Analysis Of Epidemiological Data Research Articles

Differential privacy Kalman filtering for graphical dynamic systems: Performance improvement and privacy calibration

This paper investigates differential privacy Kalman filtering for graphical dynamic systems. An enhanced differential privacy Kalman filter is initially developed by leveraging the topology, a unique characteristic of graphical dynamic systems, to improve the filtering performance. And then upper and lower error bounds of the enhanced filter are established to evaluate the recipient's ability to infer sensitive data. Based on these error bounds, a privacy calibration guideline is provided to balance privacy and usability of sensitive data. A notable feature of the enhanced filter is that its Kalman gain matrix is a diagonal matrix, which facilitates the independent update of information at each node by reducing the coupling between nodes. This feature diminishes the accumulation of filtering errors, thereby improving the data availability for the recipient. Finally, the effectiveness of the proposed approach is verified through a simulation of epidemiological data analysis, and the results show that the enhanced filter performs well in systems with high privacy levels.

Voluntary counselling and testing points (VCTs) in Poland as a complementary and accessible alternative to public healthcare facilities: A comparative analysis of epidemiological data from the VCTs and the National Institute of Public Health NIH-National Research Institute (2015-2022).

Voluntary counselling and testing points (VCTs) offer anonymous and free HIV tests in Poland. They also play an essential role in educational initiatives focused on the prevention and diagnosis of HIV and other sexually transmitted infections. However, no comprehensive data is available that summarizes the results of the work carried out by these VCTs. Therefore, our aim was to conduct a comparative analysis of epidemiological data obtained from VCTs and data reported by the epidemiological surveillance undertaken by the National Institute of Public Health NIH-National Research Institute (NIPH NIH-NRI) covering the period from 2015 to 2022. This retrospective analysis was conducted on data from 258 071 people attending VCTs in Poland in 2015-2022. On average, 32 259 individuals underwent testing each year, with a notable increase in the number of people being tested in November. The average positivity rate was 1.39% (3576/258 071). The Masovian voivodeship conducted the most tests and had the highest number of positive results. The comparative analysis of the frequency of detecting positive results in VCTs and those reported in NIPH NIH-NRI data revealed that, on average, 31.49% (3576/11 356) of positive results in Poland between 2015 and 2022 were identified through tests conducted at VCTs. The positive results identified in VCTs constituted approximately one-third of all results reported by the National Institute of Public Health NIH-National Research Institute, highlighting the importance of VCTs. Moreover, the high availability of testing in the Masovian voivodeship resulted in better detection of HIV. The educational actions performed during European Testing Week increased the number of tests performed in November.

Optimal design of electromagnetic field exposure maps in large areas

The mapping of electromagnetic field (EMF) exposure over large areas is a very useful tool for the analysis of epidemiological data and risk assessment. Its production requires a costly measurement process. To optimize the effort and ensure the representativeness of the exposure map, criteria for the selection of the sites to be measured must be established. This paper presents a methodology for conducting EMF exposure maps suitable for risk assessment evaluation in large areas. The proposal combines radio wave propagation criteria and GIS methods to optimize the sampling effort. The design criteria are based on the determination of a rectangular grid of 250 m side and the identification of the emitters within the area under study. Both urban and rural sites are analysed in the proposal and line of sight conditions (LOS) are considered to reduce the number of points required and thus optimize the measurement effort. Depending on the extent and regularity of the surface, the density of measurement points has been estimated to be between 8 and 10 points per square kilometre in the urban area. The proposed methodology has been applied to a case study of a 2.8 km2 urban area within a 35.11 km2 municipality, obtaining an average point density of 9.64 points/km2 in the urban area. The differences in exposure depending on the application of the criteria have been analysed by means of the statistical values of the sets and the subtraction of the maps generated using kriging techniques. According to our results, if LOS measurements are not properly incorporated, the mean value of the EMF is underestimated in the area under study.

Transmission characteristics in Tuberculosis by WGS: nationwide cross-sectional surveillance in China

ABSTRACT China, with the third largest share of global tuberculosis cases, faces a substantial challenge in its healthcare system as a result of the high burden of multidrug-resistant and rifampicin-resistant tuberculosis (MDR/RR-TB). This study employs a genomic epidemiological approach to assess recent tuberculosis transmissions between individuals, identifying potential risk factors and discerning the role of transmitted resistant isolates in the emergence of drug-resistant tuberculosis in China. We conducted a population-based retrospective study on 5052 Mycobacterium tuberculosis (MTB) isolates from 70 surveillance sites using whole genome sequencing (WGS). Minimum spanning tree analysis identified resistance mutations, while epidemiological data analysis pinpointed transmission risk factors. Of the 5052 isolates, 23% (1160) formed 452 genomic clusters, with 85.6% (387) of the transmissions occurring within the same counties. Individuals with younger age, larger family size, new cases, smear positive, and MDR/RR were at higher odds for recent transmission, while higher education (university and above) and occupation as a non-physical workers emerged as protective factors. At least 61.4% (251/409) of MDR/RR-TB were likely a result of recent transmission of MDR/RR isolates, with previous treatment (crude OR = 2.77), smear-positive (cOR = 2.07) and larger family population (cOR = 1.13) established as risk factors. Our findings highlight that local transmission remains the predominant form of TB transmission in China. Correspondingly, drug-resistant tuberculosis is primarily driven by the transmission of resistant tuberculosis isolates. Targeted interventions for high-risk populations to interrupt transmission within the country will likely provide an opportunity to reduce the prevalence of both tuberculosis and drug-resistant tuberculosis.

Estimating the reproduction number and transmission heterogeneity from the size distribution of clusters of identical pathogen sequences

Quantifying transmission intensity and heterogeneity is crucial to ascertain the threat posed by infectious diseases and inform the design of interventions. Methods that jointly estimate the reproduction number R and the dispersion parameter k have however mainly remained limited to the analysis of epidemiological clusters or contact tracing data, whose collection often proves difficult. Here, we show that clusters of identical sequences are imprinted by the pathogen offspring distribution, and we derive an analytical formula for the distribution of the size of these clusters. We develop and evaluate an inference framework to jointly estimate the reproduction number and the dispersion parameter from the size distribution of clusters of identical sequences. We then illustrate its application across a range of epidemiological situations. Finally, we develop a hypothesis testing framework relying on clusters of identical sequences to determine whether a given pathogen genetic subpopulation is associated with increased or reduced transmissibility. Our work provides tools to estimate the reproduction number and transmission heterogeneity from pathogen sequences without building a phylogenetic tree, thus making it easily scalable to large pathogen genome datasets.

Evaluating ChatGPT-4.0's data analytic proficiency in epidemiological studies: A comparative analysis with SAS, SPSS, and R.

OpenAI's Chat Generative Pre-trained Transformer 4.0 (ChatGPT-4), an emerging artificial intelligence (AI)-based large language model (LLM), has been receiving increasing attention from the medical research community for its innovative 'Data Analyst' feature. We aimed to compare the capabilities of ChatGPT-4 against traditional biostatistical software (i.e. SAS, SPSS, R) in statistically analysing epidemiological research data. We used a data set from the China Health and Nutrition Survey, comprising 9317 participants and 29 variables (e.g. gender, age, educational level, marital status, income, occupation, weekly working hours, survival status). Two researchers independently evaluated the data analysis capabilities of GPT-4's 'Data Analyst' feature against SAS, SPSS, and R across three commonly used epidemiological analysis methods: Descriptive statistics, intergroup analysis, and correlation analysis. We used an internally developed evaluation scale to assess and compare the consistency of results, analytical efficiency of coding or operations, user-friendliness, and overall performance between ChatGPT-4, SAS, SPSS, and R. In descriptive statistics, ChatGPT-4 showed high consistency of results, greater analytical efficiency of code or operations, and more intuitive user-friendliness compared to SAS, SPSS, and R. In intergroup comparisons and correlational analyses, despite minor discrepancies in statistical outcomes for certain analysis tasks with SAS, SPSS, and R, ChatGPT-4 maintained high analytical efficiency and exceptional user-friendliness. Thus, employing ChatGPT-4 can significantly lower the operational threshold for conducting epidemiological data analysis while maintaining consistency with traditional biostatistical software's outcome, requiring only specific, clear analysis instructions without any additional operations or code writing. We found ChatGPT-4 to be a powerful auxiliary tool for statistical analysis in epidemiological research. However, it showed limitations in result consistency and in applying more advanced statistical methods. Therefore, we advocate for the use of ChatGPT-4 in supporting researchers with intermediate experience in data analysis. With AI technologies like LLMs advancing rapidly, their integration with data analysis platforms promises to lower operational barriers, thereby enabling researchers to dedicate greater focus to the nuanced interpretation of analysis results. This development is likely to significantly advance epidemiological and medical research.

Pervasive environmental chemicals impair oligodendrocyte development.

Exposure to environmental chemicals can impair neurodevelopment, and oligodendrocytes may be particularly vulnerable, as their development extends from gestation into adulthood. However, few environmental chemicals have been assessed for potential risks to oligodendrocytes. Here, using a high-throughput developmental screen in cultured cells, we identified environmental chemicals in two classes that disrupt oligodendrocyte development through distinct mechanisms. Quaternary compounds, ubiquitous in disinfecting agents and personal care products, were potently and selectively cytotoxic to developing oligodendrocytes, whereas organophosphate flame retardants, commonly found in household items such as furniture and electronics, prematurely arrested oligodendrocyte maturation. Chemicals from each class impaired oligodendrocyte development postnatally in mice and in a human 3D organoid model of prenatal cortical development. Analysis of epidemiological data showed that adverse neurodevelopmental outcomes were associated with childhood exposure to the top organophosphate flame retardant identified by our screen. This work identifies toxicological vulnerabilities for oligodendrocyte development and highlights the need for deeper scrutiny of these compounds' impacts on human health.

Abstract P109: HDL Cholesterol Confers Exceptionally Strong Cardioprotective and Metabolic Effects in Native Hawaiian and Pacific Islander Populations

Relative to the general population, Native Hawaiian and Pacific Islander (NHPI) communities are significantly more prone to obesity, diabetes, and heart disease. Our population-based longitudinal study focuses on HDL cholesterol levels and cardiovascular risk among NHPI and other (comparison) populations. Given the importance of health disparities in cardiovascular disease among the people of Hawai'i, this study holds considerable importance for establishing more diverse, equitable, and inclusive healthcare and precision medicine approaches. Specifically, we communicate a novel data-driven finding, revealed from a statistical and machine learning analysis of epidemiological data from the NIH All of Us Research Program, showing that the cardioprotective effect of high-density lipoprotein (HDL) cholesterol is significantly stronger in NHPI populations relative to other racial/ethnic demographics (including White, Black, and Hispanic/Latinx communities). Our results indicate that: 1) the cardioprotective effect of HDL against coronary artery disease (CAD), acute myocardial infarction (MI), and major adverse cardiovascular events (MACE), is much more powerful in NHPI populations compared to any other racial/ethnic groups currently represented in All of Us . 2) HDL has an exceptionally strong negative relationship with Type II diabetes (T2D) incidence in NHPI populations, which is also significantly stronger than in other ethnicities. In NHPI populations, these results suggest that an additional emphasis ought to be placed on the cardiac and metabolic-protective effect of HDL level as a key biomarker/risk factor in physicians’ assessment of cardiometabolic disease risk. These cardiovascular health equity findings highlight the importance of more and improved diversity, equity, and inclusion efforts to adequately serve growing subpopulations of historically underrepresented groups such as NHPIs within the US healthcare system.

Visualization of Spatial–Temporal Epidemiological Data: A Scoping Review

In recent years, the proliferation of health data sources due to computer technologies has prompted the use of visualization techniques to tackle epidemiological challenges. However, existing reviews lack a specific focus on the spatial and temporal analysis of epidemiological data using visualization tools. This study aims to address this gap by conducting a scoping review following the PRISMA-ScR guidelines, examining the literature from 2000 to 2024 on spatial–temporal visualization techniques when applied to epidemics, across five databases: PubMed, IEEE Xplore, Scopus, Google Scholar, and ACM Digital Library until 24 January 2024. Among 1312 papers reviewed, 114 were selected, emphasizing aggregate measures, web platform tools, and geospatial data representation, particularly favoring choropleth maps and extended charts. Visualization techniques were predominantly utilized for real-time data presentation, trend analysis, and predictions. Evaluation methods, categorized into standard methodology, user experience, task efficiency, and accuracy, were observed. Although various open-access datasets were available, only a few were commonly used, mainly those related to COVID-19. This study sheds light on the current trends in visualizing epidemiological data over the past 24 years, highlighting the gaps in standardized evaluation methodologies and the limited exploration of individual epidemiological data and diseases acquired in hospitals during epidemics.

Assessing Workplace Violence: Methodological Considerations.

The risk of violence is present in all workplaces. It must be accurately assessed to establish prevention and protection measures tailored to the features of each situation. The risk management process requires compliance in a sequential order: 1) risk identification, 2) quantitative risk assessment, and 3) impact assessment. Gathering workers' experiences using lists, focus groups, or participatory ergonomics groups is necessary to identify the phenomenon. For risk assessment, spontaneous reporting of events is often insufficient. It may be complemented with two methods: systematic recording of violent events that occurred in the past year during periodic medical examinations of workers and targeted surveys. The epidemiological analysis of data from individual interviews and surveys provides the phenomenon's prevalence, incidence, and evolution. Moreover, reporting the harm suffered by victims of violence allows constructing impact matrices to allocate resources where they are most needed.

Craniocervical Tetanus: A Practical Consideration During Work-up of Acute-Onset Trismus.

This clinical record revisits the classical and pathognomonic features of craniocervical tetanus in a 65-year-old farmer who presented with acute-onset trismus, multiple cranial nerve pareses (III, IX, and X), risus sardonicus, and spasm of the head-neck musculature. This paper explores the relevant literature and presents a brief pictorial analysis of the global epidemiologic data. With most countries successfully adopting the maternal and neonatal tetanus elimination (MNTE) program, the incidence and mortality of tetanus across age groups have sharply reduced in high-income and most middle-income nations. In adults, tetanus is now encountered in specialized situations like waning immunity and incomplete vaccination, in the resource-poor and low-income nations, in countries achieving MNTE recently, and as cluster cases in the aftermath of natural disasters involving human settlements. Therefore, present-day practicing otolaryngologists and residents who have limited exposure to the tell-tale clinical features of craniocervical tetanus should consider it during work-up of acute-onset trismus in adults in susceptible situations and with a conducive background. The clinical spectrum of craniocervical tetanus as depicted in this report, including the demonstration of the pathognomonic positive spatula test, provides valuable learning points for otolaryngologists in this regard.

IMPACT OF THE COVID-19 PANDEMIC ON THE EPIDEMIOLOGY OF AIDS IN BRAZIL

Introduction: The HIV/AIDS epidemic poses a global challenge to public health, exacerbated by the COVID-19 pandemic. Investigating the effects of this health crisis on AIDS epidemiology in Brazil is crucial. Methodology: Epidemiological, descriptive, and retrospective study using SINAN data from 2014 to 2022, totaling 187,947 cases. Quantitative analysis of distribution by sex, age, race, and region. Results: Reduction in cases observed from 2017, more pronounced in men and in the Southeast and South regions. Male predominance (70% of cases). Concentration in the age range of 20 to 49 years (75% of cases). Browns and blacks more affected. Discussion: Integration of different epidemiological dimensions provides a comprehensive overview of the epidemic in Brazil. Highlights the need for tailored public policies, improvement of information systems, and surveillance. Conclusion: Between 2014 and 2022, analysis of AIDS epidemiological data in Brazil reveals a decrease in diagnoses, particularly among men in the Southeast and South, with possible underreporting. Male predominance, concentration of cases among 20 to 49-year-olds, and racial disparities necessitate customized policies. Enhancing information systems is crucial.

Spatiotemporal genotype replacement of H5N8 avian influenza viruses contributed to H5N1 emergence in 2021/2022 panzootic.

Since 2020, clade 2.3.4.4b highly pathogenic avian influenza H5N8 and H5N1 viruses have swept through continents, posing serious threats to the world. Through comprehensive analyses of epidemiological, genetic, and bird migration data, we found that the dominant genotype replacement of the H5N8 viruses in 2020 contributed to the H5N1 outbreak in the 2021/2022 wave. The 2020 outbreak of the H5N8 G1 genotype instead of the G0 genotype produced reassortment opportunities and led to the emergence of a new H5N1 virus with G1's HA and MP genes. Despite extensive reassortments in the 2021/2022 wave, the H5N1 virus retained the HA and MP genes, causing a significant outbreak in Europe and North America. Furtherly, through the wild bird migration flyways investigation, we found that the temporal-spatial coincidence between the outbreak of the H5N8 G1 virus and the bird autumn migration may have expanded the H5 viral spread, which may be one of the main drivers of the emergence of the 2020-2022 H5 panzootic.IMPORTANCESince 2020, highly pathogenic avian influenza (HPAI) H5 subtype variants of clade 2.3.4.4b have spread across continents, posing unprecedented threats globally. However, the factors promoting the genesis and spread of H5 HPAI viruses remain unclear. Here, we found that the spatiotemporal genotype replacement of H5N8 HPAI viruses contributed to the emergence of the H5N1 variant that caused the 2021/2022 panzootic, and the viral evolution in poultry of Egypt and surrounding area and autumn bird migration from the Russia-Kazakhstan region to Europe are important drivers of the emergence of the 2020-2022 H5 panzootic. These findings provide important targets for early warning and could help control the current and future HPAI epidemics.

C-reactive protein concentration has limited value in the diagnosis of meningoencephalitis of unknown origin in dogs.

To evaluate blood and cerebrospinal fluid (CSF) concentrations of C-reactive protein (CRP) in dogs with meningoencephalitis of unknown origin (MUO); to evaluate whether blood CRP concentration is associated with epidemiological, clinicopathologic, and MRI findings; and to investigate blood CRP predictive power in survival. 30 client-owned dogs with MUO, 15 client-owned dogs with steroid-responsive meningitis arteritis (SRMA; positive control group), and 15 healthy dogs (negative control group). Blood CRP concentration was measured in each group, while it was performed in CSF only in the MUO and SRMA groups. The analysis of epidemiological data included breed, age, sex, duration of clinical signs, and history of seizures. Blinded analysis of MRI was performed based on a classification grid, and traditional CSF analysis parameters were assessed. The predictive power of blood CRP concentration regarding survival at 6 months was investigated. Of the 30 dogs with MUO, 9 (30%) had an increased CRP concentration in blood, and 3 (10%) showed a measurable CRP in CSF. Median blood CRP concentration in dogs with MUO was 0.1 mg/L (range, 0.1 to 102 mg/L), which was not statistically different from the healthy dog group but significantly lower than the SRMA control group. Only the duration of clinical signs was positively associated with an increased blood CRP level. Blood CRP concentration was not associated with survival at 6 months. Blood CRP concentration is of limited value for the diagnosis and prognosis of dogs with MUO. Chronicity of the disease may be associated with an increased concentration of blood CRP.

Impact of COVID-19 vaccination on the severity of the course and outcomes of the disease in hospitalized patients in St. Petersburg

Vaccination against infection caused by the SARS-CoV-2 virus, despite the problems of a biological and social nature, remains the main preventive measure to prevent the spread of this infection. The aim is to assess the effect of COVID-19 vaccine prophylaxis on the incidence of severe forms and deaths among hospitalized patients. A retrospective epidemiological analysis of official data on 13,778 patients hospitalized in the main repurposed hospitals of the city of St. Petersburg was carried out, of which 973 people had a fatal disease. The frequency of pneumonia and deaths among vaccinated and unvaccinated patients was analyzed. Correlation and regression analysis was used to determine the nature of the relationship between these factors. An analysis of the incidence of pneumonia and deaths in patients with different vaccination status showed their statistically significant predominance among unvaccinated patients (p < 0.05). Quantitative fluctuations in deaths in 2021–2022 were established due to the beneficial effect of preventive vaccinations against COVID-19, expressed in a decrease in hospital mortality rates. The greatest reduction in mortality was achieved in the group of vaccinated patients in the absence of pneumonia. The risk of adverse outcomes was highest in the presence of pneumonia and the absence of vaccinations. A significant favorable factor was the vaccination coverage of hospitalized patients. COVID-19 vaccine prophylaxis has a positive effect on both the severity of this infection and its outcomes. However, a critical factor in this case is the degree of immunization of the population.

From disease surveillance to public action. Re-inforcing both epidemiological surveillance and data analysis: an illustration with *Mycobacterium bovis*

From disease surveillance to public action. Re-inforcing both epidemiological surveillance and data analysis: an illustration with *Mycobacterium bovis*

Regional epidemiological features of infectious diseases with fecal-oral transmission in the socialist republic of Vietnam

Aim: To identify regional epidemiological features of infectious diseases spread by fecal-oral transmission and the factors influencing them in four regions of Vietnam.Materials and methods: Retrospective epidemiological analysis of data of 10 infectious diseases spread by fecal-oral transmission in Vietnam for the period 2017-2022. Maps of incidence by province was created using the QGIS 3.28 program. Correlation coefficients between the incidence of the studied diseases and socio-economic factors were established.Results: It was revealed that the incidence of the 10 studied diseases was 443.1±113.5 0 /0000 and tends to decrease. The highest incidence was recorded in Tay Nguyen. Cases of diarrheal syndrome (330.1±73.8 0 /0000) and enteroviral vesicular stomatitis (HMFD) (93.6±33.4 0 /0000) accounted for 95.65% of all registered cases. Diarrhea is distributed mainly among children under 4 years of age (1090.3±384.8 0 /0000) and 5-9 years old (60.9±18.5 0 /0000). Regional epidemiological features of diarrhea and HMFD are shown. The highest incidence of the HMFD was recorded among children under 4 years of age in Dong Thap (4635.8 0 /0000) and Ho Chi Minh City (4210.5 0 /0000), and the highest incidence of diarrheal syndrome was in Kon Tum (2621.2 0 /0000), Thai Binh (2556.6 0 /0000) and Dien Bien (1461.9 0 /0000). Relationships were established between the incidence of diarrhea and levels of access to safe water (rSpearman = – 0.393; p = 0.001), to the sanitation system (rSpearman = – 0.267; p = 0.035), average monthly income (rSpearman = – 0.424; p = 0.001), poverty levels (rSpearman = 0.403; p = 0.001).Conclusion: The high incidence of infectious diseases spread by fecal-oral transmission in Vietnam is due to the high incidence of diarrhea and HMFD. A high incidence of diarrhea is typical for provinces with low levels of access to safe water and sanitation systems, high levels of poverty and low average monthly income. Incidence of HMFD is high among children under 4 years old, especially in the southern provinces with high population density in the summer and autumn seasons.

Evaluating the efficiency of medical care for children with diabetes mellitus in different regions of Ukraine over the past 20 years (2002–2021) of peacetime

Background. The growing number of children with diabetes creates a global economic problem, including a financial burden on the country’s health care system and economic stress for families of children with diabetes. The purpose was to assess the effectiveness of medical care for children with diabetes in different regions of Ukraine over the last 20 years (2002–2021) of peacetime. Material and methods. The article presents the results of statistical evaluation and epidemiological analysis of data from the Center for Medical Statistics of the Ministry of Health of Ukraine on the rates of disability, hospitalization, and inpatient care among the pediatric population in 2002–2021. Statistical processing of the results was carried out using MS Excel, XLSTAT-Pro. Results. During 2002–2021, an increase in the rate of primary disability due to diabetes mellitus was highest among adolescents — by 4.1 times and lowest among primary schoolchildren — by 3.4 times; among children 0–6 years old, it increased by 3.6 times. The proportion of children with disabilities due to diabetes as of 2017 is 12 % among the age group of 0–6 years, and 25 % in adolescents (15–17 years). In 2013–2021, the hospitalization rate among children with diabetes increased from 1.27 to 1.35 per 1,000 of the relevant population, and the average length of hospital stay decreased by 19 %. The rate of mortality due to diabetes complications among hospitalized children varies and does not have a specific trend (in 2021, it was 0.02 per 100 in-patients). Conclusions. The analysis of the efficiency of medical care for children with diabetes during 2002–2021 in the context of increasing prevalence and incidence of diabetes showed stable trends towards a huge increase in the level of primary and general disability, a slight increase in hospitalization rates, and a decrease in the average length of hospital stay. These results call for a detailed study of the causes, control, and revision of protocol documents for the management of such patients.

Age-related Disparities in Pan-Cancer Mortality and Causes of Death: Analysis of Surveillance, Epidemiology, and End Results (SEER) Data.

Comprehensive analysis of mortality and causes of death (COD) in cancers was of importance to conduct intervention strategies. The current study aimed to investigate the mortality rate and COD among cancers, and to explore the disparities between age. Initially, cancer patients diagnosed between 2010 and 2019 from the surveillance, epidemiology, and end results (SEER) database were extracted. Then, frequencies and percentage of deaths, and mortality rate in different age groups were calculated. Meanwhile, age distribution of different COD across tumor types was illustrated while the standardized mortality ratios (SMR) stratified by age were calculated and visualized. A total of 2,670,403 death records were included and digestive system cancer (688,953 death cases) was the most common primary cancer type. The mortality rate increased by 5.6% annually in total death, 4.0% in cancer-specific death and 10.9% in non-cancer cause. As for cancer-specific death, the age distribution varied among different primary tumor types due to prone age and prognosis of cancer. The top five non-cancer causes in patients older than 50 were cardiovascular and cerebrovascular disease, other causes, COPD and associated conditions, diabetes as well as Alzheimer. The SMRs of these causes were higher among younger patients and gradually dropped in older age groups. Mortality and COD of cancer patients were heterogeneous in age group due to primary tumor types, prone age and prognosis of cancer. Our study conducted that non-cancer COD was a critical part in clinical practice as well as cancer-specific death. Individualized treatment and clinical intervention should be made after fully considering of the risk factor for death in different diagnosis ages and tumor types.

Whole systems approaches to diet and healthy weight: A scoping review of reviews.

Obesity is a global epidemic affecting all age groups, populations, and income levels across continents, though is known to disproportionately affect socioeconomically disadvantaged populations. The causes of obesity are complex, informed by diet and weight practices, but shaped by social, commercial, and environmental factors and government policy. Consequently, a Whole System Approach (WSA)-which considers the many causes of obesity and shifts the focus away from individuals as points of intervention and puts an emphasis on understanding and improving the system in which people live-is required. This scoping review of reviews aims to: determine how WSAs to diet and healthy weight have been implemented and evaluated nationally and internationally; to determine what models or theories have been used to implement WSAs; describe how WSAs have been evaluated; determine if WSAs are effective; and to identify the contribution of the public and/or service users in the development of WSAs. Systematic searches were carried out using CINAHL, Scopus, PsycINFO (ProQuest), the Cochrane Library, and MEDLINE. Included review papers were those that focused on the application of a whole system approach to diet and/or healthy weight, and/or reported the theory/model used to implement or simulate this approach. Databases were searched from 1995 to March 2022 using a combination of text and Medical Subject Headings (MeSH terms). In addition, reference sections of identified articles were examined for additional relevant articles. Covidence software was used to screen titles and abstracts from the electronic databases and resolve conflicts. A total of 20,308 articles were initially retrieved; after duplicate removal 7,690 unique title and abstracts were reviewed, and 110 articles were selected for full text review. On completion of full text review, 8 review articles were included for data extraction. These included: one umbrella review, four systematic reviews, a rapid review, and two literature reviews (one of which was on strategic reports written for government and public health policy). Evaluations of WSA were mainly process evaluations although health outcomes were assessed in some studies. Several conceptual frameworks or mathematical modelling approaches have been applied to WSAs for diet, healthy weight, and obesity to inform their planning or delivery, and to understand/map the associated systems. Common mathematical approaches include agent based or System Dynamic Modelling. Underlying both conceptual and mathematical models is an understanding how the elements of the complex systems impact each other to affect diet, healthy weight, and obesity. WSA implementations have reported some success in positively impacting health outcomes including reducing Body Mass Index, reducing sugary food intake, and increasing physical activity. Public and user involvement in WSA was not widely reported. The application of WSA to diet and healthy weight shows promise, yet the research is lagging behind their implementation. Further robust evidence for using WSA to address diet and healthy weight are required, including incorporating process and outcome evaluations (perhaps using established approaches such as Systems Dynamic Modelling). Furthermore, the analysis of epidemiological data alongside longitudinal process and outcome evaluation regarding the implementation of a WSA is required.