: Higher variability in LDL-C, HDL-C, and TC levels was associated with an elevated risk of IHD, suggesting that lipid variability could be considered as an independent risk factor of IHD.
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Isquemia Miocárdica , Triglicerídeos , Humanos , Isquemia Miocárdica/sangue , Isquemia Miocárdica/epidemiologia , Masculino , Feminino , Pessoa de Meia-Idade , China/epidemiologia , Estudos de Coortes , Idoso , Adulto , Triglicerídeos/sangue , Fatores de Risco , Lipídeos/sangue , LDL-Colesterol/sangue , HDL-Colesterol/sangueRESUMO
BACKGROUND: Dysphagia is a health concern that causes severe complications and affects the life quality of the older population. This study aimed to determine the diagnostic performance of the Eating Assessment Tool (EAT)-2 compared with the EAT-10 and the Water Swallow Test (WST) in screening for dysphagia. METHODS: A cross-sectional study was conducted among 5,090 community-dwelling older adults. Dysphagia was evaluated using both a subjective measure, the 10-item EAT (EAT-10) and an objective measure, the WST. The kappa index in pairs were analyzed. The validity and reliability of EAT-2 were also assessed. RESULTS: The sensitivity and specificity of the EAT-2 were 96.3 % and 94.8 %, respectively. The kappa index between the EAT-2 and EAT-10 was 0.64, whereas it was 0.11 between the EAT-10 and WST. CONCLUSIONS: The EAT-2 was a simpler screening tool for dysphagia. Combining the subjective questionnaire (EAT-10 or EAT-2) and the objective test (WST) is recommended.
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Transtornos de Deglutição , Humanos , Idoso , Transtornos de Deglutição/diagnóstico , Vida Independente , Estudos Transversais , Reprodutibilidade dos Testes , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Epidemiology is considered to be the fundamental science of public health and plays an important role in clinical competence and professional development. The objective of this study is to evaluate the effectiveness of a short-term course for the teaching of epidemiology, which was designed as a community-based class for medical students. METHOD: This course was designed according to Kern's six-step approach to curriculum development. A total of 75 undergraduates were recruited. Forty-one students were assigned to an experimental group engaged in theoretical teaching and practical courses, while 34 students were assigned to the control group only taking theoretical courses. All participants were asked to complete a pre- and post-course survey and to take a test after completing the course. The scores between the experimental and control groups were compared using the Wilcoxon test. RESULT: The experimental group showed significantly higher self-assessment scores in course understanding (p = 0.0126) and clinical practice skills (p = 0.0005) after completing the course, while no significant difference was observed in the control group. In addition, students in the experimental group reported significantly higher interest (p = 0.0015), stronger learning motivation (p = 0.0113) and a better mastery of epidemiology (p = 0.0167) after completing the course than those in the control group. However, test scores (p = 0.0859) and pass rates (p = 0.1755) demonstrated no statistical significance between the two groups. CONCLUSION: The short-term practical course in epidemiology exerted significantly positive effects on the improvement of student learning enthusiasm, course understanding and clinical practice skills. These findings provide new ideas and statistical evidence for the development of epidemiological instruction. Future studies should explore how to more widely and optimally apply community-based courses to the teaching of epidemiology.
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Estudantes de Medicina , Humanos , Currículo , Aprendizagem , Motivação , EnsinoRESUMO
We investigated the association of long-term exposure to atmospheric PM2.5 with non-accidental and cause-specific mortality in Yinzhou, China. From July 2015 to January 2018, a total of 29,564 individuals aged ≥ 40 years in Yinzhou were recruited for a prospective cohort study. We used the Cox proportional-hazards model to analyze the relationship of the 2-year average concentration of PM2.5 prior to the baseline with non-accidental and cause-specific mortality. The median PM2.5 concentration was 36.51 µg/m3 (range: 25.57-45.40 µg/m3). In model 4, the hazard ratios per 10 µg/m3 increment in PM2.5 were 1.25 (95%CI: 1.04-1.50) for non-accidental mortality and 1.38 (95%CI:1.02-1.86) for cardiovascular disease mortality. We observed no associations between PM2.5 and deaths from respiratory disease or cancer. In the subgroup analysis, interactions were observed between PM2.5 and age, as well as preventive measures on hazy days. The observed association between long-term exposure to atmospheric PM2.5 at a relatively moderate concentration and the risk of non-accidental and cardiovascular disease mortality among middle-aged and elderly Chinese adults could provide evidence for government decision-makers to revise environmental policies towards a more stringent standard.
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Importance: Emerging studies have suggested that environmental factors are associated with fracture. However, little is known about the association of neighborhood walkability and residential greenness with fracture. Objective: To investigate the association of long-term exposure to walkability and greenness with incident fracture and explore the potential interaction effect. Design, Setting, and Participants: This cohort study recruited participants aged 40 years or older in Ningbo, China from June 2015 to January 2018. Participants were observed for outcomes through February 2023, with data analysis conducted in March 2023. Exposures: Neighborhood walkability was measured by a modified walkability calculation method according to a walk score tool. Residential greenness was assessed by satellite-derived normalized difference vegetation index (NDVI) within a 1000-m buffer. Main Outcomes and Measures: Incident fracture was ascertained according to International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes via the Yinzhou Health Information System. Cox proportional hazards models were fit, with age as time scale to estimate the associations of walkability and greenness with fracture. Potential effect modification was explored by covariates, as well as the interactive effect of walkability and greenness. Results: A total of 23â¯940 participants were included in this study with 13â¯735 being female (57.4%). The mean (SD) age at baseline was 63.4 (9.4) years. During a follow-up period of 134â¯638 person-years, 3322 incident fractures were documented. In the full adjusted model, every IQR increment in neighborhood walkability and residential greenness was associated with a hazard ratio (HR) of 0.88 (95% CI, 0.83-0.92) and 0.84 (95% CI, 0.80-0.89), respectively, for fracture. Furthermore, the association of greenness and fracture was greater with an increase in walkability. The HR (Q4 vs Q1) for greenness was 0.62 (95% CI, 0.46-0.82) in neighborhoods with the highest quartile of walkability. Conclusions and Relevance: This population cohort study suggested that long-term exposure to neighborhood walkability and residential greenness were both associated with lower risk of incident fracture. The benefits of greenness increased in more walkable areas.
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Fraturas Ósseas , Sistemas de Informação em Saúde , Humanos , Feminino , Masculino , Estudos de Coortes , China , Análise de DadosRESUMO
BACKGROUND: Dysphagia, or swallowing disorders, has become a growing concern due to the aging population, and health literacy plays a crucial role in active aging. However, the relationship between them remains unclear. AIMS: To investigate the association between health literacy and dysphagia among community-dwelling older adults in China. METHODS: A survey was conducted on 4462 older adults aged 65 and above in a community in Yiwu City, China, from May 2021 to January 2022. Swallowing problems were assessed using a 30 ml water swallowing test (WST) and the Eating Assessment Tool-10 questionnaire (EAT-10). The participants' health literacy was evaluated using the Chinese Health Literacy Scale (CHLS). Logistic regression and t tests were employed to measure the association between them. RESULTS: The prevalence of dysphagia was 5.70% and 7.85% as determined by EAT-10 and 30 ml-WST, respectively. The health literacy level of community-dwelling older adults was 24.4 ± 4.93 (9-45). Participants with dysphagia exhibited lower levels of health literacy (p < 0.05). The logistic regression model demonstrated an inverse association between health literacy and dysphagia (OR = 0.94, 95%CI = 0.91-0.96 for EAT-10, and OR = 0.93, 95%CI = 0.92-0.95 for WST). Moreover, this association remained significant even after adjusting for covariates. DISCUSSION: Older adults with dysphagia have lower levels of health literacy, particularly in terms of their ability to seek medical advice, acquire and evaluate medical information, and access social support resources. CONCLUSIONS: Health literacy is associated with dysphagia among community-dwelling older adults. Effective interventions should be implemented to provide support in terms of both medical services and social support for this population.
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Transtornos de Deglutição , Letramento em Saúde , Humanos , Idoso , Transtornos de Deglutição/epidemiologia , Vida Independente , Estudos Transversais , EnvelhecimentoRESUMO
BACKGROUND: Sleep disorders are a common syndrome and could affect the life quality of the older adults. AIMS: This study aimed to investigate the association between nutritional status and sleep quality in the Chinese community-dwelling older adults. METHODS: A total of 2,878 participants ≥ 65 years old from the Yiwu Elderly Cohort were included in the study. Nutritional status was assessed using the Mini Nutritional Assessment Short Form (MNA-SF). Participants were categorized as subjects with malnutrition, at risk of malnutrition or well-nourished based on their MNA-SF score. Pittsburgh Sleep Quality Index (PSQI) was used to identify sleep disorders. PSQI score ≥ 6 was categorized as poor sleep quality. RESULTS: Among the 2,878 participants (mean age 72.71 ± 5.79 years, 50.3% men), 31.5% (n = 906) were classified as having sleep disorders, and 25.5% were identified as malnutrition or at risk of malnutrition. We found a significantly relationship between nutritional status and sleep quality in older adults, and the results showed well-nourished decreased the risk of sleep disorders (OR = 0.32, 95% CI = 0.13, 0.75). And well-nourished status was significantly associated with less daytime dysfunction, adequate sleep duration, and good subjective sleep quality (all P < 0.05). CONCLUSION: There was a close association of nutritional status and sleep quality in older adults. We should pay more attention to the nutritional status of older people with sleep problems, as well as the sleep quality of older adults with malnutrition.
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Desnutrição , Estado Nutricional , Masculino , Idoso , Humanos , Feminino , Vida Independente , População do Leste Asiático , Qualidade do Sono , Avaliação Geriátrica/métodos , Desnutrição/epidemiologia , Avaliação NutricionalRESUMO
BACKGROUND: Essential trace elements (ETEs) are essential nutrients for keeping the nervous system functioning. Associations between ETEs and cognitive function are still inconclusive and limited. OBJECTIVES: We aimed to investigate the individual and joint associations between ETEs and cognitive function among older adults. METHODS: A population (N = 2181) at an average age≥ 65 from Yiwu cohort in China was available for this study. Whole blood chromium (Cr), selenium (Se), manganese (Mn), and copper (Cu) concentrations were measured by inductively coupled plasma mass spectrometry (ICP-MS). Cognitive function was assessed using the Mini-Mental State Examination (MMSE), consisting of five specific cognitive domains: orientation, registry, attention and calculation, recall, and language and praxis. Linear regression, restricted cubic spline (RCS) analysis, and Bayesian kernel machine regression (BKMR) were used to analyze the individual and joint associations between ETEs and cognitive function. RESULTS: The association between Cr and MMSE score presented an inverted-U shape (Q3 versus Q1: ß = 0.774, 95 % CI: 0.297, 1.250; Q4 versus Q1: ß = 0.481, 95 % CI: 0.006, 0.956); and Cr was especially associated with the registry, recall, and language and praxis. Per IQR (36.32 µg/L) increase of Se was positively associated with the MMSE score (ß = 0.497, 95 % CI: 0.277, 0.717) and all five cognitive domains. The BKMR showed that the dose-response association between Se and cognitive function increased initially and then decreased with increasing Se concentration when fixed the other ETEs in median. ETEs mixture was positively associated with cognitive function, and Se (posterior inclusion probabilities, PIPs = 0.915) was the most important contributor within the ETEs mixture. CONCLUSIONS: The nonlinear association between Cr and cognitive function suggested further exploration of an appropriate concentration range for ETEs. A positive association between mixed ETEs and cognitive function is a reminder that their joint association should be considered. Further prospective studies or intervention studies are warranted to validate our findings in the future.
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Selênio , Oligoelementos , Humanos , Idoso , Estudos Prospectivos , Teorema de Bayes , Cromo , CogniçãoRESUMO
AIMS/HYPOTHESIS: The age-specific associations between type 2 diabetes and cancer risk are not fully understood. The aim of this study was to assess how age at diagnosis modifies the associations between type 2 diabetes and cancer risk. METHODS: We used data from the Yinzhou Health Information System, and included 42,279 individuals who were newly diagnosed with type 2 diabetes between 2010 and 2014, as well as 166,010 age- and sex-matched control individuals without diabetes who were selected randomly from the electronic health records of the entire population. Patients were divided into four age groups according to age at diagnosis: <50, 50-59, 60-69 and ≥70 years. Stratified Cox proportional hazards regression models, with age as the time scale, were used to estimate the HRs and 95% CIs for the associations of type 2 diabetes with the risks of overall and site-specific cancers. Population-attributable fractions were also calculated for outcomes associated with type 2 diabetes. RESULTS: During median follow-up periods of 9.20 and 9.32 years, we identified 15,729 incident cancer cases and 5383 cancer deaths, respectively. Patients diagnosed with type 2 diabetes before 50 years of age had the highest relative risks of cancer incidence and mortality, with HRs (95% CI) of 1.35 (1.20, 1.52) for overall cancer incidence, 1.39 (1.11, 1.73) for gastrointestinal cancer incidence, 2.02 (1.50, 2.71) for overall cancer mortality, and 2.82 (1.91, 4.18) for gastrointestinal cancer mortality. Risk estimates decreased gradually with each decade increase in diagnostic age. The population-attributable fractions for overall cancer and gastrointestinal cancer mortality also decreased with increasing age. CONCLUSIONS/INTERPRETATION: The associations of type 2 diabetes with cancer incidence and mortality varied by age at diagnosis, with a higher relative risk among patients who were diagnosed at a younger age.
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Diabetes Mellitus Tipo 2 , Neoplasias , Humanos , Idoso , Estudos de Coortes , Estudos Retrospectivos , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/epidemiologia , Incidência , Neoplasias/epidemiologia , Neoplasias/etiologia , Fatores de RiscoRESUMO
BACKGROUND: Neurodegenerative disease has a great adverse impact on population's death and disability worldwide. However, the association of air pollution and residential greenness with neurodegenerative disease and their potential mechanisms still remain uncertain. METHODS: We used data from a population-based prospective cohort in Ningbo, China. Exposure to PM2.5, PM10 and NO2 were assessed by land-use regression (LUR) models and residential greenness was estimated by Normalized Difference Vegetation Index (NDVI). Our primary outcomes were all neurodegenerative diseases, Parkinson's disease (PD) and Alzheimer's disease (AD). Cox proportional hazards regression models were used to examine the association of air pollution and residential greenness with risk of incident neurodegenerative disease. Furthermore, we also explored the potential mediation relationship and effect modification between greenness and air pollutants. RESULTS: During the follow-up period, we identified a total of 617 incident neurodegenerative diseases, 301 PD and 182 AD. In single-exposure models, PM2.5 was positively associated with all outcomes (e.g. AD hazard ratio (HR): 1.41, 95 % confidence interval (CI): 1.09-1.84, per interquartile range (IQR) increment), whereas residential greenness showed protective effects (e.g. neurodegenerative disease, HR: 0.82, 95%CI: 0.75-0.90, per IQR increment for NDVI in 1000 m buffer). NO2 was positively associated with risk of neurodegenerative disease and PM10 was associated with neurodegenerative disease and AD. In two-exposure models, after adjustment for PM2.5, the association for greenness generally attenuated towards null. Moreover, we identified the significant modification effect of greenness on PM2.5 on additive and multiplicative scales. CONCLUSION: In this prospective study, we found that exposure to higher residential greenness and lower concentrations of particulate matter were associated with lower risk of neurodegenerative disease, PD and AD. Residential greenness could modify the association of PM2.5 with neurodegenerative disease.
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Poluentes Atmosféricos , Poluição do Ar , Doenças Neurodegenerativas , Humanos , Estudos de Coortes , Estudos Prospectivos , Doenças Neurodegenerativas/epidemiologia , Doenças Neurodegenerativas/induzido quimicamente , Dióxido de Nitrogênio/análise , Poluição do Ar/análise , Poluentes Atmosféricos/análise , Material Particulado/análise , China/epidemiologia , Exposição Ambiental/análiseRESUMO
BACKGROUND: Cancer is one of the most common causes of death. Excess body weight (EBW), a risk factor for cancer, is highly prevalent in China. We aimed to estimate the number and proportion of cancer deaths attributed to EBW and their changes during 2006-2015 in China. METHODS: Population attributable fractions in 2006, 2010, and 2015 were calculated with 1) prevalence of overweight/obesity, exacted from the China Health and Nutrition Survey conducted in 8-9 provinces of China in 1997, 2000, and 2004; 2) relative risks for EBW and site-specific cancers, obtained from previous studies; 3) data on cancer deaths in 2006, 2010, and 2015, originated from the Chinese Cancer Registry Annual Report. RESULTS: In 2015, EBW contributed to 45,918 (3.1% of all) cancer deaths in China, with 24,978 (2.6%) in men and 20,940 (3.8%) in women. By region, the fraction of cancer deaths attributable to EBW ranged from 1.6% (West) to 4.1% (Northeast). Cancers of liver, stomach, and colorectum were the main EBW-attributable cancers. The fractions of cancer deaths attributable to EBW were 2.4% (95%CI: 0.8-4.2%) in 2006, 2.9% (95%CI: 1.0-5.2%) in 2010, and 3.1% (95%CI: 1.0-5.4%) in 2015, respectively, and increased for all gender, region, and cancer site during 2006-2015. CONCLUSIONS: The proportion of cancer deaths attributed to EBW was higher in women and Northeastern China, with an upward trend in the recent decade. A combination of comprehensive and individualized measures is necessary to reduce the prevalence of EBW and related cancer burden in China.
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Neoplasias , Obesidade , Masculino , Humanos , Feminino , Obesidade/epidemiologia , Obesidade/complicações , Aumento de Peso , Fatores de Risco , Sobrepeso/epidemiologia , Sobrepeso/complicações , China/epidemiologiaRESUMO
Evidence regarding associations of general and abdominal obesity with the risk of conventional adenomas (ADs) and serrated polyps (SPs) from Asian population is scarce. Our study aimed to investigate the independent and joint associations of general obesity assessed by body mass index (BMI) and abdominal obesity assessed by waist circumference (WC) or waist-to-hip ratio (WHR) with the risk of ADs and SPs among 25 222 participants recruited by a population-based screening program. Compared to participants with normal BMI, those with a BMI ≥28 kg/m2 had increased risk of ADs (odds ratio [OR] 1.52, 95% confidence interval [CI]: 1.36-1.70) and SPs (OR 1.69, 95% CI: 1.38-2.07). For participants with a WC ≥102 cm (≥88 cm for females), the risk of ADs (OR 1.37, 95% CI: 1.25-1.51) and SPs (OR 1.81, 95% CI: 1.52-2.16) was higher than that of the reference group. For participants with a WHR ≥0.95 (≥0.90 for females), the risk of ADs (OR 1.26, 95% CI: 1.16-1.36) and SPs (OR 1.46, 95% CI: 1.26-1.69) was higher than that of the reference group. Moreover, participants with both BMI ≥28 kg/m2 and WC ≥102 cm (≥88 cm for females) had 61% and 119% higher risk of ADs (OR 1.61, 95% CI: 1.39-1.85) and SPs (OR 2.19, 95% CI: 1.70-2.82) compared to those with both normal BMI and WC. These findings indicate that both general and abdominal obesity are associated with SPs and ADs, presenting stronger association with SPs than ADs. Moreover, the association is more evident when both obesities exist.
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Adenoma , Obesidade Abdominal , Feminino , Humanos , Obesidade Abdominal/complicações , Obesidade Abdominal/epidemiologia , Obesidade/complicações , Obesidade/epidemiologia , Relação Cintura-Quadril , Circunferência da Cintura , Índice de Massa Corporal , Ásia Oriental , Adenoma/epidemiologia , Adenoma/etiologia , Fatores de RiscoRESUMO
BACKGROUND: Physical function (PF), such as muscle strength, performing daily activities, has gradually declined with the increase of age, causing the occurrence of disability and diseases burden. Air pollution exposure and physical activity (PA) were both linked to PF. We aimed to explore the individual and joint effects of particulate matter <2.5 µm (PM2.5) and PA on PF. METHODS: A total of 4537 participants and 12,011 observations aged ≥45 years old from the China Health and Retirement Longitudinal Study (CHARLS) cohort from 2011 to 2015 were included into the study. PF was assessed by a combined score of four tests, including grip strength, walking speed, sense of balance, and chair standing tests. Air pollution exposure data was from The ChinaHighAirPollutants (CHAP) dataset. The annual PM2.5 exposure for each individual was estimated based on county-level resident addresses. We estimated the volume of moderate-to-vigorous physical activity (MVPA) by quoting metabolic equivalent (MET). Multivariate linear model was conducted for baseline analysis, and linear mixed model with random participant intercepts was constructed for cohort longitudinal analysis. RESULTS: PM2.5 was negatively associated with PF, while PA was positively associated with PF in baseline analysis. In cohort longitudinal analysis, a 10 µg/m3 increase in PM2.5 was associated to a 0.025 point (95 % CI: -0.047, -0.003) decrease in PF score, and a 10-MET-h/week increase in PA was related to a 0.004 point (95 % CI: 0.001, 0.008) increase in PF score. The association between PM2.5 and PF decreased by increased PA intensity, and PA reversed the detrimental effects between PM2.5 and PF. CONCLUSION: PA attenuated the association of air pollution with PF at both high and low levels of air pollution, implying that PA may be an effective behavior to reduce the adverse effects of poor air quality on PF.
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Poluentes Atmosféricos , Poluição do Ar , Humanos , Pessoa de Meia-Idade , Estudos Longitudinais , Estudos de Coortes , Exercício Físico/fisiologia , Poluição do Ar/análise , Material Particulado/análise , Poluentes Atmosféricos/análise , Exposição Ambiental/análiseRESUMO
AIM: To investigate the associations of baseline body mass index (BMI) and longitudinal BMI trajectories with all-cause mortality among patients with type 2 diabetes mellitus (T2DM). METHODS,: We used data from the diabetes surveillance system of Yinzhou Health Information System with T2DM patients registered from 2010 to 2015. Participants aged ≥ 40 years were included and were followed up until September 30, 2021. The latent class growth mixture model was used to identify different changing patterns in BMI for 5 years from registration. Cox proportional hazards models were used to examine the associations of baseline BMI and 5-year BMI trajectories with all-cause mortality. RESULTS: We observed a nonlinear association between baseline BMI and all-cause mortality (P for nonlinearity < 0.001), with an increased risk of death for low but not high BMI. However, compared with participants with medium-stable BMI for 5 years from baseline, individuals with increasing BMI had higher mortality, with adjusted hazard ratios (95% confidence intervals) 1.21 (1.02;1.43) for early-increasing and 1.47 (1.19;1.80) for late-sharp increasing groups. CONCLUSION: These findings suggest that while obesity itself may not be associated with an increased risk for mortality, weight gain, and in particular rapid weight gain, is a risk factor for mortality among patients with T2DM.
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Diabetes Mellitus Tipo 2 , Humanos , Índice de Massa Corporal , Diabetes Mellitus Tipo 2/complicações , Obesidade/complicações , Obesidade/epidemiologia , Fatores de Risco , Aumento de PesoRESUMO
BACKGROUND: Epidemiological studies have reported an association between traffic-related pollution with risk of metabolic syndrome (MetS). However, evidence from prospective studies on the association of walkability and nitrogen dioxide (NO2) with MetS is still scarce. We, therefore, aimed to evaluate the association of long-term exposure to NO2 and walkability with hazards of incident MetS. METHODS: A total of 17,965 participants without MetS diagnosed within one year at baseline were included in our study from a population-based prospective cohort in Yinzhou District, Ningbo, Zhejiang Province, China. Participants were followed up by the regional Health Information System (HIS) until December 15, 2021. MetS was defined based on the criteria of Chinese Diabetes Society (CDS2004). We used walkscore tools, calculating with amenity categories and decay functions, and spatial-temporal land-use regression (LUR) models to estimate walkability and NO2 concentrations. We used Cox proportional hazards regression models to examine the association of walkability and NO2 with hazards of MetS incidence reporting with hazard ratios (HRs) and 95% confidence intervals (CIs). RESULTS: Overall, we followed up 77,303 person-years and identified 4040 incident cases of MetS in the entire cohort. Higher walkability was inversely associated with incident MetS (HR = 0.94, 95 % CI: 0.91-0.99), whereas NO2 was positively associated with MetS incidence (HR = 1.07, 95 %CI: 1.00-1.15) per interquartile range increment in two-exposure models. Furthermore, we found a significant multiplicative interaction between walkability and NO2. Stronger associations were observed for NO2 and incident MetS among men, smokers, drinkers and participants who aged < 60 years and had higher levels of income. CONCLUSION: In summary, we found living in areas with lower walkability and higher concentrations of NO2 were associated with increased incidence of MetS. The beneficial effect of higher walkability may be attenuated by exposure to NO2.
Assuntos
Poluentes Atmosféricos , Poluição do Ar , Síndrome Metabólica , Masculino , Humanos , Estudos de Coortes , Síndrome Metabólica/epidemiologia , Estudos Prospectivos , Dióxido de Nitrogênio/análise , Exposição Ambiental , China/epidemiologia , Poluentes Atmosféricos/análise , Material Particulado/análiseRESUMO
OBJECTIVES: We tried to develop a more concise health literacy scale for Chinese older adults. METHODS: A draft scale based on the Health Literacy Questionnaire (HLQ) was developed, and revised by experts. We conducted a pilot study to test the readability and establish a standard inquiry method within 10 residents. We tested the validity and internal consistency using a field test with 3,739 participants. RESULTS: Overall standardized Cronbach's α of Chinese Health Literacy Scale (CHLS) was 0.86 and that of each dimension ranged from 0.69 to 0.81. Nearly all dimensions had satisfactory factor loadings (0.33-0.98). The correlation coefficient between the score of each item and its dimension ranged from 0.59 to 0.92. CONCLUSIONS: The performance of CHLS was almost the same as the HLQ but more concise. It might play a role in reflecting the health literacy of older adults in China and further promoting their health.