With the population aging, mental health of the middle-aged and elderly adults is of great concern, especially in middle-aged and elderly women. Compared with urban women, rural women are more likely to suffer from mental diseases due to their poorer health status, lower education level and backward living conditions, however, the accessibility of mental health services among them is low.
To understand the prevalence of depression among middle-aged and elderly women in rural China and analyze its influencing factors, in order to provide empirical evidence for improving the mental health of middle-aged and elderly women.
From May to July 2021, the follow-up data of the 2018 China Health and Retirement Longitudinal Study (CHARLS) was extracted, and rural women aged 45 years and above were selected as the study subjects (n=6 736) . The scores of the simplified version of the Center for Epidemiologic Studies Depression Scale (CES-D) were used to determine the depression status of rural middle-aged and elderly women. Chi-square tests and multivariate Logistic regression model were used to analyze the influencing factors of the occurence of depressive symptoms among rural middle-aged and elderly women (including individual characteristics, health behaviors, social participation and utilization of medical services utilization) .
The CES-D score of 6 736 rural middle-aged and elderly women was (20.0±6.9) , 42.46% (2 860/6 736) of whom had depressive symptoms. The results of multivariate Logistic regression analysis showed that satisfication with health status〔OR (95%CI) =0.40 (0.36, 0.45) 〕, sleep duration ≥6 h〔OR (95%CI) =0.48 (0.43, 0.54) 〕, Internet use〔OR (95%CI) =0.63 (0.50, 0.80) 〕 and satisfication with life 〔OR (95%CI) =0.25 (0.21, 0.30) 〕 were correlated with lower risk of depression; hysical disability〔OR (95%CI) =1.41 (1.16, 1.71) 〕, suffering from chronic diseases〔OR (95%CI) =1.35 (1.21, 1.50) 〕, receiving outpatient services within 1 month〔OR (95%CI) =1.25 (1.09, 1.43) 〕 and hospitalization services within 1 year〔OR (95%CI) =1.31 (1.13, 1.52) 〕 were correlated with higher risk of depression.
Based on the results of this study, the depression status of middle-aged and elderly women in rural China is relatively severe and affected by individual characteristics, health behaviors, social participation, and the medical services utilization. It is recommended that governments and civil affairs departments at all levels pay close attention to the mental health of rural middle-aged and elderly women, especially through the intervention and prevention from multiple dimensions such as health promotion and education, medical service quality, and accessibility of information, in order to promote the construction of healthy villages and process of health aging in China.
China is facing an increasing number of chronic disease patients. Health-related quality of life (HRQoL) is an important indicator assessing the effect of prevention and treatment measures for chronic diseases, so it is important to select an appropriate HRQoL measurement tool for these patients.
To compare the validity, consistency and correlation of the Chinese Medicinal Quality of Life scale (CQ-11D) , Short-form 6-dimension version 1 (SF-6Dv1) , and the 3-level version of EQ-5D (EQ-5D-3L) in terms of utility values measuring HRQoL in chronic disease patients, and to identify a scale that is most applicable to Chinese chronic disease patients.
From February 2021 to April 2021, this study recruited the initial sample of Chinese people using quota sampling with quotas based on sex and age from a total of 28 representative provinces, autonomous regions or municipalities selected from seven geographical regions (north China, northeast China, east China, central China, southwest China, northwest China, and south China, with 2 to 6 selected from each of the regions) . A face-to-face survey was used to collect the sample people's basic demographic information and the situation of chronic diseases, and self-reported HRQoL measured using the CQ-11D, SF-6Dv1 and EQ-5D-3L, respectively, then according to the survey results, those with chronic diseases were selected, and the utility values of the three scales in them were analyzed. Bland-Altman chart and intraclass correlation coefficient (ICC) were used to analyze the consistency and correlation of the three scales. Kruskal-Wallis H test was used for univariate analysis to determine whether or not there is a statistically significant difference between the utility values of the scales across age or sex groups.
A total of 692 chronic disease patients were finally included. The mean (standard deviation) of utility scores of CQ-11D, SF-6Dv1 and EQ-5D-3L scales were (0.855±0.168) , (0.793±0.132) and (0.876±0.136) , respectively. The top three prevalent chronic diseases were hypertension (n=275) , arthritis (n=128) and hyperlipidemia (n=124) . Histogram showed that EQ-5D-3L had obvious ceiling effect, and CQ-11D was more widely distributed. The Bland-Altman chart showed that the consistency between the three scales was relatively good, and the points within the 95% limits of agreement (LOA) were all about 95%. The strength of correlation between CQ-11D and visual analogue score (VAS) was the highest (P<0.001) . The ICC among the three scales ranged from 0.528 to 0.625, showing a moderate level of correlation (P<0.001) . Both Bland-Altman chart and ICC analysis showed that SF-6Dv1 and EQ-5D-3L had the best consistency. The results of analysis for the three chronic diseases in subgroups were similar to those in the total sample. Univariate analysis showed that male patients with hypertension or hyperlipidemia had higher utility scores of three scales than their female counterparts (P<0.05) . And the utility scores of three scales were the lowest in 60-year-olds and above among patients with hyperlipidemia.
The ceiling effect of EQ-5D-3L scale is obvious in patients with chronic diseases. CQ-11D demonstrated a wide range of distribution of utility values in measuring the three chronic diseases, which may be more suitable for measuring HRQoL in Chinese chronic disease population, as no ceiling effect was observed and its correlation with VAS was the strongest.
Mild cognitive impairment (MCI) is an important stage to intervene and delay the progression of dementia, and it has been shown closely associated with genetic factors, among which apolipoprotein E (APOE) ε4 is recognized as an important risk allele of MCI in the medical field. Due to the lack of Genome-Wide Association Study (GWAS) summary data of MCI, it is common to use the GWAS summary data of Alzheimer's disease (AD) as the base dataset to calculate the polygenic risk score (PRS) of MCI, resulting in suboptimal PRS genetic risk prediction for MCI.
To explore the and optimize the statistical modeling strategy of genetic risk in MCI from the perspective of generalized linear model and machine learning, using meta-polygenic risk score (metaPRS) and APOEε4 as important predictors.
PRS for the 12 MCI-related traits were calculated and integrated into metaPRS for MCI by elastic-net Logistic regression model. SCOREAPOE was calculated by weighting the APOEε4 effect size with age correction. XGBoost, GBM, Logistic regression and Lasso regression were used as statistical modeling methods to verify the inclusion strategies of different predictors based on metaPRS, SCOREAPOE and basic demographic information (age, gender, education level) . AUC and F-measure were used to evaluate the predictive effect of statistical modeling of genetic risk of MCI.
metaPRS and SCOREAPOE have high predictive value for the genetic risk of MCI. After including metaPRS, SCOREAPOE and basic demographic information (age, gender, education level) , the predictive effect of each statistical modeling method is XGBoost (AUC=0.69, F-measure=0.88) , GBM (AUC=0.76, F-measure=0.87) , Logistic regression (AUC=0.77, F-measure=0.89) , and Lasso regression (AUC=0.76, F-measure=0.92) .
When the sample size is 325 (less than 500) , the Lasso regression model constructed by including metaPRS, SCOREAPOE and basic demographic information (age, gender, education level) as predictors has the best effect on MCI genetic risk prediction, providing a new idea and perspective for statistical modeling of genetic risk of complex diseases such as MCI.
The development of traditional Chinese medicine (TCM) has been listed as a national development strategy with vigorous improvement of TCM service capacity in primary care institutions as the important elements, however, there are few studies on the disease spectrum of TCM in community health service institutions.
To analysis the TCM disease spectrum in outpatient clinics of contracted residents by family doctors in Shenzhen community health service centers (abbreviated as CHSC) and understand the capability of TCM in Shenzhen health centers, thus providing a theoretical basis for promoting the development of TCM in primary care in China.
From May to June 2022, the records of outpatient consultations with treatment cost of 10 Shenzhen CHSCs from 2021-01-01 to 2021-06-30 were extracted by the unified information platform of the Health Commission of Shenzhen Municipality (Hangchuang Community Health Service Center Business System) . The 385 138 records with purpose of TCM treatment, matching diagnosis and treatment costs, first diagnosis can be coded in Classification and Codes of Diseases and ZHENG of Traditional Chinese Medicine (TCD) were collected. The disease spectrum was analyzed based on the classification of disease in TCD, mainly involving department categories, specialty system classifications, and TCM disease terms.
A total of 385 138 records of TCM diagnosis and treatment were selected in this study, including 170 077 (44.16%) male cases and 215 061 (55.84%) female cases, with an average age of (36.7±9.4) years. All of the 7 TCD categories of disease spectrum were involved, including internal medicine accounting for 56.98% (219 445 cases) , pediatrics accounting for 20.56% (79 201 cases) , otolaryngology accounting for 12.45% (47 965 cases) , gynecology accounting for 7.95% (30 620 cases) , surgery accounting for 1.51% (5 797 cases) , orthopedics accounting for 0.37% (1 407 cases) and ophthalmology accounting for 0.18% (703 cases) . Apart from the specialty system classifications of tumor diseases, cancer diseases in each category, classifications of middle canthal disease, black eye disease, pupillary disease, traumatic eye disease in Ophthalmology, the disease spectrum involves all specialty system classifications in 7 categories. The cumulative diagnosis and treatment volume of several disease spectrums accounted for 90.00% of the total diagnosis and treatment in each category. The top 5 system diseases in the spectrum included respiratory system diseases accounting for 54.19% (208 701 cases) , musculoskeletal system diseases accounting for 19.05% (73 369 cases) , gynecological system diseases accounting for 7.95% (30 620 cases) , cardiovascular and cerebrovascular system diseases accounting for 7.15% (27 539 cases) , and the digestive system diseases accounting for 4.98% (19 162 cases) . Patients aged <15 years and 15-24 years mainly suffered from diseases related to the respiratory and digestive systems, and the incidence of diseases such as paralysis, dizziness, headache, insomnia, fatigue were increased with the increase of age; cold ranked the first for patients aged below 45 years, the paralysis of muscle and joint pain ranked the first for patients aged above 45 years.
The TCM diseases spectrum in Shenzhen CHSCs is wide, but the categories are relatively concentrated and single, mainly involving internal medicine, concentrating on respiratory system diseases, musculoskeletal system diseases, gynecological system diseases, cardiovascular and cerebrovascular system diseases, and digestive system diseases. It is necessary to strengthen and expand the TCM diagnosis and treatment capabilities in CHSCs to better meet diverse health needs of the residents.
In China, a country with relatively serious burden of chronic obstructive pulmonary disease (COPD) , COPD is the third leading cause of death, and ranks third among all diseases in terms of disability adjusted life years (DALYs) . Effective prediction of the burden of COPD based on its prevalence, mortality and DALYs rate will provide theoretical support for the formulation of prevention and control measures.
To describe and analyze the burden of COPD and its temporal trends from 1990 to 2019, and to forecast the COPD burden between 2020 and 2024 in China, provide a basis for scientific prevention and control of COPD in China.
In December 2021, data about indicators measuring the burden of COPD in China from 1990—2019, including COPD prevalence, mortality and DALYs rates, were extracted from the Global Burden of Disease 2019. The average annual percentage change was used to measure the temporal trend of COPD prevalence, mortality and DALYs rates over the period. Autoregressive moving average (ARIMA) and neural network autoregressive (NNAR) models for COPD prevalence, mortality and DALYs rates were constructed based on data from 1990-2016 (training set) , and their predictive performance was tested using data from 2017—2019 (test set) . The relative error, mean absolute percentage error (MAPE) , mean absolute error (MAE) and root mean square error (RMSE) between predicted and actual values of these two models were calculated for comparing their goodness of fit and predictive performance. And the better model was used to estimate the COPD disease burden from 2020 to 2024.
COPD prevalence, mortality and DALYs rates in China during 1990—2019: (1) The prevalence of COPD in the whole population increased from 2 344.40/100 000 to 3 175.37/100 000, with an average annual growth rate of 1.04%. And the average annual growth rates of COPD prevalence were 0.92% and 1.13% for men and women, respectively. (2) The mortality rate of COPD in the whole population decreased from 105.09/100 000 to 72.94/100 000, with an average annual rate of decrease of 1.29%. And the mortality rates in both men and women showed a decreasing trend, with average annual rates of decrease of 0.83% and 1.83%, respectively. (3) The rate of COPD DALYs in the whole Chinese population decreased from 2 206.55/100 000 to 1 400.71 /100 000, with an average annual rate of decrease of 1.56%. And the rates of DALYs in both men and women showed a decreasing trend, with average annual rates of decrease of 1.37% and 1.86%, respectively. The predicted values of the trends by both ARIMA and NNAR models were basically consistent with the actual values of trends, but the ARIMA model had smaller relative error, MAPE, MAE and RMSE, indicating that it may have better prediction accuracy. And by the ARIMA model, the predicted COPD prevalence in 2020—2024 was 3 229.77/100 000, 3 262.44/100 000, 3 292.38/100 000, 3 322.31/100 000, and 3 352.25/100 000, respectively; the predicted mortality rates were 74.50/100 000, 75.49/100 000, 76.11/100 000, 76.50/100 000, and 76.75/100 000, respectively; the predicted DALYs rates were 1 429.56/100 000, 1 452.07/100 000, 1 469.64/100 000, 1 483.35/100 000, and 1 494.05/100 000, respectively.
The trend of burden of COPD in China was predicted to be increased from 2020 to 2024 by the ARIMA model. Owing to the high goodness of fit and predictive accuracy demonstrated in the prediction, the ARIMA model may be used as a tool for predicting short-term burden of COPD.
Along with the advance in the concept of healthy aging, the activities of daily living (ADL) in middle-aged and older Chinese adults has become a research focus. However, factors associated with the impairment of ADL in this group have been assessed in most of available studies while the changes in the process of ADL impairment have been scarcely explored.
To assess the prevalence and associated factors of decline in ADL during the aging process of middle-aged and older adults.
This study was conducted in March 2021. Data were collected from the four waves (2011, 2013, 2015, and 2018) of China Health and Retirement Longitudinal Study (CHARLS) , involving 11 439 individuals (≥45 years old) with normal baseline ADL followed up during 2011—2013, 2013—2015, or 2015—2018. Panel-data multinomial logit model was used to assess the associations of 13 factors (defined as independent variables, including demographics, health status, resource accessibility, and social psychology) with the decline in ADL (defined as dependent variable) in these people over the follow-up period.
The numbers of cases of declined ADL over the three follow-up periods (2011—2013, 2013—2015, and 2015—2018) were 1 829 (44.53%) , 1 758 (40.43%) , 1 215 (40.72%) , respectively. Multinomial logit regression analysis indicated that age, gender, place of residence, education level, number of chronic diseases, prevalence of falls, prevalence of perceived pain, use of auxiliary equipment, natural logarithm of personal income per capita, and level of depression were associated with the decline in ADL (P<0.05) .
The decline in ADL in middle-aged and older Chinese adults may be related to age, education level, number of chronic diseases, auxiliary equipment usage, per capita income, and depression. To reduce the prevalence of declined ADL in this population, we put forward the following recommendations: promoting the construction of a public service system, strengthening chronic disease management in middle-aged and older adults, incentivizing the development of rehabilitation services market, increasing medical subsidies for specific groups, and attaching importance to the mental health of middle-aged and older adults.
Weight management should be extended to the entire population and not limited to special populations. Exploring the willingness, status, measures and influencing factors of adults' weight management, may contribute to the development of a reasonable, scientific, and easily operable method for reaching or maintaining a healthy weight.
To understand the prevalence and associated factors regarding achieving or maintaining a healthy weight in residents aged 18-79 in Beijing.
A survey was conducted from August to December 2017 with a stratified multistage sample of 13 188 permanent residents aged 18-79 from Beijing's 16 districts using a self-compiled questionnaire for understanding their self-assessed weight, weight changes within the past 12 months, and use of methods for weight control. The prevalence of weight management was compared by different characteristics. Methods for weight management used by weight controllers were comparatively analyzed by sex and age. We explored the differences in daily dietary habits and physical activity between weight controllers and non-weight controllers. Multivariate Logistic regression was used to analyze the factors associated with the implementation of weight management.
The overall prevalence of weight management in the residents over the last 12 months was 29.90% (3 947/13 188) . The prevalence of weight management differed statistically by sex, marital status, level of education, diabetes prevalence, current smoking status, physical activity status, voluntary health check-ups, assessment of weight, change in weight over the past 12 months, and BMI (P<0.05) . Diet control〔87.31% (3 446/3 947) 〕 and physical exercise〔78.34% (3 092/3 947) 〕were the most widely used weight management methods. The proportion of men who used physical exercise and smoking for weight control was significantly higher than that of women (P<0.001) , whereas the proportion of women who used diet control and weight loss medications for weight control was significantly higher than that of men (P<0.05) . The proportion of residents who used physical exercise and smoking for weight control was differed statistically by age groups (P<0.05) . 2 668 cases (67.60%) used both diet control and physical exercise to control weight, among whom 60-70 year olds accounted for a higher percentage than did 18-44 year olds and 45-59 year olds (P<0.001) . 625 cases (15.83%) relied only on diet control to control weight, among whom 18-44 year olds accounted for a higher percentage than did 45-59 year olds and 60-79 year olds (P<0.001) . The prevalence of weight management by physical activity or smoking differed significantly across age groups. Compared with non-weight controllers, weight controllers had lower prevalence of inadequate intake of fresh fruit and vegetables and excessive intake of red meat (P<0.05) . Moreover, they had higher prevalence of doing ≥ 150 min of moderate to vigorous intensity activities per week (P<0.001) . Furthermore, they had higher prevalence of spending ≥4 hours per day in leisure-time sedentary behaviors (P<0.001) . Multivariate regression analysis showed that age<60 years, women, married/unmarried cohabitation, higher level of education (junior high school and above) , current non-smoking, alcohol consumption within the past 7 days, physical inactivity, voluntary physical examinations, correctly assessing one's own weight, weight gain/loss ≥ 2.5 kg in the past 12 months, and having a BMI within the range of normal to obesity were associated with higher possibility of implementing weight management (P<0.05) .
In these Beijing residents aged 18-79 years, diet control and increased exercise were popular for weight control, but the use of unhealthy weight management methods was also found. When guiding residents to use proper methods to control weight, individualized management programs should be developed with sex, age, education level and other factors taken into consideration.
China has a large baseline number of patients with hepatitis B virus (HBV) -related chronic liver disease, and it is urgently to contain HBV infection prevalence. To do this, the issue that needs to be addressed quickly is transforming the hospital-based management into community-, hospital-, patient- and society-based management.
To quantify preferences of health management in patients with HBV-related chronic liver disease from Hubei Province, providing a basis for the development of strategies for containing chronic hepatitis disease and for managing such patients.
From July 2018 to July 2019, a discrete choice experiment survey was carried out with a multistage random sample of 180 patients with HBV-related chronic liver disease recruited from three cities (Wuhan, Shiyan, and Xiangyang) of Hubei Province using a questionnaire for collecting their general information, and preferences related to health management (choice sets in the discrete choice experiment consist of place for regular health checkups, average monthly expense for health management of HBV-related chronic liver disease, followed health management, and ways of accessing health management information of HBV-related chronic liver disease with different options) . The mixed Logit model developed in 15.0 was used for data analysis.
The response rate of the survey was 89.4% (161/180) . Patients were more tended to choose a management pattern with lower average monthly expense, a hospital as the place for regular medical examinations, self-management or accessing health management information using offline approaches (P<0.05) . The amount of an additional monthly expense that the patients were willing to pay was 256.75 yuan if the place for regular health checkups was changed to a hospital from a community, 96.87 yuan if the management pattern was changed to self-management from a patient support group-based management, and 52.94 yuan if the approaches for accessing health management information were changed to offline from online. Compared with other choices, the change in the place for regular health checkups from a community to a hospital was the most popular in the patients (willingness increased by 87.29%) .
Patients with HBV-related chronic liver disease preferred to undergo regular health checkups and access health management information in hospitals, but were less likely to contract a family doctor or invest in health. To improve the containment of chronic liver disease, we put forward the following recommendations: strengthening hospitals' capabilities in treating HBV-related chronic liver disease, and their services delivered by a family doctor team, guiding patients to change the idea of "focusing on treatment rather than prevention", and delivering integrated online and offline services.
Prevalence，Awareness，Treatment and Control Rates of Hypertension in Chinese Adults: Trend and Associated Factors from 1991 to 2015
As a major common chronic noncommunicable in Chinese adults, hypertension is associated with increased risk of a variety of cardiovascular and cerebrovascular diseases such as coronary atherosclerosis and stroke. Hypertension has become a major public health issue in China due to increasing prevalence but low treatment and control rates.
To estimate the prevalence, awareness, treatment and control rates of hypertension in Chinese adults from 1991 to 2015.
Data were collected from nine waves of the China Health and Nutrition Survey conducted between 1991—2015, involving adults (≥18 years old) with complete information, including age, sex, blood pressure values, demographic characteristics, smoking, drinking status, height, weight, waist circumference, blood pressure value and disease history. The trends of hypertension prevalence, awareness, treatment and control rates and associated factors in adults during the period of 25 years were analyzed.
In 1991, the prevalence, awareness, treatment and control ratesof hypertension in adults were 14.77% (1 291/8 743) , 27.58% (356/1 291) , 15.80% (204/1 291) , and 5.89% (76/1 291) , respectively, while these four indicators in 2015 were 32.67% (4 520/13 834) , 48.08% (2 173/4 520) , 40.51% (1 831/4 520) , and 14.65% (662/4 520) , respectively. There was an increasing tread for prevalence of hypertension from 1991 to 2015. Increasing trends of awareness, treatment and control rates were found from 2000 to 2015. The prevalence, awareness, treatment and control rates of hypertension were alwaysaffected by age, gender, behavior habits, knowledge level and other factors.
The treatment and control rates of hypertension in Chinese adults are increasing, but still relatively lower in comparison to its increasing prevalence. So it is recommended for relevant government departments to take measures to enhance hypertension treatment and control rates in adults, so that the progression of hypertension would be delayed.
Spectrum of Mortality from Circulatory Diseases in China from 2004 to 2015
Two circulatory diseases, cardiovascular and cerebrovascular diseases have become the leading death causes in China, and their morbidity and mortality are still rising. Revealing the urban/rural-specific, gender-specific and region-specific differences in the order of circulatory diseases ranked by mortality and its changing trend will provide a scientific basis for the prevention and control of circulatory diseases.
To analyze the spectrum of mortality from circulatory diseases ranked by mortality, mainly cardiovascular and cerebrovascular diseases, in China from 2004 to 2015, by areas (urban/rural) , sex and region and its changing trend.
Information about deaths and mortality due to circulatory diseases stemmed from the data of circulatory disease from 2004 to 2015 defined by National Disease Surveillance System Cause-of-Death Surveillance Data Set. The urban/rural-specific, gender-specific and region-specific differences in the mortality from circulatory diseases and their changing trend were analyzed with χ2 test by SPSS 13.0.
During 2004 to 2013, the six circulatory diseases leading to deaths ranked by mortality in a descending order were: cerebrovascular disease, ischemic heart disease, other circulatory diseases, hypertensive heart disease/kidney disease, rheumatic fever and rheumatic heart disease. And the order of these diseases from 2014—2015 was: cerebrovascular disease, ischemic heart disease, hypertensive heart disease/kidney disease, other circulatory diseases, rheumatic fever and rheumatic heart disease. From 2006 to 2015, the mortality of cerebrovascular and ischemic heart diseases increased year by year. From 2004 to 2015, the mortality of hypertensive heart disease/kidney disease increased slowly year by year. There was no significant change in the mortality of rheumatic fever and rheumatic heart disease but a double wave change in the mortality of other circulatory diseases with peaks in 2006 and 2013. The urban/rural-specific mortality: the difference was statistically significant for cerebrovascular disease each year, for rheumatic fever and rheumatic heart disease each year except in 2006 and 2015, for hypertensive heart disease/kidney disease each year except in 2005, for ischemic heart disease each year except in 2015, and for other diseases of the circulatory system each year except in 2004, 2005, 2011 and 2012 (P<0.05) . The gender-specific mortality: the difference was statistically significant for rheumatic fever and rheumatic heart disease, ischemic heart disease and cerebrovascular disease each year, for other diseases of the circulatory system each year except in 2005, and for hypertensive heart disease/kidney disease only in 2005 and 2015 (P<0.05) . The region-specific mortality: the difference was statistically significant for each disease in each year of the period (P<0.05) .
There were extremely significant urban/rural-specific, gender-specific and region-specific differences in the mortality of circulatory diseases. The incidence of ischemic heart disease was high in urban areas, while that of other circulatory diseases was high in rural areas. The incidence of rheumatic fever and rheumatic heart disease was high for females, while that of other circulatory diseases was high in males. The region-specific mortality difference was statistically significant for rheumatic fever and rheumatic heart disease, hypertensive heart disease/kidney disease, ischemic heart disease and cerebrovascular disease as well as other circulatory diseases. Therefore, prevention and treatment priorities for circulatory diseases should be determined and targeted interventions should be delivered according to region-specific differences.
Values of Different Obesity Indicators in Predicting the Risk of Hyperuricemia：a Comparative Study
In China, hyperuricemia (HUA) is increasingly prevalent, which is often accompanied by multi-system diseases, and has become the second leading metabolic disease after diabetes mellitus. How to effectively contain its prevalence has become an important public health issue that needs to be solved urgently.
To examine relationships of different obesity indices〔waist circumference (WC) , body mass index (BMI) , waist-to-height ratio (WHtR) , body shape index (ABSI) , body roundness index (BRI) , visceral adiposity index (VAI) and lipid aggregation index (LAP) 〕with HUA, and compare their predictive values for HUA, providing a reference basis for early HUA screening and prevention.
Cluster sampling was used to recruit physical examinees from the health management center of a grade A tertiary hospital from January to December 2020. Anthropometric indices included in the analysis included WC, BMI, WHtR, ABSI, BRI, VAI and LAP. Binary Logistic regression was used to assess the correlation of HUA with different obesity indices. Receiver operating characteristic (ROC) curve analysis was performed to estimate the predictive values of these indices for HUA with suggested optimal cut-off points presented.
Of the 32 344 physical examinees in total, 13 546 (41.84%) were found with HUA. Men had higher detection rate of HUA than women〔54.11% (10 026/18 530) vs 25.43% (3 520/13 844) 〕 (P<0.001) . The values of all these obesity indices were higher in male HUA patients than in female HUA patients, with statistically significant differences (P<0.001) . Binary Logistic regression showed that after correcting for confounding variables, WC, BMI, WHtR, ABSI, BRI, VAI, and LAP were all statistically associated with HUA occurrence in both men and women (P<0.001) . In men, the area under the ROC curve (AUC) of WC, BMI, WHtR, ABSI, BRI, VAI and LAP in predicting HUA was 0.612, 0.626, 0.602, 0.512, 0.602, 0.617 and 0.642, respectively, with corresponding optimal cut-off points of 80.5 cm, 24.3 kg/m2, 0.48, 0.072, 3.8, 1.4 and 26.7. In women, the AUC for WC, BMI, WHtR, ABSI, BRI, VAI and LAP in predicting HUA was 0.637, 0.636, 0.637, 0.555, 0.638, 0.583, and 0.660, respectively, with corresponding optimal cut-off points of 72.5 cm, 22.7 kg/m2, 0.47, 0.074, 4.2, 1.3 and 15.3. In both male and female physical examinees, the AUC of LAP predicting HUA was higher than the other six obesity indicators (P<0.05) , and the AUC of ABSI predicting HUA was lower than the other six obesity indicators (P<0.05) .
These seven obesity indices were all significantly associated with the occurrence of HUA in men and women. The predictive values of them for HUA were different, and LAP may be the best indicator for predicting the risk of HUA in either men or women.
Longitudinal Cohort Study of the Association of Triglyceride-glucose Index with Hypertension among Teachers from a University
Triglyceride-glucose (TyG) index is regarded as a novel alternative to insulin resistance (IR) , a core pathophysiological mechanism of hypertension. However, it is still controversial about the association of TyG index with hypertension, and relevant longitudinal research is limited.
Attempt to examine the association of TyG index with hypertension among teachers from a university.
A retrospective cohort study was conducted from January 2015 to December 2019. Participants (n=602) were teachers from a university who had normal blood pressure and consecutively underwent the annual physical examinations. Their physical examination data were collected, including demographic characteristics, anamnesis, medication history, and biochemical indices in venous blood. The cumulative incidence of hypertension was calculated and compared across groups〔Q1-Q4 (first to fourth quartiles) 〕 of TyG index quartiles. The association of TyG index with hypertension was analyzed, and further analyzed by sex, age, and BMI using generalized estimating equation (GEE) .
A total of 174 cases were found to have hypertension during the 5 years, with 5-year cumulative incidence of hypertension of 28.9%. The 5-year cumulative incidence was 37.4% (101/270) for males and 22.0% (73/332) for females with a statistical difference (χ2=17.23, P<0.001) . The 5-year cumulative incidence of hypertension in Q1 to Q4 groups was 16.8% (25/149) , 24.7% (37/150) , 32.9% (50/152) and 41.1% (62/151) , respectively, revealing that the cumulative incidence of hypertension increased with the elevation of TyG (χ2=23.97, P<0.001) . Multivariate analysis using GEE approach showed that compared to Q1 group, the risk of hypertension significantly increased in Q3 group〔OR (95%CI) =1.546 (1.026, 2.330) 〕 and Q4 group〔OR (95%CI) =1.872 (1.209, 2.901) 〕 after adjusting for gender, age, BMI, γ-GGT, ALT, total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, uric acid, urea nitrogen. Further analysis revealed that in individuals with the fourth quartile of TyG index, men had higher risk of hypertension than women (P<0.05) . In individuals aged 45-54 years, those with the third or fourth quartile of TyG index had higher risk of hypertension (P<0.05) . In individuals with normal weight, those with the third or fourth quartile of TyG index had higher risk of hypertension (P<0.05) .
Elevated TyG index may be associated with increased risk of hypertension, so it could be used as an independent predictor of hypertension in general population, especially in men, 45-54-year-olds, or those with normal weight. And measurement of TyG index may be used to early screening for hypertension.
Health Literacy Regarding Infection Disease Prevention and Treatment among Residents of Taizhou，Zhejiang：Temporal Trends and Associated Factors
Due to repeated COVID-19 outbreaks worldwide, COVID-19 containment in China has become a routine social issue, entering a new phase of containment, and residents' health literacy about infection disease prevention and treatment has obtained increasing attentions.
To explore the health literacy about infection disease prevention and treatment in residents of Taizhou, Zhejiang during 2017—2020, and to analyze the trend of changes as well as influencing factors, providing scientific evidence for the precise implementation of actions for achieving "Healthy Taizhou 2030".
This study was implemented from 2017 to 2020 with Taizhou permanent residents aged between 15 and 69 selected using multistage random sampling, for investigating their demographics, socioeconomic features and health literacy about infection disease prevention and treatment using the National Residents' Health Literacy Monitoring Questionnaire developed by us. In January 2021, the data of health literacy about infection disease prevention and treatment of residents in Taizhou City in four years was analyzed. The health literacy data during 2017—2020 were comparatively analyzed after being processed with weight standardization, and the trend of changes during the period was analyzed using a Chi-squared test for linear trend. Binary logistic regression was used for identifying factors associated with relevant health literacy of these residents in 2020.
The number of respondents for the survey conducted in four consecutive years from 2017 to 2020, was 3 595, 5 389, 5 929, and 5 847, respectively. The samples in the four yearly surveys showed basically similar demographics, with those aged 45-54 (27.42%-30.46%) , education level was junior high school (27.78%-29.93%) , occupation was farmer (44.52%-58.03%) accounting for the largest proportion. The urban to rural population ratio for the sample of four consecutive yearly surveys was 0.50∶1, 0.55∶1, 0.54∶1 and 0.52∶1, respectively. And the male to female ratio was 1∶1, 0.95∶1, 0.99∶1 and 0.94∶1, respectively. The prevalence of having health literacy about infection disease prevention and treatment for 2017—2020 was 7.86% (642/3 595) , 19.00% (1 024/5 389) , 19.51% (1 157/5 929) , and 27.14% (1 587/5 847) , respectively. After the data were processed with weight standardization, the prevalence of health literacy regarding infectious disease prevention and treatment in 15-69-year-old residents in 2017—2020 was 22.25%, 24.72%, 25.34% and 33.14%, respectively. The health literary level regarding infectious disease prevention and treatment in the residents showed a successive linear increment during the study period regardless of living in rural or urban areas, sex, age (except for 65-69 year olds) , and education level (except for illiteracy/lower illiteracy) , and occupation (P<0.05) . Multivariate Logistic regression analysis showed that gender, age, education level, out-of-pocket health care costs in the past year, and annual household income were associated with health literacy regarding infectious disease prevention and treatment (P<0.05) .
Our analysis indicates that some advances in prevention and control as well as health education regarding infectious diseases have been achieved in Taizhou, but there is still much room for improvement. In the "golden window" period for normalized prevention and control of COVID-19, it is suggested that Taizhou should strengthen health education regarding infectious disease prevention and treatment for key groups, such as those who are middle-aged and elderly, lower educated, or engage in a career as a farmer or worker, to further improve relevant heath literacy of Taizhou residents.
