Objective Elevated depressive symptoms are well-documented among geriatric adults with cardiovascular disease(CVD);however,few studies have accounted for long-term cumulative depressive symptom exposure.This study det...Objective Elevated depressive symptoms are well-documented among geriatric adults with cardiovascular disease(CVD);however,few studies have accounted for long-term cumulative depressive symptom exposure.This study determined the relationship between cumulative depressive symptoms and CVD.Methods Individual participant data were obtained from the China Health and Retirement Longitudinal Study(CHARLS)and Health and Retirement Study(HRS).Eligible participants had access to assessment information on depressive symptoms and had no history of CVD at baseline.Long-term cumulative depressive symptoms were estimated by calculating the area under the curve based on the Center for Epidemiological Studies Depression Scale.Results Herein,8,861 participants from CHARLS(mean age:58.58 years;male:48.6%)and 7,284 from HRS(60.94 years;35.0%)were enrolled.The median follow-up period was 5 years for the CHARLS and10 years for the HRS.Compared with the first quartile of cumulative depressive symptoms,the HRs(95%CI)in the fourth quartile were 1.73(1.48,2.02)for predicting CVD(P<0.001),1.83(1.52,2.19)for heart disease(P<0.001),1.53(95%CI:1.17,1.99)for stroke(P=0.002)in CHARLS.For HRS,the HRs(95%CI)were 1.41(95%CI:1.27,1.57;P<0.001),1.42(95%CI:1.26,1.59;P<0.001),and 1.30(95%CI:1.06,1.58;P=0.010)respectively.Strong dose-response relationships were observed,with similar results for the two cohorts.Conclusion Long-term cumulative depressive symptoms were significantly associated with incident CVD in middle-aged and older adults,providing insights into controlling long-term depressive symptoms to improve this cohort's health.展开更多
Background:Despite highly effective vaccines against SARS-CoV-2,COVID-19 vaccine hesitancy persisted in some populations in England during the pandemic,with rates and motivations for hesitancy varying by demographic g...Background:Despite highly effective vaccines against SARS-CoV-2,COVID-19 vaccine hesitancy persisted in some populations in England during the pandemic,with rates and motivations for hesitancy varying by demographic group.Addressing the drivers of vaccine hesitancy through targeted interventions in hesitant groups is a public health priority for better and more rapid control of disease spread.We aimed to characterise the determinants and subtypes of vaccine hesitancy and identify more persistent forms of hesitancy via analysis of vaccine uptake in a large cross-sectional cohort with linked National Health Service(NHS)data.展开更多
Existing evidence suggests residential greenness is beneficial to human,while no research to date explored the associations of greenness with age-related macular degeneration(AMD).To evaluate the association of greenn...Existing evidence suggests residential greenness is beneficial to human,while no research to date explored the associations of greenness with age-related macular degeneration(AMD).To evaluate the association of greenness with AMD,modification and mediation effect of air pollution,we conducted this prospective study.We con-structed weighted quantile sum(WQS)index as co-exposure to nitrogen oxides(NO_(x)),particulate matter<2.5μm(PM_(2.5)),particulate matter<10μm(PM10).Stratified Cox regression models were applied to test the effect of exposure.Effect modification of air pollution was assessed.Stratified Cox models through the indirect method and Aalen additive risk models were used in mediation analysis.Over median follow-up of 11.67 years,4596 AMD events were ascertained.Hazard ratios(HRs)and 95%confidence intervals(95%CIs)of incident AMD for pollution per interquartile range(IQR)increment were 1.10(1.04–1.16)for nitrogen dioxide(NO_(2)),1.09(1.03–1.15)for NO_(x),1.14(1.05–1.24)for PM_(2.5),1.13(1.05–1.21)for PM10.The HR(95%CI)of AMD associated with greenness 1000 m buffer per IQR increment was 0.91(0.86–0.97),300 m buffer was 0.94(0.89–0.99).The as-sociation between greenness 1000 m and AMD was 28.59%,44.77%,35.59%,32.31%and 27.08%mediated by the decreased WQS index,NO_(2),NO_(x),PM_(2.5) and PM10,respectively.Increased greenness was associated with lower AMD incidence,and air pollution partly mediate it,which implies that interventions aimed at improving air quality and increasing greenness could have a dual benefit in mitigating AMD risk.展开更多
Background:To determine whether initiating a glucagon-like peptide-1 receptor agonist(GLP-1 RA)within 3 months of type 2 diabetes(T2DM)diagnosis alters the subsequent risk of overall and site-specific cancer and wheth...Background:To determine whether initiating a glucagon-like peptide-1 receptor agonist(GLP-1 RA)within 3 months of type 2 diabetes(T2DM)diagnosis alters the subsequent risk of overall and site-specific cancer and whether this association differs by baseline body-mass index(BMI).Methods:This retrospective cohort study used electronic health records from the TriNetX U.S.research network.Adults aged 20 years or older diagnosed with T2DM between 2016 and 2024 were included if they received any hypoglycemic agents within 3 months before and after diagnosis.Following 1:1 propensity score matching,both the GLP-1 RA user and non-user groups included 183,264 patients.The study outcome was defined as a diagnosis of malignant neoplasms.Hazard ratios(HRs)for overall and site-specific cancer risk were estimated using Cox proportional hazards models.Kaplan–Meier analysis and stratified analysis by BMI were performed.Results:Early GLP-1 RA use demonstrated a modest but significant association with reduced overall cancer risk(HR 0.93;95%CI:0.90–0.96).Reduced risks were noted for cancers of the digestive(HR 0.81),respiratory(HR 0.66),and female genital(HR 0.87)systems.In stratified analysis,benefits were more pronounced in patients with BMI≥30,particularly for pancreatic and colorectal cancers.Conclusion:Early initiation of GLP-1 receptor agonists in patients with diagnosed T2DM was associated with a modest reduction in overall cancer risk,particularly among individuals with obesity.These findings highlight the dual metabolic and oncologic value of prompt GLP-1 RA therapy.展开更多
Vitamin D deficiency(VDD)represents a significant nutritional concern among children and adolescents.The estimated prevalence of VDD in China is 46.8%in this population^([1]).VDD during childhood and adolescence has b...Vitamin D deficiency(VDD)represents a significant nutritional concern among children and adolescents.The estimated prevalence of VDD in China is 46.8%in this population^([1]).VDD during childhood and adolescence has been associated with the onset of various conditions,including acute respiratory infections,asthma,atopic dermatitis,and food allergies^([2]).Multiple factors,including age,sun exposure,adiposity,and genetics,influence vitamin D levels^([2,3]).Increasing attention has been directed toward understanding the environmental determinants that may influence vitamin D status.Given the potential of metallic pollutants to disrupt endocrine function and their ubiquity in the environment,investigating the effects of metal exposure on human vitamin D status,particularly in vulnerable populations,is imperative.展开更多
Cohort studies are important epidemiological methods to investigate associations between environmental factors,individual characteristics,and disease or other health outcomes.As a paradigm of cohort studies,the Framin...Cohort studies are important epidemiological methods to investigate associations between environmental factors,individual characteristics,and disease or other health outcomes.As a paradigm of cohort studies,the Framingham Heart Study(FHS)is the longest-running cardiovascular epidemiological study,starting in 1948.展开更多
BACKGROUND Although the link between cardiovascular disease(CVD)and various cancers is well-established,the relationship between CVD risk and colorectal cancer(CRC)remains underexplored.AIM To elucidate the relationsh...BACKGROUND Although the link between cardiovascular disease(CVD)and various cancers is well-established,the relationship between CVD risk and colorectal cancer(CRC)remains underexplored.AIM To elucidate the relationship between CVD risk scores and CRC incidence.METHODS In this population-based cohort study,participants from the 2009 National Health Checkup were followed-up until 2020.The cardiovascular(CV)risk score was calculated as the sum of risk factors(age,family history of coronary artery disease,hypertension,smoking status,and high-density lipoprotein levels)with high-density lipoprotein(≥60 mg/dL)reducing the risk score by one.The primary outcome was incidence of newly diagnosed CRC.RESULTS Among 2526628 individuals,30329 developed CRC during a mean follow-up of 10.1 years.Categorized by CV risk scores(0,1,2,and≥3).CRC risk increased with higher CV risk scores after adjusting for covariates[(hazard ratio=1.155,95%confidence interval:1.107-1.205)in risk score≥3,P<0.001].This association individuals not using statins.Moreover,even in participants without diabetes,a higher CV risk was associated with an increased CRC risk.CONCLUSION Increased CV risk scores were significantly associated with higher CRC risk,especially among males,younger populations,and non-statin users.Thus,males with a higher CV risk score,even at a younger age,are recommended to control their risk factors and undergo individualized CRC screening.展开更多
Objective To investigate the association between ABO blood types and gestational diabetes mellitus(GDM)risk.Methods A prospective birth cohort study was conducted.ABO blood types were determined using the slide method...Objective To investigate the association between ABO blood types and gestational diabetes mellitus(GDM)risk.Methods A prospective birth cohort study was conducted.ABO blood types were determined using the slide method.GDM diagnosis was based on a 75-g,2-h oral glucose tolerance test(OGTT)according to the criteria of the International Association of Diabetes and Pregnancy Study Groups.Logistic regression was applied to calculate the odds ratios(ORs)and 95%confidence intervals(CIs)between ABO blood types and GDM risk.Results A total of 30,740 pregnant women with a mean age of 31.81 years were enrolled in this study.The ABO blood types distribution was:type O(30.99%),type A(26.58%),type B(32.20%),and type AB(10.23%).GDM was identified in 14.44%of participants.Using blood type O as a reference,GDM risk was not significantly higher for types A(OR=1.05)or B(OR=1.04).However,women with type AB had a 19%increased risk of GDM(OR=1.19,95%CI=1.05–1.34;P<0.05),even after adjusting for various factors.This increased risk for type AB was consistent across subgroup and sensitivity analyses.Conclusion The ABO blood types may influence GDM risk,with type AB associated with a higher risk.Incorporating it—either as a single risk factor or in combination with other known factors—could help identify individuals at risk for GDM before or during early pregnancy.展开更多
Lung cancer, the leading cause of cancer deaths worldwide and in China, has a 19.7% five-year survival rate due to terminal-stage diagnosis^([1-3]).Although low-dose computed tomography(CT) screening can reduce mortal...Lung cancer, the leading cause of cancer deaths worldwide and in China, has a 19.7% five-year survival rate due to terminal-stage diagnosis^([1-3]).Although low-dose computed tomography(CT) screening can reduce mortality, high false positive rates can create economic and psychological burdens.展开更多
OBJECTIVE The emergence of evolving variants of Coronavirus disease 2019(COVID-19)has fostered the need for change of newer and adaptive treatments for these infections.During the COVID-19 pandemic and persists,tradit...OBJECTIVE The emergence of evolving variants of Coronavirus disease 2019(COVID-19)has fostered the need for change of newer and adaptive treatments for these infections.During the COVID-19 pandemic and persists,traditional Chinese medicine(TCM)herbs exhibit significant bioactivity and therapeutic effect.This study is aimed to evaluate the efficacy of four TCM preparations on 28-day mortality risk of patients and changes of the laboratory indicators.METHODS The retrospective cohort study included patients with COVID-19 who were admitted to the Jiangsu Province Hospital of Chinese Medicine from December 15,2022 to January 15,2023,and those died within 48 hours of admission or cannot be tracked for outcomes were excluded.The primary outcome was survival status in 28 days(death or survival)starting from the day of admission.The second outcomes were laboratory indicators,including absolute lymphocyte count,lactate dehydrogenase,creatinine,and blood urea nitrogen.Binary logistic regressions were used to estimate the effect of TCM preparations on the primary and secondary outcomes in main analysis.Meanwhile,heterogeneity and robustness of results from main analysis were assessed by subgroup analyses and multiple sensitivity analyses.RESULTS 1816 eligible patients were included in analysis dataset,including 573 patients received standard care(control group)and 1243 patients received TCM preparations(hospital preparation group).The 28-day mortality rate of hospital preparation group was lower than that of control group(4.75%vs.14.83%),and the difference was statistically significant(χ^(2)=54.666,P<0.001).The risk of 28-day mortality was 0.535 times lower in the hospital preparation group as compared with the control group(OR=0.46,95%CI:0.305-0.708,P<0.001)showed by multivariable binary logistic regressions.Subgroup analyses showed that taking TCM preparations reduced the 28-day mortality risk.Sensitivity analyses demonstrated that the results of the main analysis for primary outcomes were robust.For secondary outcomes,the risk of abnormal absolute lymphocyte counts at discharge in the hospital preparation group decreased by 0.284 times(OR=0.703,95%CI:0.515-0.961,P=0.027).CONCLUSION Compared with standard of care,taking four hospital preparations including Kanggan Heji,Feining Heji,Qishen Gubiao Keli,and Qianghuo Qushi Qingwen Heji decreased risk of 28-day mortality among hospitalized COVID-19 patients.TCM therapy achieves adequate therapeutic effects in COVID-19.展开更多
BACKGROUND Patients with BRAF V600E mutant metastatic colorectal cancer(mCRC)have a low incidence rate,poor biological activity,suboptimal response to conventional treatments,and a poor prognosis.In the previous cohor...BACKGROUND Patients with BRAF V600E mutant metastatic colorectal cancer(mCRC)have a low incidence rate,poor biological activity,suboptimal response to conventional treatments,and a poor prognosis.In the previous cohort study on mCRC conducted by our team,it was observed that integrated Chinese and Western medicine treatment could significantly prolong the overall survival(OS)of patients with colorectal cancer.Therefore,we further explored the survival benefits in the population with BRAF V600E mutant mCRC.AIM To evaluate the efficacy of integrated Chinese and Western medicine in the treatment of BRAF V600E mutant metastatic colorectal cancer.METHODS A cohort study was conducted on patients with BRAF V600E mutant metastatic colorectal cancer admitted to Xiyuan Hospital of China Academy of Chinese Medical Sciences and Traditional Chinese Medicine Hospital of Xinjiang Uygur Autonomous Region from January 2016 to December 2022.The patients were divided into two cohorts.RESULTS A total of 34 cases were included,with 23 in Chinese-Western medicine cohort(cohort A)and 11 in Western medicine cohort(cohort B).The median overall survival was 19.9 months in cohort A and 14.2 months in cohort B,with a statistically significant difference(P=0.038,hazard ratio=0.46).The 1-3-year survival rates were 95.65%(22/23),39.13%(9/23),and 26.09%(6/23)in cohort A,and 63.64%(7/11),18.18%(2/11),and 9.09%(1/11)in cohort B,respectively.Subgroup analysis showed statistically significant differences in median OS between the two cohorts in the right colon,liver metastasis,chemotherapy,and first-line treatment subgroups(P<0.05).CONCLUSION Integrated Chinese and Western medicine can prolong the survival and reduce the risk of death in patients with BRAF V600E mutant metastatic colorectal cancer,with more pronounced benefits observed in patients with right colon involvement,liver metastasis,combined chemotherapy,and first-line treatment.展开更多
BACKGROUND Depression is a significant risk factor for diabetes,particularly type 2 diabetes.However,depressive symptoms differ from clinical depression.Previous research has not fully considered the relationship betw...BACKGROUND Depression is a significant risk factor for diabetes,particularly type 2 diabetes.However,depressive symptoms differ from clinical depression.Previous research has not fully considered the relationship between the trajectory of depressive symptoms and the risk of developing diabetes over time.AIM To investigate the association between depressive symptoms,their trajectories,and the risk of developing diabetes in two prospective cohort studies.METHODS In the first phase we analyzed the association between depressive symptoms and the risk of developing diabetes separately using the Health and Retirement Study(HRS).Depressive symptom trajectories were assessed by examining changes in depressive symptoms at baseline and again 8 years later.We then identified specific depressive symptom trajectories that increased the risk of diabetes in the second phase.Finally,we confirmed the association between depressive symptoms and their trajectories with diabetes risk using the English Longitudinal Study of Ageing(ELSA)as a validation study.Depressive symptom trajectories were categorized into five states based on changes in the modified 8-item Center for Epidemiological Studies-Depression scores:Persistently high;increasing;fluctuating;decreasing;and persistently low.Diabetes mellitus was defined as self-reported,physician-diagnosed diabetes.Cox proportional hazards models were used to assess hazard ratios(HR)and 95%confidence intervals(CI),adjusting for potential confounders.RESULTS In the first phase a total of 27658 participants were included(HRS:18633,ELSA:9025),among whom 6582 had depressive symptoms(HRS:4547,ELSA:2035),6407 had somatic depressive symptoms(HRS:4414,ELSA:1993),and 26415 had cognitive-affective depressive symptoms(HRS:17755,ELSA:8660).We found that overall depressive symptoms(HRS:HR=1.14,95%CI:1.07-1.22;ELSA:HR=1.18,95%CI:1.03-1.34)and somatic depressive symptoms(HRS:HR=1.14,95%CI:1.07-1.22;ELSA:HR=1.25,95%CI:1.10-1.42)increased the risk of diabetes,while cognitive depressive symptoms were not associated with diabetes risk.Over an 8-year follow-up we identified 19729 trajectories of overall,somatic,and cognitive-affective depressive symptoms(HRS:13918,ELSA:5811).In the second phase we found that persistently high(HRS:HR=1.22,95%CI:1.06-1.40,ELSA:HR=1.54,95%CI:1.16-2.05 in total and HRS:HR=1.24,95%CI:1.07-1.43,ELSA:HR=1.79,95%CI:1.36-2.35 in somatic)and fluctuating(HRS:HR=1.09,95%CI:1.01-1.17,ELSA:HR=1.33,95%CI:1.14-1.55 in total and HRS:HR=1.10,95%CI:1.02-1.18,ELSA:HR=1.31,95%CI:1.13-1.53 in somatic)trajectories of overall and somatic depressive symptoms increased the risk of diabetes,while increasing trajectories may also raise diabetes risk.However,decreasing trajectories were not associated with diabetes risk.Cognitive-affective depressive symptoms showed no association with diabetes risk regardless of trajectory changes.Sensitivity analyses confirmed the reliability of the findings.CONCLUSION Persistently high and fluctuating trajectories of overall and somatic depressive symptoms increased the risk of diabetes,while decreasing trajectories were not associated with diabetes risk.In contrast trajectories of cognitiveaffective depressive symptoms show no relationship with diabetes risk.Focusing on depressive symptom trajectories,particularly those of somatic depressive symptoms,represented a viable strategy for future diabetes prevention.展开更多
Objective To investigate hypertension(HTN)trends,key risk factors,and gender disparities in rural China,and to propose targeted strategies for improving HTN control in resource-limited settings.Methods This longitudin...Objective To investigate hypertension(HTN)trends,key risk factors,and gender disparities in rural China,and to propose targeted strategies for improving HTN control in resource-limited settings.Methods This longitudinal study used data from the Henan Rural Cohort Study,including baseline(2015–2017;n=39,224)and follow-up(2018–2022;n=28,621)participants.HTN was defined as systolic/diastolic blood pressure≥140/90 mmHg,self-reported diagnosis,or use of antihypertensive medication.Severity was classified using a 7-tier blood pressure(BP)staging system(optimal,normal,high normal,and HTN stages 1–4).A generalized linear mixed-effects model(GLMM)identified associated risk factors.Results HTN prevalence increased modestly from 32.7%(95%CI:32.2–33.2)to 33.9%(95%CI:33.3%–34.4%).Awareness and treatment improved from 20.1%to 25.3%,and from 18.8%to 24.4%,respectively,but control rates remained low(6.2%to 12.3%).After adjustment,women had a 1.53-fold higher HTN risk than men(OR=1.53,95%CI:1.43–1.63),revealing gender-specific trends.Key risk factors included alcohol use(OR=1.37,95%CI:1.27–1.47)and overweight status(OR=1.76,95%CI:1.66–1.86).BP staging showed an increase in optimal BP(42.3%to 45.8%),but stagnant management of advanced HTN stages.Conclusion Hypertension in rural China is shaped by behavioral risk factors and healthcare access gaps.Gender-sensitive,community-based interventions,including task-shifting models,are necessary to mitigate the growing burden of hypertension.展开更多
Objective The relationship between fish consumption and stroke is inconsistent,and it is uncertain whether this association varies across predicted stroke risks.Methods A cohort study comprising 95,800 participants fr...Objective The relationship between fish consumption and stroke is inconsistent,and it is uncertain whether this association varies across predicted stroke risks.Methods A cohort study comprising 95,800 participants from the Prediction for Atherosclerotic Cardiovascular Disease Risk in China project was conducted.A standardized questionnaire was used to collect data on fish consumption.Participants were stratified into low-and moderate-to-high-risk categories based on their 10-year stroke risk prediction scores.Hazard ratios(HRs)and 95%confidence intervals(CIs)were estimated using Cox proportional hazard models and additive interaction by relative excess risk due to interaction(RERI),attributable proportion(AP),and synergy index(SI).Results During 703,869 person-years of follow-up,2,773 incident stroke events were identified.Higher fish consumption was associated with a lower risk of stroke,particularly among moderate-to-high-risk individuals(HR=0.53,95%CI:0.47-0.60)than among low-risk individuals(HR=0.64,95%CI:0.49-0.85).A significant additive interaction between fish consumption and predicted stroke risk was observed(RERI=4.08,95%CI:2.80-5.36;SI=1.64,95%CI:1.42-1.89;AP=0.36,95%CI:0.28-0.43).Conclusion Higher fish consumption was associated with a lower risk of stroke,and this beneficial association was more pronounced in individuals with moderate-to-high stroke risk.展开更多
BACKGROUND Gamma-glutamyl transferase(GGT)is a known surrogate marker of hepatic dysfunction and oxidative stress.It has recently been reported to be associated with metabolic diseases,cardiovascular diseases,and mali...BACKGROUND Gamma-glutamyl transferase(GGT)is a known surrogate marker of hepatic dysfunction and oxidative stress.It has recently been reported to be associated with metabolic diseases,cardiovascular diseases,and malignancies including pancreatic cancer.However,data on its association with pancreatic cystic neo-plasm(PCN),is unknown.AIM To investigate the association of GGT with the incidence of PCN.METHODS In this nationwide retrospective cohort study,participants who received general health checkup by National Health Insurance Service in 2009 were included.Newly diagnosed PCNs from one year after the checkup to 2020 were identified.Participants were divided into quartiles based on GGT levels.Multivariable cox proportional hazard models estimated the risk of PCNs according to GGT quartiles(Q1-Q4).Subgroup analyses by age,sex,and comorbidities,and sensitivity analyses varying lag periods and GGT categorizations were performed.RESULTS There were 28940 cases of PCNs among 2655665 eligible participants.The incidence rate was 1.09 cases per 1000 person-years,with a median follow-up of 10.32(interquartile range:10.09-10.58)years.In multivariate regression analysis,adjusted hazard ratios for GGT quartiles using Q1 group as a reference were:1.04[95%confidence interval(CI):1.005-1.075]for Q2,1.065(95%CI:1.03-1.102)for Q3,and 1.109(95%CI:1.07-1.15)for Q4.Subgroup analysis showed consistent results across age,sex,and comorbidities.In sensitivity analyses,the association remained robust even at 3-year and 5-year lag periods.A clear dose-response relationship was also observed when using GGT deciles(All P for trend<0.001).CONCLUSION Higher GGT level is associated with increased risk of PCNs.Therefore,serum GGT levels might have a role as a biomarker for the development of PCNs.展开更多
Evidence on the association between osteoporosis and dementia is not fully clear.This study aimed to investigate the potential association between osteoporosis and the subsequent risk of dementia among older adults.We...Evidence on the association between osteoporosis and dementia is not fully clear.This study aimed to investigate the potential association between osteoporosis and the subsequent risk of dementia among older adults.We performed a cohort study of176150 community-dwelling older adults aged≥65 years and free of cognitive impairment between 2018 and 2022 using integrated healthcare data from Shenzhen,China.Diagnoses of osteoporosis,osteoporotic fractures,and dementia were identified through linked outpatient and inpatient medical records and death registration records.Multivariate Cox proportional hazards models were used to estimate the adjusted hazard ratios(HRs)and 95%confidence intervals(CIs)of incident dementia associated with osteoporosis and osteoporotic fractures.The mean(SD)age of the total study population was 70.7(5.4)years,and 9605 had a previous diagnosis of osteoporosis.Over a median follow-up of 2.2(IQR:1.8–4.3,maximum:5.5)years,corresponding to 505423person-years at risk,1367 incident all-cause dementia cases,including 617 Alzheimer's disease and 298 vascular dementia cases,occurred.Physician-diagnosed osteoporosis was associated with a higher risk of all-cause dementia(HR:1.80,95%CI:1.53–2.12).The increased dementia risk tended to be more prominent among patients with osteoporotic fractures(HR:2.43,95%CI:1.83–3.23)than those without(HR:1.63,95%CI:1.35–1.97).Results were similar for Alzheimer's disease and vascular dementia.This study provides evidence that older adults with osteoporosis,especially those with osteoporotic fractures,have an elevated risk of incident dementia.Effective prevention and management of osteoporosis among the older population may be promising to mitigate the dual burden of osteoporosis and dementia.展开更多
Background:Cardiorespiratory fitness(CRF)is a powerful health marker recommended by the American Heart Association as a clinical vital sign.Comparing the predictive validity of objectively measured CRF(the"gold s...Background:Cardiorespiratory fitness(CRF)is a powerful health marker recommended by the American Heart Association as a clinical vital sign.Comparing the predictive validity of objectively measured CRF(the"gold standara")and estimated CRF is clinically relevant because estimated CRF is more feasible.Our objective was to meta-analyze cohort studies to compare the associations of objectively measured,exerciseestimated,and non-exercise-estimated CRF with all-cause and cardiovascular disease(CVD)mortality in adults.Methods:Systematic searches were conducted in 9 databases(MEDLINE,SPORTDiscus,Embase,Scopus,PsycINFO,Web of Science,PubMed,CINAHL,and the Cochrane Library)up to April 11,2024.We included full-text refereed cohort studies published in English that quantified the association(using risk estimates with 95%confidence intervals(95%CIs))of objectively measured,exercise-estimated,and non-exercise-estimated CRF with all-cause and CVD mortality in adults.CRF was expressed as metabolic equivalents(METs)of task.Pooled relative risks(RR)for all-cause and CVD mortality per 1-MET(3.5 mL/kg/min)higher level of CRF were quantified using random-effects models.Results:Forty-two studies representing 35 cohorts and 3,813,484 observations(81%male)(362,771 all-cause and 56,471 CVD deaths)were included.The pooled RRs for all-cause and CVD mortality per higher MET were 0.86(95%CI:0.83-0.88)and 0.84(95%CI:0.80-0.87),respectively.For both all-cause and CVD mortality,there were no statistically significant differences in RR per higher MET between objectively measured(RR range:0.86-0.90)and maximal exercise-estimated(RR range:0.85-0.86),submaximal exercise-estimated(RR range:0.91-0.94),and non-exercise-estimated CRF(RR range:0.81-0.85).Conclusion:Objectively measured and estimated CRF showed similar dose-response associations for all-cause and CVD mortality in adults.Estimated CRF could provide a practical and robust alternative to objectively measured CRF for assessing mortality risk across diverse populations.Our findings underscore the health-related benefits of higher CRF and advocate for its integration into clinical practice to enhance risk stratification.展开更多
BACKGROUND Chronic idiopathic uveitis(CIU)and juvenile idiopathic arthritis-associated uveitis(U-JIA)are both vision-threatening conditions that share similar autoimmune mechanisms,but treatment approaches differ sign...BACKGROUND Chronic idiopathic uveitis(CIU)and juvenile idiopathic arthritis-associated uveitis(U-JIA)are both vision-threatening conditions that share similar autoimmune mechanisms,but treatment approaches differ significantly.In managing U-JIA,various treatment options are employed,including biological and non-biological disease-modifying anti-rheumatic drugs.These drugs are effective in clinical trials.Given the lack of established diagnostic and treatment guidelines as well as the limited number of therapeutic options available,patients with CIU frequently do not receive optimal and timely immunosuppression.This study highlighted the necessity for additional research to develop novel diag-nostic techniques,targeted therapies,and enhanced treatment outcomes for young individuals with CIU.AIM To compare the characteristics and outcomes of U-JIA and CIU.METHODS A retrospective cohort study analyzed data from 110 pediatric patients(under 18 years old)with U-JIA and 40 pediatric patients with CIU.Data was collected between 2012 and 2023.The study focused on demographic,clinical,treatment,and outcome variables.RESULTS The median onset age of arthritis was 6.4 years(2.7 years;9.3 years).In 28.2%of cases uveitis preceded the onset of arthritis.In 17.3%of cases it occurred simultan-eously.In 53.6%of cases it followed arthritis.Both groups had similar onset ages,antinuclear antibodies/human leukocyte antigen positivity rates,and ESR levels,with a slight predominance of females(60.9%vs 42.5%,P=0.062),and higher C-reactive protein levels in the U-JIA group.Anterior uveitis was more prevalent in patients with U-JIA(P=0.023),although the frequency of symptomatic,unilateral,and complicated forms did not differ significantly.The use of methotrexate(83.8%vs 96.4%)and biologics(64.7%vs 82.1%)was comparable,as was the rate of remission on methotrexate treatment(70.9%vs 56.5%)and biological therapy(77.8%vs 95%),but a immunosuppressive treatment delay in CIU observed.Patients with CIU were less likely to receive methotrexate[hazard ratio(HR)=0.48,P=0.005]or biological treatment(HR=0.42,P=0.004),but they were more likely to achieve remission with methotrexate(HR=3.70,P=0.001).CONCLUSION Treatment of uveitis is often limited to topical measures,which can delay systemic therapy and affect the outcome.Methotrexate and biological agents effectively manage eye inflammation.It is essential to develop standardized protocols for the diagnosis and management of uveitis,and collaboration between rheumatologists and ophthal-mologists is needed to achieve optimal outcomes in the treatment of CIU.展开更多
BACKGROUND Depressive symptoms differ from clinical depression.However,the relationship between depressive symptom trajectories and stroke risk across diverse geographic regions remains unclear.AIM To address the gap ...BACKGROUND Depressive symptoms differ from clinical depression.However,the relationship between depressive symptom trajectories and stroke risk across diverse geographic regions remains unclear.AIM To address the gap in the existing understanding of the relationship between depressive symptom trajectories and stroke risk,the current study utilized three representative cohorts.METHODS In this study,we used three representative cohorts from Asia,Europe,and the Americas:China Health and Retirement Longitudinal Study(CHARLS),English Longitudinal Study of Ageing(ELSA),and Health and Retirement Study(HRS).Depressive symptoms were assessed using the 8-item Center for Epidemiological Studies Depression scale and categorized into somatic and cognitive-affective subtypes.The trajectories of depressive symptoms were monitored over four surveys starting from baseline and classified into five distinct states:persistently low,decreasing,fluctuating,increasing,and consistently high.Selfreported physician diagnoses were used to evaluate the subsequent stroke events.Hazard ratios(HRs)and 95%confidence intervals(95%CIs)were computed using Cox proportional-risk models adjusted for potential confounding factors.RESULTS A total of 7990 participants from CHARLS(females:52.3%,mean age:63.4 years),5642 participants from ELSA(females:56.2%,mean age:63.7 years),and 12260 participants from HRS(females:61.4%,mean age:64.7 years)participated in this study.The median follow-up periods were 5 years for CHARLS,8 years for ELSA,and 10 years for HRS.In comparison with the persistently low trajectory,consistently high and fluctuating trajectories of total depressive symptoms increased the risk of stroke in all three cohorts(CHARLS:HR=1.80,95% CI:1.36-2.38;ELSA:HR=1.50,95% CI:1.02-2.21;HRS:HR=1.45,95% CI:1.29-1.62 for consistently high;CHARLS:HR=1.47,95% CI:1.14-1.90;ELSA:HR=1.44,95% CI:1.17-1.77;HRS:HR=1.26,95% CI:1.13-1.41 for fluctuating).Increasing trajectories enhanced the risk in the European cohort(ELSA:HR=1.71,95% CI:1.06-2.74),while decreasing trajectories did not increase stroke risk in any cohort.For somatic depressive symptoms,consistently high and fluctuating trajectories increased the risk of stroke across all cohorts(CHARLS:HR=2.16,95% CI:1.67-2.79;ELSA:HR=1.94,95% CI:1.34-2.81;HRS:HR=1.79,95% CI:1.49-2.15 for consistently high;CHARLS:HR=1.35,95% CI:1.20-1.62;ELSA:HR=1.56,95% CI:1.27-1.92;HRS:HR=1.33,95% CI:1.20-1.46 for fluctuating).Increasing trajectories only increased the risk in the European cohort(ELSA:HR=1.95,95% CI:1.11-3.43),while decreasing trajectories did not increase stroke risk in the European and American cohorts.For cognitive-affective depressive symptoms,consistently high and fluctuating trajectories increased the risk in the Asian and European cohorts(CHARLS:HR=2.06,95% CI:1.52-2.81;ELSA:HR=1.25,95% CI:1.02-1.54 for consistently high;CHARLS:HR=1.63,95% CI:1.23-2.16;ELSA:HR=1.58,95% CI:1.11-2.24 for fluctuating).Increasing trajectories increased the risk only in the American cohort(HRS:HR=14.67,95% CI:1.87-114.91).CONCLUSION Consistently high and fluctuating trajectories of total and somatic depressive symptoms were associated with an increased risk for stroke across all populations.Consistently high,fluctuating,and increasing trajectories of cognitive-affective symptoms pose a risk for certain populations.These findings highlight the importance of targeted interventions for managing depressive symptoms as potential strategies for stroke prevention,particularly in regions where specific symptom trajectories are prevalent.展开更多
Objective Although dietary preferences influence chronic diseases,few studies have linked dietary preferences to mortality risk,particularly in large cohorts.To investigate the relationship between dietary preferences...Objective Although dietary preferences influence chronic diseases,few studies have linked dietary preferences to mortality risk,particularly in large cohorts.To investigate the relationship between dietary preferences and mortality risk(all-cause,cancer,and cardiovascular disease[CVD])in a large adult cohort.Methods A cohort of 1,160,312 adults(mean age 62.48±9.55)from the Shenzhen Healthcare Big Data Cohort(SHBDC)was analyzed.Hazard ratios(HRs)for mortality were estimated using the Cox proportional hazards model.Results The study identified 12,308 all-cause deaths,of which 3,865(31.4%)were cancer-related and 3,576(29.1%)were attributed to CVD.Compared with a mixed diet of meat and vegetables,a mainly meat-based diet(hazard ratio[HR]=1.13;95%confidence interval[CI]:1.02,1.27)associated with a higher risk of all-cause mortality,while mainly vegetarian(HR=0.87;95%CI:0.78,0.97)was linked to a reduced risk.Furthermore,there was a stronger correlation between mortality risk and dietary preference in the>65 age range.Conclusion A meat-based diet was associated with an increased risk of all-cause mortality,whereas a mainly vegetarian diet was linked to a reduced risk.展开更多
基金supported by the Guangdong Basic and Applied Basic Research Foundation(2021A1515011629)Construction of High-level University of Guangdong(G623330580and G621331128)Guangdong Province Universities and Colleges Pearl River Scholar Funded Scheme(2019)。
文摘Objective Elevated depressive symptoms are well-documented among geriatric adults with cardiovascular disease(CVD);however,few studies have accounted for long-term cumulative depressive symptom exposure.This study determined the relationship between cumulative depressive symptoms and CVD.Methods Individual participant data were obtained from the China Health and Retirement Longitudinal Study(CHARLS)and Health and Retirement Study(HRS).Eligible participants had access to assessment information on depressive symptoms and had no history of CVD at baseline.Long-term cumulative depressive symptoms were estimated by calculating the area under the curve based on the Center for Epidemiological Studies Depression Scale.Results Herein,8,861 participants from CHARLS(mean age:58.58 years;male:48.6%)and 7,284 from HRS(60.94 years;35.0%)were enrolled.The median follow-up period was 5 years for the CHARLS and10 years for the HRS.Compared with the first quartile of cumulative depressive symptoms,the HRs(95%CI)in the fourth quartile were 1.73(1.48,2.02)for predicting CVD(P<0.001),1.83(1.52,2.19)for heart disease(P<0.001),1.53(95%CI:1.17,1.99)for stroke(P=0.002)in CHARLS.For HRS,the HRs(95%CI)were 1.41(95%CI:1.27,1.57;P<0.001),1.42(95%CI:1.26,1.59;P<0.001),and 1.30(95%CI:1.06,1.58;P=0.010)respectively.Strong dose-response relationships were observed,with similar results for the two cohorts.Conclusion Long-term cumulative depressive symptoms were significantly associated with incident CVD in middle-aged and older adults,providing insights into controlling long-term depressive symptoms to improve this cohort's health.
文摘Background:Despite highly effective vaccines against SARS-CoV-2,COVID-19 vaccine hesitancy persisted in some populations in England during the pandemic,with rates and motivations for hesitancy varying by demographic group.Addressing the drivers of vaccine hesitancy through targeted interventions in hesitant groups is a public health priority for better and more rapid control of disease spread.We aimed to characterise the determinants and subtypes of vaccine hesitancy and identify more persistent forms of hesitancy via analysis of vaccine uptake in a large cross-sectional cohort with linked National Health Service(NHS)data.
基金supported by the High-level Talents Introduction Plan from Central South University(No.502045003)the National Natural Science Foundation of China(No.42277438)Hunan Provincial Natural Science Foundation for Distinguished Young Scholars(No.2024JJ2082)to Fang Xiao,and the Postgraduate Independent Exploration and Innovation Project of Central South University,China(Nos.2024ZZTS0557 and 2023ZZTS0993)。
文摘Existing evidence suggests residential greenness is beneficial to human,while no research to date explored the associations of greenness with age-related macular degeneration(AMD).To evaluate the association of greenness with AMD,modification and mediation effect of air pollution,we conducted this prospective study.We con-structed weighted quantile sum(WQS)index as co-exposure to nitrogen oxides(NO_(x)),particulate matter<2.5μm(PM_(2.5)),particulate matter<10μm(PM10).Stratified Cox regression models were applied to test the effect of exposure.Effect modification of air pollution was assessed.Stratified Cox models through the indirect method and Aalen additive risk models were used in mediation analysis.Over median follow-up of 11.67 years,4596 AMD events were ascertained.Hazard ratios(HRs)and 95%confidence intervals(95%CIs)of incident AMD for pollution per interquartile range(IQR)increment were 1.10(1.04–1.16)for nitrogen dioxide(NO_(2)),1.09(1.03–1.15)for NO_(x),1.14(1.05–1.24)for PM_(2.5),1.13(1.05–1.21)for PM10.The HR(95%CI)of AMD associated with greenness 1000 m buffer per IQR increment was 0.91(0.86–0.97),300 m buffer was 0.94(0.89–0.99).The as-sociation between greenness 1000 m and AMD was 28.59%,44.77%,35.59%,32.31%and 27.08%mediated by the decreased WQS index,NO_(2),NO_(x),PM_(2.5) and PM10,respectively.Increased greenness was associated with lower AMD incidence,and air pollution partly mediate it,which implies that interventions aimed at improving air quality and increasing greenness could have a dual benefit in mitigating AMD risk.
基金financial support fromthe Chung Shan Medical University Hospital,Taiwan(CSH-2022-A-009).
文摘Background:To determine whether initiating a glucagon-like peptide-1 receptor agonist(GLP-1 RA)within 3 months of type 2 diabetes(T2DM)diagnosis alters the subsequent risk of overall and site-specific cancer and whether this association differs by baseline body-mass index(BMI).Methods:This retrospective cohort study used electronic health records from the TriNetX U.S.research network.Adults aged 20 years or older diagnosed with T2DM between 2016 and 2024 were included if they received any hypoglycemic agents within 3 months before and after diagnosis.Following 1:1 propensity score matching,both the GLP-1 RA user and non-user groups included 183,264 patients.The study outcome was defined as a diagnosis of malignant neoplasms.Hazard ratios(HRs)for overall and site-specific cancer risk were estimated using Cox proportional hazards models.Kaplan–Meier analysis and stratified analysis by BMI were performed.Results:Early GLP-1 RA use demonstrated a modest but significant association with reduced overall cancer risk(HR 0.93;95%CI:0.90–0.96).Reduced risks were noted for cancers of the digestive(HR 0.81),respiratory(HR 0.66),and female genital(HR 0.87)systems.In stratified analysis,benefits were more pronounced in patients with BMI≥30,particularly for pancreatic and colorectal cancers.Conclusion:Early initiation of GLP-1 receptor agonists in patients with diagnosed T2DM was associated with a modest reduction in overall cancer risk,particularly among individuals with obesity.These findings highlight the dual metabolic and oncologic value of prompt GLP-1 RA therapy.
基金supported by grants from the National Natural Science Foundation of China(G.F.Wang,grant number 82204071)(P.Y.Su,grant numbers 81874268 and 82473655)the Research Funds of the Center for Big Data and Population Health of IHM(P.Y.Su,No.JKS2023016)Anhui Provincial Health Commission Scientific Research Project(Y.Zhou,No.AHWJ2023A30027)。
文摘Vitamin D deficiency(VDD)represents a significant nutritional concern among children and adolescents.The estimated prevalence of VDD in China is 46.8%in this population^([1]).VDD during childhood and adolescence has been associated with the onset of various conditions,including acute respiratory infections,asthma,atopic dermatitis,and food allergies^([2]).Multiple factors,including age,sun exposure,adiposity,and genetics,influence vitamin D levels^([2,3]).Increasing attention has been directed toward understanding the environmental determinants that may influence vitamin D status.Given the potential of metallic pollutants to disrupt endocrine function and their ubiquity in the environment,investigating the effects of metal exposure on human vitamin D status,particularly in vulnerable populations,is imperative.
文摘Cohort studies are important epidemiological methods to investigate associations between environmental factors,individual characteristics,and disease or other health outcomes.As a paradigm of cohort studies,the Framingham Heart Study(FHS)is the longest-running cardiovascular epidemiological study,starting in 1948.
文摘BACKGROUND Although the link between cardiovascular disease(CVD)and various cancers is well-established,the relationship between CVD risk and colorectal cancer(CRC)remains underexplored.AIM To elucidate the relationship between CVD risk scores and CRC incidence.METHODS In this population-based cohort study,participants from the 2009 National Health Checkup were followed-up until 2020.The cardiovascular(CV)risk score was calculated as the sum of risk factors(age,family history of coronary artery disease,hypertension,smoking status,and high-density lipoprotein levels)with high-density lipoprotein(≥60 mg/dL)reducing the risk score by one.The primary outcome was incidence of newly diagnosed CRC.RESULTS Among 2526628 individuals,30329 developed CRC during a mean follow-up of 10.1 years.Categorized by CV risk scores(0,1,2,and≥3).CRC risk increased with higher CV risk scores after adjusting for covariates[(hazard ratio=1.155,95%confidence interval:1.107-1.205)in risk score≥3,P<0.001].This association individuals not using statins.Moreover,even in participants without diabetes,a higher CV risk was associated with an increased CRC risk.CONCLUSION Increased CV risk scores were significantly associated with higher CRC risk,especially among males,younger populations,and non-statin users.Thus,males with a higher CV risk score,even at a younger age,are recommended to control their risk factors and undergo individualized CRC screening.
基金supported by the Capital’s Funds for Health Improvement and Research(No.2024-2G-2118)the National Key Research and Development Program of China(2016YFC1000101)+2 种基金the Leading Talents in the Construction Project of High-Level Public Health Technical Talents in Beijing(2022-1-003)the“Green Seedling”Youth Program by the Beijing Hospitals Authority(QML20231402)the Young Elite Scientist Sponsorship Program by the Beijing Association for Science and Technology(BYESS2022200)。
文摘Objective To investigate the association between ABO blood types and gestational diabetes mellitus(GDM)risk.Methods A prospective birth cohort study was conducted.ABO blood types were determined using the slide method.GDM diagnosis was based on a 75-g,2-h oral glucose tolerance test(OGTT)according to the criteria of the International Association of Diabetes and Pregnancy Study Groups.Logistic regression was applied to calculate the odds ratios(ORs)and 95%confidence intervals(CIs)between ABO blood types and GDM risk.Results A total of 30,740 pregnant women with a mean age of 31.81 years were enrolled in this study.The ABO blood types distribution was:type O(30.99%),type A(26.58%),type B(32.20%),and type AB(10.23%).GDM was identified in 14.44%of participants.Using blood type O as a reference,GDM risk was not significantly higher for types A(OR=1.05)or B(OR=1.04).However,women with type AB had a 19%increased risk of GDM(OR=1.19,95%CI=1.05–1.34;P<0.05),even after adjusting for various factors.This increased risk for type AB was consistent across subgroup and sensitivity analyses.Conclusion The ABO blood types may influence GDM risk,with type AB associated with a higher risk.Incorporating it—either as a single risk factor or in combination with other known factors—could help identify individuals at risk for GDM before or during early pregnancy.
基金supported by the National Natural Science Foundation of China(grant numbers 82204127 and 72204172)。
文摘Lung cancer, the leading cause of cancer deaths worldwide and in China, has a 19.7% five-year survival rate due to terminal-stage diagnosis^([1-3]).Although low-dose computed tomography(CT) screening can reduce mortality, high false positive rates can create economic and psychological burdens.
文摘OBJECTIVE The emergence of evolving variants of Coronavirus disease 2019(COVID-19)has fostered the need for change of newer and adaptive treatments for these infections.During the COVID-19 pandemic and persists,traditional Chinese medicine(TCM)herbs exhibit significant bioactivity and therapeutic effect.This study is aimed to evaluate the efficacy of four TCM preparations on 28-day mortality risk of patients and changes of the laboratory indicators.METHODS The retrospective cohort study included patients with COVID-19 who were admitted to the Jiangsu Province Hospital of Chinese Medicine from December 15,2022 to January 15,2023,and those died within 48 hours of admission or cannot be tracked for outcomes were excluded.The primary outcome was survival status in 28 days(death or survival)starting from the day of admission.The second outcomes were laboratory indicators,including absolute lymphocyte count,lactate dehydrogenase,creatinine,and blood urea nitrogen.Binary logistic regressions were used to estimate the effect of TCM preparations on the primary and secondary outcomes in main analysis.Meanwhile,heterogeneity and robustness of results from main analysis were assessed by subgroup analyses and multiple sensitivity analyses.RESULTS 1816 eligible patients were included in analysis dataset,including 573 patients received standard care(control group)and 1243 patients received TCM preparations(hospital preparation group).The 28-day mortality rate of hospital preparation group was lower than that of control group(4.75%vs.14.83%),and the difference was statistically significant(χ^(2)=54.666,P<0.001).The risk of 28-day mortality was 0.535 times lower in the hospital preparation group as compared with the control group(OR=0.46,95%CI:0.305-0.708,P<0.001)showed by multivariable binary logistic regressions.Subgroup analyses showed that taking TCM preparations reduced the 28-day mortality risk.Sensitivity analyses demonstrated that the results of the main analysis for primary outcomes were robust.For secondary outcomes,the risk of abnormal absolute lymphocyte counts at discharge in the hospital preparation group decreased by 0.284 times(OR=0.703,95%CI:0.515-0.961,P=0.027).CONCLUSION Compared with standard of care,taking four hospital preparations including Kanggan Heji,Feining Heji,Qishen Gubiao Keli,and Qianghuo Qushi Qingwen Heji decreased risk of 28-day mortality among hospitalized COVID-19 patients.TCM therapy achieves adequate therapeutic effects in COVID-19.
基金Supported by National Natural Science Foundation of China,No.82174461Hospital Capability Enhancement Project of Xiyuan Hospital,CACMS,No.XYZX0201-22Technology Innovation Project of China Academy of Chinese Medical Sciences,No.CI2021A01811.
文摘BACKGROUND Patients with BRAF V600E mutant metastatic colorectal cancer(mCRC)have a low incidence rate,poor biological activity,suboptimal response to conventional treatments,and a poor prognosis.In the previous cohort study on mCRC conducted by our team,it was observed that integrated Chinese and Western medicine treatment could significantly prolong the overall survival(OS)of patients with colorectal cancer.Therefore,we further explored the survival benefits in the population with BRAF V600E mutant mCRC.AIM To evaluate the efficacy of integrated Chinese and Western medicine in the treatment of BRAF V600E mutant metastatic colorectal cancer.METHODS A cohort study was conducted on patients with BRAF V600E mutant metastatic colorectal cancer admitted to Xiyuan Hospital of China Academy of Chinese Medical Sciences and Traditional Chinese Medicine Hospital of Xinjiang Uygur Autonomous Region from January 2016 to December 2022.The patients were divided into two cohorts.RESULTS A total of 34 cases were included,with 23 in Chinese-Western medicine cohort(cohort A)and 11 in Western medicine cohort(cohort B).The median overall survival was 19.9 months in cohort A and 14.2 months in cohort B,with a statistically significant difference(P=0.038,hazard ratio=0.46).The 1-3-year survival rates were 95.65%(22/23),39.13%(9/23),and 26.09%(6/23)in cohort A,and 63.64%(7/11),18.18%(2/11),and 9.09%(1/11)in cohort B,respectively.Subgroup analysis showed statistically significant differences in median OS between the two cohorts in the right colon,liver metastasis,chemotherapy,and first-line treatment subgroups(P<0.05).CONCLUSION Integrated Chinese and Western medicine can prolong the survival and reduce the risk of death in patients with BRAF V600E mutant metastatic colorectal cancer,with more pronounced benefits observed in patients with right colon involvement,liver metastasis,combined chemotherapy,and first-line treatment.
文摘BACKGROUND Depression is a significant risk factor for diabetes,particularly type 2 diabetes.However,depressive symptoms differ from clinical depression.Previous research has not fully considered the relationship between the trajectory of depressive symptoms and the risk of developing diabetes over time.AIM To investigate the association between depressive symptoms,their trajectories,and the risk of developing diabetes in two prospective cohort studies.METHODS In the first phase we analyzed the association between depressive symptoms and the risk of developing diabetes separately using the Health and Retirement Study(HRS).Depressive symptom trajectories were assessed by examining changes in depressive symptoms at baseline and again 8 years later.We then identified specific depressive symptom trajectories that increased the risk of diabetes in the second phase.Finally,we confirmed the association between depressive symptoms and their trajectories with diabetes risk using the English Longitudinal Study of Ageing(ELSA)as a validation study.Depressive symptom trajectories were categorized into five states based on changes in the modified 8-item Center for Epidemiological Studies-Depression scores:Persistently high;increasing;fluctuating;decreasing;and persistently low.Diabetes mellitus was defined as self-reported,physician-diagnosed diabetes.Cox proportional hazards models were used to assess hazard ratios(HR)and 95%confidence intervals(CI),adjusting for potential confounders.RESULTS In the first phase a total of 27658 participants were included(HRS:18633,ELSA:9025),among whom 6582 had depressive symptoms(HRS:4547,ELSA:2035),6407 had somatic depressive symptoms(HRS:4414,ELSA:1993),and 26415 had cognitive-affective depressive symptoms(HRS:17755,ELSA:8660).We found that overall depressive symptoms(HRS:HR=1.14,95%CI:1.07-1.22;ELSA:HR=1.18,95%CI:1.03-1.34)and somatic depressive symptoms(HRS:HR=1.14,95%CI:1.07-1.22;ELSA:HR=1.25,95%CI:1.10-1.42)increased the risk of diabetes,while cognitive depressive symptoms were not associated with diabetes risk.Over an 8-year follow-up we identified 19729 trajectories of overall,somatic,and cognitive-affective depressive symptoms(HRS:13918,ELSA:5811).In the second phase we found that persistently high(HRS:HR=1.22,95%CI:1.06-1.40,ELSA:HR=1.54,95%CI:1.16-2.05 in total and HRS:HR=1.24,95%CI:1.07-1.43,ELSA:HR=1.79,95%CI:1.36-2.35 in somatic)and fluctuating(HRS:HR=1.09,95%CI:1.01-1.17,ELSA:HR=1.33,95%CI:1.14-1.55 in total and HRS:HR=1.10,95%CI:1.02-1.18,ELSA:HR=1.31,95%CI:1.13-1.53 in somatic)trajectories of overall and somatic depressive symptoms increased the risk of diabetes,while increasing trajectories may also raise diabetes risk.However,decreasing trajectories were not associated with diabetes risk.Cognitive-affective depressive symptoms showed no association with diabetes risk regardless of trajectory changes.Sensitivity analyses confirmed the reliability of the findings.CONCLUSION Persistently high and fluctuating trajectories of overall and somatic depressive symptoms increased the risk of diabetes,while decreasing trajectories were not associated with diabetes risk.In contrast trajectories of cognitiveaffective depressive symptoms show no relationship with diabetes risk.Focusing on depressive symptom trajectories,particularly those of somatic depressive symptoms,represented a viable strategy for future diabetes prevention.
基金supported by the National Natural Science Foundation of China(Grant NO:81930092 and 81973128)Natural Science Foundation of Henan Province(Grant NO:23230042151)+1 种基金Science and Technology Innovation Team Support Plan of Colleges and Universities in Henan Province(Grant NO:21IRTSTHN029)the Foundation of National Key Program of Research and Development of China(Grant No:2016YFC0900803).
文摘Objective To investigate hypertension(HTN)trends,key risk factors,and gender disparities in rural China,and to propose targeted strategies for improving HTN control in resource-limited settings.Methods This longitudinal study used data from the Henan Rural Cohort Study,including baseline(2015–2017;n=39,224)and follow-up(2018–2022;n=28,621)participants.HTN was defined as systolic/diastolic blood pressure≥140/90 mmHg,self-reported diagnosis,or use of antihypertensive medication.Severity was classified using a 7-tier blood pressure(BP)staging system(optimal,normal,high normal,and HTN stages 1–4).A generalized linear mixed-effects model(GLMM)identified associated risk factors.Results HTN prevalence increased modestly from 32.7%(95%CI:32.2–33.2)to 33.9%(95%CI:33.3%–34.4%).Awareness and treatment improved from 20.1%to 25.3%,and from 18.8%to 24.4%,respectively,but control rates remained low(6.2%to 12.3%).After adjustment,women had a 1.53-fold higher HTN risk than men(OR=1.53,95%CI:1.43–1.63),revealing gender-specific trends.Key risk factors included alcohol use(OR=1.37,95%CI:1.27–1.47)and overweight status(OR=1.76,95%CI:1.66–1.86).BP staging showed an increase in optimal BP(42.3%to 45.8%),but stagnant management of advanced HTN stages.Conclusion Hypertension in rural China is shaped by behavioral risk factors and healthcare access gaps.Gender-sensitive,community-based interventions,including task-shifting models,are necessary to mitigate the growing burden of hypertension.
基金supported by the Chinese Academy of Medical Sciences(CAMS)Innovation Fund for Medical Sciences(2021-I2M-1-010,2019-I2M-2-003,and 2017-I2M-1-004)the National High Level Hospital Clinical Research Funding(2022-GSPGG-1,2022-GSP-GG-2)+2 种基金the Research Unit of Prospective Cohort of Cardiovascular Diseases and Cancers,CAMS(2019RU038)the National Key Research and Development Program of China(2018YFE0115300 and 2017YFC0211700)the National Natural Science Foundation of China(82030102,12126602).
文摘Objective The relationship between fish consumption and stroke is inconsistent,and it is uncertain whether this association varies across predicted stroke risks.Methods A cohort study comprising 95,800 participants from the Prediction for Atherosclerotic Cardiovascular Disease Risk in China project was conducted.A standardized questionnaire was used to collect data on fish consumption.Participants were stratified into low-and moderate-to-high-risk categories based on their 10-year stroke risk prediction scores.Hazard ratios(HRs)and 95%confidence intervals(CIs)were estimated using Cox proportional hazard models and additive interaction by relative excess risk due to interaction(RERI),attributable proportion(AP),and synergy index(SI).Results During 703,869 person-years of follow-up,2,773 incident stroke events were identified.Higher fish consumption was associated with a lower risk of stroke,particularly among moderate-to-high-risk individuals(HR=0.53,95%CI:0.47-0.60)than among low-risk individuals(HR=0.64,95%CI:0.49-0.85).A significant additive interaction between fish consumption and predicted stroke risk was observed(RERI=4.08,95%CI:2.80-5.36;SI=1.64,95%CI:1.42-1.89;AP=0.36,95%CI:0.28-0.43).Conclusion Higher fish consumption was associated with a lower risk of stroke,and this beneficial association was more pronounced in individuals with moderate-to-high stroke risk.
文摘BACKGROUND Gamma-glutamyl transferase(GGT)is a known surrogate marker of hepatic dysfunction and oxidative stress.It has recently been reported to be associated with metabolic diseases,cardiovascular diseases,and malignancies including pancreatic cancer.However,data on its association with pancreatic cystic neo-plasm(PCN),is unknown.AIM To investigate the association of GGT with the incidence of PCN.METHODS In this nationwide retrospective cohort study,participants who received general health checkup by National Health Insurance Service in 2009 were included.Newly diagnosed PCNs from one year after the checkup to 2020 were identified.Participants were divided into quartiles based on GGT levels.Multivariable cox proportional hazard models estimated the risk of PCNs according to GGT quartiles(Q1-Q4).Subgroup analyses by age,sex,and comorbidities,and sensitivity analyses varying lag periods and GGT categorizations were performed.RESULTS There were 28940 cases of PCNs among 2655665 eligible participants.The incidence rate was 1.09 cases per 1000 person-years,with a median follow-up of 10.32(interquartile range:10.09-10.58)years.In multivariate regression analysis,adjusted hazard ratios for GGT quartiles using Q1 group as a reference were:1.04[95%confidence interval(CI):1.005-1.075]for Q2,1.065(95%CI:1.03-1.102)for Q3,and 1.109(95%CI:1.07-1.15)for Q4.Subgroup analysis showed consistent results across age,sex,and comorbidities.In sensitivity analyses,the association remained robust even at 3-year and 5-year lag periods.A clear dose-response relationship was also observed when using GGT deciles(All P for trend<0.001).CONCLUSION Higher GGT level is associated with increased risk of PCNs.Therefore,serum GGT levels might have a role as a biomarker for the development of PCNs.
基金supported by the Shenzhen Medical Academy of Research and Translation(Grant C2302001)the Noncommunicable Chronic Diseases-National Science and Technology Major Project(Grant 2023ZD0503500)+5 种基金the National Natural Science Foundation of China(Grants 82030102,12126602)the Shenzhen Science and Technology Innovation Committee(No.ZDSYS20200810171403013)the Talents enlisted in major talent programs of Guangdong Province(20210N020921)the Shenzhen Development and Reform Committee(No.XMHT20230108022)the Medical Research Innovation Project(Grant G030410001)the Shenzhen Medical Research Funds(Grant A2402041)。
文摘Evidence on the association between osteoporosis and dementia is not fully clear.This study aimed to investigate the potential association between osteoporosis and the subsequent risk of dementia among older adults.We performed a cohort study of176150 community-dwelling older adults aged≥65 years and free of cognitive impairment between 2018 and 2022 using integrated healthcare data from Shenzhen,China.Diagnoses of osteoporosis,osteoporotic fractures,and dementia were identified through linked outpatient and inpatient medical records and death registration records.Multivariate Cox proportional hazards models were used to estimate the adjusted hazard ratios(HRs)and 95%confidence intervals(CIs)of incident dementia associated with osteoporosis and osteoporotic fractures.The mean(SD)age of the total study population was 70.7(5.4)years,and 9605 had a previous diagnosis of osteoporosis.Over a median follow-up of 2.2(IQR:1.8–4.3,maximum:5.5)years,corresponding to 505423person-years at risk,1367 incident all-cause dementia cases,including 617 Alzheimer's disease and 298 vascular dementia cases,occurred.Physician-diagnosed osteoporosis was associated with a higher risk of all-cause dementia(HR:1.80,95%CI:1.53–2.12).The increased dementia risk tended to be more prominent among patients with osteoporotic fractures(HR:2.43,95%CI:1.83–3.23)than those without(HR:1.63,95%CI:1.35–1.97).Results were similar for Alzheimer's disease and vascular dementia.This study provides evidence that older adults with osteoporosis,especially those with osteoporotic fractures,have an elevated risk of incident dementia.Effective prevention and management of osteoporosis among the older population may be promising to mitigate the dual burden of osteoporosis and dementia.
基金supported by a grant from the European Union's Horizon 2020 research and innovation programme under the Marie Sklodowska Curie(Grant agreement No.101028929)supported by an Investigator Grant from the Medical Research Future Fund(MRF1193862)supported by an Australian Government Research Training Program Scholarship.
文摘Background:Cardiorespiratory fitness(CRF)is a powerful health marker recommended by the American Heart Association as a clinical vital sign.Comparing the predictive validity of objectively measured CRF(the"gold standara")and estimated CRF is clinically relevant because estimated CRF is more feasible.Our objective was to meta-analyze cohort studies to compare the associations of objectively measured,exerciseestimated,and non-exercise-estimated CRF with all-cause and cardiovascular disease(CVD)mortality in adults.Methods:Systematic searches were conducted in 9 databases(MEDLINE,SPORTDiscus,Embase,Scopus,PsycINFO,Web of Science,PubMed,CINAHL,and the Cochrane Library)up to April 11,2024.We included full-text refereed cohort studies published in English that quantified the association(using risk estimates with 95%confidence intervals(95%CIs))of objectively measured,exercise-estimated,and non-exercise-estimated CRF with all-cause and CVD mortality in adults.CRF was expressed as metabolic equivalents(METs)of task.Pooled relative risks(RR)for all-cause and CVD mortality per 1-MET(3.5 mL/kg/min)higher level of CRF were quantified using random-effects models.Results:Forty-two studies representing 35 cohorts and 3,813,484 observations(81%male)(362,771 all-cause and 56,471 CVD deaths)were included.The pooled RRs for all-cause and CVD mortality per higher MET were 0.86(95%CI:0.83-0.88)and 0.84(95%CI:0.80-0.87),respectively.For both all-cause and CVD mortality,there were no statistically significant differences in RR per higher MET between objectively measured(RR range:0.86-0.90)and maximal exercise-estimated(RR range:0.85-0.86),submaximal exercise-estimated(RR range:0.91-0.94),and non-exercise-estimated CRF(RR range:0.81-0.85).Conclusion:Objectively measured and estimated CRF showed similar dose-response associations for all-cause and CVD mortality in adults.Estimated CRF could provide a practical and robust alternative to objectively measured CRF for assessing mortality risk across diverse populations.Our findings underscore the health-related benefits of higher CRF and advocate for its integration into clinical practice to enhance risk stratification.
文摘BACKGROUND Chronic idiopathic uveitis(CIU)and juvenile idiopathic arthritis-associated uveitis(U-JIA)are both vision-threatening conditions that share similar autoimmune mechanisms,but treatment approaches differ significantly.In managing U-JIA,various treatment options are employed,including biological and non-biological disease-modifying anti-rheumatic drugs.These drugs are effective in clinical trials.Given the lack of established diagnostic and treatment guidelines as well as the limited number of therapeutic options available,patients with CIU frequently do not receive optimal and timely immunosuppression.This study highlighted the necessity for additional research to develop novel diag-nostic techniques,targeted therapies,and enhanced treatment outcomes for young individuals with CIU.AIM To compare the characteristics and outcomes of U-JIA and CIU.METHODS A retrospective cohort study analyzed data from 110 pediatric patients(under 18 years old)with U-JIA and 40 pediatric patients with CIU.Data was collected between 2012 and 2023.The study focused on demographic,clinical,treatment,and outcome variables.RESULTS The median onset age of arthritis was 6.4 years(2.7 years;9.3 years).In 28.2%of cases uveitis preceded the onset of arthritis.In 17.3%of cases it occurred simultan-eously.In 53.6%of cases it followed arthritis.Both groups had similar onset ages,antinuclear antibodies/human leukocyte antigen positivity rates,and ESR levels,with a slight predominance of females(60.9%vs 42.5%,P=0.062),and higher C-reactive protein levels in the U-JIA group.Anterior uveitis was more prevalent in patients with U-JIA(P=0.023),although the frequency of symptomatic,unilateral,and complicated forms did not differ significantly.The use of methotrexate(83.8%vs 96.4%)and biologics(64.7%vs 82.1%)was comparable,as was the rate of remission on methotrexate treatment(70.9%vs 56.5%)and biological therapy(77.8%vs 95%),but a immunosuppressive treatment delay in CIU observed.Patients with CIU were less likely to receive methotrexate[hazard ratio(HR)=0.48,P=0.005]or biological treatment(HR=0.42,P=0.004),but they were more likely to achieve remission with methotrexate(HR=3.70,P=0.001).CONCLUSION Treatment of uveitis is often limited to topical measures,which can delay systemic therapy and affect the outcome.Methotrexate and biological agents effectively manage eye inflammation.It is essential to develop standardized protocols for the diagnosis and management of uveitis,and collaboration between rheumatologists and ophthal-mologists is needed to achieve optimal outcomes in the treatment of CIU.
文摘BACKGROUND Depressive symptoms differ from clinical depression.However,the relationship between depressive symptom trajectories and stroke risk across diverse geographic regions remains unclear.AIM To address the gap in the existing understanding of the relationship between depressive symptom trajectories and stroke risk,the current study utilized three representative cohorts.METHODS In this study,we used three representative cohorts from Asia,Europe,and the Americas:China Health and Retirement Longitudinal Study(CHARLS),English Longitudinal Study of Ageing(ELSA),and Health and Retirement Study(HRS).Depressive symptoms were assessed using the 8-item Center for Epidemiological Studies Depression scale and categorized into somatic and cognitive-affective subtypes.The trajectories of depressive symptoms were monitored over four surveys starting from baseline and classified into five distinct states:persistently low,decreasing,fluctuating,increasing,and consistently high.Selfreported physician diagnoses were used to evaluate the subsequent stroke events.Hazard ratios(HRs)and 95%confidence intervals(95%CIs)were computed using Cox proportional-risk models adjusted for potential confounding factors.RESULTS A total of 7990 participants from CHARLS(females:52.3%,mean age:63.4 years),5642 participants from ELSA(females:56.2%,mean age:63.7 years),and 12260 participants from HRS(females:61.4%,mean age:64.7 years)participated in this study.The median follow-up periods were 5 years for CHARLS,8 years for ELSA,and 10 years for HRS.In comparison with the persistently low trajectory,consistently high and fluctuating trajectories of total depressive symptoms increased the risk of stroke in all three cohorts(CHARLS:HR=1.80,95% CI:1.36-2.38;ELSA:HR=1.50,95% CI:1.02-2.21;HRS:HR=1.45,95% CI:1.29-1.62 for consistently high;CHARLS:HR=1.47,95% CI:1.14-1.90;ELSA:HR=1.44,95% CI:1.17-1.77;HRS:HR=1.26,95% CI:1.13-1.41 for fluctuating).Increasing trajectories enhanced the risk in the European cohort(ELSA:HR=1.71,95% CI:1.06-2.74),while decreasing trajectories did not increase stroke risk in any cohort.For somatic depressive symptoms,consistently high and fluctuating trajectories increased the risk of stroke across all cohorts(CHARLS:HR=2.16,95% CI:1.67-2.79;ELSA:HR=1.94,95% CI:1.34-2.81;HRS:HR=1.79,95% CI:1.49-2.15 for consistently high;CHARLS:HR=1.35,95% CI:1.20-1.62;ELSA:HR=1.56,95% CI:1.27-1.92;HRS:HR=1.33,95% CI:1.20-1.46 for fluctuating).Increasing trajectories only increased the risk in the European cohort(ELSA:HR=1.95,95% CI:1.11-3.43),while decreasing trajectories did not increase stroke risk in the European and American cohorts.For cognitive-affective depressive symptoms,consistently high and fluctuating trajectories increased the risk in the Asian and European cohorts(CHARLS:HR=2.06,95% CI:1.52-2.81;ELSA:HR=1.25,95% CI:1.02-1.54 for consistently high;CHARLS:HR=1.63,95% CI:1.23-2.16;ELSA:HR=1.58,95% CI:1.11-2.24 for fluctuating).Increasing trajectories increased the risk only in the American cohort(HRS:HR=14.67,95% CI:1.87-114.91).CONCLUSION Consistently high and fluctuating trajectories of total and somatic depressive symptoms were associated with an increased risk for stroke across all populations.Consistently high,fluctuating,and increasing trajectories of cognitive-affective symptoms pose a risk for certain populations.These findings highlight the importance of targeted interventions for managing depressive symptoms as potential strategies for stroke prevention,particularly in regions where specific symptom trajectories are prevalent.
基金supported by the National Natural Science Foundation of China(No.82425052).
文摘Objective Although dietary preferences influence chronic diseases,few studies have linked dietary preferences to mortality risk,particularly in large cohorts.To investigate the relationship between dietary preferences and mortality risk(all-cause,cancer,and cardiovascular disease[CVD])in a large adult cohort.Methods A cohort of 1,160,312 adults(mean age 62.48±9.55)from the Shenzhen Healthcare Big Data Cohort(SHBDC)was analyzed.Hazard ratios(HRs)for mortality were estimated using the Cox proportional hazards model.Results The study identified 12,308 all-cause deaths,of which 3,865(31.4%)were cancer-related and 3,576(29.1%)were attributed to CVD.Compared with a mixed diet of meat and vegetables,a mainly meat-based diet(hazard ratio[HR]=1.13;95%confidence interval[CI]:1.02,1.27)associated with a higher risk of all-cause mortality,while mainly vegetarian(HR=0.87;95%CI:0.78,0.97)was linked to a reduced risk.Furthermore,there was a stronger correlation between mortality risk and dietary preference in the>65 age range.Conclusion A meat-based diet was associated with an increased risk of all-cause mortality,whereas a mainly vegetarian diet was linked to a reduced risk.
