Abstract
Cohort studies investigating the treatment of chronic non-communicable diseases (NCDs) with traditional Chinese medicine (TCM) have considerably accumulated in recent years. To systematically and for the first time present the achievements and dilemmas of cohort studies, strict inclusion and exclusion criteria were used to search publications from the Web of Science, PubMed, Embase, Cochrane Library, and China National Knowledge Infrastructure databases for cohort studies on NCDs with TCM since the establishment of these databases. Information on the year of publication, exposure factors, diseases, and outcome indicators was obtained, and a literature quality assessment and bibliometric descriptive analysis were conducted. A total of 182 published articles involving 1,615,106 cases were included. There were 110 non-prospective cohort studies and 72 prospective cohort studies. The diseases involved in the cohort studies were, in the order of the number of published articles, malignant tumors (82 articles, 45.05%), cardiovascular diseases (35 articles, 19.23%), neurological diseases (29 articles, 15.93%), chronic kidney diseases (16 articles, 8.79%), liver cirrhosis (8 articles, 4.40%), diabetes mellitus (8 articles, 4.40%), and chronic respiratory diseases (4 articles, 2.20%). The study participants were mainly from China (177 articles, 97.25%). The number of cohort studies increased significantly in the last 5 years (65 articles, 35.71%), and following the Newcastle-Ottawa Scale (NOS) literature quality evaluation, the number of articles that received a score of four to five was high (116 articles, 63.73%), and the overall quality needs to be improved. The application of cohort studies in the field of TCM for the prevention and treatment of NCDs has developed rapidly in the past 5 years, focusing on the prevention and treatment of tumors as well as cardiovascular and cerebrovascular diseases. However, the design and implementation of cohort studies still have considerable limitations. To provide more clinical evidence, researcher should actively cooperate with evidence-based methodologists and standardize the implementation of cohort studies.
Highlights
Chronic non-communicable diseases are a group of chronic conditions other than acute infections or parasitic injuries, maternal and perinatal conditions, or nutritional deficiencies (Wagner and Brath, 2012)
1) The study design was a cohort study; 2) The study had a clear classification of the exposure and non-exposure groups; 3) The exposure factors of the study were related to traditional Chinese medicine (TCM) interventions, which were defined as various dosage forms of TCM formulas, acupuncture, manipulation, etc.; 4) The study endpoints should be related to important non-communicable diseases (NCDs); NCDs included in this study included malignant tumors, cardiovascular diseases, respiratory diseases, diabetes and related complications, liver cirrhosis, chronic kidney disease, and neurological diseases; and 5) The language is limited to Chinese or English
Cohort studies in the field of TCM were initiated relatively late in comparison to modern medicine (Nong et al, 2004), the number of such studies has rapidly increased and their quality has improved in the past decade
Summary
Chronic non-communicable diseases are a group of chronic conditions other than acute infections or parasitic injuries, maternal and perinatal conditions, or nutritional deficiencies (Wagner and Brath, 2012). Cardiovascular diseases, diabetes, and chronic respiratory diseases account for the highest morbidity, mortality, and disability rates (World Health Organization, 2018b). Such a huge impact on individuals and the society has hastened the need for the prevention and control of NCDs with multiple therapies. As complementary and alternative medicine is widely used in Asia and has a global impact, the role of traditional Chinese medicine (TCM) in the prevention and treatment of chronic NCDs has received increasing attention worldwide, and approximately 61% of anticancer drugs and 50% of cardiovascular drugs were developed from natural herbal products in recent years (Newman and Cragg, 2020; Zhao et al, 2020), especially since the Nobel Prize was awarded for research on artemisinin from TCM (Ma et al, 2020). The effect of TCM on preventing and treating chronic NCDs and improving the clinical prognosis of some diseases has been confirmed by an increasing number of clinical studies (Hershman et al, 2018; Yang et al, 2012)
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