General Chinese Population Research Articles

Risk Factors Associated With Echinococcosis in the General Chinese Population: A Meta-Analysis and Systematic Review.

BackgroundEchinococcosis is a severe zoonotic disease that imposes a substantial burden on human life. This meta-analysis aimed to summarize available data on the prevalence of human echinococcosis and identify the key risk factors for echinococcosis in the Chinese general population.MethodsRelevant studies were comprehensively searched in the PubMed, EMBASE, Web of Science, Cochrane, Chinese National Knowledge Infrastructure (CNKI), Chongqing VIP Information (VIP), Wanfang and SinoMed databases until August 22, 2020. A random-effects model was used to estimate the pooled odds ratio (OR) and 95% confidence interval (95% CI). The I2 and Q statistics were calculated to evaluate the heterogeneity, and potential sources of heterogeneity were identified using sensitivity analysis and subgroup analysis. Publication bias was estimated by funnel plots and Egger's test.ResultsA total of 1026 studies were identified through the database search, of which 26 were eligible for this meta-analysis. The pooled prevalence of AE and CE were 2.88% and 5.66%, respectively. Ethnicity (OR = 2.93, 95% CI: 1.81–4.75; I2 = 0), herdsman occupation (OR = 2.66, 95% CI: 2.25–3.14; I2 = 8.0%), not washing hands before meals (OR = 2.40, 95% CI: 1.34–4.28; I2 = 82.8%) and being female (OR = 1.45, 95% CI: 1.26–1.66; I2 = 33.9%) were risk factors for AE. The top five risk factors for CE were ethnicity (OR = 3.18, 95% CI: 1.55–6.52; I2 = 79.2%), nomadism (OR = 2.71, 95% CI: 1.65–4.47; I2 = 55.8%), drinking nonboiled water (OR = 2.47, 95% CI: 1.36–4.47; I2 = 85.7), feeding viscera to dogs (OR = 2.35, 95% CI: 1.89–2.91; I2 = 21.5%), and herdsman occupation (OR = 2.19, 95% CI: 1.67–2.86; I2 = 85.1%).ConclusionsThis study generalized articles that have contributed to our current understanding of the epidemic of human echinococcosis (AE and CE) in China over the years. The results support that the ethnicity and dog-related factors are major risk factors for both CE and AE. The identification of echinococcosis risk factors may aid researchers and policymakers in improving surveillance and preventive measures aimed at reducing Echinococcus granulosus and Echinococcus multilocularis infection in humans.

Application of the protection motivation theory to understand determinants of compliance with the measure of banning gathering size >4 in all public areas for controlling COVID-19 in a Hong Kong Chinese adult general population.

BackgroundRestriction of gathering size in all public areas is a newly and commonly exercised governmental social distancing policy during the COVID-19 pandemic. Its effectiveness depends on the general public’s compliance. This study applied the Protection Motivation Theory (PMT) to investigate determinants (i.e., perceived severity, perceived susceptibility, perceived response efficacy, and perceived self-efficacy) of compliance with the social distancing policy of banning gathering of >4 people in all public areas (BG4PA) in the Hong Kong general adult population.Methods300 participants were interviewed through a population-based telephone survey during April 21–28, 2020.ResultsThe compliance rate of BG4PA was high (78%). Adjusted for the background factors, multiple linear regression analysis found that perceived response efficacy and perceived self-efficacy were significantly and positively associated with compliance with BG4PA (p<0.05), while the associations between perceived severity/perceived susceptibility and compliance were of marginal significance (0.05<p<0.10). A stepwise linear regression model considered four PMT constructs as candidates; its final model only selected self-efficacy but not the other three PMT constructs.ConclusionsPMT can be applied to understand compliance with BG4PA. Perceived response efficacy and perceived self-efficacy were more influential than perceived severity and perceived susceptibility. Health promotion may focus on improving coping appraisal.

The Development of a Short Chinese Version of the State-Trait Anxiety Inventory.

BackgroundFew studies on anxiety in China have used the full version of the Spielberger State-Trait Anxiety Inventory (STAI) due to its length, despite its numerous advantages. The goal of this study was to develop a short Chinese version of the STAI and examine its reliability and validity among the general Chinese population and psychiatric patients diagnosed with anxiety.MethodA total of 1,142 participants were invited to test the short Chinese version of the STAI; item analysis, validity testing and internal consistency reliability analysis were performed. Subsequently, 40 participants were enrolled to assess retest reliability 1 week later. Finally, 330 participants, including 33 psychiatric patients with anxiety, were used to assess the criterion and empirical validity. The Self-Rating Anxiety Scale (SAS) and Satisfaction with Life Scale (SWLS) were used as criteria, and receiver operating characteristic (ROC) analysis was conducted to evaluate the discrimination of the short version of the STAI between the groups with and without anxiety disorders.ResultThe short Chinese version of the STAI contains six items for each subscale (STAI-S-6 and STAI-T-6). The Pearson correlation coefficients between the two shortened Chinese versions of the STAI and the full-length STAI were 0.970 and 0.962, the Cronbach’s α coefficients were 0.871 and 0.842, and the retest reliability values were 0.728 and 0.813 (p < 0.001). Confirmatory factor analysis showed that the 2-factor model achieved an adequate model fit: for the STAI-S-6, CFI = 0.986, TLI = 0.974, and RMSEA = 0.075, and for the STAI-T-6, CFI = 0.994, TLI = 0.988, and RMSEA = 0.052. The short Chinese version of the STAI had a significant positive correlation with the SAS score (r = 0.289, 0.313; p < 0.001) and a negative correlation with the SWLS score (r = −0.476, 0.554; p < 0.001). A significant difference in the level of anxiety was found between participants with and without anxiety disorders. The diagnostic accuracy of the STAI-S-6 and STAI-T-6 for major anxiety disorder was acceptable, with areas under the ROC curves of 0.798 and 0.745, respectively.ConclusionThe short Chinese version of the STAI demonstrates sound psychometric properties and is applicable in evaluating the level of anxiety in Chinese populations.

How to improve public health literacy based on polycentric public goods theory: preferences of the Chinese general population

BackgroundIn the current era of big data, it is critical to address people’s demand for health literacy. At present, the traditional mode of communicating scientific health knowledge and information technology is interchangeable, resulting in the emergence of a new mode of communicating health literacy. To publicize health education and health literacy in a targeted way, to meet the public’s needs, and to understand how the public’s demand for subjects, contents, and forms of health literacy service has changed in the era of COVID-19, the investigation of public’s demand for health information and health literacy was conducted.ObjectiveThis study aims to understand the differences in demand for health literacy service providers, contents, channels, forms, and facilities among Chinese citizens with different genders, ages, education levels, economic conditions, and living environments, and to provide reasonable recommendations for developing public health literacy.MethodsQuestionnaire Star was used to conduct a large sample of random online surveys. In Wuhan, Hubei Province, 2184 questionnaires were issued, 8 invalid questionnaires were eliminated, and 2176 were recovered, with an effective rate of 99.6%. IBM SPSS Statistics 20 was utilized to analyze the survey data.Results(1) In health literacy service providers selected by the public, the proportion of government departments or government collaboration with other institutions exceeded 73%, indicating that health literacy services are public goods; (2) access to health literacy services was lower in township areas than in urban areas (P < 0.001, 3) internet media and communicating with acquaintances, which have the highest popularity rate, were also the two channels that were least trusted by the public; and (4) the differences in contents and service channels of health literacy among residents with different genders, ages, education levels, economic status, and living environments were statistically significant.Conclusions(1) It is recommended to establish an integrated health literacy service model with multi-center supply. Government departments, medical institutions, and media should cooperate effectively to provide health literacy services. (2) The government should pay attention to the fairness of health education and strengthen the supply of health literacy services in township areas. (3) It is critical to strengthen the public’s ability to discriminate network information and pay attention to scientific thinking cultivation. (4) Health literacy service providers must focus on the differences between public demands and improve the connotation of health literacy services.

Green tea consumption and risk of depressive symptoms: Results from the TCLSIH Cohort Study

BackgroundThe prospective studies on the effect of particular type of tea consumption, especially green tea, on depressive symptoms are limited. ObjectiveThe aim of this study is to investigate the prospective association between green tea consumption and depressive symptoms in a large general adult population. MethodsThis prospective cohort study investigated 7524 participants aged 25 to 90 years from May 2013 to December 2018 and they were free of cardiovascular disease, cancer, and depressive symptoms at baseline. Green tea consumption was obtained through a validated food frequency questionnaire. Depressive symptoms were assessed by using the Self-Rating Depressive Scale (SDS). The association between green tea consumption and depressive symptoms was analyzed by Cox proportional hazards regression models. ResultsA total of 1064 first incident cases of depressive symptoms (SDS ≥45) occurred during 14,661 person-years of follow-up (median follow-up of 2.0 years). In the crude model, the hazard ratios (95% confidence intervals) were 1.00 (reference), 0.95 (0.81, 1.12), 0.97 (0.83, 1.14) and 0.95 (0.79, 1.14), respectively. After adjusting for demographic characteristics, lifestyle factors, and dietary intake, the multivariable adjusted hazard ratios (95% confidence intervals) were 1.00 (reference), 0.88 (0.74, 1.05), 0.84 (0.69, 1.02) and 0.78 (0.63, 0.97), respectively. ConclusionsThe prospective study suggests that frequent green tea consumption is associated with a decreased risk of depressive symptoms in the general Chinese population.

Abnormal fasting blood glucose enhances the risk of long-term exposure to air pollution on dyslipidemia: A cross-sectional study

Both long-term exposure to air pollution and abnormal fasting blood glucose (FBG) are linked to dyslipidemia prevalence. However, the joint role of air pollution and FBG on dyslipidemia remains unknown clearly. In this study, we aimed to test whether abnormal FBG could enhance the risks of long-term exposure to air pollutants on dyslipidemia in general Chinese adult population. The present study recruited 8917 participants from 4 cities in Hebei province, China. Participants' individual exposure to air pollutants was evaluated by the Empirical Bayesian Kriging statistical model in ArcGIS10.2 geographic information system. Dyslipidemia was defined according to Guidelines for the Prevention and Treatment of Dyslipidemia in Chinese Adults. Subjects were grouped into normal, prediabetes, diabetes according to FBG level. Generalized linear models were applied to analyze the interaction of air pollutants and FBG on dyslipidemia prevalence. The prevalence of dyslipidemia was 43.83% in our investigation. After adjusting all covariates, we found the risk of four air pollutants (PM2.5, PM10, NO2, SO2) on dyslipidemia prevalence was stronger as higher FBG level, and the adjusted odd ratio of interaction (ORinter (95% CI)) between PM2.5, PM10, NO2, SO2 and FBG levels on dyslipidemia was 1.171 (1.162, 1.189), 1.119 (1.111, 1.127), 1.124 (1.115, 1.130), 1.107 (1.098, 1.115), respectively. Stratified analyses indicated the modifying effects of FBG on the association of air pollution with dyslipidemia were stronger among male, less than 65 years old, overweight/obesity (all Pinter<0.1). Our study concluded that high FBG levels strengthened the risk of long-term exposure to air pollution on dyslipidemia, especially more noticeable in male, less than 65 years old, overweight.

The Association Between Hyperuricemia and Obesity Metabolic Phenotypes in Chinese General Population: A Retrospective Analysis.

PurposeSerum uric acid (UA) not only affects the development of obesity but also alters the metabolic status in obese subjects; thus we investigated the relationship between serum UA and the overweight/obese metabolic phenotypes.MethodsThe demographic, biochemical, and hematological data were collected for 12,876 patients undergoing routine physical examination, and 6,912 participants were enrolled in our study. Participants were classified into four obesity metabolic phenotypes according to their BMI and the presence of metabolic syndrome: metabolically healthy overweight/obese (MHOO), metabolically healthy and normal weighted (MHNW), metabolically abnormal and overweight/obese (MAOO), and metabolically abnormal but normal weighted (MANW). Univariate and multivariate logistic regression analysis, stratified analysis, and also interaction analysis were conducted to analyze the relationship between serum UA and obesity metabolic phenotypes.ResultsMultivariable logistic regression analysis showed that hyperuricemia was positively associated with MHOO, MANW, and MAOO phenotypes relative to MHNW. After adjusting for the confounding factors, the odds ratios (OR) for individuals with hyperuricemia to be MHOO, MANW, and MAOO phenotypes were 1.86 (1.42–2.45), 2.30 (1.44–3.66), and 3.15 (2.34–4.24), respectively. The ORs for having MHOO, MANW, and MAOO increased 6% [OR: 1.06 (1.05–1.07), P < 0.0001], 5% [OR: 1.05 (1.03–1.07), P < 0.0001], and 11% [OR: 1.11 (1.10–1.13), P < 0.0001] for each 10 unit (μmol/L) of increase in serum UA level. Stratification analysis as well as an interaction test showed that sex and age did not interfere with the association of hyperuricemia with each metabolic phenotype. In terms of the components of the metabolic syndrome, after adjusting for other confounding factors including all of the metabolic indicators except itself, hyperuricemia was positively associated with increased BMI [OR: 1.66 (1.32–2.09), P < 0.0001], hypertriglyceridemia [OR: 1.56 (1.21–2.02), P = 0.0006], and hypertension [OR: 1.22 (1.03–1.46), P = 0.0233], while it had no significant association with hyperglycemia and low HDL-C (all P > 0.05).ConclusionIn our study, we discovered that hyperuricemia was positively associated with MHOO, MANW, and MAOO phenotypes, and this relationship was independent of sex and age.

Progression-free survival at 3 years is a reliable surrogate for 5-year overall survival for patients suffering from locally advanced esophageal squamous cell carcinoma.

BackgroundDespite 3‐year survival being used as a primary endpoint in some randomized controlled trials (RCTs), limited evidence supports the use of intermediate endpoints to evaluate the effect of new therapies in esophageal squamous cell cancer (ESCC). This study aimed to systematically evaluate progression‐free survival at 3 years (3‐year PFS) and overall survival (OS) among patients with ESCC.MethodsWe identified 528 patients newly diagnosed with locally advanced ESCC who received definitive radiotherapy. OS was compared with an age‐ and sex‐matched general Chinese population using the standardized mortality ratio (SMR). Regression analysis was used to validate the correlation between PFS and OS using published data.ResultsThe annual risk of progression decreased to 11.5% after 3 years. Patients who did not achieve 3‐year PFS had a median postprogression survival (PPS) of 7.3 months, with a 5‐year OS rate of 9.6% and a SMR of 15.0 (95% confidence interval [CI], 12.9–17.5). Conversely, the SMR for patients who achieved 3‐year PFS was 0.9 (95% CI, 0.6–1.3). We observed a significant correlation between log hazard ratio (HR) (PFS) and log HR (OS) at the trial level (r = 0.89; 95% CI, 0.88–0.90). The strongest correlation was observed between 3‐year PFS and 5‐year OS in RCTs and retrospective studies.ConclusionsPatients exhibiting progression within 3 years experienced poor survival, whereas patients achieving 3‐year PFS had excellent outcomes. Our study supports 3‐year PFS as a reliable primary endpoint for study design and risk stratification in locally advanced ESCC.

Value of estimated pulse wave velocity to identify left ventricular hypertrophy prevalence: insights from a general population

BackgroundAortic stiffness shares a similar profile of risk factors with left ventricular hypertrophy (LVH) and can also lead to LVH by itself. Published data have demonstrated the correlation between aortic stiffness and LVH. Recent data have revealed estimated pulse wave velocity (ePWV) to be a simple and cost-effective marker of the severity of aortic stiffness. Our analysis aimed to explore the association between ePWV and LVH prevalence, and to investigate the incremental value of ePWV for the identification of LVH prevalence.MethodsThe present analysis based on a cross-sectional survey which included 11,597 participants from rural areas of southeastern China between Sep 2020 and Feb 2021. ePWV was formulated based on mean blood pressure and age according to a published algorithm.ResultsThe prevalence of LVH was 14.56%. With the adjustment of age, sex, education, income and physical activity level, current drinking and smoking status, BMI, waist circumference, serum creatinine, total cholesterol, high density cholesterol, mean blood pressure, fasting plasma glucose, anti-hypertensive therapy, anti-diabetic therapy, lipid-lowering therapy, and cardiovascular disease history, every standard deviation increment of ePWV associated with a 2.993 times risk of LVH prevalence. When dividing ePWV into quartiles, the top quartile had a 4.520 times risk of LVH prevalence when compared with the bottom quartile. Furthermore, smooth spline analysis displayed that the association was linear in the whole range of ePWV (p for non-linearity = 0.073). Additionally, subgroup analysis revealed the association was robust to sex, obesity and diabetes, and younger people and hypertensive population were more vulnerable to the increase of ePWV than their corresponding counterparts. Finally, ROC analysis showed a significant advancement when introducing ePWV into established risk factors (0.787 vs. 0.810, p for comparison < 0.001), and reclassification analysis also confirmed significant improvement from ePWV to identify LVH prevalence (category-free net reclassification analysis = 0.421, p < 0.001; integrated discrimination index = 0.023, p < 0.001).ConclusionOur analysis demonstrated a linear association between ePWV and LVH prevalence. Furthermore, our results suggest younger people and hypertensive population are more likely to have LVH prevalence with the increase of ePWV. More importantly, our findings implicate the incremental value of ePWV to optimize the identification of LVH prevalence in a general Chinese population.

IDF21-0198 Lens autofluorescence ratio, is associated with diabetes in the general Chinese population

Background: Advanced glycation end products (AGEs) play a major role in the pathogenesis of diabetes-related complications. The levels of AGEs in lens, detected by their autofluorescence, is increased in individuals with diabetes. Aim: The present study explored the relationship between lens fluorescence ratio (LFR) and diabetes in order to strengthen the understanding of the disease mechanism of diabetes and find new markers of diabetes. Method: In this cross-sectional study, 4705 participants were recruited from 8 provinces in China between September 2019 to January 2021. The biomicroscope (ClearPath DS‑120) was used to measured the LFR. Diabetes was ascertained by self-report history or based on WHO 1999 diagnostic criteria. Results: LFR was higher in individuals with diabetes than those without (23.27 ± 6.51 vs. 19.45 ± 5.08, p < 0.001). LFR correlated with fasting plasma glucose (FPG) (r = 0.30, P < 0.001), serum glycated haemoglobin A1c (HbA1c) (r = 0.29, P < 0.001) in the overall population, but stronger in the diabetes population. Participants in the highest quartile of LFR had over a 4-fold risk of diabetes compared with the lowest quartile (OR 4.28, 95% CI 3.32, 5.52, p < 0.001). Univariate analysis revealed that an increase in LFR of one percent was associated with a 1.13-fold higher odds of diabetes (OR 1.13, 95% CI 1.11, 1.15, p < 0.001) and this association became weakened after controlling for cardiometabolic factors (OR 1.06, 95% CI 1.04, 1.08, p < 0.001). Mediation analysis showed that, insulin resistance, which was assessed by triglyceride-glucose (TyG) index, may mediate the relationship between LFR and diabetes. The AUC value of LFR for screening diabetes was 0.673. Discussion: This multicenter cross-sectional study of a general community population shows that LFR is associated with the risk of diabetes, which can be independent of conventional risk factors, including age, sex, waist circumference, blood lipids, the metabolic syndrome, eGFR and HbA1c. Participants in the highest quartile of LFR had over a fourfold risk of diabetes compared with the lowest quartile in our study. After adjusting for age, sex, waist circumference, blood lipids, the metabolic syndrome, eGFR and HbA1c, participants in the highest quartile of LFR remain to have over a onefold risk of diabetes compared with the lowest quartile. Our research firstly showed that insulin resistance, which was assessed by TyG index, may mediate the positive relationship between LFR and diabetes by the mediation analysis. There is increasing evidence that AGEs are related to the development of insulin resistance. In the present study, the level of LFR in diabetic population was significantly higher than that in non-diabetic population, which was in agreement with previous findings. In this large population-based study we found that with the AUC value of LFR in identifying diabetes 0.673.

Familial hypercholesterolemia in China requires greater efforts

Familial hypercholesterolemia in China requires greater efforts

Indoor exposure to phthalates and its burden of disease in China.

China's profoundly rapid modernization in the past two decades has resulted in dramatic changes in indoor environmental exposures. Among these changes, exposure to phthalates has attracted increasing attention. We aimed to characterize indoor phthalate exposure and to estimate the disease burden attributable to indoor phthalate pollution from 2000 to 2017 in China. We integrated the national exposure level of indoor phthalates from literature through systematic review and Monte Carlo simulation. Dose-response relationships between phthalate exposure and health outcomes were obtained by systematic review and meta-analysis. Based on existing models for assessing probabilities of causation and a comprehensive review of available data, we calculated the disability-adjusted life years (DALYs) among the general Chinese population resulting from exposure to indoor phthalate pollution. We found that DnBP, DiBP, and DEHP were the most abundant phthalates in indoor environments of residences, offices, and schools with medians of national dust phase concentration from 74.5µg/g to 96.3µg/g, 39.6µg/g to 162.5µg/g, 634.2µg/g to 1,394.7µg/g, respectively. The national equivalent exposure for children to phthalates in settled dust was higher than that of adults except for DiBP and DnOP. Dose-response relationships associated with DEP, DiBP, DnBP, BBzP, and DEHP exposures were established. Between 2000 and 2017, indoor phthalate exposure in China has led to 3.32million DALYs per year, accounting for 0.90% of total DALYs across China. The annual DALY associated with indoor phthalate pollution in China was over 2000 people per million, which is about 2~3 times of the DALY loss due to secondhand smoke (SHS) in six European countries or the sum of the DALY loss caused by indoor radon and formaldehyde in American homes. Our study indicates a considerable socioeconomic impact of indoor phthalate exposure for a modernizing human society. This suggest the need for relevant national standard and actions to reduce indoor phthalate exposure.

The effect of nature exposure, nature connectedness on mental well-being and ill-being in a general Chinese population

Exposure to nature is associated with various mental health benefits. Nature connectedness (NC), a psychological construct that measures individuals’ subjective sense of connection to nature, is found to influence the relationship between nature exposure and mental health, including well-being and ill-being. However, studies from non-Western cultures have only examined either nature exposure and mental health or NC and mental health, with little research investigating the relationship among all three in a single study. Based on a face-to-face survey in Guangzhou (N = 863), this study investigates the relationship among nature exposure (greenspace visitation frequency, duration, and greenspace accessibility), NC, and mental well-being and ill-being. Based on the results, NC is stronger than nature exposure in predicting mental well-being, while greenspace visitation frequency and duration are stronger than NC in predicting ill-being. Having a higher-than-average NC is associated with a 7% increase in feelings of worthwhileness, a 6.4% increase in life satisfaction, and a 2.5% decrease in depression risk. NC could function as both mediator and moderator, depending on the specific nature exposure–mental health link examined. Future studies are required to understand the complex interaction of nature exposure, NC, and mental health. Our study indicates that a shift in policymaking to enhance NC is recommended to achieve the related psychological benefits. To this end, research on the influencing factors of NC (e.g., characteristics of nature experiences) and effective interventions to cultivate NC are required.

Psychometric Properties of the Chinese Version of the Brief State Rumination Inventory.

State rumination, unlike trait rumination which is described as a persistent and stable response style, is usually triggered by a specific stressful event and causes negative emotions within a short period of time. The measurement methods of trait rumination, such as the ruminative response scale (RRS), are therefore not fully applicable to state rumination. Recently, researchers have developed the brief state rumination inventory (BSRI) to characterize state rumination, addressing the gap in the field of accurate measurement of state rumination. To develop such an effective tool in the Chinese context, we developed a Chinese version of the BSRI and tested its psychometric properties. Two studies were conducted to address the research goal. In Study 1, we recruited 512 subjects, each of whom completed the Chinese version of the BSRI, RRS, emotional regulation questionnaire (ERQ), depression–anxiety–stress scale (DASS), and positive and negative affect scale (PANAS). Results showed that the scores of the BSRI were positively correlated with all other scale scores (ps < 0.001), and the correlation with the RRS was the highest, indicating that the BSRI showed good convergent validity. Additionally, the Cronbach's alpha coefficient for the Chinese version of the BSRI was 0.93. Study 2 aimed to examine the ecological validity of the Chinese version of the BSRI. We recruited another 54 subjects who were randomly divided into two groups, with 27 in the rumination induction group and 27 in the distraction group, and recorded the BSRI scores of the two groups before and after a specific experiment. We found there was a significant increase in BSRI scores after rumination induction (t = 3.91, p < 0.001), while there was no significant difference in the concrete distraction group before and after the experiment (t = 0.70, p = 0.48). In sum, the Chinese version of the BSRI showed good reliability and validity for assessing state rumination in the general Chinese population.

Cystatin C-based estimated GFR performs best in identifying individuals with poorer survival in an unselected Chinese population: results from the China Health and Retirement Longitudinal Study (CHARLS).

ABSTRACTBackgroundThe decline in estimated glomerular filtration rate (eGFR) has been reported as a risk factor for mortality. However, it remains unclear which eGFR equation is most useful in predicting death in the general Chinese population.MethodsThe association was examined between eGFR and all-cause mortality using data from the China Health and Retirement Longitudinal Study. Participants with complete data in 2011 and survival follow-up in 2013, 2015 and 2018 were included and analyzed in three separate cohorts, which included 8160, 8154 and 8020 participants, respectively. Logistic regression analyses, receiver operating characteristic curve, continuous net reclassification improvement (NRI) and integrated discrimination improvement (IDI) were computed to compare the discriminative power of eGFR derived by abbreviated Modification of Diet in Renal Disease (MDRD), Chinese coefficient–modified MDRD (MDRD-CN), Japanese coefficient–modified MDRD (MDRD-JPN), CKD-EPIcr, Japanese coefficient–modified CKD-EPIcr (CKD-EPIcr-JPN), CKD-EPIcys, CKD-EPIcr-cys, CKD-EPIcr fit without race and CKD-EPIcr-cys fit without race.ResultsA decreased eGFR (<60 ml/min/1.73 m2) was significantly associated with increased mortality at 2 years no matter which eGFR equation was used (odds ratio ranged between 2.02 and 4.94, all P < 0.001). The association remained significant after adjusting multiple covariates when MDRD-CN, CKD-EPIcys or CKD-EPIcr-cys fit without race was used. CKD-EPIcys showed the highest discriminative power for mortality (area under the curve 0.744 ± 0.40) and outperformed other equations (all P < 0.001) except for CKD-EPIcr-cys. The overall risk classification was also improved when the CKD-EPIcys equation was adopted as indicated by continuous NRI and IDI. Similar results were observed at 4 and 7 years.ConclusionsA decline in eGFR by all equations could predict poorer survival, among which the CKD-EPIcys equation showed the best discriminative power.

The Prevention Behaviors and Impact Mechanisms Among Different Chinese Social Classes at the Early Stage of COVID-19 Pandemic.

BackgroundWhether the pandemic can be effectively prevented and controlled depends on the entire population’s adherence to recommendations and preventive behaviors. The present study aimed to investigate the social class differences and internal mechanisms of prevention behaviors in the COVID-19 pandemic.MethodsWe conducted an online cross-sectional survey among the general Chinese population at the early stage of the COVID-19 pandemic. The survey website’s subscribers could access the questionnaire through the Tencent online platform, and a total of 1948 participants voluntarily completed it. Most of the participants were female (n = 1257, 64.528%), between the ages of 18–29 (n = 999, 51.284%), university graduates (n = 1015, 52.105%), and had an annual family income below 100,000 yuan (n = 1119, 57.444%). The differences in COVID-19 prevention behaviors among different social classes, the mediating role of infectious threat perception and the moderating role of perceived epidemic transparency were examined.Results1) There were significant differences in prevention behaviors among different social classes. 2) The level of infectious threat perception played a mediating role in the relationship between social class and prevention behavior. When the individuals were from a lower social class, the level of threat perception and the level of COVID-19 prevention behaviors were also lower. 3) Perceived epidemic transparency played a moderating role in the relationship between social class and COVID-19 prevention behavior. It also played a moderating role in the relationship between social class and infectious threat perception.ConclusionIn the implementation of epidemic prevention and control measures, different social classes should be targeted and guided differently. In particular, lower-class individuals can be guided by improving the perceptions of epidemic transparency and infectious threat.

Association Between Atrial Fibrillation and the Risk of Cardiovascular Mortality Among Elderly Adults With Ischemic Stroke in Northeast China: A Community-Based Prospective Study.

BackgroundElderly people are susceptible to atrial fibrillation (AF) and ischemic stroke (IS); however, less information is known about the association between AF and the risk of cardiovascular disease (CVD) mortality in elderly population with IS. We aimed to investigate the features of AF among aged people with IS and to illustrate whether AF accounted for CVD mortality.MethodsAt baseline, 790 patients with IS were enrolled from the general northeast Chinese elderly population (>60 years) between September 2017 to March 2019. The prevalence, awareness, and treatment of AF in each age group were analyzed, as well as major-related cardiovascular risk factors. The population was followed until July 31, 2021, and information on CVD death was obtained.ResultsA total of 25 people had AF, and the prevalence of AF in the elderly population with IS was 3.2%. The AF prevalence grew along with age from 1% (60–64 years) to 4.3% (70–74 years) and 4.2% (≥75 years), which was higher in the urban residents than in the rural residents (5.7 vs. 2.2%, P = 0.014). The awareness and treatment rates of patients with AF were 80 and 8%. After a median follow-up period of 3.3 years, 58 subjects died due to CVD and 5 subjects were accompanied with AF (rate 70.6/1,000 person-years). Elderly IS patients with AF had a 3.65-fold increased risk of CVD death in the fully adjusted model when compared with non-AF participants.ConclusionThe AF prevalence increased with age among the elderly population with IS. Moreover, elderly patients with IS in northeast China with AF had a higher CVD mortality. Therefore, early screening and prompt management of AF in elderly population with IS in northeast China are required.

Organ meat consumption and risk of nonalcoholic fatty liver disease: the TCLSIH study.

Prospective cohort studies linking organ meat consumption and nonalcoholic fatty liver disease (NAFLD) are limited, especially in Asian populations. This study aimed to prospectively investigate the association between organ meat consumption and risk of NAFLD in a general Chinese adult population. This prospective cohort study included a total of 15,568 adults who were free of liver disease, cardiovascular disease, and cancer at baseline. Dietary information was collected at baseline using a validated food frequency questionnaire. NAFLD was diagnosed by abdominal ultrasound after excluding other causes related to chronic liver disease. Cox proportional regression models were used to assess the association between organ meat consumption and risk of NAFLD. During a median of 4.2 years of follow-up, we identified 3,604 incident NAFLD cases. After adjusting for demographic characteristics, lifestyle factors, vegetable, fruit, soft drink, seafood, and red meat consumption, the multivariable hazard ratios (95% confidence intervals) for incident NAFLD across consumption of organ meat were 1.00 (reference) for almost never, 1.04 (0.94, 1.15) for tertile 1, 1.08 (0.99, 1.19) for tertile 2, and 1.11 (1.01, 1.22) for tertile 3, respectively (P for trend <0.05). Such association did not differ substantially in the sensitivity analysis. Our study indicates that organ meat consumption was related to a modestly higher risk of NAFLD among Chinese adults. Further investigations are needed to confirm this finding.

Population Norms for SF-6Dv2 and EQ-5D-5L in China.

To derive the population norms for EQ-5D-5L and SF-6Dv2 among the Chinese general population. Data collected alongside the Chinese SF-6Dv2 valuation study conducted between June and September 2019 were used. SF-6Dv2 and EQ-5D-5L, as well as social-demographic characteristics and self-reported chronic conditions, were collected through face-to-face interviews among a representative sample of the general population stratified by age, gender, education, and area of residence (urban/rural) in China. SF-6Dv2 and EQ-5D-5L responses were converted to utility values using the corresponding Chinese value sets. Utility values for both measures and EQ VAS scores were summarized by age and gender, and then described by different social-demographic characteristics and chronic conditions. A total of 3397 respondents (51.2% male, age range 18-90 years) were included. 420 (12.4%) and 1726 (50.8%) respondents reported no problems on all SF-6Dv2 and EQ-5D-5L dimensions, respectively. The mean [standard deviation (SD)] utility values were 0.827 (0.143) for SF-6Dv2 and 0.946 (0.096) for EQ-5D-5L. The mean (SD) EQ VAS score was 87.1 (11.5). Respondents who resided in rural areas, were married, and were employed had higher utility values. Respondents with memory-related diseases or stroke had lower utility values than those with other chronic conditions. Utility values decreased with the increase in the number of chronic conditions. This study reports the first Chinese population norms for the EQ-5D-5L and SF-6Dv2 derived using a representative sample of the Chinese general population. The norms can be used as references for economic evaluations and healthcare decision-making in China.

Usefulness of estimated pulse wave velocity for identifying prevalent coronary heart disease: findings from a general Chinese population

BackgroundAortic stiffness and coronary heart disease (CHD) share a similar spectrum of risk factors; previous studies have identified the association between aortic stiffness and CHD. Recent studies have demonstrated estimated pulse wave velocity (ePWV) as a simple and easy-acquired indicator of aortic stiffness. Our work aims to evaluate the association between ePWV and the prevalence of CHD and assess the value of ePWV for the identification of prevalent CHD.MethodsThe current cross-sectional work included 7012 subjects from rural areas of southeastern China between September 2020 and February 2021. ePWV was calculated from age and mean blood pressure by specific algorithm.ResultsThe prevalence of CHD in our population was 3.58% (251 patients among 7012 subjects). After adjusting for age, sex, education, income and exercise level, current smoking and drinking status, body mass index, waist circumference, fasting plasma glucose, total cholesterol, high density lipoprotein, estimated glomerular filtration rate and cerebrovascular diseases, each standard deviation increment of ePWV would produce an additional 37.8% risk of prevalent CHD. Moreover, after dividing ePWV into quartiles, the 4th quartile of ePWV showed a significant risk of prevalent CHD (OR (95% CI): 3.567 (1.963–6.479)) when compared with the 1st quartile. Additionally, the subgroup analysis showed the association between ePWV and prevalent CHD was robust to several common risk factors of CHD, including age, sex, body mass index, hypertension, diabetes and reduced estimated glomerular filtration rate. Finally, the area under curve (AUC) displayed an improvement when adding ePWV into common CHD risk factors (0.705 vs. 0.718. P = 0.044). Consistently, net reclassification index (0.436, 95% CI: 0.301–0.571, P < 0.001) and integrated discrimination index (0.004, 95% CI: 0.001–0.006, P = 0.002) demonstrated the value of ePWV to optimize the identification of prevalent CHD in the general population.ConclusionThe present analysis implicates the robust association between ePWV, a simple, rapid, and practical marker of aortic stiffness, and prevalent CHD in the general Chinese population. More importantly, the results suggest the value of ePWV as a potential marker to improve the identification of prevalent CHD.