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

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.

Doctor-reported hospital management of acute coronary syndrome in China: A nationwide survey of 1029 hospitals in 30 provinces

Background: Despite recent improvements in the hospital treatment of ACS, little is known about current cardiological practice in China or use of evidence-based approach in Chinese hospitals. Methods: A questionnaire about doctor-reported hospital management of ACS was posted to the head of the cardiology department of 1397 hospitals across 30 provinces of China. Reported use of various clinical procedures and treatments were analysed and compared between different types of hospital. Results: Of the 1029 (74%) hospitals that responded, 43% were tier III (tertiary) hospitals. For STEMI, primary PCI was used as the main reperfusion therapy by 50.2% of tier III and 9.3% of tier II/I (secondary) hospitals. Most of hospitals also used various proven therapy routinely for STEMI and NSTEMI/UA, including anti-platelet therapy (98% and 93%), anticoagulant (96% and 90%), statin (97% and 94%), oral β-blockers (87% and 86%) and ACE-I (88% and 83%). However, certain therapies with little or no proven value (eg, G.I.K., magnesium and Chinese tradition medicine) remained used routinely by 25% - 40% of tier II/I hospitals. After discharge, statin, antiplatelet, β-blockers and ACE-I were reportedly used routinely by 85% - 95% of the responders for secondary prevention. Conclusions: With a few exceptions, doctor-reported hospital management of ACS in China is largely consistent with that recommended by current guidelines. Large nationwide registries are needed to assess long-term adherence to treatments after hospital discharge.

Rethinking the Encoder-decoder Structure in Medical Image Segmentation from Releasing Decoder Structure

Medical image segmentation has witnessed rapid advancements with the emergence of encoder-decoder based methods.In the encoder-decoder structure,the primary goal of the decoding phase is not only to restore feature map resolution,but also to mitigate the loss of feature information incurred during the encoding phase.However,this approach gives rise to a challenge:multiple up-sampling operations in the decoder segment result in the loss of feature information.To address this challenge,we propose a novel network that removes the decoding structure to reduce feature information loss(CBL-Net).In particular,we introduce a Parallel Pooling Module(PPM)to counteract the feature information loss stemming from conventional and pooling operations during the encoding stage.Furthermore,we incorporate a Multiplexed Dilation Convolution(MDC)module to expand the network's receptive field.Also,although we have removed the decoding stage,we still need to recover the feature map resolution.Therefore,we introduced the Global Feature Recovery(GFR)module.It uses attention mechanism for the image feature map resolution recovery,which can effectively reduce the loss of feature information.We conduct extensive experimental evaluations on three publicly available medical image segmentation datasets:DRIVE,CHASEDB and MoNuSeg datasets.Experimental results show that our proposed network outperforms state-of-the-art methods in medical image segmentation.In addition,it achieves higher efficiency than the current network of coding and decoding structures by eliminating the decoding component.

Associations of polygenic risk scores with risks of stroke and its subtypes in Chinese

Background and purpose Previous studies,mostly focusing on the European population,have reported polygenic risk scores(PRSs)might achieve risk stratification of stroke.We aimed to examine the association strengths of PRSs with risks of stroke and its subtypes in the Chinese population.Methods Participants with genome-wide genotypic data in China Kadoorie Biobank were split into a potential training set(n=22191)and a population-based testing set(n=72150).Four previously developed PRSs were included,and new PRSs for stroke and its subtypes were developed.The PRSs showing the strongest association with risks of stroke or its subtypes in the training set were further evaluated in the testing set.Cox proportional hazards regression models were used to estimate the association strengths of different PRSs with risks of stroke and its subtypes(ischaemic stroke(IS),intracerebral haemorrhage(ICH)and subarachnoid haemorrhage(SAH)).Results In the testing set,during 872919 person-years of follow-up,8514 incident stroke events were documented.The PRSs of any stroke(AS)and IS were both positively associated with risks of AS,IS and ICH(p<0.05).The HR for per SD increment(HR_(SD))of PRSAS was 1.10(95%CI 1.07 to 1.12),1.10(95%CI 1.07 to 1.12)and 1.13(95%CI 1.07 to 1.20)for AS,IS and ICH,respectively.The corresponding HR_(SD) of PRS_(IS) was 1.08(95%CI 1.06 to 1.11),1.08(95%CI 1.06 to 1.11)and 1.09(95%CI 1.03 to 1.15).PRS_(ICH) was positively associated with the risk of ICH(HR_(SD)=1.07,95%CI 1.01 to 1.14).PRSS_(AH) was not associated with risks of stroke and its subtypes.The addition of current PRSs offered little to no improvement in stroke risk prediction and risk stratification.Conclusions In this Chinese population,the association strengths of current PRSs with risks of stroke and its subtypes were moderate,suggesting a limited value for improving risk prediction over traditional risk factors in the context of current genome-wide association study under-representing the East Asian population.

Prevalence and Risk Factors for Chronic Obstructive Pulmonary Disease Among Adults Aged 50 and Above-10 CKB Study Areas,China,2020–2021

What is already known about this topic?The prevalence of COPD in Chinese individuals aged 50 years and above was obviously higher than that in younger adults,but the risk factors for this age group were unclear.What is added by this report?The prevalence was estimated at 12.8%and 5.7%for males and females over 50 in 2020–2021,with confirmed risk factors of cigarette smoking,a family history of respiratory diseases,respiratory symptoms,and a history of cough or respiratory diseases during childhood.What are the implications for public health practice?The findings may help clinicians and the public identify individuals at high risk of COPD and take targeted measures in a timely manner.

The Association Between Preserved Ratio Impaired Spirometry and Mortality –– 10 CKB Study Areas, China, 2004–2022

What is already known about this topic?China has the world’s most significant public health and economic burden of chronic respiratory disease.However,the association between preserved ratio impaired spirometry(PRISm)and mortality risk is unknown.What is added by this report?The PRISm group exhibited a 37%higher risk of allcause mortality than the normal group,and the risks of death from cardiovascular diseases,neoplasms,respiratory diseases,and infectious and parasitic diseases were also increased in PRISm.Moreover,the presence of respiratory symptoms or disease was associated with an increased risk of mortality in PRISm.What are the implications for public health practice?It is imperative to enhance public awareness of PRISm and to implement measures to facilitate the regression of PRISm toward normal lung function.

Multimorbidity patterns and association with mortality in 0.5 million Chinese adults

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 deserved particular attention in Chinese adults.

Associations of muscle mass,strength,and quality with all-cause mortality in China:a population-based cohort study

Background It remains unclear about the association of muscle mass,strength,and quality with death in the general Chinese population of diverse economical and geographical backgrounds.The present study aimed to comprehensively examine such associations across different regions in China.Methods Based on the China Kadoorie Biobank study,the present study included 23,290 participants who were aged 38 to 88 years and had no prevalent cardiovascular diseases or cancer.Muscle mass and grip strength were measured using calibrated instruments.Arm muscle quality was defined as the ratio of grip strength to arm muscle mass.Low muscle mass,grip strength,and arm muscle quality were defined as the sex-specific lowest quintiles of muscle mass index,grip strength,and arm muscle quality,respectively.Cox proportional hazards models yielded hazard ratios(HRs)and 95%confidence intervals(CIs)for risks of all-cause mortality in relation to muscle mass,strength,and quality.Results During a median follow-up of 3.98 years,739 participants died.The HR(95%CI)of all-cause mortality risk was 1.28(1.08–1.51)for low appendicular muscle mass index,1.38(1.16–1.62)for low total muscle mass index,1.68(1.41–2.00)for low grip strength,and 1.41(1.20–1.66)for low arm muscle quality in models adjusted for sociodemographic characteristics,lifestyle factors,and medical histories.Conclusion Low muscle mass,grip strength,and arm muscle quality are all associated with short-term increased risks of mortality,indicating the importance of maintaining normal muscle mass,strength,and quality for general Chinese adults.

National survey of doctor-reported secondary preventive treatment for patients with acute coronary syndrome in China

Background Long-term use of antiplatelet agents, statins, beta-blockers and angiotensin-converting enzyme inhibitors are proven therapies for secondary prevention in acute coronary syndrome. However, little is known of physicians＇ opinion about their use in China. Methods In 2010, standard questionnaires were posted to chief cardiologists in 1397 geographically diverse and representative sample of tertiary and secondary hospitals in China, collecting information about their opinions on the recommended treatments for acute coronary syndrome. Results A total of 1009 （72%） cardiologists responded with a valid questionnaire. Of them, 77% reported routine use of all the four main secondary preventive treatments, with little difference between secondary and tertiary hospitals （75% vs. 79%, P=0.16）. Of the cardiologists reporting routine or selective use of aspirin, beta-blockers, statins and angiotensin-converting enzyme inhibitors, 94%, 85%, 73% and 86% would recommend indefinite use respectively. For all the 4 treatments combined, only 63.5% reported indefinite use at the same time, with no significant difference between secondary and tertiary hospitals （62% vs. 65%, P=0.17）, nor between hospitals with or without fast track for primary percutaneous coronary intervention （66% vs. 61%, P=0.50）. Conclusions Although Chinese cardiologists seem we treatments for acute coronary syndrome, there is still gap in use of these treatments. informed about the value of main secondary preventive their understanding of the need for combined and prolonged

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

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.

Development of a prediction model to identify undiagnosed chronic obstructive pulmonary disease patients in primary care settings in China

Background:At present,a large number of chronic obstructive pulmonary disease(COPD)patients are undiagnosed in China.Thus,this study aimed to develop a simple prediction model as a screening tool to identify patients at risk for COPD.Methods:The study was based on the data of 22,943 subjects aged 30 to 79 years and enrolled in the second resurvey of China Kadoorie Biobank during 2012 and 2013 in China.We stepwisely selected the predictors using logistic regression model.Then we tested the model validity through P-P graph,area under the receiver operating characteristic curve(AUROC),ten-fold cross validation and an external validation in a sample of 3492 individuals from the Enjoying Breathing Program in China.Results:The final prediction model involved 14 independent variables,including age,sex,location(urban/rural),region,educational background,smoking status,smoking amount(pack-years),years of exposure to air pollution by cooking fuel,family history of COPD,history of tuberculosis,body mass index,shortness of breath,sputum and wheeze.The model showed an area under curve(AUC)of 0.72(95%confidence interval[CI]:0.72-0.73)for detecting undiagnosed COPD patients,with the cutoff of predicted probability of COPD=0.22,presenting a sensitivity of 70.13%and a specificity of 62.25%.The AUROC value for screening undiagnosed patients with clinically significant COPD was 0.68(95%CI:0.66-0.69).Moreover,the ten-fold cross validation reported an AUC of 0.72(95%CI:0.71-0.73),and the external validation presented an AUC of 0.69(95%CI:0.68-0.71).Conclusion:This prediction model can serve as a first-stage screening tool for undiagnosed COPD patients in primary care settings.

Lung cancer risk score for ever and never smokers in China

Background:Most lung cancer risk prediction models were developed in European and North-American cohorts of smokers aged≥55 years,while less is known about risk profiles in Asia,especially for never smokers or individuals aged<50 years.Hence,we aimed to develop and validate a lung cancer risk estimate tool for ever and never smokers across a wide age range.Methods:Based on the China Kadoorie Biobank cohort,we first systematically selected the predictors and explored the nonlinear association of predictors with lung cancer risk using restricted cubic splines.Then,we separately developed risk prediction models to construct a lung cancer risk score(LCRS)in 159,715 ever smokers and 336,526 never smokers.The LCRS was further validated in an independent cohort over a median follow-up of 13.6 years,consisting of 14,153 never smokers and 5,890 ever smokers.Results:A total of 13 and 9 routinely available predictors were identified for ever and never smokers,respectively.Of these predictors,cigarettes per day and quit years showed nonlinear associations with lung cancer risk(Pnon-linear<0.001).The curve of lung cancer incidence increased rapidly above 20 cigarettes per day and then was relatively flat until approximately 30 cigarettes per day.We also observed that lung cancer risk declined sharplywithin the first 5 years of quitting,and then continued to decrease but at a slower rate in the subsequent years.The 6-year area under the receiver operating curve for the ever and never smokers’models were respectively 0.778 and 0.733 in the derivation cohort,and 0.774 and 0.759 in the validation cohort.In the validation cohort,the 10-year cumulative incidence of lung cancerwas 0.39%and 2.57%for ever smokers with low(<166.2)and intermediate-high LCRS(≥166.2),respectively.Never smokers with a high LCRS(≥21.2)had a higher 10-year cumulative incidence rate than those with a low LCRS(<21.2;1.05%vs.0.22%).An online risk evaluation tool(LCKEY;http://ccra.njmu.edu.cn/lckey/web)was developed to facilitate the use of LCRS.Conclusions:The LCRS can be an effective risk assessment tool designed for ever and never smokers aged 30 to 80 years.

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

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 genetic risk.

Minimal improvement in coronary artery disease risk prediction in Chinese population using polygenic risk scores:evidence from the China Kadoorie Biobank

Background:Several studies have reported that polygenic risk scores(PRSs)can enhance risk prediction of coronary artery disease(CAD)in European populations.However,research on this topic is far from sufficient in non-European countries,including China.We aimed to evaluate the potential of PRS for predicting CAD for primary prevention in the Chinese population.Methods:Participants with genome-wide genotypic data from the China Kadoorie Biobank were divided into training(n=28,490)and testing sets(n=72,150).Ten previously developed PRSs were evaluated,and new ones were developed using clumping and thresholding or LDpred method.The PRS showing the strongest association with CAD in the training set was selected to further evaluate its effects on improving the traditional CAD risk-prediction model in the testing set.Genetic risk was computed by summing the product of the weights and allele dosages across genome-wide single-nucleotide polymorphisms.Prediction of the 10-year first CAD events was assessed using hazard ratios(HRs)and measures of model discrimination,calibration,and net reclassification improvement(NRI).Hard CAD(nonfatal I21-I23 and fatal I20-I25)and soft CAD(all fatal or nonfatal I20-I25)were analyzed separately.Results:In the testing set,1214 hard and 7201 soft CAD cases were documented during a mean follow-up of 11.2 years.The HR per standard deviation of the optimal PRS was 1.26(95%CI:1.19-1.33)for hard CAD.Based on a traditional CAD risk prediction model containing only non-laboratory-based information,the addition of PRS for hard CAD increased Harrell’s C index by 0.001(-0.001 to 0.003)in women and 0.003(0.001 to 0.005)in men.Among the different high-risk thresholds ranging from 1%to 10%,the highest categorical NRI was 3.2%(95%CI:0.4-6.0%)at a high-risk threshold of 10.0%in women.The association of the PRS with soft CAD was much weaker than with hard CAD,leading to minimal or no improvement in the soft CAD model.Conclusions:In this Chinese population sample,the current PRSs minimally changed risk discrimination and offered little improvement in risk stratification for soft CAD.Therefore,this may not be suitable for promoting genetic screening in the general Chinese population to improve CAD risk prediction.

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

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.

Ideal cardiovascular health and mortality:pooled results of three prospective cohorts in Chinese adults

Background: Evidence on the relations of the American Heart Association’s ideal cardiovascular health (ICH) with mortality in Asians is sparse, and the interaction between behavioral and medical metrics remained unclear. We aimed to fill the gaps. Methods: A total of 198,164 participants without cancer and cardiovascular disease (CVD) were included from the China Kadoorie Biobank study (2004-2018), Dongfeng-Tongji cohort (2008-2018), and Kailuan study (2006-2019). Four behaviors (i.e., smoking, physical activity, diet, body mass index) and three medical factors (i.e., blood pressure, blood glucose, and blood lipid) were classified into poor, intermediate, and ideal levels (0, 1, and 2 points), which constituted 8-point behavioral, 6-point medical, and 14-point ICH scores. Results of Cox regression from three cohorts were pooled using random-effects models of meta-analysis. Results: During about 2 million person-years, 20,176 deaths were recorded. After controlling for demographic characteristics and alcohol drinking, hazard ratios (95% confidence intervals) comparing ICH scores of 10-14 vs. 0-6 were 0.52 (0.41-0.67), 0.44 (0.37-0.53), 0.54 (0.45-0.66), and 0.86 (0.64-1.14) for all-cause, CVD, respiratory, and cancer mortality. A higher behavioral or medical score was independently associated with lower all-cause and CVD mortality among the total population and populations with different levels of behavioral or medical health equally, and no interaction was observed. Conclusions: ICH was associated with lower all-cause, CVD, and respiratory mortality among Chinese adults. Both behavioral and medical health should be improved to prevent premature deaths.

肥胖与缺血型脑卒中和出血型脑卒中发病风险的关联

欧美等国家的研究发现,超重/肥胖是缺血型脑卒中与出血型脑卒中的发病危险因素。据估算,中国1/5的脑卒中患者是由于超重/肥胖(体重指数>23 kg/m2)引起的。与欧美等国家相比,中国居民的超重/肥胖率较低,但脑卒中的发病率却较高,且高血压的管理率较低。因此,本研究基于中国人群,探讨超重/肥胖与不同类型的脑卒中发病风险的关联,以及血压对关联强度的影响。

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

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.

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

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.