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Multimorbidity patterns and association with mortality in 0.5 million Chinese adults

Chinese Medical Journal 2022年第6期135卷 648-657页

作者： Junning Fan Zhijia Sun Canqing Yu Yu Guo Pei Pei Ling Yang Yiping Chen Huaidong Du Dianjianyi Sun Yuanjie Pang Jun Zhang Simon Gilbert Daniel Avery Junshi Chen Zhengming Chen Jun Lyu Liming Li On Behalf of the China Kadoorie Biobank Collaborative Group Department of Epidemiology and Biostatistics School of Public HealthPeking UniversityBeijing 100191China Peking University Center for Public Health and Epidemic Preparedness and Response Peking UniversityBeijing 100191China National Clinical Research Center of Cardiovascular Diseases National Center for Cardiovascular DiseasesFuwai HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100037China China Kadoorie Biobank National Coordination Centre Chinese Academy of Medical SciencesBeijing 100730China Nuffield Department of Population Health Medical Research Council Population Health Research UnitUniversity of OxfordOxford OX37LFUnited Kingdom Nuffield Department of Population Health University of OxfordClinical Trial Service Unit and Epidemiological Studies Unit(CTSU)Oxford OX37LFUnited Kingdom Suzhou Center for Disease Control and Prevention SuzhouJiangsu 215004China China National Center for Food Safety Risk Assessment Beijing 100022China Key Laboratory of Molecular Cardiovascular Sciences Peking UniversityMinistry of EducationBeijing 100191China 不详

Background:Few studies have assessed the relationship between multimorbidity patterns and mortality risk in the Chinese population.We aimed to identify multimorbidity patterns and examined the associations of multimorbidity patterns and the number of chronic diseases with the risk of mortality among Chinese middle-aged and older adults.Methods:We used data from the China Kadoorie Biobank and included 512,723 participants aged 30 to 79 years.Multimorbidity was defined as the presence of two or more of the 15 chronic diseases collected by self-report or physical examination at baseline.Multimorbidity patterns were identified using hierarchical cluster analysis.Cox regression was used to estimate the associations of multimorbidity patterns and the number of chronic diseases with all-cause and cause-specific mortality.Results:Overall,15.8%of participants had multimorbidity.The prevalence of multimorbidity increased with age and was higher in urban than rural participants.Four multimorbidity patterns were identified,including cardiometabolic multimorbidity(diabetes,coronary heart disease,stroke,and hypertension),respiratory multimorbidity(tuberculosis,asthma,and chronic obstructive pulmonary disease),gastrointestinal and hepatorenal multimorbidity(gallstone disease,chronic kidney disease,cirrhosis,peptic ulcer,and cancer),and mental and arthritis multimorbidity(neurasthenia,psychiatric disorder,and rheumatoid arthritis).During a median of 10.8 years of follow-up,49,371 deaths occurred.Compared with participants without multimorbidity,cardiometabolic multimorbidity(hazard ratios[HR]=2.20,95%confidence intervals[CI]:2.14-2.26)and respiratory multimorbidity(HR=2.13,95%CI:1.97-2.31)demonstrated relatively higher risks of mortality,followed by gastrointestinal and hepatorenal multimorbidity(HR=1.33,95%CI:1.22-1.46).The mortality risk increased by 36%(HR=1.36,95%CI:1.35-1.37)with every additional disease.Conclusion:Cardiometabolic multimorbidity and respiratory multimorbidity posed the highest threat on mortality risk and d

关键词： Multimorbidity Pattern Mortality Chinese

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Geographic Variations in the Prevalence,Awareness,Treatment,and Control of Dyslipidemia among Chinese Adults in 2018–2019:A Cross-sectional Study

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Biomedical and Environmental Sciences 2023年第4期36卷 313-323页

作者： ZHANG Mei PENG Ke ZHANG Xiao LIU Yi Shu LIU Xiao Ying HAN Gui Yuan SHI Yu HUANG Zheng Jing LI Chun ZHAO Zhen Ping WANG Li Min LI Yi Chong National Center for Chronic and Non-communicable Disease Control and Prevention Chinese Center for Disease Control and PreventionBeijing 100050China National Clinical Research Center for Cardiovascular Diseases ShenzhenFuwai Hospital Chinese Academy of Medical SciencesShenzhen 518057GuangdongChina The George Institute for Global Health 2042New South WalesAustralia School of Medical Science Faculty of Medicine and HealthUniversity of Sydney2006New South WalesAustralia

Objective To investigate the spatial patterns of the prevalence,awareness,treatment,and control rates of dyslipidemia at the provincial level in China.Methods A national and provincial representative cross-sectional survey was conducted among 178,558 Chinese adults in 31 provinces in China's Mainland in 2018–2019,using a multi-stage,stratified,cluster-randomized sampling design.Subjects,as households,were selected,followed by a home visit to collect information.Both descriptive and linear regression procedures were applied in the analyses.Results The overall prevalence of dyslipidemia was 35.6%,and wide geographic variations of prevalence,treatment,and control rates of dyslipidemia were identified among 178,558 eligible participants with a mean age of 55.1±13.8 years.The highest-lowest difference regarding the provincial level prevalence rates were 19.7%vs.2.1%for high low-density lipoprotein cholesterol,16.7%vs.2.5%for high total cholesterol,35.9%vs.5.4%for high triglycerides,and 31.4%vs.10.5%for low high-density lipoprotein cholesterol.The treatment rate of dyslipidemia was correlated with the socio-demographic index(PChinese population and its wide geographic variations in prevalence,treatment,and control suggest that China needs both integrated and localized public health strategies across provinces to improve lipid management.

关键词： Lipids management Dyslipidemia Public health Chinese

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Comparison of outcomes between immediate implantbased and autologous reconstruction: 15-year, single-center experience in a propensity score-matched Chinese cohort

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Cancer Biology & Medicine 2022年第9期19卷 1410-1421页

作者： Shanshan He Bowen Ding Gang Li Yubei Huang Chunyong Han Jingyan Sun Qingfeng Huang Jing Liu Zhuming Yin Shu Wang Jian Yin Department of Breast Reconstruction Key Laboratory of Breast Cancer Prevention and TherapyTianjin Medical UniversityMinistry of EducationSino‐Russian Joint Research Center for Oncoplastic Breast SurgeryTianjin Medical University Cancer Institute&HospitalNational Clinical Research Center for CancerKey Laboratory of Cancer Prevention and TherapyTianjinTianjin’s Clinical Research Center for CancerTianjin 300060China School of Pharmacy University College LondonLondon WC1N 1AXUK Department of Cancer Epidemiology and Biostatistics Tianjin Medical University Cancer Institute&HospitalNational Clinical Research Center for CancerKey Laboratory of Cancer Prevention and TherapyTianjinTianjin’s Clinical Research Center for CancerTianjin 300060China

Objective:The number of immediate breast reconstruction(IBR)procedures has been increasing in China.This study aimed to investigate the oncological safety of IBR,and to compare the survival and surgical outcomes between implant-based and autologous reconstruction.Methods:Data from patients diagnosed with invasive breast cancer who underwent immediate total breast reconstruction between 2001 and 2016 were retrospectively reviewed.Long-term breast cancer-specific survival(BCSS),disease-free survival(DFS),and locoregional recurrence-free survival(LRFS)were evaluated.Patient satisfaction with the breast was compared between the implantbased and autologous groups.BCSS,DFS,and LRFS were compared between groups after propensity score matching(PSM).Results:A total of 784 IBR procedures were identified,of which 584 were performed on patients with invasive breast cancer(implantbased,n=288;autologous,n=296).With a median follow-up of 71.3 months,the 10-year estimates of BCSS,DFS,and LRFS were 88.9%[95%confidence interval(CI)(85.1%–93.0%)],79.6%[95%CI(74.7%–84.8%)],and 94.0%[95%CI(90.3%–97.8%)],respectively.A total of 124 patients completed the Breast-Q questionnaire,and no statistically significant differences were noted between groups(P=0.823).After PSM with 27 variables,no statistically significant differences in BCSS,DFS,and LRFS were found between the implant-based(n=177)and autologous(n=177)groups.Further stratification according to staging,histological grade,lymph node status,and lymph-venous invasion status revealed no significant survival differences between groups.Conclusions:Both immediate implant-based and autologous reconstruction were reasonable choices with similar long-term oncological outcomes and patient-reported satisfaction among patients with invasive breast cancer in China.

关键词： Oncological safety immediate breast reconstruction implant-based autologous Chinese propensity-score matched

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Validation of the Meta-Analysis Global Group in Chronic Heart Failure risk score for the prediction of 1-year mortality in a Chinese cohort

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Chinese Medical Journal 2022年第23期135卷 2829-2835页

作者： Duo Xu Yanjing Dong Bo Zhang Li Li Chenyang Jiang Department of Cardiology Sir Run Run Shaw HospitalZhejiang University School of MedicineHangzhouZhejiang 3100016China Department of Cardiology CHC International HospitalCixiZhejiang 315310China

Background: The Meta-Analysis Global Group in Chronic Heart Failure (MAGGIC) risk score was developed in 2013 to predict survival in heart failure (HF) patients. However, it has yet to be validated in a Chinese population. Our study aimed to investigate the ability of the score to predict 1-year mortality in a Chinese population.Methods: Consecutive patients with HF were retrospectively selected from the inpatient electronic medical records of the cardiology department in a regional hospital in China. A total integer score was calculated for each enrolled patient based on the value of each risk factor in the MAGGIC scoring system. Each enrolled patient was followed for at least 1 year. The observational endpoint of this study was all-cause mortality. The predictive ability of the MAGGIC score was assessed by comparing observed and predicted mortality within 1 year.Results: Between January 2018 and December 2020, a total of 635 patients were included in the study: 57 (9.0%) of whom died within 1 year after discharge. The average age of all patients was 74.6 ± 11.2 years, 264 of them (41.6%) were male, and the average left ventricular ejection fraction was 50.7% ± 13.2%. The area under the receiver operating characteristic curve was 0.840 (95% confidence interval: 0.779, 0.901), which indicated a fair discriminatory ability of the score. The Hosmer-Lemeshow test result (χ^(2) = 12.902, degree of freedom = 8,P = 0.115) indicated that the MAGGIC score had good calibration. The decision curve analysis showed that the MAGGIC score yielded a good clinical net benefit and net reduction in interventions.Conclusions: This validation of the MAGGIC score showed that it has a good ability to predict 1-year mortality in Chinese patients with HF after discharge. Due to regional and inter-hospital differences, external validation studies need to be further confirmed in other centers.

关键词： Validation Risk prediction MAGGIC Heart failure Mortality Chinese

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Clinical efficacy of comprehensive therapy based on traditional Chinese medicine patterns on patients with pneumoconiosis: a pilot double-blind, randomized, and placebo-controlled study

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Frontiers of Medicine 2022年第5期16卷 736-744页

作者： Jiansheng Li Hulei Zhao Yang Xie Jieya Li Qingwei Li Xuexin Chen Weiyu Zhang Collaborative Innovation Center for Chinese Medicine and Respiratory Diseases Co-constructed by Henan Province&Education Ministry of China Henan University of Chinese MedicineZhengzhou 450046China Henan Key Laboratory of Chinese Medicine for Respiratory Disease Henan University of Chinese MedicineZhengzhou 450046China Department of Respiratory Diseases The First Affiliated Hospital of Henan University of Chinese MedicineZhengzhou 450000China Department of Pneumoconiosis Henan Hospital for Occupational DiseasesZhengzhou 450052China Department of Respiratory Diseases Jiaozuo Coal Industry Group Co.Ltd.Central HospitalJiaozuo 454000China Department of Pneumoconiosis Yima Coal Industry Group Co.Ltd.General HospitalYima 472300China

Effective therapy options for pneumoconiosis are lacking.Traditional Chinese medicine(TCM)presents a favorable prospect in the treatment of pneumoconiosis.A pilot study on TCM syndrome differentiation can evaluate the clinical efficacy and safety of TCM and lay a foundation for further clinical research.A double-blind,randomized,and placebo-controlled trial was conducted for 24 weeks,in which 96 patients with pneumoconiosis were randomly divided into the control and treatment groups.Symptomatic treatment was conducted for the two groups.The treatment group was treated with TCM syndrome differentiation,and the control group was treated with placebo.The primary outcomes were the six-minute walking distance(6MWD)and the St.George Respiratory Questionnaire(SGRQ)score.The secondary outcomes were the modified British Medical Research Council Dyspnea Scale(mMRC),Chronic Obstructive Pulmonary Disease Assessment Test(CAT),Hospital Anxiety and Depression Scale(HADS),and pulmonary function.Only 83 patients from the 96 patients with pneumoconiosis finished the study.For the primary outcome,compared with the control groups,the treatment group showed a significantly increased 6MWD(407.90 m vs.499.51 m;95%confidence interval(CI)47.25 to 135.97;P<0.001)and improved SGRQ total score(44.48 vs.25.67;95%CI 27.87 to 9.74;P<0.001).The treatment group also significantly improved compared with the control group on mMRC score(1.4 vs.0.74;95%CI 1.08 to 0.23;P=0.003),CAT score(18.40 vs.14.65;95%CI 7.07 to 0.43;P=0.027),and the total symptom score(7.90 vs.5.14;95%CI 4.40 to 1.12;P<0.001).No serious adverse events occurred.This study showed that TCM syndrome differentiation and treatment had a favorable impact on the exercise endurance and quality of life of patients with pneumoconiosis.

关键词： pneumoconiosis randomized controlled trials traditional Chinese medicine

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Efficacy and safety of obinutuzumab for the first-line treatment of follicular lymphoma:a subgroup analysis of Chinese patients enrolled in the phase III GALLIUM study

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Chinese Medical Journal 2022年第4期135卷 433-440页

作者： Xiaonan Hong Yuqin Song Yuankai Shi Qingyuan Zhang Wei Guo Gang Wu Junmin Li Jifeng Feng Anastasiia Kinkolykh Andrea Knapp Tongyu Lin Department of Medical Oncology Fudan University Shanghai Cancer CenterShanghai 200032China Key Laboratory of Carcinogenesis and Translational Research(Ministry of Education) Peking University Cancer Hospital and InstituteBeijing 100142China National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted DrugsBeijing 100021China Department of Medical Oncology Harbin Medical University Cancer HospitalHarbin Medical UniversityHarbinHeilongjiang 150081China Department of Hematology The First Hospital of Jilin UniversityChangchunJilin 130015China Department of Medical Oncology Cancer CenterUnion HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhanHubei 430023China Shanghai Institute of Hematology State Key Laboratory of Medical GenomicsNational Research Center for Translational Medicine at ShanghaiRuijin Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghai 200025China Department of Medical Oncology Jiangsu Cancer HospitalNanjing Medical University Affiliated Cancer HospitalNanjingJiangsu 210009China Consultant to F.Hoffmann-La Roche Ltd BaselSwitzerlandvia GCE Solutions-an IQVIA businessSwitzerland Product Development Oncology F.Hoffmann-La Roche LtdBaselSwitzerland Department of Medical Oncology Sun Yat-Sen University Cancer CenterState Key Laboratory of Oncology in South Chinaand Collaborative Innovation Center for Cancer MedicineGuangzhouGuangdong 510075China

Backgrounds:GALLIUM is a global phase Ⅲ study that demonstrated significant improvements in progression-free survival(PFS)for obinutuzumab plus chemotherapy(G-chemo)vs.rituximab plus chemotherapy(R-chemo)in previously untreated patients with follicular lymphoma(FL).This study aimed to report the results of a subgroup of patients in China.Methods:Patients were randomized to G-chemo or R-chemo.Responders received maintenance therapy for 2 years or until disease progression.The primary endpoint was investigator(INV)-assessed PFS.Secondary endpoints included the overall response rate(ORR)and complete response rate(CRR)at the end of induction chemotherapy,overall survival(OS),and safety.Results:Overall,58 patients with FL were randomized to the G-chemo(n=25)and R-chemo arms(n=33).The INV-assessed PFS rate at 3 years was 81.8%in the G-chemo arm,vs.70.2%in the R-chemo arm(hazard ratio 0.35;95%confidence interval:0.09-1.34;P=0.1120).The INV-assessed CRRs(without positron emission tomography[PET])in these arms were 24.0%and 21.2%,respectively,whereas the ORRs were 80.0%and 90.9%,respectively.INV-assessed CRR-PET was 52.6%in the G-chemo,vs.60.9%in the R-chemo.Median OS was not reached in either arm.Grade 3 to 5 adverse events were more frequent in the R-chemo arm(97.0%vs.88.0%).Conclusions:The results of this subgroup analysis were consistent with those of the global population,and they suggest that G-chemo has a positive benefit-risk profile in patients from China with FL.Trial registration:ClinicalTrials.gov,No.NCT01332968.

关键词： Chinese Follicular lymphoma GALLIUM Obinutuzumab Rituximab

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Cytogenetic Characteristics of Childhood Acute Lymphoblastic Leukemia:A Study of 1541 Chinese Patients Newly Diagnosed between 2001 and 2014

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Current Medical Science 2022年第1期42卷 201-209页

作者： Meng-meng YIN Rui-chi WU Jing GAO Shao-yan HU Xiao-ming LIU Xiao-fan ZHU Shu-hong SHEN Jing-yan TANG Jing CHEN Qun HU Department of Pediatric Hematology Tongji HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhan 430030China Department of Hematology/Oncology Shanghai Children’s Medical CenterShanghai Jiaotong University School of MedicineShanghai 200000China Children’s Hospital of Soochow University Suzhou 215000China State Key Laboratory of Experimental Hematology National Clinical Research Center for Blood DiseasesInstitute of Hematology&Blood Diseases HospitalChinese Academy of Medical Sciences&Peking Union Medical CollegeTianjin 300000China

Objective:Cytogenetic abnormalities have been proven to be the most valuable parameter for risk stratification of childhood acute lymphoblastic leukemia(ALL).However,studies on the prevalence of cytogenetic abnormalities and their correlation to clinical features in Chinese pediatric patients are limited,especially large-scale studies.Methods:We collected the cytogenetics and clinical data of 1541 children newly diagnosed with ALL between 2001 and 2014 in four Chinese hospitals,and retrospectively analyzed their clinical features,prognosis and risk factors associated with pediatric ALL.

关键词： cytogenetics characteristics childhood Chinese acute lymphoblastic leukemia.

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Breast cancer screening and early diagnosis in Chinese women

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Cancer Biology & Medicine 2022年第4期19卷 450-467页

作者： Rui Ding Yi Xiao Miao Mo Ying Zheng Yi-Zhou Jiang Zhi-Ming Shao Key Laboratory of Breast Cancer in Shanghai Department of Breast SurgeryFudan University Shanghai Cancer CenterShanghai 200032China Department of Oncology Shanghai Medical CollegeFudan UniversityShanghai 200032China Department of Cancer Prevention Fudan University Shanghai Cancer CenterDepartment of OncologyShanghai Medical CollegeFudan UniversityShanghai 200032China Precision Cancer Medicine Center Fudan University Shanghai Cancer CenterShanghai 200032China

Breast cancer is the most common malignant tumor in Chinese women,and its incidence is increasing.Regular screening is an effective method for early tumor detection and improving patient prognosis.In this review,we analyze the epidemiological changes and risk factors associated with breast cancer in China and describe the establishment of a screening strategy suitable for Chinese women.Chinese patients with breast cancer tend to be younger than Western patients and to have denser breasts.Therefore,the age of initial screening in Chinese women should be earlier,and the importance of screening with a combination of ultrasound and mammography is stressed.Moreover,Chinese patients with breast cancers have several ancestry-specific genetic features,and aiding in the determination of genetic screening strategies for identifying high-risk populations.On the basis of current studies,we summarize the development of risk-stratified breast cancer screening guidelines for Chinese women and describe the significant improvement in the prognosis of patients with breast cancer in China.

关键词： Breast cancer screening Chinese imaging screening genetic test

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CASC15 Gene Polymorphisms and Glioma Susceptibility in Chinese Children

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Current Medical Science 2022年第4期42卷 797-802页

作者： Hui-ran LIN Yong-ping CHEN Hui-tong CHEN Xiao-ping LIU Jing-ying ZHOU Xiao-kai HUANG Li YUAN Zhen-jian ZHUO Faculty of Medicine Macao University of Science and TechnologyMacao 999078China Department of Pediatric Surgery Guangzhou Institute of PediatricsGuangdong Provincial Key Laboratory of Research in Structural Birth Defect DiseaseGuangzhou Women and Children's Medical CenterGuangzhou Medical UniversityGuangzhou 510623China Department of Hematology Guangzhou Women and Children's Medical CenterGuangzhou Medical UniversityGuangzhou 510623China Department of Hematology the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical UniversityWenzhou 325027China Department of Pathology Guangzhou Women and Children's Medical CenterGuangzhou Medical UniversityGuangzhou 510623China

Objective:Gliomas are the most common tumors in the central nervous system.The cancer susceptibility candidate 15(CASC15)gene has been reported to be a susceptibility gene for several types of cancer.No studies have been carried out on the predisposing effect of CASC15 gene single nucleotide polymorphisms(SNPs)on glioma risk.Methods:In order to determine whether CASC15 gene SNPs are involved in glioma susceptibility,the first association study in a relatively large sample,which consisted of 171 patients and 228 healthy controls recruited from China,was performed.The contribution of SNPs(rs6939340 A>G,rs4712653 T>C and rs9295536 C>A)to the risk of glioma was evaluated by multinomial logistic regression,based on the calculation of the odds ratio(OR)and 95%confidence interval(CI).Results:In the single locus and combined analysis,it was revealed that the genetic risk score had no significant associations between CASC15 gene SNPs and glioma risk.However,in the stratified analysis,a significant decrease in risk of glioma was observed in subjects ofChinese children.However,more well-designed case-control studies and functional experiments are needed to further explore the role of CASC15 gene SNPs.

关键词： cancer susceptibility candidate 15 polymorphisms glioma susceptibility Chinese

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Prevalence and risk factors of osteoporosis detected by dual-energy X-ray absorptiometry among Chinese patients with primary biliary cholangitis

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World Journal of Gastroenterology 2023年第29期29卷 4580-4592页

作者： Jia-Liang Chen Yao Liu Yu-Fei Bi Xian-Bo Wang Center of Integrative Medicine Beijing Ditan HospitalCapital Medical UniversityBeijing 100015China

BACKGROUND Osteoporosis is an extrahepatic complication of primary biliary cholangitis(PBC)that increases the risk of fractures and mortality.However,Epidemiological studies of osteoporosis in patients with PBC in China and the Asia-Pacific region is lack.AIM To assess the prevalence and clinical characteristics of osteoporosis in Chinese patients with PBC.METHODS This retrospective analysis included consecutive patients with PBC from a tertiary care center in China who underwent bone mineral density(BMD)assessment using dual-energy X-ray absorptiometry between January 2013 and December 2021.We defined subjects with T-scores≤-2.5 in any sites(L1 to L4,femoral neck,or total hip)as having osteoporosis.Demographic,serological,clinical,and histological data were collected.Independent risk factors for osteoporosis were identified by multivariate logistic regression analysis.RESULTS A total of 268 patients with PBC[236 women(88.1%);mean age,56.7±10.6 years;163 liver biopsies(60.8%)]were included.The overall prevalence of osteoporosis in patients with PBC was 45.5%(122/268),with the prevalence of osteoporosis in women and men being 47.0%and 34.4%,respectively.The prevalence of osteoporosis in postmenopausal women was significantly higher than that in premenopausal women(56.3%vs 21.0%,PChinese patients with PBC,allowing for prior screening of BMD in those PBC patients with older age,lower BMI,previous steroid therapy and advanced liver disease.

关键词： Primary biliary cholangitis Osteoporosis Bone mineral density Dual-energy X-ray absorptiometry Prevalence Chinese

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