Objective:To estimate the potential causal impact of Enterovirus A71(EV71)vaccination program on the reduction of EV71-infected hand,foot,and mouth disease(HFMD)in Zhejiang Province.Methods:We utilized the longitudina...Objective:To estimate the potential causal impact of Enterovirus A71(EV71)vaccination program on the reduction of EV71-infected hand,foot,and mouth disease(HFMD)in Zhejiang Province.Methods:We utilized the longitudinal surveillance dataset of HFMD and EV71 vaccination in Zhejiang Province during 2010-2019.We estimated vaccine efficacy using a Bayesian structured time series(BSTS)model,and employed a negative control outcome(NCO)model to detect unmeasured confounding and reveal potential causal association.Results:We estimated that 20,132 EV71 cases(95%CI:16,733,23,532)were prevented by vaccination program during 2017-2019,corresponding to a reduction of 29%(95%CI:24%,34%).The effectiveness of vaccination increased annually,with reductions of 11%(95%CI:6%,16%)in 2017 and 66%(95%CI:61%,71%)in 2019.Children under 5 years old obtained greater benefits compared to those over 5 years.Cities with higher vaccination coverage experienced a sharper EV71 reduction compared to those with lower coverage.The NCO model detected no confounding factors in the association between vaccination and EV71 cases reduction.展开更多
What is already known about this topic?Previous studies have mainly focused on the relationship between temperature and mortality from stroke,but analysis on the effects on years of life lost(YLL)is limited.What is ad...What is already known about this topic?Previous studies have mainly focused on the relationship between temperature and mortality from stroke,but analysis on the effects on years of life lost(YLL)is limited.What is added by this report?YLLs were used as the health outcome,and cold and hot weather were found to be significantly associated with an increase in YLLs from stroke and for different groups,with a stronger effect found to be associated with low temperature.What are the implications for public health practice?These findings could help identify vulnerable regions and populations that have a more serious temperaturerelated burden and to guide the practical and effective measures for stroke control from a YLL perspective.展开更多
Although exposure to air pollution increases the risk of premature mortality and years of life lost(YLL),the effects of daily air quality improvement to the life expectancy of respiratory diseases remained unclear.We ...Although exposure to air pollution increases the risk of premature mortality and years of life lost(YLL),the effects of daily air quality improvement to the life expectancy of respiratory diseases remained unclear.We applied a generalized additive model(GAM)to assess the associations between daily PM_(2.5) exposure and YLL from respiratory diseases in 96 Chinese cities during 2013–2016.We further estimated the avoidable YLL,potential gains in life expectancy,and the attributable fraction by assuming dailyPM_(2.5) concentration decrease to the air quality standards of China and World Health Organization.Regional and national results were generated by random-effects meta-analysis.A total of 861,494 total respiratory diseases and 586,962 chronic obstructive pulmonary disease(COPD)caused death from 96 Chinese cities were recorded during study period.Each 10 mg/m3 increase of PM_(2.5) in 3-day moving average(lag02)was associated with 0.16(95%CI:0.08,0.24)years increment in life expectancy from total respiratory diseases.The highest effect was observed in Southwest region with 0.42(95%CI:0.22,0.62)years increase in life expectancy.By attaining the WHO's Air Quality Guidelines,we estimated that an average of 782.09(95%CI:438.29,1125.89)YLLs caused by total respiratory death in each city could be avoided,which corresponded to 1.15%(95%CI:0.67%,1.64%)of the overall YLLs,and 0.12(95%CI:0.07,0.17)years increment in life expectancy.The results of COPD were generally consistent with total respiratory diseases.Our findings indicate that reduction in daily PM_(2.5) concentrations might lead to longer life expectancy from respiratory death.展开更多
The evidence for the effects of environmental factors on COVID-19 case fatality remains controversial,and it is crucial to understand the role of preventable environmental factors in driving COVID-19 fatality.We thus ...The evidence for the effects of environmental factors on COVID-19 case fatality remains controversial,and it is crucial to understand the role of preventable environmental factors in driving COVID-19 fatality.We thus conducted a nationwide cohort study to estimate the effects of environmental factors(temperature,particulate matter[PM2.5,PM10],sulfur dioxide[SO2],nitrogen dioxide[NO2],and ozone[O3])on COVID-19 case fatality.A total of 71,808 confirmed COVID-19 cases were identified and followed up for their vital status through April 25,2020.Exposures to ambient air pollution and temperature were estimated by linking the city-and county-level monitoring data to the residential community of each participant.For each participant,two windows were defined:the period from symptom onset to diagnosis(exposure window I)and the period from diagnosis date to date of death/recovery or end of the study period(exposure window II).Cox proportional hazards models were used to estimate the associations between these environmental factors and COVID-19 case fatality.COVID-19 case fatality increased in association with environmental factors for the two exposure windows.For example,each 10 mg/m^(3) increase in PM2.5,PM10,O3,and NO2 in window I was associated with a hazard ratio of 1.11(95%CI 1.09,1.13),1.10(95%CI 1.08,1.13),1.09(95 CI 1.03,1.14),and 1.27(95%CI 1.19,1.35)for COVID-19 fatality,respectively.A significant effect was also observed for low temperature,with a hazard ratio of 1.03(95%CI 1.01,1.04)for COVID-19 case fatality per 1C decrease.Subgroup analysis indicated that these effects were stronger in the elderly,as well as in those with mild symptoms and living in Wuhan or Hubei.Overall,the sensitivity analyses also yielded consistent estimates.Short-term exposure to ambient air pollution and low temperature during the illness would play a nonnegligible part in causing case fatality due to COVID-19.Reduced exposures to high concentrations of PM2.5,PM10,O3,SO2,and NO2 and low temperature would help improve the prognosis and reduce public health burden.展开更多
Although a number of studies have examined the etiology of lung cancer in Xuanwei County, China, other types of cancer in this county have not been reported systematically. This study aimed to investigate the temporal...Although a number of studies have examined the etiology of lung cancer in Xuanwei County, China, other types of cancer in this county have not been reported systematically. This study aimed to investigate the temporal trend of eight major cancers in Xuanwei County using data from three mortality surveys （1973-1975, 1990-1992, and 2004-2005）. The Chinese population in 1990 was used as a standard population to calculate age- standardized mortality rates. Cancers of lung, liver, breast, brain, esophagus, leukemia, rectum, and stomach were identified as the leading cancers in this county in terms of mortality rate. During the three time periods, lung cancer remained as the most common type of cancer. The mortality rates for all other types of cancer were lower than those of the national average, but an increasing trend was observed for all the cancers, particularly from 1990-1992 to 2004-2005. The temporal trend could be party explained by changes in risk factors, but it also may be due to the improvement in cancer diagnosis and screening. Further epidemiological studies are warranted to systematically examine the underlying reasons for the temporal trend of the major cancers in Xuanwei County.展开更多
What is already known about this topic?Previous studies have illustrated the benefits of physical activity on cardiometabolic multimorbidity(CMM),while limited studies have concentrated on the trajectory of CMM progre...What is already known about this topic?Previous studies have illustrated the benefits of physical activity on cardiometabolic multimorbidity(CMM),while limited studies have concentrated on the trajectory of CMM progression.What is added by this report?Through multi-stage regression analysis,we found that physical activity could reduce the risk of CMM incidence.Participants initially free of cardiometabolic diseases(CMDs)may benefit more from engaging in recommended physical activity.What are the implications for public health practice?Adults,especially those initially free of CMDs,should engage in WHO-recommended physical activity as early as possible to prevent CMD incidence and further progression.展开更多
Summary What is already known about this topic?Numerous epidemiological studies have documented the association between ambient nitrogen dioxide(NO2)and mortality and morbidity of respiratory diseases,however,research...Summary What is already known about this topic?Numerous epidemiological studies have documented the association between ambient nitrogen dioxide(NO2)and mortality and morbidity of respiratory diseases,however,research on the effect of NO2 on the length of hospital stay(LOS)and hospitalization expenditure is limited.What is added by this report?This study collected the respiratory hospitalization,hospital expenditure,and LOS for respiratory diseases from 2017-2019 in Shanxi,China,and comprehensively evaluated the association between ambient NO2 exposure and respiratory hospitalization,expenditure,and LOS.What are the implications for public health practice?This study provides evidence on the association between ambient NO2 and respiratory burden,suggesting that continuously reducing the NO2 concentrations could prevent respiratory diseaseassociated hospital admissions and decrease the relative burden in Shanxi Province and other similar regions.展开更多
An increasing number of patients are being killed by coronavirus disease 2019(COVID-19),however,risk factors for the fatality of COVID-19 remain unclear.A total of 21,392 COVID-19 cases were recruited in the Hubei Pro...An increasing number of patients are being killed by coronavirus disease 2019(COVID-19),however,risk factors for the fatality of COVID-19 remain unclear.A total of 21,392 COVID-19 cases were recruited in the Hubei Province of China between December 2019 and February 2020,and followed up until March 18,2020.We adopted Cox regression models to investigate the risk factors for case fatality and predicted the death probability under specific combinations of key predictors.Among the 21,392 patients,1,020(4.77%)died of COVID-19.Multivariable analyses showed that factors,including age(R60 versus<45 years,hazard ratio[HR]=7.32;95%confidence interval[CI],5.42,9.89),sex(male versus female,HR=1.31;95%CI,1.15,1.50),severity of the disease(critical versus mild,HR=39.98;95%CI,29.52,48.86),comorbidity(HR=1.40;95%CI,1.23,1.60),highest body temperature(>39C versus<39C,HR=1.28;95%CI,1.09,1.49),white blood cell counts(>103109/L versus(4–10)3109/L,HR=1.69;95%CI,1.35,2.13),and lymphocyte counts(<0.83109/L versus(0.8–4)3109/L,HR=1.26;95%CI,1.06,1.50)were significantly associated with case fatality of COVID-19 patients.Individuals of an older age,who were male,with comorbidities,and had a critical illness had the highest death probability,with 21%,36%,46%,and 54%within 1–4 weeks after the symptom onset.Risk factors,including demographic characteristics,clinical symptoms,and laboratory factors were confirmed to be important determinants of fatality of COVID-19.Our predictive model can provide scientific evidence for a more rational,evidence-driven allocation of scarce medical resources to reduce the fatality of COVID-19.展开更多
基金supported the grants from National Key R&D Program of China (2022YFC2305305)by grants from consultancy project (2022-JB-06)by the Chinese Academy of Engineering (CAE)the Bill&Melinda Gates Foundation[Grant Number:INV-016826].
文摘Objective:To estimate the potential causal impact of Enterovirus A71(EV71)vaccination program on the reduction of EV71-infected hand,foot,and mouth disease(HFMD)in Zhejiang Province.Methods:We utilized the longitudinal surveillance dataset of HFMD and EV71 vaccination in Zhejiang Province during 2010-2019.We estimated vaccine efficacy using a Bayesian structured time series(BSTS)model,and employed a negative control outcome(NCO)model to detect unmeasured confounding and reveal potential causal association.Results:We estimated that 20,132 EV71 cases(95%CI:16,733,23,532)were prevented by vaccination program during 2017-2019,corresponding to a reduction of 29%(95%CI:24%,34%).The effectiveness of vaccination increased annually,with reductions of 11%(95%CI:6%,16%)in 2017 and 66%(95%CI:61%,71%)in 2019.Children under 5 years old obtained greater benefits compared to those over 5 years.Cities with higher vaccination coverage experienced a sharper EV71 reduction compared to those with lower coverage.The NCO model detected no confounding factors in the association between vaccination and EV71 cases reduction.
基金The National Key R&D Program of China(2018YFA0606200)the National Natural Science Foundation of China(82041021)Bill&Melinda Gates Foundation(INV-006371).
文摘What is already known about this topic?Previous studies have mainly focused on the relationship between temperature and mortality from stroke,but analysis on the effects on years of life lost(YLL)is limited.What is added by this report?YLLs were used as the health outcome,and cold and hot weather were found to be significantly associated with an increase in YLLs from stroke and for different groups,with a stronger effect found to be associated with low temperature.What are the implications for public health practice?These findings could help identify vulnerable regions and populations that have a more serious temperaturerelated burden and to guide the practical and effective measures for stroke control from a YLL perspective.
基金supported by the National Key R&D Program of China(Grant No.2016YFC0206501)the National Natural Science Foundation of China(Grant No.81972993)+1 种基金the Fundamental Research Funds for the Central Universities(Grant No.20ykpy86)the Guangdong Basic and Applied Basic Research Foundation(Grant No.2019A1515110003).
文摘Although exposure to air pollution increases the risk of premature mortality and years of life lost(YLL),the effects of daily air quality improvement to the life expectancy of respiratory diseases remained unclear.We applied a generalized additive model(GAM)to assess the associations between daily PM_(2.5) exposure and YLL from respiratory diseases in 96 Chinese cities during 2013–2016.We further estimated the avoidable YLL,potential gains in life expectancy,and the attributable fraction by assuming dailyPM_(2.5) concentration decrease to the air quality standards of China and World Health Organization.Regional and national results were generated by random-effects meta-analysis.A total of 861,494 total respiratory diseases and 586,962 chronic obstructive pulmonary disease(COPD)caused death from 96 Chinese cities were recorded during study period.Each 10 mg/m3 increase of PM_(2.5) in 3-day moving average(lag02)was associated with 0.16(95%CI:0.08,0.24)years increment in life expectancy from total respiratory diseases.The highest effect was observed in Southwest region with 0.42(95%CI:0.22,0.62)years increase in life expectancy.By attaining the WHO's Air Quality Guidelines,we estimated that an average of 782.09(95%CI:438.29,1125.89)YLLs caused by total respiratory death in each city could be avoided,which corresponded to 1.15%(95%CI:0.67%,1.64%)of the overall YLLs,and 0.12(95%CI:0.07,0.17)years increment in life expectancy.The results of COPD were generally consistent with total respiratory diseases.Our findings indicate that reduction in daily PM_(2.5) concentrations might lead to longer life expectancy from respiratory death.
基金This study was supported by the National Natural Science Foundation of China(82041021 and 42041001)the Bill&Melinda Gates Foundation(INV-006371)the General Program of the State Key Laboratory of Infectious Disease Prevention and Control of China(2020SKLID201).
文摘The evidence for the effects of environmental factors on COVID-19 case fatality remains controversial,and it is crucial to understand the role of preventable environmental factors in driving COVID-19 fatality.We thus conducted a nationwide cohort study to estimate the effects of environmental factors(temperature,particulate matter[PM2.5,PM10],sulfur dioxide[SO2],nitrogen dioxide[NO2],and ozone[O3])on COVID-19 case fatality.A total of 71,808 confirmed COVID-19 cases were identified and followed up for their vital status through April 25,2020.Exposures to ambient air pollution and temperature were estimated by linking the city-and county-level monitoring data to the residential community of each participant.For each participant,two windows were defined:the period from symptom onset to diagnosis(exposure window I)and the period from diagnosis date to date of death/recovery or end of the study period(exposure window II).Cox proportional hazards models were used to estimate the associations between these environmental factors and COVID-19 case fatality.COVID-19 case fatality increased in association with environmental factors for the two exposure windows.For example,each 10 mg/m^(3) increase in PM2.5,PM10,O3,and NO2 in window I was associated with a hazard ratio of 1.11(95%CI 1.09,1.13),1.10(95%CI 1.08,1.13),1.09(95 CI 1.03,1.14),and 1.27(95%CI 1.19,1.35)for COVID-19 fatality,respectively.A significant effect was also observed for low temperature,with a hazard ratio of 1.03(95%CI 1.01,1.04)for COVID-19 case fatality per 1C decrease.Subgroup analysis indicated that these effects were stronger in the elderly,as well as in those with mild symptoms and living in Wuhan or Hubei.Overall,the sensitivity analyses also yielded consistent estimates.Short-term exposure to ambient air pollution and low temperature during the illness would play a nonnegligible part in causing case fatality due to COVID-19.Reduced exposures to high concentrations of PM2.5,PM10,O3,SO2,and NO2 and low temperature would help improve the prognosis and reduce public health burden.
文摘Although a number of studies have examined the etiology of lung cancer in Xuanwei County, China, other types of cancer in this county have not been reported systematically. This study aimed to investigate the temporal trend of eight major cancers in Xuanwei County using data from three mortality surveys （1973-1975, 1990-1992, and 2004-2005）. The Chinese population in 1990 was used as a standard population to calculate age- standardized mortality rates. Cancers of lung, liver, breast, brain, esophagus, leukemia, rectum, and stomach were identified as the leading cancers in this county in terms of mortality rate. During the three time periods, lung cancer remained as the most common type of cancer. The mortality rates for all other types of cancer were lower than those of the national average, but an increasing trend was observed for all the cancers, particularly from 1990-1992 to 2004-2005. The temporal trend could be party explained by changes in risk factors, but it also may be due to the improvement in cancer diagnosis and screening. Further epidemiological studies are warranted to systematically examine the underlying reasons for the temporal trend of the major cancers in Xuanwei County.
基金Supported by the Bill&Melinda Gates Foundation(Grant Number:INV-016826).
文摘What is already known about this topic?Previous studies have illustrated the benefits of physical activity on cardiometabolic multimorbidity(CMM),while limited studies have concentrated on the trajectory of CMM progression.What is added by this report?Through multi-stage regression analysis,we found that physical activity could reduce the risk of CMM incidence.Participants initially free of cardiometabolic diseases(CMDs)may benefit more from engaging in recommended physical activity.What are the implications for public health practice?Adults,especially those initially free of CMDs,should engage in WHO-recommended physical activity as early as possible to prevent CMD incidence and further progression.
基金Fund Project for Guiding Local Science and Technology Development by the Central Government(No.:YDZX20191400002737).
文摘Summary What is already known about this topic?Numerous epidemiological studies have documented the association between ambient nitrogen dioxide(NO2)and mortality and morbidity of respiratory diseases,however,research on the effect of NO2 on the length of hospital stay(LOS)and hospitalization expenditure is limited.What is added by this report?This study collected the respiratory hospitalization,hospital expenditure,and LOS for respiratory diseases from 2017-2019 in Shanxi,China,and comprehensively evaluated the association between ambient NO2 exposure and respiratory hospitalization,expenditure,and LOS.What are the implications for public health practice?This study provides evidence on the association between ambient NO2 and respiratory burden,suggesting that continuously reducing the NO2 concentrations could prevent respiratory diseaseassociated hospital admissions and decrease the relative burden in Shanxi Province and other similar regions.
基金We thank all the staff involved in the field survey and the anonymous reviewers for the valuable comments.We appreciate the support provided by the National Natural Science Foundation of China(82041021).
文摘An increasing number of patients are being killed by coronavirus disease 2019(COVID-19),however,risk factors for the fatality of COVID-19 remain unclear.A total of 21,392 COVID-19 cases were recruited in the Hubei Province of China between December 2019 and February 2020,and followed up until March 18,2020.We adopted Cox regression models to investigate the risk factors for case fatality and predicted the death probability under specific combinations of key predictors.Among the 21,392 patients,1,020(4.77%)died of COVID-19.Multivariable analyses showed that factors,including age(R60 versus<45 years,hazard ratio[HR]=7.32;95%confidence interval[CI],5.42,9.89),sex(male versus female,HR=1.31;95%CI,1.15,1.50),severity of the disease(critical versus mild,HR=39.98;95%CI,29.52,48.86),comorbidity(HR=1.40;95%CI,1.23,1.60),highest body temperature(>39C versus<39C,HR=1.28;95%CI,1.09,1.49),white blood cell counts(>103109/L versus(4–10)3109/L,HR=1.69;95%CI,1.35,2.13),and lymphocyte counts(<0.83109/L versus(0.8–4)3109/L,HR=1.26;95%CI,1.06,1.50)were significantly associated with case fatality of COVID-19 patients.Individuals of an older age,who were male,with comorbidities,and had a critical illness had the highest death probability,with 21%,36%,46%,and 54%within 1–4 weeks after the symptom onset.Risk factors,including demographic characteristics,clinical symptoms,and laboratory factors were confirmed to be important determinants of fatality of COVID-19.Our predictive model can provide scientific evidence for a more rational,evidence-driven allocation of scarce medical resources to reduce the fatality of COVID-19.
