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Management characteristics and prognosis after stroke in China:findings from a large nationwide stroke registry

Stroke & Vascular Neurology 2021年第1期6卷 1-9页

作者： Haiqiang Qin Yiping Chen Gaifen Liu Iain Turnbull Runhua Zhang Zixiao Li Yilong Wang Liping Liu Xingquan Zhao Zhengming Chen Yongjun Wang department of Neurology Beijing Tiantan HospitalCapital Medical UniversityBeijingChina China National Clinical Research Center for Neurological Diseases BeijingChina Center of Stroke Beijing Institute for Brain DisordersBeijingChina Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease BeijingChina Medical Research Council population health Research Unit Nuffield Department of Population HealthUniversity of OxfordOxfordUK Clinical Trial Service Unit&Epidemiological Studies Unit Nuffield Department of Population HealthUniversity of OxfordOxfordUK

Background and purpose There is limited nationwide evidence about the standard management characteristics of stroke types and prognosis in China.This study aimed to assess clinical characteristics,in-hospital and after-discharge management characteristics and prognosis for stroke types in China.Methods A nationwide registry recruited 14244 imaging-confirmed first-ever incident strokes from 132 hospitals across 31 provinces of China during 2007-2008,recording presenting characteristics,diagnostic procedures and in-hospital treatment.After hospital discharge,patients were followed up for 6 months.Conventional statistical methods were used to examine the patterns of management and prognosis.Results Overall,68.7%,26.9%and 4.4%were ischaemic stroke(IS),intracerebral haemorrhage(ICH),and subarachnoid haemorrhage(SAH),respectively.Only 20%were managed in a dedicated stroke unit.Among IS,1.3%received thrombolysis within 3 hours after symptom onset,whereas the proportions of receiving in-hospital antiplatelet therapy,neuroprotective agents and traditional Chinese medicines(TCM)were 88.4%,69.7%and 70.6%,respectively.For ICH,63.3%and 36.3%received neuroprotective agents and TCM in hospital,respectively.At discharge,70.7%and 38.0%of the patients with IS were given antiplatelet and statin therapies,respectively,decreasing to 64.8%and 23.9%,respectively,at 6 months.In-hospital mortality was 3.2%,9.3%and 10.1%for IS,ICH and SAH,respectively,with a further 8.6%,18.2%and 22.0%,respectively,died by 6 month.Meanwhile,in-hospital recurrence rate was 2.6%,1.9%and 7.2%for IS,ICH and SAH,respectively,with a further 8.0%,5.1%and 7.5%,respectively,recurred by 6 month.Conclusions In China,the mortality rate of stroke is lower than that reported from west populations,though most strokes are not managed in specialised stroke unit.There is widespread use of some unproven therapies but limited proven treatments,especially after discharge,leading to unnecessary recurrent risks.

关键词： protective prognosis mortality

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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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Association between fresh fruit consumption and the risk of chronic obstructive pulmonary disease-related hospitalization and death in Chinese adults: A prospective cohort study

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中华医学杂志（英文版） 2023年第19期136卷 2316-2323页

作者： Xin Huang Jiachen Li Weihua Cao Jun Lyu Yu Guo Pei Pei Qingmei Xia Huaidong Du Yiping Chen Yang Ling Rene Kerosi Rebecca Stevens Xujun Yang Junshi Chen Canqing Yu Zhengming Chen Liming Li on behalf of China Kadoorie Biobank China 100191 China Peking University Center for Public health and Epidemic Preparedness and Response Beijing 100191 China Key Laboratory of Molecular Cardiovascular Sciences (Peking University) Ministry of Education Beijing 100191 China100191 China 100037 China 100730 Nuffield Department of Population Health Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU) University of Oxford Oxford OX3 7LF UK Medical Research Council Population Health Research Unit at the University of Oxford Oxford OX3 7LF UK China 741020 China 100022 China Peking University Center for Public health and Epidemic Preparedness and Response Beijing 100191 China100191 Nuffield Department of Population Health Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU) University of Oxford Oxford OX3 7LF UK

Background: Existing evidence suggests that fruit consumption is a significant influencing factor for chronic obstructive pulmonary disease (COPD), but this is unclear in the Chinese population. We examined the association of fresh fruit consumption with the risk of COPD-related hospitalization and death in a nationwide, population-based prospective cohort from China. Methods: Between 2004 and 2008, the China Kadoorie Biobank recruited >0.5 million adults aged 30 to 79 years from ten diverse regions across China. After excluding individuals diagnosed with major chronic diseases and prevalent COPD, the prospective analysis included 421,428 participants. Cox regression was used to calculate the hazard ratios (HRs) for the association between fresh fruit consumption and risk of COPD-related hospitalization and death, with adjustment for established and potential confounders. Results: During a mean follow-up of 10.9 years, 11,292 COPD hospitalization events and deaths were documented, with an overall incidence rate of 2.47/1000 person-years. Participants who consumed fresh fruit daily had a 22% lower risk of COPD-related hospitalization and death compared with non-consumers (HR= 0.78, 95% confidence interval [CI]: 0.71–0.87). The inverse association between fresh fruit consumption and COPD-related hospitalization and death was stronger among non-current smokers and participants with normal body mass index (BMI) (18.5 kg/m 2 ≤ BMI < 24.0 kg/m 2 ); the corresponding HRs for daily fresh fruit consumption were 0.78 (95% CI: 0.68–0.89) and 0.69 (95% CI: 0.59–0.79) compared with their counterparts, respectively. Conclusions: High-frequency fruit consumption was associated with a lower risk of COPD in Chinese adults. Increasing fruit consumption, together with cigarette cessation and weight control, should be considered in the prevention and management of COPD.

关键词： Fresh fruit Chronic obstructive pulmonary disease Smoking Body mass index

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数字化乳腺摄影对癌症检出率和召回率的影响:英国国家卫生服务机构乳腺癌筛查项目中的1130万次筛查

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国际医学放射学杂志 2019年第3期 353-353页

作者：庞国栋 R.G.Blanks M.G.Wallis R.Alison O.Kearins J.Jenkins J.Patnick Cancer Epidemiology Unit Nuffield Department of Population HealthOxford University

摘要目的探讨在一项大型全国筛查项目中,将屏-片乳腺摄影转为数字乳腺摄影(DM)所产生的影响。材料与方法回顾性分析从2009—2010年至2015—2016年英国国家

关键词：召回率乳腺癌筛查检出率数字乳腺摄影卫生服务机构

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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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Genetic and healthy lifestyle factors in relation to the incidence and prognosis of severe liver disease in the Chinese population

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Chinese Medical Journal 2023年第16期136卷 1929-1936页

作者： Yuanjie Pang Jun Lv Christiana Kartsonaki Canqing Yu Yu Guo Yiping Chen Ling Yang Iona Y.Millwood Robin G.Walters Silu Lv Sushila Burgess Sam Sansome Junshi Chen Zhengming Chen Liming Li department of Epidemiology and Biostatistics School of Public HealthPeking UniversityBeijing 100191China Key Laboratory of Epidemiology of Major Diseases(Peking University) Ministry of EducationBeijing 100191China Peking University Center for Public health and Epidemic Preparedness&Response Beijing 100191China Nuffield Department of Population Health Clinical Trial Service Unit&Epidemiological Studies Unit(CTSU)University of OxfordOxford OX37LFUK Nuffield Department of Population Health Medical Research Council Population Health Research Unit(MRC PHRU)at the University of OxfordUniversity of OxfordOxford OX37LFUK National Clinical Research Center of Cardiovascular Diseases National Center for Cardiovascular DiseasesBeijing 100730China Fuwai Hospital Chinese Academy of Medical Sciences167 Beilishi RoadXicheng DistrictBeijing 100037China Licang Center for Disease Prevention and Control Licang DistrictQingdaoShandong 266041China National Center for Food Safety Risk Assessment Beijing 100021China

Background:Severe liver disease(SLD),including cirrhosis and liver cancer,constitutes a major disease burden in China.We aimed to examine the association of genetic and healthy lifestyle factors with the incidence and prognosis of SLD.Methods:The study population included 504,009 participants from the prospective China Kadoorie Biobank aged 30-79 years.The individuals were from 10 diverse areas in China without a history of cancer or liver disease at baseline.Cox regression was used to estimate adjusted hazard ratios(HRs)for incident SLD and death after SLD diagnosis associated with healthy lifestyle factors(smoking,alcohol,physical activity,and central adiposity).Additionally,the contribution of genetic risk for hepatitis B virus(HBV,assessed by genetic variants in major histocompatibility complex,class II,DP/DQ[HLA-DP/DQ]genes)was also estimated.Results:Compared with those with 0-1 healthy lifestyle factor,participants with 2,3,and 4 factors had 12%(HR 0.88[95%confidence interval[CI]0.85,0.92]),26%(HR 0.74[95%CI:0.69,0.79]),and 44%(HR 0.56[95%CI:0.48,0.65])lower risks of SLD,respectively.Inverse associations were observed among participants with both low and high genetic risks(HR per 1-point increase 0.83[95%CI:0.74,0.94]and 0.91[95%CI:0.82,1.02],respectively;P_(interaction)=0.51),although with a non-significant trend among those with a high genetic risk.Inverse associations were also observed between healthy lifestyle factors and liver biomarkers regardless of the genetic risk.Despite the limited power,healthy lifestyle factors were associated with a lower risk of death after incident SLD among participants with a low genetic risk(HR 0.59[95%CI:0.37,0.96]).Conclusions:Lifestyle modification may be beneficial in terms of lowering the risk of SLD regardless of the genetic risk.Moreover,it is also important for improving the prognosis of SLD in individuals with a low genetic risk.Future studies are warranted to examine the impact of healthy lifestyles on SLD prognosis,particularly among individuals with a high ge

关键词： healthy lifestyle Gene-environment interaction Liver cancer Cirrhosis Prognosis China

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Multimorbidity patterns and association with mortality in 0.5 million Chinese adults

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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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Association of physical activity with risk of chronic kidney disease in China:A population-based cohort study

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Journal of Sport and health Science 2024年第2期13卷 204-211页

作者： Kexiang Shi Yunqing Zhu Jun Lv Dianjianyi Sun Pei Pei Huaidong Du Yiping Chen Ling Yang Bing Han Rebecca Stevens Junshi Chen Zhengming Chen Liming Li Canqing Yu China Kadoorie Biobank collaborative group department of Epidemiology&Biostatistics School of Public HealthPeking University Health Science CenterBeijing 100191China Peking University Center for Public health and Epidemic Preparedness&Response Beijing 100191China Key Laboratory of Epidemiology of Major Diseases(Peking University) Ministry of EducationBeijing 100191China Clinical Trial Service Unit&Epidemiological Studies Unit(CTSU) Nuffield Department of Population HealthUniversity of OxfordOxford OX37LFUK Medical Research Council population health Research Unit at the University of Oxford Oxford OX37LFUK NCDs Prevention and Control department Henan Center for Disease Control and PreventionZhengzhou 450016China China National Center for Food Safety Risk Assessment Beijing 100022China 不详

Background:Information on the association between physical activity(PA)and the risk of chronic kidney disease(CKD)is limited.We aimed to explore the associations of total,domain-specific,and intensity-specific PA with CKD and its subtypes in China.Methods:The study included 475,376 adults from the China Kadoorie Biobank aged 30-79 years during 2004-2008 at baseline.An interviewer-administered questionnaire was used to collect the information about PA,which was quantified as metabolic equivalent of task hours per day(MET-h/day)and categorized into 4 groups based on quartiles.Cox regression was used to analyze the association between PA and CKD risk.Results:During a median follow-up of 12.1 years,5415 incident CKD cases were documented,including 1159 incident diabetic kidney disease(DKD)cases and 362 incident hypertensive nephropathy(HTN)cases.Total PA was inversely associated with CKD risk,with an adjusted hazard ratio(HR,95%confidence interval(95%CI))of 0.83(0.75-0.92)for incident CKD in the highest quartile of total PA as compared with participants in the lowest quartile.Similar results were observed for risk of DKD and HTN,and the corresponding HRs(95%CIs)were 0.75(0.58-0.97)for DKD risk and 0.56(0.37-0.85)for HTN risk.Increased nonoccupational PA,low-intensity PA,and moderate-to-vigorous-intensity PA were significantly associated with a decreased risk of CKD,with HRs(95%CIs)of 0.80(0.73-0.88),0.85(0.77-0.94),and 0.85(0.76-0.95)in the highest quartile,respectively.Conclusion:PA,including nonoccupational PA,low-intensity PA,and moderate-to-vigorous-intensity PA,was inversely associated with the risk of CKD,including DKD,HTN,and other CKD,and such associations were dose dependent.

关键词： Chronic kidney disease Domain Intensity Physical activity

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Fresh fruit consumption and diabetes: a prospective cohort study of 0.5 million adults in the China Kadoorie Biobank

Fresh fruit consumption and diabetes: a prospective cohort s...

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第十二届全国营养科学大会

作者： Huaidong Du Liming Li Derrick A.Bennett Yu Guo Zheng Bian Junshi Chen Tim Key Rory Collins Richard Peto Zhengming Chen CTSU Nuffield Department of Population HealthUniversity of Oxford Chinese Academy of Medical Sciences School of Public health Peking University

Background:Several studies in Western populations have observed that a higher consumption of fruit could help to prevent diabetes incidence,but no such beneficial effect has been reported from China.More importantly,to date there is little direct evidence about the associations of fruit consumption with mortality and incidence of

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饮食、营养及癌症风险:已知与前景

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英国医学杂志中文版 2020年第7期23卷 368-373页

作者： Timothy J Key Kathryn E Bradbury Aurora Perez-Comago Rashmi Sinha Konstantinos K Tsilidis Shoichiro Tsugane 徐欣悦(译) 严雪敏(校) Cancer Epidemiology Unit Nuffield Department of Population HealthUniversity of OxfordOxfordUK National Institute for health Innovation School of Population HealthUniversity of AucklandAucklandNew Zealand Metabolic Epidemiology Branch Division of Cancer Epidemiology and GeneticsNational Cancer InstituteNational Institutes of HealthBethesdaMDUSA department of Hygiene and Epidemiology University of Ioannina School of MedicineIoanninaGreece department of Kpidemiology and Biostatistics School of Public HealthImperial College LondonLondonUK Center for Public health Sciences National Cancer CenterTokyoJapan 中国医学科学院北京协和医院消化内科

几十年来科学家们就认为,营养在癌症发展中起着重要的作用。早在20世纪60年代就有流行病学研究显示,不同人群的癌症发病率差别非常大,而且从癌症低发国家移民到高发国家后,移民们的癌症发病率可能上升到与移民国家原住民的癌症发病率相... 详细信息

几十年来科学家们就认为,营养在癌症发展中起着重要的作用。早在20世纪60年代就有流行病学研究显示,不同人群的癌症发病率差别非常大,而且从癌症低发国家移民到高发国家后,移民们的癌症发病率可能上升到与移民国家原住民的癌症发病率相当,甚至更高1-2。这些观察结果提示环境是导致癌症发生的重要因素。

关键词：癌症发病率流行病学研究癌症发生癌症风险癌症发展原住民移民营养

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