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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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Development,validation and comparison of multivariable risk scores for prediction of total stroke and stroke types in Chinese adults:a prospective study of 0.5 million adults

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Stroke & Vascular Neurology 2022年第4期7卷 328-336,I0023-I0045页

作者： Matthew Chun Robert Clarke Tingting Zhu David Clifton Derrick A Bennett Yiping Chen Yu Guo Pei Pei Jun Lv Canqing Yu Ling Yang Liming Li Zhengming Chen Benjamin J Cairns 无 Clinical Trial Service Unit and Epidemiological Studies Nuffield Department of Population HealthUniversity of OxfordOxfordUK Department of Engineering Science University of OxfordOxfordUK Department of Biomedical Engineering Oxford-Suzhou Centre for Advanced ResearchSuzhouChina Medical Research Council Health Research Unit Nuffield Department of Population HealthUniversity of OxfordOxfordUK CKB Project Department Fuwai Hospital Chinese Academy of Medical SciencesNational Center for Cardiovascular DiseasesBeijingChina CKB Project Department Chinese Academy of Medical SciencesBeijingChina Department of Epidemiology and Biostatistics School of Public HealthPeking UniversityBeijingChina Department of Epidemiology Peking University Center for Public Health and Epidemic Preparedness and ResponseBeijingChina On behalf of the china kadoorie biobank Collaborative Group

Background and purpose Low-income and middle-income countries have the greatest stroke burden,yet remain understudied.This study compared the utility of Framingham versus novel risk scores for prediction of total stroke and stroke types in Chinese adults.Methods china kadoorie biobank(CKB)is a prospective study of 512726 adults,aged 30-79 years,recruited from 10 areas in china in 2004-2008.By 1 January 2018,43234 incident first stroke cases(36310 ischaemic stroke(IS);8865 haemorrhagic stroke(HS))were recorded in 503842 participants with no history of stroke at baseline.We compared the predictive utility of the Framingham Stroke Risk Profile(FSRP)with novel CKB stroke risk scores and included recalibration,refitting,stratifying by study area and addition of other risk factors.Discrimination was assessed using area under the receiver operating characteristic curve(AUC)and calibration was assessed using Greenwood-Nam-D’Agostinoχ^(2) statistics.Results Incidence of total stroke varied fivefold by area in china.The FSRP had good discrimination for total stroke(AUC(95%CI);men:0.78(0.77 to 0.79),women:0.77(95%CI 0.76 to 0.78)),but poor calibration(χ^(2);men:1,825,women:3,053),substantially underestimating absolute risks.Recalibration reducedχ^(2) by>80%,but did not improve discrimination.Refitting the FSRP did not materially improve discrimination,but further improved calibration.Stratification by area improved discrimination(AUC;men:0.82(0.82 to 0.83);women:0.82(0.82 to 0.83)),but not calibration.Adding other risk factors yielded modest,but statistically significant,improvements in the AUCs.The findings for IS and HS were similar to those for total stroke.Conclusions The FSRP reliably differentiated Chinese adults with incident stroke,but substantially underestimated the absolute risks of stroke.Novel local risk prediction equations that took account of differences in stroke incidence within china enhanced risk prediction of total stroke and major stroke pathological types.

关键词： prediction income absolute

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Pregnancy Loss in Relation to the Risks of Female-Specific Cancers in a Population-Based Cohort and Mendelian Randomization Study — china, 2004–2017

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china CDC weekly 2023年第19期5卷 413-418,I0001,I0002页

作者： Yongle Zhan Yawen Wang Yimin Qu Lin Zhang Xuan Liu Ruiyi Liu Peng Xue Jiaxu Wang Dongxu Qin Hexin Yue Canqing Yu Jun Lyu Yu Guo Zhengming Chen Yu Jiang Liming Li china kadoorie biobank Collaborative Group Department of Epidemiology and Biostatistics School of Population Medicine and Public HealthChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina Division of Urology Department of SurgeryLKS Faculty of MedicineThe University of Hong KongHong Kong Special Administrative RegionChina Jockey Club School of Public Health and Primary Care The Chinese University of Hong KongHong Kong Special Administrative RegionChina Melbourne School of Population and Global Health The University of MelbourneVictoriaAustralia centre of Cancer Research Victorian Comprehensive Cancer CentreMelbourneVictoriaAustralia Department of Epidemiology and Biostatistics School of Public HealthPeking University Health Science CenterBeijingChina Fuwai Hospital Xishan Branch Court Chinese Academy of Medical SciencesBeijingChina Clinical Trial Service Unit&Epidemiological Studies Unit(CTSU) Nuffield Department of Population HealthUniversity of OxfordOxfordUK.&Joint first authors 不详

Summary What is already known about this topic?Limited evidence exists regarding the relationship between pregnancy loss and female-specific cancers within the Chinese population from prospective cohort studies.What is added by this report?Terminations were associated with a 13%lower risk of endometrial cancer,whereas stillbirths were related to an 18%higher risk of cervical cancer.Rural residents with a history of pregnancy loss experienced a 19%and 38%increased risk of breast and cervical cancers,respectively,compared to their urban counterparts.Moreover,a positive graded relationship between live births and pregnancy loss on cervical cancer was observed.What are the implications for public health practice?This study has significant implications for identifying women at an increased risk for breast and genital cancers and contributes to the development of effective public health strategies for female cancer prevention.Future research on reproductive history,particularly in rural areas,should be given priority in efforts to improve female cancer screening and early detection.

关键词： Population Rural birth

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Risk factors for cardiovascular disease in the Chinese population:recent progress and implications

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Global Health Journal 2020年第3期4卷 65-71页

作者： Yuanjie Pang Jun Lyu Canqing Yu Yu Guo Liming Lee Department of Epidemiology&Biostatistics School of Public HealthPeking University Health Science Centre38 Xueyuan RoadBeijing 100191China Key Laboratory of Molecular Cardiovascular Sciences Ministry of EducationPeking UniversityBeijing 100191China Chinese Academy of Medical Sciences 9 Dongdan San TiaoBeijing 100730China

Cardiovascular disease(CVD)is the leading cause of death in both urban and rural areas of china.The current evidence regarding CVD risk factors was primarily established in Western countries,with limited generalizability to the Chinese population.In china,a growing number of population-based prospective cohort studies have emerged that have yielded substantial research data on CVD risk factors in the past five years.The research studies have covered biological risk factors(e.g.,blood lipids,blood pressure,blood glucose,adiposity),lifestyle risk factors(e.g.,smoking,alcohol,diet,physical activity),environmental risk factors(e.g.,ambient and indoor air pollution),and risk prediction.This study aimed to systematically review the research progress on CVD risk factors in the Chinese population in the past five years.Prospective studies in china have identified biological,lifestyle,and environmental risk factors for CVD and its main subtypes,along with some protective factors unique to the Chinese(e.g.,spicy food and green tea).This review aimed to provide high-quality evidence for achieving the Outline of Healthy china 2030,developing disease prevention guidelines and measures,and deepening efforts for popularization of health knowledge.

关键词： Cardiovascular disease Cohort study Chinese Risk factor Lifestyle Risk prediction china kadoorie biobank

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