Table of Content

15 January 2026, Volume 29 Issue 02

Previous Issue   

Guidelines·Consensus

Expert Consensus on Early Screening and Prevention of Coronary Artery Disease in Young People

Cardiovascular Internal Medicine Professional Committee of China Medical Education Association, Cardiovascular Health Medicine Branch of China International Exchange and Promotion Association for Medical Care

2026, 29(02):  137-147.  DOI: 10.12114/j.issn.1007-9572.2025.0221

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Coronary artery disease (CAD) in young adults (aged<45 years old) encompasses a range of conditions affecting the coronary arteries, including atherosclerosis, vasospasm, inflammation, embolism, spontaneous dissection, aneurysm, physical or chemical injury, development, and abnormal drainage. Among these, coronary heart disease (CHD) resulting from coronary atherosclerosis is the most prevalent. This consensus addresses the current landscape of CAD in young adults, focusing on the epidemiology, risk factors, diagnosis, screening methods, and preventive strategies for young-onset coronary CHD. It particularly emphasizes the critical importance of early screening. Routine tests-including lipid profiles, blood glucose levels, and renal function assessment-are recommended for specific high-risk populations (e.g., individuals with family history of premature CHD, metabolic syndrome, chronic immune-mediated inflammatory diseases, or impaired renal function). Genetic testing (e.g., for familial hypercholesterolemia-related genes) should also be incorporated for risk assessment. Prevention strategies center on lifestyle interventions, such as adopting a low-salt, low-fat diet; engaging in regular physical activity; smoking cessation; limiting alcohol intake; maintaining good sleep hygiene; and minimizing exposure to air pollution. Additionally, guideline-directed management of dyslipidemia, hyperglycemia, hyperhomocysteinemia, and hypertension is recommended. For patients with comorbidities such as chronic kidney disease (CKD) or chronic immune-mediated inflammatory diseases, multidimensional biomarker monitoring and targeted interventions are essential. The consensus highlights that current evidence on young-onset CHD remains limited. Future research should strengthen the evidence regarding risk stratification, optimal screening frequency, and effective treatment strategies. Through multidisciplinary collaboration and enhanced public education, the goal is to reduce the incidence and disease burden of CHD in this young population.

Chinese General Practice/Primary Care Services

The Current Status of the Quality of Family Doctor Contract Services Based on General Practitioners' Perspectives: a Semi-structured Interview Study

CUI Yajia, JIN Guanghui

2026, 29(02):  148-154.  DOI: 10.12114/j.issn.1007-9572.2024.0353

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Background

Family doctor contract services (FDCS) is an important measure for deepening medical reform in China, aimed at improving people's health level and the efficiency of the health service system. FDCS has achieved rapid development in terms of quantity, but there is currently a lack of research evidence related to the quality of FDCS.

Objective

To understand the current status and existing problems of home medicine service quality in Beijing from the perspective of general practitioners, and provide reference for improving the quality of FDCS.

Methods

Eighteen general practitioners from 18 community health service institutions in 9 districts of Beijing were selected through purposive sampling from August 2023 to June 2024, and semi-structured interviews were conducted with general practitioners based on the structure process outcome framework interview outline. Analyze the data through thematic analysis and extract interview themes.

Results

The study extracted 3 themes and 11 sub-themes. Theme 1: The structural quality of FDCS (policy guidance and implementation, institutional conditions and facilities, assessment and incentive mechanisms for FDCS, home healthcare team building). Theme 2: Process quality of FDCS (contract service content, referral and treatment service process, outpatient service standards). Theme 3: The effectiveness of FDCS (improvement in residents' health levels, increased willingness to seek medical treatment, need to strengthen residents' recognition of home medicine services, increased occupational pressure on general practitioners).

Conclusion

Since the implementation of home medical services, the quality of services has gradually improved, but there are still some limiting factors. We should strengthen policy support, optimize service content and processes, integrate quality evaluation systems with incentive mechanisms, enhance the comprehensive service capabilities of general practitioners and establish efficient home medical teams.

A Qualitative Study on the Difference of Role Expectations of General Practitioners in Functional Communities from the Perspective of Supply and Demand

GE Libin, ZHAI Jiayi, YUAN Jing, TANG Yanwen, QIN Li, DONG Ming

2026, 29(02):  155-161.  DOI: 10.12114/j.issn.1007-9572.2024.0159

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Background

After years of practice, the service of general practitioners (GP) has achieved certain results in the health management of key groups such as the elderly, pregnant women, children, and patients with chronic disease. However, the services of "functional community" groups represented by young and middle-aged working people still needs to be improved.

Objective

Based on the role theory, this study conducts a qualitative research on the role expectations of GP in functional communities from the perspectives of GP and residents. The aim is to enhance the role image and function of GP and better meet the service demand.

Methods

From September to November 2023, a semi-structured interview was conducted among 8 GPs and 16 residents of 4 community health service centers in Jiading District, Shanghai, with the method of snowball sampling combined, and a directional content analysis was conducted on the interview results.

Results

Taking the four important contents of "quality expectation, image expectation, obligation expectation and behavior expectation" in the role expectation theory as the theme, it extracts the 14 sub-themes of clinical ability, work quality, culture, science and education, medical ethics, communication efficiency, work spirit, emotional expectation, treatment service, consultation service, consultation coordination, cost control obligation, service effectiveness, service accessibility and service standardization. It is found that both parties have the same expectation on medical ethics, good communication, life-saving, effective service and standard service, but have different expectations on cost control obligations, and other expectations are different.

Conclusion

The expectation of consistency between the supply and demand sides stems from the traditional ideal image of general practitioners, and the expectation of difference between the supply and demand sides stems from the misperception of the role and function of family doctors on both sides. The strategy to solve the contradiction between the misperception of family doctors in functional communities and the actual service of family doctors in reality is proposed.

Construction of Emergency Response Capacity Evaluation Indicators System for Major Infectious Diseases in Primary Medical Institutions in Beijing: Based on Emergency Management Theory and the Resilience Concept

WANG Jiaxin, WU Hao, ZHAO Yali

2026, 29(02):  162-169.  DOI: 10.12114/j.issn.1007-9572.2023.0834

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Background

Emergency response capacity of primary healthcare institutions in epidemic prevention and control greatly practiced and improved during the prevention and control of COVID-19 epidemic, and in this context, the construction of a more targeted and practical emergency response capacity evaluation indicators system for major infectious diseases in primary medical institutions is necessary.

Objective

To construct an emergency response capacity evaluation indicators system for major infectious diseases in primary medical institutions in Beijing, based on the theory of emergency management and resilience.

Methods

From October to November in 2022, a preliminary emergency response capacity evaluation indicators system for major infectious diseases in primary medical institutions in Beijing, was constructed by literature analysis method, policy induction method, and focus group discussion method. From March to May in 2023, two rounds of correspondence were conducted using the modified delphi method, and the emergency response capacity evaluation indicators system for major infectious diseases in primary medical institutions in Beijing, was determined according to the results of modified Delphi method, and the weights of all of the evaluation indicators were determined by analytic hierarchy process.

Results

The effective recovery rates of the questionnaires in the two rounds of modified Delphi method was 94.4% (17/18) and 100.0% (17/17), respectively, and the expert authority coefficient was 0.84. The coordination coefficients of the importance and operability of the indicators was 0.144 (P<0.05), 0.190 (P<0.05), respectively, in the first round of modified Delphi method; was 0.104 (P<0.05), 0.155 (P<0.05), respectively, in the second round of modified Delphi method. In the eventually formed emergency response capacity evaluation indicators system for major infectious diseases in primary medical institutions in Beijing, there were 3 first-level indicators (preparedness capacity, disposal capacity, and assessment and recovery capacity), 18 second-level indicators, and 56 third-level indicators, and the weight of the 3 first-level indicator was 0.528, 0.333 and 0.140, respectively.

Conclusion

Based on the theoretical framework of emergency management and the concept of resilience, we constructed the emergency response capacity evaluation indicators system for major infectious diseases in primary medical institutions in Beijing, in which the indicators can be dynamically adjusted according to the actual situation, so as to more truly reflect the emergency response capacity for major infectious diseases, and to provide a reference for the evaluation of emergency response capacity for major infectious diseases in primary healthcare institutions.

Article

Long-term Medication Adherence Attitudes and Behaviors of Stroke Patients in Rural Areas of China and Related Factors: Based on Follow-up Data from a Certain County in Hebei Province

LONG Yutong, LU Shiyu, TAN Jie, YANG Bolu, DUAN Jingying, YANG Tongde, YAN Lijing, GONG Enying, SHAO Ruitai

2026, 29(02):  170-179.  DOI: 10.12114/j.issn.1007-9572.2025.0206

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Background

Good medication adherence can significantly reduce the risk of recurrence in stroke patients and is crucial for the secondary prevention of stroke. However, existing research primarily focuses on short-term medication and adherence behaviors among rural stroke patients, while studies on the long-term medication adherence behaviors of patients with a history of stroke in rural areas are limited.

Objective

To analyze the long-term medication behavior, adherence attitude and behavior of stroke survivors in rural areas of China, and identify the factors related to medication behavior.

Methods

System-integrated technology-enabled intervention (SINEMA) study, a research project focusing on the management of stroke patients in rural areas, which was conducted in 60 villages across 5 towns of Nanhe County, Hebei Province in 2017—the subjects of this study were all stroke survivors who had previously participated in the 2017 SINEMA study, consented to participate in the follow-up survey conducted from May to July 2024, and completed the survey. The study investigated the medication use of the subjects, including antihypertensive drugs, statins, antiplatelet drugs, and hypoglycemic drugs. Meanwhile, the Maastricht Utrecht Adherence in Hypertension-16 (MUAH-16) scale was employed to assess the subjects' medication adherence attitudes, specifically focusing on the dimensions of positive medical and medication attitudes. The Morisky Green Levine Scale was used to measure the medication adherence behaviors of patients taking the above four categories of drugs, with a score of 0 defined as high adherence. Descriptive analysis was applied to present the basic characteristics of the patients, their medication adherence status, and the relevant factors identified through multivariate Logistic regression analysis.

Results

A total of 912 participants were included in this study, with a mean age of (72.0±7.9) years. Among them, 46.1% (420/912) were female. Regarding medication use, 772 cases (84.6%) reported taking antihypertensive drugs, 547 cases (59.9%) took antiplatelet drugs, 427 cases (46.8%) used statins, and 203 cases (22.3%) took hypoglycemic drugs. Among patients currently taking these four types of drugs, the adherence rate to hypoglycemic drugs was 77.3% (157/203), to antihypertensive drugs was 71.5% (552/772), to antiplatelet drugs was 71.2% (392/547), and to statins was 71.2% (304/427). The survey also showed that 49.2% (449/912) of the patients held a relatively positive attitude towards medication use. Results from multivariate Logistic regression analysis showed that among patients taking antihypertensive medications, those with higher educational attainment (secondary school and above: OR=1.87, 95%CI=1.13-3.09) and positive attitudes toward medical care and medication use (OR=1.53, 95%CI=1.08-2.17) had higher medication adherence, while patients capable of independently completing work tasks (OR=0.56, 95%CI=0.32-0.99) and those visiting village clinics ≥1 time per month (OR=0.68, 95%CI=0.53~0.88) had lower medication adherence (P<0.05). For patients taking antiplatelet drugs, higher educational attainment (secondary school and above: OR=1.79, 95%CI=1.09-2.96) was linked to better medication adherence, whereas patients with hemorrhagic stroke (OR=0.55, 95%CI=0.31-0.98) had lower medication adherence (P<0.05). Among patients on statins, those visiting village clinics ≥1 time per month (OR=0.67, 95%CI=0.46-0.98) showed lower medication adherence (P<0.05). As for patients taking antidiabetic medications, male patients (OR=0.21, 95%CI=0.06-0.73), those enrolled in the chronic and major disease insurance program (OR=0.34, 95%CI=0.15-0.79), and individuals visiting village clinics ≥1 time per month (OR=0.34, 95%CI=0.13-0.89) all had significantly lower medication adherence (P<0.05).

Conclusion

Stroke survivors in rural areas with a longer disease history tend to exhibit relatively higher levels of medication adherence; however, nearly one-third of patients still fail to consistently follow treatment recommendations. The determinants of adherence vary across different types of medications, highlighting the need for tailored interventions to enhance medication adherence and secondary prevention behaviors in this population.

Relationship between the Chinese Visceral Adipose Index and Cardiovascular Disease in Postmenopausal Women: a Prospective Cohort Study

FAN Zhuanzhuan, LI Wenting, MA Guoliang

2026, 29(02):  180-187.  DOI: 10.12114/j.issn.1007-9572.2025.0117

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Background

Cardiovascular disease (CVD) is a major threat to the health of women, particularly postmenopausal women, who are at higher risk. The reduction in estrogen levels following menopause may contribute to visceral fat accumulation, which is closely linked to insulin resistance, chronic inflammation, and lipid metabolism disorders, potentially increasing the risk of CVD. However, the relationship between Chinese visceral adipose index (CVAI) and CVD risk in this population remains insufficiently explored.

Objective

To explore the relationship between CVAI and CVD in postmenopausal women, and thereby provide information on the prevention of CVD in this high-risk population.

Methods

Based on the data of China Health and Retirement Longitudinal Study (CHARLS) from 2015 to 2020, we enrolled 4 743 postmenopausal women aged≥45 years free of CVD at baseline in 2015. The CVAI at baseline was used as the exposure, while incident CVD events during follow-up in 2018 and 2020 served as the outcome. Cox proportional hazards regression models were employed to assess the association between CVAI and CVD risk. Restricted cubic spline (RCS) analysis was further applied to evaluate potential dose-response relationships.

Results

At the end of the follow-up period, the incidence rates of CVD, heart disease, and stroke among the 4 743 postmenopausal women were 20.2% (958/4 743), 13.6% (645/4 743), 8.3% (393/4 743), respectively. The participants were stratified into quartiles based on their baseline CVAI levels, with the following cutoff values: Q1 (≤84.78)(n=742), Q2 (84.78, 108.49)](n=1 249), Q3 (108.49, 132.01](n=1 463), and Q4 (>132.01)(n=1 289). After adjustment for confounding factors, Cox proportional hazards regression showed that compared to the Q1 reference group, women in the CVAI Q2, Q3 and Q4 groups faced significantly elevated risks, the risk of CVD increased by 33% (HR=1.33, 95%CI=1.00-1.76) in Q2, 69% (HR=1.69, 95%CI=1.29-2.21) in Q3 and 82% (HR=1.82, 95%CI=1.38-2.14) in Q4, the risk of stroke increased by 76% (HR=1.76, 95%CI=1.10-2.82) in Q3, 95% (HR=1.95, 95%CI=1.21-3.14) in Q4, and the risk of heart disease increased by 57% (HR=1.57, 95%CI=1.14-2.15) in Q3, and 68% (HR=1.68, 95%CI=1.21-2.33) in Q4, respectively. RCS analysis confirmed dose-response relationships between CVAI and risks of CVD, heart disease, and stroke (P<0.05). Subgroup analyses further indicated that the association between CVAI and CVD risk remained significant only among women aged <65 years, ≥65 years, those with BMI<24.35 kg/m², and rural residents (P<0.05).

Conclusion

Elevated CVAI significantly increases CVD risk in postmenopausal women, particularly in those with lower BMI, or residing in rural areas. Targeted monitoring and management of visceral obesity in these high-risk subgroups are warranted to mitigate CVD incidence.

Study on the Current Status and Influencing Factors of Mild Cognitive Impairment in Elderly Patients with Type 2 Diabetes Mellitus from the Perspective of "Physical Disease-related Adjustable Constitution": a Case Study in Sichuan Province

MA Yuping, QIAO Mengyuan, HE Yanyun, XU Manru, CHEN Chongli, WU Wenbin

2026, 29(02):  188-194.  DOI: 10.12114/j.issn.1007-9572.2025.0029

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Background

The global rise in the prevalence of type 2 diabetes mellitus (T2DM) among the elderly has emerged as a significant public health concern. T2DM is known to exert detrimental effects on cognitive function. However, there remains a lack of simple and effective indicators for the early detection and monitoring of this condition, highlighting an urgent need for further investigation. The present study utilizes real-world cross-sectional data to explore the disease from the perspective of "physical disease-related adjustable constitution" offering potential clinical value for the diagnosis and treatment.

Objective

To investigate the prevalence of type 2 diabetes mellitus with mild cognitive impairment (MCI) among the elderly in the Sichuan region, and to identify the factors influencing its occurrence.

Methods

Elderly patients aged ≥60 years with type 2 diabetes mellitus were selected for the survey conducted from November 2021 to November 2023. The participants were recruited from various communities and three nursing homes across six cities in Sichuan Province, namely Chengdu, Deyang, Bazhong, Emeishan, Meishan, and Mianyang. A face-to-face survey was administered using a paper-based questionnaire, which collected basic demographic information, the Changsha version of the Montreal Cognitive Assessment (MoCA), and the Traditional Chinese Medicine constitution assessment. Univariate analysis, followed by multifactorial Logistic regression, was performed to identify potential independent factors influencing the occurrence of type 2 diabetes mellitus with MCI. Pearson correlation analysis was used to explore the correlation between different cognitive domains and yang deficiency constitution.

Results

A total of 407 questionnaires were distributed, of which 397 were valid, yielding a response rate of 97.54%. Among the 397 participants, 348 (87.7%) were elderly individuals residing in communities, and 49 (12.3%) were from nursing homes. A total of 84 participants were identified with MCI, resulting in a prevalence of 21.2% for T2DM with MCI. Based on cognitive status, participants were divided into two groups: those with T2DM and MCI (n=84) and those with T2DM without MCI (n=313). Statistically significant differences were observed between the two groups in terms of education level, depression, reading books and newspapers, as well as Traditional Chinese Medicine (TCM) constitutions including qi deficiency, yang deficiency, phlegm-dampness, and damp-heat (P<0.05). Multivariate Logistic regression analysis identified educational level (junior high school: OR=0.487, 95%CI=0.253-0.939; university and above: OR=0.149, 95%CI=0.034-0.659) and a yang deficiency constitution (OR=2.284, 95%CI=1.220-4.279) as independent risk factors for MCI in elderly patients with T2DM (P<0.05). The results of the correlation analysis showed that the score of the yang deficiency constitution score was negatively correlated with the delayed memory domain score of cognitive function (r=-0.106, P<0.05).

Conclusion

The prevalence of MCI among elderly patients with type 2 diabetes mellitus in Sichuan Province is 21.2%. Low educational attainment and a yang deficiency constitution are significant risk factors for the development of MCI in this population. In line with the Traditional Chinese Medicine theory that constitution can be differentiated, constitution is related, and constitution can be adjusted, early identification and targeted intervention for yang deficiency constitution may help mitigate the progression of cognitive impairment in patients with diabetes.

The Association of Age at Menopause with Fasting Glucose and Diabetes

LUO Jiaoling, ZHANG Weisen, CHAI Zhihao, ZHU Feng, ZHU Tong, JIN Yali, PAN Jing, JIANG Chaoqiang

2026, 29(02):  195-200.  DOI: 10.12114/j.issn.1007-9572.2025.0106

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Background

Diabetes mellitus is a common chronic disease in postmenopausal women. However, little is known about whether early or delayed age at menopause increases the risk of postmenopausal diabetes.

Objective

To explore the correlation between the early or delayed age of menopause and fasting blood glucose and diabetes in natural postmenopausal women, so as to provide evidence for the prevention and control of diabetes in this population.

Methods

A cross-sectional study was conducted using baseline survey data from 4 905 postmenopausal women aged 50 and older in the Guangzhou Prospective Cohort Study on Chronic Diseases in Middle-aged and Elderly Adults. Data were collected between November 2017 and January 2020, covering demographic characteristics, socioeconomic status, lifestyle factors, medical history, and reproductive history. Physical examinations were conducted, including measurements of fasting blood glucose and blood lipid levels. The generalized linear regression (GLM) and Logistic regression models (LRM) were used to analyze the relationship of menopausal age with fasting blood glucose levels and diabetes.

Results

The mean age of the participants was (60.1±5.8) years and the mean age of menopause (50.3±3.1) years. Among them, 351 women experienced early menopause (≤45 years), 4 157 had normal menopause (46-54 years), and 397 had delayed menopause (≥55 years). Results from GLM showed that a linear association between menopausal age ≥50 years and fasting blood glucose (β=0.024, 95%CI=0.001-0.046, P<0.05) was found, whereas no significant linear relationship was observed in those with menopausal age <50 years (β=0.019, 95%CI=-0.002 to 0.040, P>0.05). Comparing with the normal age of menopause, the delayed menopausal age was associated with a 41.0% higher risk of diabetes mellitus (OR=1.410, 95%CI=1.026-1.938, P<0.05) and a 97.1% increased risk of newly diagnosed diabetes mellitus (OR=1.971, 95%CI=1.186-3.276, P<0.01). In contrast, no significant associations were found between early menopause and diabetes risk (OR=0.882, 95%CI=0.612-1.273) or newly diagnosed diabetes (OR=0.760, 95%CI=0.410-1.407) (P>0.05).

Conclusion

The delayed menopausal age is associated with an increased level of fasting glucose and risk of diabetes among postmenopausal women. However, no significant correlation was found in those with early age of menopause. It is necessary to strengthen diabetes prevention and control for those with delayed menopausal age in advance.

Identification of Shared Loci between Hypertension and Parkinson's Disease

ZHOU Wenchao, LIANG Jiaqi, YAO Shangman, XUE Zhao, LIU Long, GUO Xiangjie

2026, 29(02):  201-206.  DOI: 10.12114/j.issn.1007-9572.2024.0583

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Background

Hypertension (HT) and Parkinson's disease (PD) have shown comorbidity in observational studies, but their shared genetic basis and causal relationships remain unclear.

Objective

This study utilized large-scale genome-wide association studies (GWAS) summary data to investigate the shared genetic etiology and causal relationships between HT and PD.

Methods

GWAS summary data was extracted from the R5 release of the FinnGen consortium (2 162 Parkinson's disease patients and 216 630 controls) and the summary data from the UK Biobank (including 129 909 hypertension patients and 354 689 controls), and both overall and local genetic correlations was assessed using linkage disequilibrium score regression (LDSC) and local genetic heritability estimation (ρ-HESS). Cross-trait Meta-analysis was used to identify pleiotropic single nucleotide polymorphisms (SNPs) shared between HT and PD, and bidirectional Mendelian randomization (MR) analysis was performed to infer potential causal relationships.

Results

Genetic correlation analysis revealed no significant overall correlation between HT and PD (r_g=0.067, P=0.527). Local analysis identified three marginally significant regions (P<0.05), but none reached statistical significance after Bonferroni correction (P>0.05). Cross-trait Meta-analysis confirmed 37 significant SNPs associated with both HT and PD. Bidirectional MR analysis demonstrated a significant causal effect of HT on PD (β=0.655, SE=0.278, P=0.019), while the reverse causal effect of PD on HT was not significant (β=0.002, SE=0.001, P=0.179). Sensitivity analyses further validated the robustness of the results.

Conclusion

This study found that hypertension is a risk factor for Parkinson's disease, and there is a common genetic basis and causal relationship between the two. The identification of shared genetic loci is of great significance in disease prevention and treatment strategies.

Effect of Blood Pressure Response Index on Acute Kidney Injury in Elderly Patients with Severe Pneumonia Shock

MIN Yeping, XUE Yao, FENG Tongbao, ZHANG He, LIU Fujing

2026, 29(02):  207-212.  DOI: 10.12114/j.issn.1007-9572.2025.0159

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Background

The risk factors leading to acute kidney injury (AKI) in elderly patients with severe pneumonia have not yet been fully clarified.

Objective

To investigate the association between the blood pressure response index (BPRI) and the incidence of AKI in elderly patients with severe pneumonia-induced shock.

Methods

A retrospective cohort study was conducted to collect clinical data from patients with severe pneumonia-induced shock admitted to the Second People's Hospital of Changzhou between 2016 and 2024. The clinical data of patients were systematically extracted from the hospital's electronic medical record system. BPRI was calculated as mean arterial pressure divided by the vasoactive-inotropic score. Document the incidence of AKI following hospitalization and the 30-day survival rate. Multivariate Logistic regression analysis was performed to evaluate the risk value of BPRI for AKI development. Receiver operating characteristic (ROC) curves were constructed to assess the predictive accuracy of BPRI for AKI, with the area under the curve (AUC) indicating the strength of prediction. Kaplan-Meier survival curves were used to analyze 30-day mortality among patients stratified by AKI risk, with differences tested using the Log-rank test.

Results

A total of 237 patients were included in the study, of whom 96 (40.5%) developed AKI. Multivariate Logistic regression analysis revealed that elevated BPRI was a protective factor against AKI development (OR=0.751, 95%CI=0.678-0.831, P<0.001), increased lactate (OR=1.239, 95%CI=1.039-1.477, P=0.017) and elevated SOFA scores (OR=1.930, 95%CI=1.497-2.488, P<0.001) were identified as risk factors for AKI development. ROC curve analysis demonstrated that the AUC of BPRI for predicting AKI in patients with severe pneumonia-induced shock was 0.809 (95%CI=0.752-0.865), with a cutoff value of 10.063. Patients were stratified into high-risk (BPRI≥10.063, n=79) and low-risk (BPRI<10.063, n=158) groups for AKI development based on the BPRI cutoff value. Kaplan-Meier analysis demonstrated significantly lower 30-day cumulative survival rates in the high-risk AKI group compared to the low-risk group (χ²=35.310, P<0.001).

Conclusion

Elevated BPRI serves as a protective factor against AKI development in patients with severe pneumonia-induced shock and exhibits excellent predictive performance for AKI occurrence.

Article·Multimorbidity Section

Analysis of the Impact of Multiple Chronic Diseases on the Risk of Age-related Macular Degeneration and Their Interaction Effects

ZHAO Yingying, SU Ping, CHEN Qiaoqiao, PANG Jinhong, SHI Jie, WANG Yaqian, LI Qiuchun, HE Ruiyan, WANG Yue, CHEN Xueyu, YU Yuanyuan, CHI Weiwei

2026, 29(02):  213-218.  DOI: 10.12114/j.issn.1007-9572.2024.0606

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Background

Age-related macular degeneration (AMD) is the leading cause of vision loss and impairment among individuals aged 50 and above worldwide, with an estimated 288 million people projected to be affected by 2040.

Objective

To investigate the association between various chronic diseases and AMD, analyze the interaction effects of different chronic disease combinations on AMD risk, and assess how the interaction between chronic diseases impacts AMD risk.

Methods

Based on the Cheeloo LEAD database, individuals aged 50 years and above were included. The AMD group was identified using ICD-10 coding (H35.3), and a 1∶4 matching by age and gender was conducted to select control group without AMD. Significant differences in baseline characteristics and chronic disease prevalence were found between the AMD and non-AMD groups. Multivariate Logistic regression models were used to assess the association between AMD and chronic conditions such as hypertension, diabetes, and heart disease. Collinearity was evaluated using the variance inflation factor (VIF) to ensure the robustness of the model. Interaction terms were introduced to evaluate the synergistic effects of different chronic disease combinations on AMD risk.

Results

A total of 16 780 participants were included in this study, with 3 356 in the AMD group and 13 424 in the control group. After adjusting for confounding factors, multivariate Logistic regression analysis showed that hypertension (OR=2.81, 95%CI=2.59-3.04), heart disease (OR=2.02, 95%CI=1.86-2.19), stroke (OR=1.82, 95%CI=1.66-1.99), diabetes (OR=2.72, 95%CI=2.47-2.99), dyslipidemia (OR=2.01, 95%CI=1.78-2.28), chronic gastric or digestive system diseases (OR=1.90, 95%CI=1.72-2.10), chronic liver diseases (OR=2.29, 95%CI=2.04-2.57), emotional and mental disorders (OR=2.86, 95%CI=2.49-3.29), and memory-related diseases (OR=1.86, 95%CI=1.52-2.28) were all significant risk factors for AMD (P<0.05). Interaction effect analysis revealed that the predicted probability of AMD was 0.40 when hypertension and diabetes coexisted; 0.40 for the coexistence of diabetes and dyslipidemia; and 0.45 for the coexistence of chronic liver diseases and diabetes. The predicted probability of AMD was 0.30 for the combination of hypertension and heart disease, 0.30 for the combination of stroke and heart disease, 0.30 for the combination of chronic gastric diseases and chronic liver diseases, 0.45 for the combination of emotional and mental disorders and memory-related diseases, and 0.45 for the combination of hypertension and emotional and mental disorders.

Conclusion

Hypertension, diabetes, chronic liver diseases, and other conditions were significantly associated with the occurrence of AMD. Notably, the combinations of chronic liver diseases and diabetes, emotional and mental disorders with memory-related diseases, and hypertension with diabetes had an even more pronounced impact on AMD.

Study on the Association between Multiple Chronic Conditions and Impaired Activities of Daily Living in the Elderly

CHENG Zhuozhuo, ZHANG Rui, HU Jiao, PAN Xuanda, XU Haofeng, HUANG Junting, YAN Ping, LIANG Zijing

2026, 29(02):  219-225.  DOI: 10.12114/j.issn.1007-9572.2024.0666

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Background

With the acceleration of population aging, there has been a continuous increase in the number of elderly individuals suffering from multiple chronic conditions and impaired activities of daily living (ADL), imposing a substantial healthcare burden on society. While multiple chronic conditions are highly associated with impairment in ADL, the specific mechanisms and combinatorial effects have not been fully elucidated.

Objective

This study aims to analyze the current status of multiple chronic conditions among the elderly in China and explore the association between different comorbidity combinations and ADL, thereby providing scientific evidence for chronic diseases management and functional maintenance in older adults.

Methods

Utilizing data from the 2018 China Health and Retirement Longitudinal Study (CHARLS), this study focused on individuals aged 60 years and older to compare the prevalence of impaired ADL across demographic subgroups. The Apriori algorithm was employed to perform association rules analysis to identify primary comorbidity combinations. Binary Logistic regression models were used to assess the impact of these comorbidity combinations on ADL impairment.

Results

The study included 10 999 elderly participants, and the prevalence of multiple chronic conditions was 64.91% (7 140/10 999). 3 819 individuals (34.72%) exhibited ADL impairment, 1 149 (10.45%) demonstrated basic activities of daily living (BADL) impairment, and 3 662 (33.29%) showed instrumental activities of daily living (IADL) impairment. Statistically significant differences (P<0.05) in ADL, BADL and IADL impairment rates were observed across gender, age, education level, marital status, type of residence, and the presence of multiple chronic conditions (P<0.05). The Apriori algorithm identified 8 association rules, with the highest support rule being "dyslipidemia and hypertension" (support=8.237%), the highest confidence rule being "dyslipidemia, diabetes or high blood sugar and hypertension" (confidence=78.707%), and the highest lift rule being "asthma and chronic pulmonary diseases" (lift=4.188). Hypertension exhibited the highest frequency across all comorbidity combinations. Adjusted binary Logistic regression revealed that, multiple comorbidity combinations "stroke and hypertension" "asthma and chronic pulmonary diseases", and "kidney disease, stomach or other digestive diseases, and arthritis or rheumatism" significantly impacted ADL, BADL, and IADL impairment (P<0.05). Notably, the "stroke and hypertension" combination posed the highest risk for BADL impairment, the risk of being one level more severely impaired in BADL for individuals with this comorbidity combination was 4.480 times higher than that of the population without this comorbidity combination (OR=4.480, 95%CI=3.754-5.347).

Conclusion

Hypertension serves as a central hub in elderly comorbidities networks, demonstrating strong associations with multiple chronic conditions. Multiple comorbidity combinations significantly increase the risk of ADL impairment, with the "stroke and hypertension" combination being the most pronounced. Healthcare systems should prioritize elderly populations with comorbidities, develop effective long term care policies tailored to different comorbidities, reduce the risk of disability, delay functional decline, and enhance quality of life in elderly population.

Research on Comorbidity Conditions and Comorbidity Patterns in Patients with Premature Coronary Heart Disease

ZHANG Yunqiu, LI Yangxue, LIU Haoyang, CHEN Peixuan, WANG Xingyue, CUI Jingya

2026, 29(02):  226-231.  DOI: 10.12114/j.issn.1007-9572.2023.0890

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Background

Along with the continuous change of lifestyle, the incidence and hospitalization rate of coronary heart disease are increasing and becoming younger in average age, patients are also generally suffering from other chronic diseases, namely facing the problems of comorbidities, but currently the relevant research in China is still relatively lacking.

Objective

To understand the prevalence and patterns of comorbidities in premature coronary heart disease, and to explore the correlation between comorbidities, in order to provide reference for early detection and management of comorbidities in premature coronary heart disease in China.

Methods

Electronic medical record data of 5 124 premature coronary heart disease patients (males≤55 years old, females≤65 years old) admitted to the Department of Cardiovascular Medicine, Norman Bethune Second Hospital of Jilin University from 2010 to 2022 were collected and analyzed to determine the current status of comorbidities in premature coronary heart disease. SPSS 26.0 statistical software and Python 3.11.0 were used, along with the Apriori algorithm, to mine strong association rules for premature coronary heart disease and explore the comorbidity patterns.

Results

The top three comorbidities with the highest prevalence in patients with premature coronary heart disease were hypertension (3 707 cases, 72.35%), dyslipidemia (2 134 cases, 41.65%), and diabetes (1 811 cases, 35.34%). Thirty five notable comorbidity patterns observed among the 13 chronic diseases. The binary comorbidity pattern of premature coronary heart disease takes "hypertension" as the core comorbidity, which can be accompanied by anemia, kidney disease, stroke, etc. The ternary comorbidity pattern takes "anemia + kidney disease" as the core comorbidity, which may be accompanied by diabetes and lung disease, etc. The quaternary comorbidity pattern takes "diabetes + hypertension" as the core comorbidity, which may be accompanied by stomach disease, liver disease, etc. According to the results of the association rule and cluster analysis, hypertension, diabetes, dyslipidemia, anemia, and kidney disease all had significant comorbidity rates, with a complex comorbidity relationship.

Conclusion

The predominant comorbidity disease in the population of premature coronary heart disease is hypertension, and the comorbidity pattern of "anemia + kidney disease" of early-onset coronary heart disease can be examined in future studies.

Article·Digital and Intelligent Healthcare

Development and Trends of Digital Therapeutics Industry in China: a Multidimensional Analysis Based on Approved Products by China's National Medical Products Administration

FANG Qichuan, LIANG Jun, JIAO Xiaoyi, LIU Yongcheng, ZHANG Lifang, ZHANG Huaqing, HE Yunfan, DONG Lei, XIANG Peng, LEI Jianbo

2026, 29(02):  232-239.  DOI: 10.12114/j.issn.1007-9572.2025.0167

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Background

Digital Therapeutics (DTx), as an innovative digital interventional method, is internationally regarded as a prescription "digital drug" with significant potential in chronic disease management and mental health. China's "Healthy China 2030" strategy supports healthcare digital transformation. However, there's a lack of systematic analysis on DTx products approved by China's National Medical Products Administration (NMPA). Also, there are challenges such as an imperfect regulatory framework and insufficient clinical evidence.

Objective

Conduct a systematic analysis of the characteristics of DTx products approved by the NMPA, systematically review approval trends, indication distribution, and industrial landscape, to provide evidence for regulatory policy optimization and industrial development.

Methods

Research data were primarily sourced from eight medical device databases of the NMPA. Using independent keyword searches, a total of 20 107 candidate devices were generated. After screening, 235 devices meeting the definition of DTx were identified. Seventeen product features were extracted, and statistical analysis was performed using SPSS 25.0 software.

Results

As of December 2024, NMPA had approved 235 devices that meet the definition of DTx. The number of approvals had increased yearly since 2018, with a significant increasing in 2022. Most were domestically produced (n=227, 96.60%) and approved (n=219, 93.19%) by local medical products administrations. The majority were Class Ⅱ medical devices (n=224, 95.32%), with core functions mostly focused on disease treatment (n=207, 88.09%), widely used for nervous system diseases (n=108, 45.96%). Nearly all require prescriptions (n=227, 96.60%) and often used guided behavioral intervention techniques (n=135, 57.45%). Digital technologies mainly involved online medical services (n=145, 61.70%) and primarily targeted the adult population (n=163, 69.36%). Manufacturers were mostly in economically developed regions.

Conclusion

China's DTx industry is growing due to policy support. But there are obstacles like an incomplete regulatory framework, insufficient evidence generation, and a lack of business models. It's suggested to enhance regulatory policies, emphasize real world evidence, and raise academic attention to support wider DTx adoption.

Digital Therapy for Stroke: Progress and Challenges from Screening to Intervention

YU Hao, LIAO Peng, LUO Li

2026, 29(02):  240-246.  DOI: 10.12114/j.issn.1007-9572.2025.0147

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Stroke is one of the main causes of death and disability among residents in China, which imposes a heavy burden on patients and society. Digital therapy, as an emerging treatment method, has shown great potential in the management of the entire stroke course. This article reviewed the research progress of digital therapy in stroke screening, prevention, acute phase management, rehabilitation, and long-term follow-up. It analyzed the advantages and challenges of clinical application of digital therapy and looked forward to future development directions. Current research showed that digital therapy could significantly improve the coverage and accuracy of stroke risk screening, provided personalized and high-intensity intervention plans in rehabilitation training, and improved long-term patient management outcomes through remote monitoring. However, digital therapy still faces many challenges in standardized evaluation systems, evidence-based medicine, elderly patient adaptability, data security, and medical insurance policies. In the future, it is necessary to strengthen high-quality clinical research, improve standardized evaluation systems, promote interdisciplinary collaboration, and formulate reasonable medical insurance policies to promote the standardized application and development of digital therapies in stroke prevention and treatment.

Current Status of Diagnosis and Treatment of Obstructive Sleep Apnea Along with Its Challenges and Prospects in the Context of Deep Integration of General Practice and Artificial Intelligence

YANG Xin, XU Haofeng, PAN Xuanda, LI Shaoqiang, HU Bingjie

2026, 29(02):  247-255.  DOI: 10.12114/j.issn.1007-9572.2025.0128

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Obstructive sleep apnea (OSA) is a common sleep-related breathing disorder, and its chronic nature and high correlation with many chronic diseases make its diagnosis and long-term management a great challenge. The traditional treatment model has obvious shortcomings in terms of efficiency, resource allocation, and patient compliance. In primary care, general practice emphasizes a person-centered, comprehensive management model, playing a crucial role in the early screening, diagnosis, and long-term follow-up of OSA. In recent years, the rapid development of artificial intelligence (AI) technology and its application in OSA screening, diagnosis, personalized treatment plan development and long-term follow-up have significantly improved the efficiency and accuracy of OSA diagnosis and treatment, especially through wearable devices, telemedicine and multimodal data analysis to realize the intelligent transformation of OSA management, which provides new solutions to OSA diagnosis and treatment. This review systematically described the epidemiological characteristics of OSA, the attributes of chronic diseases, and the limitations of the existing diagnosis and treatment modes, and explored the practical applications and potentials of the deep integration of general practice and AI technology in OSA management, as well as its current challenges and future prospects. It was emphasized that the future management of OSA needed to promote multidisciplinary collaboration and strengthen the deep integration of general practice and AI technology, to achieve precise and personalized high-quality management of OSA and related chronic diseases.

Article·Epidemiological Study

Analysis of the Incidence and Mortality Trends of Lung Cancer in China from 1990 to 2021 and Prediction for 2035

YANG Qinghui, HU Yingxue, NI Pingwei, LIU Xiao

2026, 29(02):  256-263.  DOI: 10.12114/j.issn.1007-9572.2024.0721

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Background

Lung cancer is a major global public health issue. As one of the countries with a high lung cancer burden, China's trends in incidence and mortality are influenced by environmental, economic, and behavioral factors, with significant regional variations. Understanding the spatiotemporal drivers of lung cancer burden and proposing precise prevention and control strategies are crucial for achieving the "Healthy China 2030" goal.

Objective

To analyze and predict the incidence and mortality trend of lung cancer in China from 1990 to 2021, explore the spatial heterogeneity of regional environmental and economic factors on the epidemic trend of lung cancer, and put forward suggestions for precise prevention and control.

Methods

Based on the Global Burden of Disease (GBD) data, the number of lung cancer cases and deaths, age-standardized incidence rate and age-standardized mortality rate of different genders and ages in China from 1990 to 2021 were extracted. The trend turning points were identified using the age-period-ecological model, the breakpoint regression (JPR) model, and the Holt exponential smoothing model. Environmental factors (PM_2.5, industrial pollution) and economic factors (per capita GDP, medical resources) were integrated, and the spatial Durbin model was used to analyze regional heterogeneity. The Holt exponential smoothing model was employed to forecast the trend in 2035.

Results

The JPR model showed that from 1990 to 2021, the age-standardized incidence rate of lung cancer in China increased by an average of 0.94% annually (95%CI=0.87%-1.01%), with the age-standardized mortality rate increasing by 0.38% (95%CI=0.31%-0.45%). The incidence of lung cancer showed significant spatial clustering (P<0.05). The Beijing-Tianjin-Hebei region, Heilongjiang, Jilin and Liaoning and the Sichuan were high-risk areas. The spatial Durbin model indicated that exposure to PM_2.5 (β=1.15, 95%CI=1.02-1.28) and large industrial waste gas emissions (β=0.89, 95%CI=0.75-1.03) were risk factors for lung cancer (P<0.05), while a high per capita GDP (β=-0.62, 95%CI=-0.78 to -0.46) and a high density of tertiary hospitals (β=-0.74, 95%CI=-0.89 to -0.59) were protective factors for lung cancer (P<0.05). It was predicted that by 2035, the age-standardized incidence rate of lung cancer across the country would reach 46.18 per 100 000, and the age-standardized mortality rate of lung cancer would reach 38.26 per 100 000. From 2022 to 2035, the incidence and mortality trends of lung cancer among women would further increase, while the trend among men would be relatively stable.

Conclusion

The burden of lung cancer in China shows a spatial differentiation feature of "high in the north and low in the south", and environmental exposure and uneven medical resources are the key driving factors. It is suggested to implement targeted screening for high-risk areas (industrial areas in the north) and population (female patients) to reduce health inequality and help achieve the national cancer prevention and control goals.

Study on Trend Analysis and Forecast of Incidence, Disease and Mortality of Chronic Obstructive Pulmonary Disease in China, 1990-2021

CHEN Xueqin, WANG Shihong, LAI Fengxia, ZHANG Jingjing, CHEN Hao, KONG Danli, DING Yuanlin

2026, 29(02):  264-272.  DOI: 10.12114/j.issn.1007-9572.2024.0455

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Background

The pathogenesis of chronic obstructive pulmonary disease (COPD) is complex. Analyzing and forecasting the epidemiological status can provide valuable insights for COPD prevention and control.

Objective

To examine COPD incidence, prevalence, and mortality in China from 1990 to 2021, and predict the incidence and mortality rates for 2022-2032 to inform COPD prevention and treatment efforts.

Methods

Based on the 2021 Global Burden of Disease (GBD) database, the incidence, prevalence, and mortality of COPD in China from 1990 to 2021 were collected. The change rate and estimated annual percentage change (EAPC) were used to describe the changing trends of COPD. The autoregressive integrated moving average model (ARIMA) was used to predict the incidence, prevalence and mortality of COPD in China from 2022 to 2032.

Results

The standardized incidence and prevalence of COPD in the whole Chinese population from 1990 to 2021 showed an increasing trend (EAPC were 2.25% and 2.53%, respectively, t values of 71.35 and 165.91, respectively, P<0.001); whereas the standardized mortality rate showed a decreasing trend compared with that in 1990 (EAPC=-0.31%, P<0.05). In 2021, the standardized incidence rate of COPD in Chinese men was 308.68/100 000 and the prevalence rate was 3 358.06/100 000; both the incidence and prevalence rates of COPD in men showed an increasing trend compared with 1990 (EAPC were 2.32%, 2.48%, t values of 64.23 and 39.67, respectively, P<0.001); whereas the standardized mortality rate in men increased from 97.13/100 000 to 101.05/100 000, but was not statistically significant in terms of trend (EAPC=0.05%, t=0.62, P=0.54). In 2021, the standardized incidence rate of COPD in Chinese women was 320.70/100 000, and the standardized prevalence rate was 3 829.79/100 000; compared with 1990, the standardized incidence and prevalence rates of COPD in women showed an increasing trend (EAPC were 2.19% and 2.59%, t values of 25.29 and 33.19, respectively, P<0.001); the standardized mortality rate in women showed a decreasing trend (EAPC=-0.77%, t=-3.36, P<0.01), from 91.43/100 000 in 1990 to 74.18/100 000. In 2021, the standardized incidence and prevalence of COPD in Chinese females were 1.04 and 1.14 times higher than that of males, respectively; and the standardized mortality rate of COPD in males was 1.36 times higher than that of females. In the age-stratified analysis, there was a weak increasing trend in the age group of 25-29 years (EAPC=0.05%, P<0.01), and fluctuations in the incidence of standardization in the age group of 30-44 years, but there was no statistical significance (P>0.05). The standardized prevalence of the population over 50 years of age showed an increasing trend and the increase was further widened with age, with the highest rise in the ≥80 years age group (EAPC=4.46%, t=89.92, P<0.001). The age-stratified trend of COPD prevalence showed significant differentiation: a significant decline in prevalence was observed in the 25-34 year olds (25-29 year olds: EAPC=-1.52%, P<0.001; 30-34 year olds: EAPC=-0.57%, P=0.045), while the prevalence of the 35-39 year olds group showed a statistically insignificant change (EAPC=-0.40%, P=0.187), whereas the 40-44 year old group showed a turnaround increase (EAPC=0.60%, P=0.047), and the 50+ year old group showed a rapid increasing trend (EAPC>2.00%, P<0.001). COPD mortality showed a significant increasing trend in the ≥80 years age group (EAPC=0.95%, P<0.001); COPD mortality continued to decrease in the under 80 years age group (all EAPC<-0.50%, P<0.001). The results of ARIMA model showed that the incidence and prevalence of COPD in China from 2022 to 2032 showed an upward trend, and the overall mortality rate declined, but the male mortality rate showed an upward trend, and the female mortality rate fluctuated but generally declined.The incidence rate of COPD in 2032 was estimated to be up to 409.39/100 000, and the prevalence rate was estimated to be up to 4 675.48/100 000. In 2032, the overall mortality rate was projected to reach 71.39/100 000, with the male mortality rate expected to reach 112.10/100 000, and the female mortality rate expected to reach 77.32/100 000.

Conclusion

From 1990 to 2021, the standardized incidence and prevalence of COPD in the whole population, male and female populations in China showed an overall increasing trend. In the elderly population, the standardized incidence and prevalence of COPD showed a growing trend, and the mortality rate of the population aged 80 years or older showed an increasing trend, whereas the mortality rate of COPD for people under 80 years of age showed a decreasing trend. Incidence and prevalence of COPD in China from 2022 to 2032 showed an increasing trend, and the overall mortality rate was decreasing, but the mortality rate of males showed an increasing trend, and the mortality rate of females fluctuates.