Cervical cancer is the seventh most common cancer globally, and the fourth most common cancer in women, accounting for about 12% of all cancers diagnosed among females. Cervical cancer and liver cancer are similar with respect to high prevalent region, with about 85% of the sufferers are from less developed regions.
To assess the long-term trends of cervical cancer incidence and mortality in China.
Data about cervical cancer incidence and mortality in Chinese adult females were extracted from the Institute for Health Metrics and Evaluation. Joinpoint regression was used for analyzing the trends of cervical cancer incidence and mortality during 1993—2017. The age-period-cohort model and intrinsic estimator method were adopted for analyzing the effects of age, period, and cohort on cervical cancer incidence and mortality.
Overall, the trends of cervical cancer incidence and mortality totally experienced a significant decrease during 1993—1998, and showed an increasing trend during 2008—2015. Joinpoint regression analysis showed that from 1993 to 2017, the standardized incidence ratio of cervical cancer increased from 9.54/100 000 to 10.88/100 000〔AAPC (95%CI) =0.6 (0.3, 0.9) , P<0.05〕, while its standardized mortality ratio decreased from 4.88/100 000 to 4.48/100 000〔AAPC (95%CI) =-0.3 (-0.5, -0.1) , P<0.05〕. Moreover, cervical cancer incidence increased significantly with age before the age of 59, and the period effect exhibited a general upward trend for both incidence and mortality. The incidence and mortality risks by birth cohort showed a declining trend except for some periods and the risks all peaked in the cohort born in 1916—1920, then leveled off and slightly decreased in younger generations.
Taken together, the decrease in the cohort effect might contribute to the decrease in cervical cancer incidence and mortality rates, while the increase of age and period effects might lead to the increase in its morbidity and mortality rates.
Cross-sectional studies have shown that the level of bilirubin in vivo is related to the progression of atherosclerosis, but the data from large-scale studies in China and even in the world are very limited.
To investigate the effect of serum total bilirubin (TBIL) and indirect bilirubin (IBIL) on the progression of carotid atherosclerosis in healthy people.
Retrospective cohort study was adopted to select 11 394 healthy people who had continuous physical examination and carotid intima-media thickness (cIMT) ≤1 mm displayed by carotid artery ultrasound examination as the research subjects in Hebei General Hospital from January 2010 to December 2019. Demographic characteristics, past medical history, physical examination, laboratory examination results of previous physical examination, carotid artery ultrasound and other information of subjects were collected. The subjects were divided into the progressive carotid atherosclerosis group and the non-progressive group according to whether cIMT increased during follow-up. The Cox proportional regression model was used to explore the effect of bilirubin on the progression of carotid atherosclerosis, and Cox regression analysis was performed by gender, age, body mass index (BMI) , hypertension, diabetes, smoking and alcohol consumption.
1 586 cases of carotid atherosclerosis progression were detected in 10 years, with a cumulative incidence rate of 13.9%. The results of Cox regression analysis showed that for every 1 standard deviation increase in TBIL and IBIL levels, the risk of carotid atherosclerosis progression decreased by 6.6% and 17.4%, respectively〔HR (95%CI) =0.934 (0.881, 0.990) ; HR (95%CI) =0.826 (0.777, 0.877) 〕 after adjustment for age, sex, BMI, smoking, alcohol consumption, hypertension, diabetes, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, total cholesterol, triglyceride, alanine aminotransferase and estimated glomerular filtration rate. Subgroup analysis showed that there was no statistical difference in the protective effects of TBIL and IBIL on different subgroups.
TBIL and IBIL levels are independent protective factors for the progression of carotid atherosclerosis in healthy subjects. Elevated bilirubin levels reduce the risk of carotid atherosclerosis progression, with IBIL being more potent in preventing carotid atherosclerosis progression.
There is no epidemiological survey of hemorrhagic stroke with a large sample size in China. Jiangxi Province faces high and rapidly increased prevalence of cerebrovascular disease in its resident population.
To understand the epidemiological characteristics and hospitalization costs of hemorrhagic stroke inpatients in Jiangxi, offering a scientific basis for preventing and controlling the disease.
Through the management system of Diagnosis Related Groups, Informaion Center, Health Commission of Jiangxi Province, the information of patients with a primary diagnosis of hemorrhagic stroke (ICD-10 code I60-I69) discharged during 2015—2019 was collected. Based the data, the epidemiological characteristics and hospitalization costs associated with hemorrhagic stroke were anayzed.
Of the 128 788 cases, 115 254 (89.49%) had cerebral hemorrhage and 13 534 (10.51%) had subarachnoid hemorrhage. During the period, the overall rate of hospitalization attributed to hemorrhagic stroke increased from 64.36/100 000 to 86.05/100 000, showing an upward trend (χ2=1 144.969, P<0.001) . The overall rate of hospitalization attributed to cerebral hemorrhage increased from 58.96/100 000 to 75.22/100 000, demonstrating an upward trend (χ2=727.089, P<0.001) . And the overall rate of hospitalization attributed to subarachnoid hemorrhage increased from 5.41/100 000 to 10.83/100 000, presenting an upward trend (χ2=659.513, P<0.001) . The top five comorbidities and complications of hemorrhagic stroke were hypertension, pulmonary infection, cerebral infarction, other cerebrovascular diseases, and diabetes. The median length of stay for hemorrhagic stroke was 14 (14) days. The median total hospitalization cost increased from 14 300.61 yuan to 15 982.47 yuan, and it varied significantly by year (H=834.590, P<0.001) . Drug cost accounted for the largest proportion of the total hospitalization cost in 2017—2019 (greater than 35% each year) , showing no significant difference across the three years (H=3.323, P=0.190) .
From 2015 to 2019, the rates of hospitalization attributed to hemorrhagic stroke and its two subtypes (cerebral and subarachnoid hemorrhage) demonstrated an upward trend in Jiangxi, with hypertension and lung infection as the most common comorbidities, and relatively heavy burden of hospitalization costs. Reducing the risk of complications and drug cost may contribute to the decrease of financial burden of these patients.
The promotion of use of antiretroviral therapy (ART) prolongs the life expectancy of people living with HIV. But age-related diseases are increasingly common, and the risks of opportunistic infections, coinfections and poor health condition are also increased significantly in this group, resulting in high medical costs and heavy economic burden. However, there are few studies on the household economic burden of HIV/AIDS patients.
To investigate the household economic burden in HIV/AIDS patients and associated factors in four regions (Beijing, Henan, Guizhou and Anhui) of China.
From December 2020 to May 2021, by use of typical sampling, three medical institutions (one in Beijing, another in Guizhou and another in Anhui) , and a center for disease control and prevention (located in Henan) were selected, where HIV/AIDS patients who received health services in 2020 were chosen by convenient sampling. A questionnaire developed by our research team was used to collect information on the patients' sociodemographic and economic features, disease-related conditions, and treatment. Household economic burden was defined as ratio of out-of-pocket medical expenses to annual household income (OME/AHI) in 2020 exceeded 25%.
A total of 1 446 patients were included. The patients were classified into two major groups by the OME/AHI ratio: ≤1% group (n=400, 27.7%) , and >1%-5% group (n=418, 28.9%) . Two hundred and thirty-seven cases (16.4%) had household economic burden. The prevalence of household economic burden differed significantly by region, sex, age, marital status, education level, occupation, urban or rural hukou, floating or permanent population, type of medical insurance, annual household income level, route of infection, CD4+ T cell count level, and type of medical treatment (P<0.001) . Stepwise multinomial Logistic regression analysis revealed the following: women had higher risk of household economic burden than men〔OR (95%CI) =1.729 (1.050, 2.853) 〕; Sixty-five-year-olds and above had higher risk of household economic burden than 18-24-year-olds〔OR (95%CI) =3.445 (1.188, 10.227) 〕; The divorced had higher risk of household economic burden than those unmarried〔OR (95%CI) =2.241 (1.073, 4.678) 〕; Public institution employees had lower risk of household economic burden than housekeepers, jobseekers, or those unemployed〔OR (95%CI) =0.287 (0.081, 0.898) 〕; Individuals with low〔OR (95%CI) =29.614 (12.348, 79.211) 〕 or low-to-middle annual household income〔OR (95%CI) =3.556 (1.471, 9.428) 〕 had higher risk of household economic burden compared with those with high annual household income; Heterosexual individuals had lower risk of household economic burden than homosexual individuals〔OR (95%CI) =0.356 (0.186, 0.670) 〕; ART non-recipients had lower risk of household economic burden than ART recipients〔OR (95%CI) =0.241 (0.055, 0.835) 〕; Individuals with CD4+ T cell count 201-350 cells/μl〔OR (95%CI) =2.347 (1.237, 4.515) 〕 or ≤200 cells/μl〔OR (95%CI) =2.365 (1.200, 4.702) 〕 had higher risk of household economic burden compared with those with CD4+ T cell count >500 cells/μl; Inpatient service recipients〔OR (95%CI) =12.492 (5.592, 27.818) 〕, and both outpatient and inpatient services recipients〔OR (95%CI) =23.69 (14.519, 39.933) 〕 had higher risk of household economic burden compared with outpatient service recipients.
HIV/AIDS patients had relatively low OME/AHI ratio generally, but some of them had household economic burden. Factors associated with household economic burden may include sociodemographic and economic factors such as sex, age, marital status, occupation, annual household income, and features related to HIV/AIDS and treatment such as route of infection, use of ART treatment, CD4+ T cell count level, and type of medical treatment. To tangibly reduce the household economic burden of in this group, more attention should be paid to women, the elderly, those with very poor condition or low annual household income. Besides, it is essential to continue to implement and improve relevant medical insurance policies.
