Trends in smoking prevalence and implication for chronic diseases in China: serial national cross-sectional surveys from 2003 to 2013

Scrutinizing Socio-Economic Determinants of Adolescent Tobacco Uptake in Türkiye: An Empirical Overview

The prevalence of tobacco use among young individuals is a significant public health concern. This study investigated the socioeconomic factors that contribute to smoking behavior among Turkish adolescents using a Zero-Inflated Ordered Probit model. We gathered smoking prevalence data (38,182 people, aged 11-18) from Türkiye from the Global Youth Tobacco Survey organized by the World Health Organization. The results show that adolescents exhibit lower rates of smoking, and parental employment acts as a deterrent to adolescent smoking. There is a higher probability that young individuals who frequently smoke and have mothers with a higher level of education will quit smoking. In addition, the results indicate that for individuals who are smokers or non-smokers, advertisements on several platforms, such as social media, increase the probability of initiating tobacco usage. Moreover, as age and gender play a significant role in influencing smoking habits, income has a paradoxical relationship with more frequent smoking. This study demonstrated the complex relationships between economic, educational, and environmental factors and adolescent smoking. This study recommends implementing focused and varied public health interventions in Türkiye to address youth smoking, considering socioeconomic factors and family dynamics.

Obstructive Airway Disease is Associated with Increased Cardiovascular Disease Risk Independent of Phenotype: Evidence from Two Nationwide Population-Based Studies

Background

Cardiovascular disease (CVD), as the most common comorbidity of chronic obstructive pulmonary disease (COPD), has received much attention. However, robust evidence of the relationship between other obstructive airway disease (OAD) phenotypes, such as asthma, asthma-COPD overlap (ACO), and CVD risk is limited. We aimed to compare the magnitude of CVD risk across different OAD phenotypes using two nationwide population-based studies.

Methods

We analyzed cross-sectional data from the National Health and Nutrition Examination Survey 1999-2018 (N=44,972, representing 183,508,900 adults). Survey-weighted descriptive analysis and logistic regression were used to investigate the prevalence of CVD (including heart failure, coronary heart disease, angina pectoris, and myocardial infarction) across OAD phenotypes and calculate odds ratios (ORs) with 95% confidence intervals (CIs). Additionally, longitudinal data from the China Health and Retirement Longitudinal Study (CHARLS) (N=13,533) were analyzed to validate these findings and calculate hazard ratios (HRs) with 95% CIs for new-onset CVD using Cox proportional hazards models.

Results

The weighted prevalence of at least one CVD in asthma, COPD, and ACO was 6.21%, 16.82%, and 20.75%, respectively. Individuals with asthma, COPD, and ACO had a significantly higher prevalence of CVD than those without OAD, with ORs of 1.55 (95% CI: 1.34-1.78), 1.76 (95% CI: 1.50-2.07), and 2.99 (95% CI: 2.47-3.61), respectively. During the 9-year follow-up, 2,444 (18.1%) individuals developed CVD in CHARLS. The incidence of CVD was significantly higher in individuals with asthma (HR=1.67, 95% CI: 1.26-2.21), COPD (HR=1.71, 95% CI: 1.48-1.97), and ACO (HR=2.67, 95% CI: 2.21-3.24) than those without OAD.

Conclusion

Individuals with OAD have a higher prevalence of comorbid CVD and an increased risk of developing CVD independent of phenotype, especially in those with ACO. These findings emphasize the need for awareness and appropriate cardiovascular screening in OAD.

Gender-associated heterogeneity of F2RL3 methylation in peripheral blood highlights its associations with early-stage male lung cancer in the Chinese population

BACKGROUND

DNA methylation alteration in peripheral blood provides a promising approach for the diagnosis of cancers. We aimed to investigate the association between blood-based methylation of F2RL3 and lung adenocarcinoma (LUAD).

METHODS

A total of 970 LUAD patients, 333 benign pulmonary nodes (BPNs), and 2413 normal controls (NCs) were included. The methylation levels of blood F2RL3 were measured by mass spectrometry. The gender-associated heterogeneity of blood F2RL3 methylation in LUAD was investigated. The blood F2RL3 methylation associations with male LUAD were assessed by logistic regression. The relations of blood F2RL3 hypomethylation to tumor size and lymph node involvement in male LUAD were also evaluated. Mann-Whitney and Kruskal-Wallis tests were conducted for the comparisons. Tissue F2RL3 methylation and expression in LUAD were investigated via UALCAN database analysis.

RESULTS

Blood-based F2RL3 methylation presented significant difference between male and female LUAD patients. While, blood F2RL3 methylation in LUAD patients were significantly lower than in BPN cases and NCs in male population. Through logistic regression analysis, the independent associations of blood F2RL3 hypomethylation with male LUAD was identified. In addition, blood F2RL3 methylation was correlated with tumor size and lymph nodes involvement in male LUAD patients.

CONCLUSIONS

In conclusion, blood-based F2RL3 methylation might be a potential biomarker for male LUAD early detection.

Hyperuricemia, gout and the associated comorbidities in China: findings from a prospective study of 0.5 million adults

Background

Despite the growing prevalence of hyperuricemia and gout, their epidemiology and associated comorbidity burden remains poorly studied in many populations, including China. We aimed to examine the patterns of plasma urate level, prevalence of hyperuricemia, and incidence of gout, and investigate the associations of gout with a range of comorbidities and all-cause mortality in Chinese adults.

Methods

The prospective China Kadoorie Biobank recruited 512,724 adults aged 30-79 years from ten diverse areas in 2004-2008 and measured plasma urate level among 16,817 participants. The incidence of gout and other diseases and deaths were monitored by electronic linkages with registries and hospital records. Cox and logistic regression yielded adjusted HRs and ORs for risks of mortality and comorbidities associated with gout, hyperuricemia, and urate level.

Findings

The gout incidence rate was 23.4 per 100,000 person-years, and was higher in men and older participants, and varied substantially by region. Gout was associated with higher risks of all-cause mortality (HR = 1.58, 95% CI 1.37-1.82), CVD (1.87, 1.64-2.14), CKD (5.61, 4.45-7.07), urolithiasis (2.50, 1.85-3.38), diabetes (1.99, 1.51-2.62), diseases of the oesophagus, stomach, and duodenum (2.14, 1.72-2.66), infectious and parasitic diseases (1.91, 1.47-2.48), arthropathies (6.06, 4.98-7.38), and other musculoskeletal disorders (2.10, 1.77-2.51). Most of these associations were bi-directional, sustained over time and little affected by adjustment for cardiometabolic risk factors. Moreover, participants who developed gout were more likely to have multiple major diseases and more hospitalisations. Among the subset with plasma urate measured, 15% had hyperuricemia, which was more common in men, older women, and urban residents, and was associated with increased risks of gout, all-cause mortality, and several cardiometabolic, renal, digestive, and musculoskeletal diseases.

Interpretation

In Chinese adults, gout was associated with several comorbidities and a poor health trajectory. Our findings reinforce the need for prevention and management of gout and associated comorbidities.

Funding

Kadoorie Charitable Foundation, National Natural Science Foundation of China, Noncommunicable Chronic Diseases-National Science and Technology Major Project, British Heart Foundation, Cancer Research UK, Wellcome Trust, UK Medical Research Council, Nuffield Department of Population Health at the University of Oxford.

The Phase-Amplitude Coupling Changes Induced by Smoking Cue After 12-H Abstinence in Young Smokers

Tobacco use causes more than 8 million deaths globally each year, and the number of younger smokers is growing. It is of great practical importance to explore the underlying neural mechanisms behind the behaviour of young smokers. During cue-induced craving, reward system in the brain generates neural oscillations at specific frequencies. The phase-amplitude coupling (PAC) can capture interactions between these frequencies and may be a more sensitive quantitative indicator for characterizing abnormal neural oscillations in smokers. We monitored the electroencephalography (EEG) data of 30 young smokers during a cue task after 12 h of abstinence, dividing the data into the neutral and smoking-related groups based on different experimental stimuli to analyse the relationship between PAC and craving. In addition, we computed the functional connectivity (FC) under the PAC mechanism. The results showed that the young smokers exposed to smoking-related cues under short-term abstinence conditions had significantly lower PAC values and reduced FC strength in the right prefrontal cortex. In contrast, there was a significant increase in PAC values in the parietal cortex and enhanced FC strength. The correlation analysis showed significant correlations between PAC values and craving. These findings demonstrate for the first time that PAC abnormalities in young smokers exposed to smoking-related cues under short-term abstinence conditions may be related to craving and inhibitory control.

A GBD 2021 study of Alzheimer's disease and other dementias attributable to metabolic risk factors and forecasts to 2045 in China

Background and aims

High fasting plasma glucose (FPG) and body mass index (BMI) are recognized as significant metabolic risk factors for Alzheimer's disease (AD) and other dementias. This study assesses the burden of AD and other dementias attributable to these risks in China using Global Burden of Disease (GBD) 2021 data.

Methods

We estimated deaths, disability-adjusted life-years (DALYs), years lived with disability (YLDs), and age-standardized rates of mortality (ASMR), DALYs (ASDR), and YLDs (ASYR) by age and sex. Temporal trends were analyzed via the average annual percentage change (AAPC), and Bayesian age-period-cohort (BAPC) models were applied to evaluate the effects of age, period, and cohort.

Results

In 2021, China recorded 76,239.36 deaths (95% UI: 2,528.26-259,225.86) from AD and other dementias due to metabolic risks, a 4.7-fold increase from 1990. Females experienced more metabolic risk-related deaths [51,844.08 (95% UI, 1,457.44, 177,037.05)] than males. The ASMR, ASDR, and ASYR showed continuous increases from 1990 to 2021, with AAPC values of 1.03, 1.31, and 1.98%, respectively. A significant increasing trend was observed across age groups from 40 to 95 years, with percentages above 0. Females presented relatively higher risks than males after 1997-2001 and within the birth cohort groups of 1957-1966. The disease burden due to HBMI is expected to rise, while that due to HFPG will decline, notable sex will persist until 2045.

Conclusion

Monitoring trends is crucial for interventions to reduce the future disease burden, particularly among women and older populations in China, to guide healthcare resource allocation effectively.

Incidence trends and projections of lip and oral cavity cancer in China 1990-2021: an age-period-cohort and decomposition analysis

OBJECTIVE

To investigate the historical trends, underlying causes, and future projections of lip and oral cavity cancer (LOCC) incidence in China.

METHODS

Annual cases and age-standardized incidence rates (ASIR) for LOCC in China from 1990 to 2021 were extracted from the Global Burden of Disease (GBD) 2021 study. Age-Period-Cohort (APC) models were employed to assess the effects of age, period, and cohort. Bayesian APC models were applied to project future incidence trends, and decomposition analysis was conducted to identify factors influencing incidence.

RESULT

From 1990 to 2021, the cases and ASIR of LOCC increased substantially in male and slightly in female. The ASIR and number of cases in male were higher than that in female during the study period. The APC model showed that the net drift of ASIR in males and females during the study period was 2.34% (95% confidence interval [CI]: 2.10% to 2.59%) and 0.26% (95% CI: 0.13 to 0.39), respectively. LOCC incidence increased the fastest among males and females aged 25-29 years. The incidence of LOCC in male and female increased with age, reaching its peak in the age group of 90-94 years (73.35/100,000 and 11.14/ 100,000, respectively). The period effect showed an increasing trend, while the birth cohort effect showed a decreasing trend. Predictions show that the incidence and cases of LOCC will continue to rise. Population growth, ageing and epidemiological factors in both male and female contributed to the rise of LOCC cases, except for a decrease in the period 1997-2013 due to changing epidemiological factors in female.

CONCLUSION

The increasing trend of LOCC in China is closely related to age, period and cohort. Future projections emphasize the need for targeted prevention focusing on high-risk groups and modifiable factors.

Smoking cessation improves health status of patients with chronic diseases: evidence from a longitudinal study of older adults in China

BACKGROUND

Smoking is a well-documented risk factor for numerous chronic diseases, and cessation is correlated with enhanced health outcomes. Nonetheless, the precise effects of smoking cessation on the health status of older adults with chronic conditions in China have not been thoroughly quantified.

OBJECTIVE

This study aims to quantitatively assess the correlations between smoking cessation and enhancements in the health outcomes of elderly Chinese individuals with chronic diseases.

METHOD

This research drew upon data from the China Health and Retirement Longitudinal Study (CHARLS). A cohort of 9914 participants was ultimately included in our analysis. Group comparisons and linear regression analyses were utilized. The investigation delved into health status scores, hematological markers, and physiological parameters.

RESULT

With each additional year of smoking cessation, former smokers demonstrated improved self-rated health and reduced EQ-5D-3L scores. Regression analysis unveiled a positive correlation between smoking cessation and enhanced self-assessed health (β estimate = 0.198), while a notable adverse effect was observed in EQ-5D-3L scores (β estimate = -0.179) and grip strength (β estimate = -2.530). Blood biomarkers also displayed noteworthy relationships with smoking cessation, showcasing rehabilitation in LDL cholesterol, total cholesterol, glucose, cystatin C, creatinine, HbA1c, and uric acid levels.

CONCLUSION

This research provides evidence highlighting the favorable health ramifications associated with smoking cessation in elderly individuals with chronic illnesses. Noteworthy improvements in both subjective health assessments and blood-based markers were observed post-smoking cessation, with benefits becoming more prominent with prolonged abstinence. These results underscore the vital importance of smoking cessation in the holistic care of chronic conditions and broader health enhancement endeavors. Further validation of these findings through an extended follow-up period is anticipated to bolster these conclusions with increased confidence.

Bone mineral density in patients using aromatase inhibitors: a clinical, nutritional, and quality of life assessment

The use of aromatase inhibitors (AIs) leads to an imbalance in bone remodeling and can cause osteoporosis. This study aimed to identify clinical, periodontal, nutritional, and biochemical determinants of bone mineral density (BMD) changes in patients using AIs. The sample consisted of 40 women using AIs and 32 controls. BMD was assessed by dual X-ray absorptiometry (DXA). Data on nutritional, anthropometric, oral and periodontal status, and oral health-related quality of life (OHRQoL) were collected. Cytokines and adipokines were quantified in saliva and serum. Thirty-nine of the 72 women had low BMD, with a similar distribution in the control and AIs groups. BMD was lower in older women using AIs (p = 0.009) and in smokers (p = 0.034). Anthropometric assessment demonstrated that women with low BMD who used AIs had lower weight (p = 0.028). Although the frequency of periodontitis was similar in all groups, higher IL-6 (p = 0.004), IL-1β (p = 0.002), and IL-33 (p = 0.006) levels were associated with poor periodontal status. Women who used AIs were 1.18 times more likely to report better OHRQoL than controls. While advanced age, smoking, and lower weight are factors associated with low BMD, the use of antiresorptive agents was a protective factor for maintaining BMD in women using AIs.

Chronic obstructive pulmonary disease burden attributable to tobacco and the trend change from 1990 to 2021 in China

INTRODUCTION

Chronic obstructive pulmonary disease (COPD) poses a serious disease burden in China, and tobacco control is considered an effective and feasible means to reduce this burden. This study analyzes the impact of tobacco on the burden of COPD in China from 1990 to 2021.

METHODS

This study conducted a comprehensive secondary dataset analysis of COPD attributable to tobacco in China using data from the Global Burden of Disease (GBD) database. This covers a range of statistics, including number of deaths, mortality rates, disability-adjusted life years (DALYs), and DALY rates. Using Joinpoint regression analysis methods, we calculated the annual percentage change (APC) and average annual percentage change (AAPC) to assess trends in COPD attributable to tobacco for various age groups and gender in China.

RESULTS

In 2021, the age-standardized mortality rate (ASMR) of COPD attributable to tobacco in China was 35.46 per 100000, and the age-standardized DALY rate (ASDR) was 589.75 per 100000, both of which were higher than global levels. In China, the ASMR attributable to tobacco showed a consistent decline from 1990 to 2021 (AAPC= -3.69%, p<0.001), as did the ASDR (AAPC= -3.73%, p<0.001), consistent with trends observed globally and across five SDI regions, with China experiencing the fastest decline. In both 1990 and 2021, the burden of COPD attributable to tobacco was greater in males compared to females. During the years from 1990 to 2021, the ASMR of COPD attributable to tobacco and the ASDR showed a declining trend in males (AAPC= -3.29% and -3.41%, respectively) and in females (AAPC= -4.99% and -4.62%, respectively) (all p<0.001). The impact of COPD linked to tobacco use in China increased with age from 1990 to 2021, with the highest mortality and DALY rates observed in the population aged ≥70 years. Regarding secondhand smoke exposure, ASMR for females was 6.29 per 100000 and the ASDR was 119.03 per 100000, while the corresponding values for males were 7.80 per 100000 and 113.10 per 100000 , indicating a higher burden among females.

CONCLUSIONS

From 1990 to 2021, the age-standardized mortality rate and age-standardized DALY rate of COPD attributable to tobacco in China showed a declining trend; however, there remains a slight gap compared to global levels. Significant differences in smoking exposure were observed based on gender and age, with a heavier burden among males and the elderly.

Relationship between parental smoking and adolescent smoking: gender differences and mediation of resilience

BACKGROUND

Though the relationship between parental smoking and adolescent smoking has been established, gender differences, and mediation of resilience in this relationship are poorly understood. This research aims to investigate the prevalence of adolescent smoking, and to understand how consequences may differ for boys and girls, as well as to explore what role resilience played in this relationship.

METHODS

Through the school-based cross-sectional survey, a total of 65,898 adolescents were involved in this study, and information were collected by self-reported questionnaire. Participants' smoking status and their parental smoking status were collected by self-made questionnaire, and resilience was assessed by the 10-item Connor-Davidson Resilience Scale (CD-RISC-10). The multivariate logistic regression was conducted to explore the relationship between parental smoking and adolescent smoking. After that, the path analysis was applied to explore the mediation of resilience in this relationship.

RESULTS

Of all participants, the rate of self-report current smoking and biologically verified smoking was 1.4% and 2.0%, respectively. Both self-reported and biologically verified prevalence of smoking among boys were higher than that in girls. There were gender differences in the impact of parental smoking on adolescent smoking: mother smoking had a negative effect on adolescent smoking, and resilience could mitigate this negative effect. Father smoking had no association with girl smoking, while father smoking was positively associated with boy smoking, and resilience was mediated in this association.

CONCLUSIONS

Our findings suggested smoking prevention in adolescents can be done differently for different genders. Besides, results indicated resilience was important in preventing adolescent smoking. Furthermore, parents quitting smoking can play an important role in preventing adolescent smoking to a certain extent.

The effect of short-term exposure to air pollution on the admission of ischemic stroke and its interaction with meteorological factors

OBJECTIVES

The aim of this study was to investigate the associations, potential effects, and interactions between short-term exposure to air pollution and the risk of ischemic stroke (IS).

STUDY DESIGN

An ecological study.

METHODS

Daily data on IS incidents, air pollution, and meteorological conditions were collected from 2017 to 2021 in Gannan. A time-stratified case-crossover design, combined with a distributional lag nonlinear model, was employed to analyze the relationship between air pollution exposure and the admission of IS. Additionally, the interaction between air pollutants and meteorological factors was examined using bivariate response surface modeling. The study also conducted stratified analyses based on gender, age, marital status, medical insurance purchase status, and season of admission.

RESULTS

In the single lag day structure, extremely low levels of PM2.5 (RR = 1.11, 95 % CI: 1.03-1.20) and PM10 (RR = 1.10, 95 % CI: 1.02-1.20) peaked on lag 3. Conversely, extremely high levels of NO2 (RR = 1.05, 95 % CI: 1.01-1.10), CO (RR = 1.19, 95 % CI: 1.03-1.37), and extremely low levels of O3 (RR = 1.09, 95 % CI: 1.01-1.19) exhibited a greater relative risk on lag 4. In the cumulative lag-day structure, extremely high levels of NO2 exhibited the most significant hazard effect at lag 05 (RR = 1.27, 95 % CI: 1.01-1.52), while extremely low levels of CO at lag 02 (RR = 1.15, 95 % CI: 1.05-1.24) and extremely low levels of O3 at lag 01 (RR = 1.20, 95 % CI: 1.04-1.40) also demonstrated notable associations. In the subgroup stratum, the association between air pollution and IS was found to be more significant in patients who were male, aged <65 years, married, had medical insurance, and were admitted during the cold season. The lowest number of IS hospitalisations occurred under low relative humidity conditions alongside increasing concentrations of CO.

CONCLUSIONS

Short-term exposure to air pollution was positively associated with an increased risk of IS. This association was influenced by factors such as being male, aged <65 years, married, having medical insurance, and admissions during the cold season. Additionally, an interaction was observed between air pollutants and meteorological factors. These findings carry significant public health implications for the prevention of IS.

Age-standardized incidence, prevalence, mortality rates and future projections of autoimmune diseases in China: a systematic analysis based on GBD 2021

This study assessed trends in age-standardized incidence (ASIR), prevalence (ASPR), and mortality rates (ASMR) per 100,000 population for asthma, Type 1 Diabetes Mellitus (T1DM), Inflammatory Bowel Disease (IBD), Multiple Sclerosis (MS), Psoriasis, and Rheumatoid Arthritis (RA) in China from 1990 to 2021 and projected ASIR trends through 2046. Data were obtained from the Global Burden of Disease (GBD) 2021 study. Trends in ASIR, ASPR, and ASMR were analyzed using Joinpoint regression to calculate annual percentage change (APC) and average APC (AAPC). Bayesian age-period-cohort (BAPC) modeling was applied to project future ASIR trends. In 2021, asthma had the highest ASIR (364.17/100,000), followed by psoriasis (59.70/100,000) and RA (13.70/100,000), while MS (0.16/100,000) and IBD (1.40/100,000) were the least common. Asthma exhibited significant declines in ASIR (-1.23% AAPC), ASPR (-1.49%), and ASMR (-4.4%). Conversely, T1DM showed rising ASIR (+ 1.16%) and ASPR (+ 1.15%) alongside declining ASMR (-2.62%). Psoriasis (+ 0.74%) and IBD (+ 2.09%) also showed rising ASIR. Gender differences were notable, with greater T1DM ASIR increases in males and more significant asthma improvements in females. By 2046, the ASIR of T1DM, psoriasis, and RA is projected to reach 5.8, 80.9, and 15.54 per 100,000, respectively, while asthma is expected to decline to 330.98 per 100,000. The rising ASIR and ASPR for most autoimmune diseases in China contrast with declining ASMR, highlighting the dual challenge of managing increasing disease burdens while sustaining reductions in mortality. Targeted prevention and management strategies are essential to address these evolving public health needs.

The Burden of Peripheral Artery Disease in China From 1990 to 2019 and Forecasts for 2030: Findings From the Global Burden of Disease Study 2019

Objectives

The incidence of peripheral arterial disease (PAD) in China is increasing. We aim to conduct a comprehensive analysis of the burden of PAD.

Methods

We collected information from 1990 to 2019 in the Global Burden of Disease (GBD 2019) study. Joinpoint regression analysis was used to calculate the annual percentage change (APC). Trends in incidence, mortality and DALYs were forecasted by Bayesian age-period-cohort (BAPC) analysis.

Results

In 2019, the number of new cases and prevalence of PAD in China accounted for nearly a quarter of the global proportion. The age-standardized incidence rate (ASIR) declined after rising until 2005. The age-standardized death rate (ASDR) maintained an upward trend. The DALYs was 0.16 million. Incidence, prevalence and DALYs are predominantly female, except for mortality, which is predominantly male. Smoking predominantly affected males, while hypertension and diabetes had a greater impact on females. By 2030, ASDR is elevated, predominantly in males. ASIR and age-standardized DALY rate decline, predominantly in females.

Conclusion

It is urgent for China to develop strategies based on the specific distribution characteristics of the PAD burden.

Association of heavy metals and bio-elements blood level with metabolic syndrome: a systematic review and meta-analysis of observational studies

Background and objectives

The literature has reported heavy metals might alter the physiological and biochemical functions of body organs and cause several health problems. So, the present systematic review and meta-analysis aimed to investigate the association of blood levels of essential or non-essential metals with metabolic syndrome (MetS).

Methods

In this systematic review, some international databases including PubMed, Embase, Scopus, and Web of Science were searched up to February 2024. All observational studies which assessed the association of three heavy metals (cadmium, mercury, lead) and bio-elements (chromium, iron, manganese, and magnesium, copper) with the risk of MetS were included. There was no limitation in the time of publication and language. A random-effects meta-analysis was performed to estimate the pooled effect sizes. Possible sources of heterogeneity were explored by meta-regression analysis.

Results

Totally, 29 studies were eligible for meta-analysis. Our results showed that increased level of cadmium (pooled OR: 1.24, 95% CI: 1.05, 1.46) and mercury (pooled OR: 1.22, 95% CI: 1.08, 1.38) significantly increased the risk of MetS. In contrast, increased level of chromium significantly reduced the risk of developing MetS (pooled OR: 0.68, 95% CI: 0.56, 0.83). Moreover, association between lead, iron, copper, magnesium, and manganese with MetS was not statistically significant (P > 0.05). However, elevated lead levels in men increased the odds of MetS.

Conclusion

Our results show a significant association between blood levels of some heavy metals, including cadmium, mercury, and lead, with increased odds of MetS. On the other hand, chromium as a biometal decreased the odds of MetS.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40200-024-01500-9.

Effects of comprehensive smoke-free legislation on smoking behaviours and macroeconomic outcomes in Shanghai, China: a difference-in-differences analysis and modelling study

BACKGROUND

China has one of the highest levels of tobacco consumption globally, and there is no national smoke-free legislation. Although more than 20 Chinese cities have passed local smoke-free laws since 2008, evidence on their effectiveness in reducing smoking behaviours and their economic benefits is scarce. By exploiting a natural quasi-experiment, whereby a comprehensive public smoking ban was implemented in Shanghai in March, 2017, this study aims to assess the impact of the policy on individual smoking behaviours and quantify its effect on macroeconomic outcomes.

METHODS

In this difference-in-differences analysis and modelling study, we used data on smoking behaviours from the 2012, 2014, 2016, and 2018 waves of the China Family Panel Studies. We used a difference-in-differences approach to investigate trends in smoking prevalence in respondents in Shanghai, relative to respondents from other direct-administered municipalities, provincial capital cities, and subprovincial municipalities (control group), after the implementation of a smoking ban in 2017. All respondents aged 18 years or older were included, with the exception of people who lived in Beijing and rural areas. The primary variable of interest in the difference-in-differences analysis was self-reported smoking status. Based on the difference-in-differences estimation of reduction in smoking prevalence, we then used a health-augmented macroeconomic model to estimate the potential macroeconomic gains if such a ban was implemented across China for the period 2017-35.

FINDINGS

14 688 respondents were included in the analysis: 5766 from Shanghai and 8922 from the control group. After the implementation of the smoking ban in Shanghai in 2017, smoking prevalence decreased by 2·2 percentage points (95% CI 2·1-2·3), equivalent to an 8·4% reduction in the number of current smokers. The smoking ban had a larger effect on men, people with a higher level of education, unmarried people, and younger people when compared with their respective counterparts. The modelling analysis showed that implementing a nationwide comprehensive public smoking ban similar to that in Shanghai would result in a 0·04-0·07% increase in the national gross domestic product in China between 2017 and 2035, outweighing the economic costs of smoking ban enforcement.

INTERPRETATION

The smoking ban in Shanghai shows that a comprehensive public smoking ban with strict enforcement is effective in curbing smoking behaviours. Moreover, the implementation of a comprehensive public smoking ban across China would be cost-effective.

FUNDING

National Social Science Fund of China.

A Qualitative Study on Illness Perception and Coping Behaviors Among Patients with Chronic Obstructive Pulmonary Disease: Implications for Intervention

Background

Understanding patients' perceptions of their illness may be more beneficial for healthcare providers in maintaining vigilance than merely focusing on the clinical status of patients. As patients' perceptions can significantly influence their behavior, it is possible that health care providers who are aware of patients' thoughts in advance may help improve their intervention programs, such as increased treatment adherence. However, current research offers limited insight into the subjective perceptions of disease among patients with Chronic Obstructive Pulmonary Disease (COPD). This study aims to deeply explore COPD patients' illness perception and coping behaviors.

Methods

A descriptive qualitative approach was used, conducting semi-structured in-depth interviews with 32 COPD patients, and verbatim data recording. Data analysis was based on thematic analysis methods proposed by Braun and Clarke.

Results

Through data analysis, we identified three themes to describe participants' perceptions and coping behaviors related to COPD: inadequate knowledge regarding the disease, improper self-management of the disease, and diverse impacts resulting from the disease.

Conclusion

Illness perception is crucial for COPD patients. Participants' descriptions underscored their perceptions of the disease as well as the various challenges and consequences they face when dealing with it. To enhance care for individuals with COPD, researchers and healthcare professionals should increase awareness about the disease among patients, understanding their coping strategies, beliefs, and recognizing its significant impacts.

Association of conventional and electronic cigarette use with suicidality in Chinese adolescents: The moderating effect of sex and school type

BACKGROUND

To estimate the prevalence of lifetime e-cigarette use and explore the association between lifetime conventional and electronic cigarette use with suicidality among Chinese adolescents, focusing on sex and school-type differences.

METHODS

A total of 22,509 students from 432 classes in 80 schools were recruited in Guangdong Province using a multistage, stratified cluster, random sampling method in 2021. Self-report questionnaires were used to collect information. Multivariable logistic regression models were performed and stratification analysis was conducted. All analyses were weighted and adjusted for the complex survey design.

RESULTS

The weighted prevalence of lifetime e-cigarette use among adolescents in Guangdong Province was 8.7 % (4.3 % were dual users and 4.4 % were e-cigarette-only users) and 2.6 % were conventional-cigarette-only users. Lifetime e-cigarette-only users (AOR [Adjusted OR] =1.46, 95 % CI = 1.21-1.76), conventional-cigarette-only users (AOR = 1.97, 95 % CI = 1.58-2.46) and dual users (AOR = 1.67, 95 % CI = 1.38-2.02) were at a higher risk of suicidal ideation than non-users. Lifetime e-cigarette-only users (AOR = 2.03, 95 % CI = 1.53-2.70), conventional-cigarette-only users (AOR = 1.97, 95 % CI = 1.42-2.73), and dual users (AOR = 2.76, 95 % CI = 2.10-3.61) had a significantly higher risk of suicide attempts than non-users. After further analysis stratified by sex and school type, the associations of lifetime cigarette use patterns with suicidality slightly varied.

LIMITATION

The cross-sectional study design and self-report information.

CONCLUSION

The prevalence of e-cigarettes among Chinese adolescents is concerning. Lifetime conventional and e-cigarette use were associated with suicidality among Chinese adolescents, with sex and school type moderating these associations. Targeted measures to restrict cigarette use, including new tobacco product (e-cigarette) use, among adolescents are warranted.

Global, regional, and national burden of ischemic stroke attributable to active smoking, 1990-2021

INTRODUCTION

Ischemic stroke is a major global health issue, with active smoking identified as a key modifiable risk factor. This study examines the burden of ischemic stroke due to active smoking from 1990 to 2021, across different sociodemographic contexts.

METHODS

Data from the Global Burden of Disease (GBD) 2021 database were used to extract information on mortality and disability-adjusted life years (DALYs) attributable to active smoking-related ischemic stroke. Countries and regions were categorized by the sociodemographic index (SDI) into five levels. Statistical analyses were conducted using R Studio, including the calculation of estimated annual percentage change (EAPC) and joinpoint regression models.

RESULTS

In 2021, there were 342674 deaths globally due to ischemic stroke caused by active smoking, with an age-standardized mortality rate (ASMR) of 4.06 and a population-attributable fraction (PAF) of 9.54%. The number of deaths increased by 35.59% from 1990 to 2021, with males aged ≥70 years experiencing the largest increase. The global age-standardized DALY rate in 2021 was 98.29, with an overall increase in DALYs by 33.55% from 1990. Regional analysis revealed significant disparities, with the middle SDI region reporting the highest number of deaths and DALYs, while the high SDI region reported the lowest. Geographically, East Asia had the highest burden in 2021. Nationally, China had the highest number of deaths and DALYs due to smoking-related ischemic stroke.

CONCLUSIONS

This study highlights the significant global burden of ischemic stroke attributable to active smoking and the critical need for targeted smoking cessation programs and stroke prevention strategies. Despite overall declines in ASMR and age-standardized DALY rates, the burden varies significantly across different regions and sociodemographic groups. Effective public health interventions, particularly in low- to middle-SDI regions, are essential to mitigate the impact of smoking-related ischemic stroke and improve global health outcomes.

Analysis of the global burden of cardiovascular diseases linked to exposure to ambient particulate matter pollution from 1990 to 2019

Background

This research endeavors to scrutinize the temporal trends and global burden of cardiovascular diseases (CVDs) associated with ambient particulate matter (PM) pollution spanning from 1990 to 2019.

Methods

Age-standardized death rates (ASDRs) and age-standardized disability-adjusted life years (DALYs) for CVDs, as well as their estimated annual percentage changes (EAPCs), were calculated using data from the Global Burden of Disease Study 2019 (GBD 2019).

Results

The global ASDR and age-standardized DALYs due to CVDs associated with PM pollution increased from 1990 to 2019, with a higher increase in males. The burden was higher among middle-aged and older adults. The ASDR and DALYs increased in low-Socio-demographic Index (SDI), low-middle-SDI, and middle-SDI countries, while they decreased in high-SDI countries. The highest burden was observed in Central Asia, North Africa, the Middle East, East Asia, and South Asia. The highest burdens were reported in Iraq, Egypt, and Uzbekistan at the national level.

Conclusion

The burden of CVDs linked to PM pollution has grown significantly from 1990 to 2019, with variations across regions and countries, highlighting the need for targeted prevention and pollution management strategies.

Trends in Cancer Incidence and Potential Associated Factors in China

Importance

Timely analysis of cancer incidence trends is crucial for cancer prevention and control, which is a public health priority in China.

Objective

To estimate incidence trends for 32 cancers in China from 1983 to 2017 and project changes to 2032, assessing distinct changes due to risk factors and an aging population.

Design, Setting, and Participants

This population-based cohort study used data from the Cancer Incidence in Five Continents database (1983-2017). New cases of 32 cancers were collected. Data were analyzed from October 15, 2023, to May 23, 2024.

Main Outcomes and Measures

Age-standardized incidence rate (AIR) standardized to the World Health Organization World Standard Population, average annual percentage changes (AAPC) using joinpoint regression, and percentage change due to aging and risk factors, using Møller decomposition analysis, stratified by cancer and sex.

Results

A total of 3 677 027 new cancer cases (54.9% male, 45.1% female) were included in the analysis. Increased AIRS were observed for 11 cancers in males and 14 in females from 1983 to 2017, with trends expected to continue until 2032. Thyroid cancer showed the highest increase (AAPC: 7.82% in males; 95% CI, 6.92%-10.38%; 8.59% in females; 95% CI, 7.84%-10.42%), followed by prostate (4.71%; 95% CI, 3.12%-9.95%) and kidney (3.61%; 95% CI, 3.11%-5.82%) cancers in males, and cervical (4.43%; 95% CI, 3.36%-9.44%) and kidney (3.66%; 95% CI, 2.98%-6.86%) cancers in females. The AIRs of lung cancer tended to decrease in males but increase in females during 1983-2017. In contrast, the AIRs of stomach, liver, larynx, and nose and sinuses cancers decreased from 1983 to 2032. From 2018 to 2032, cancer cases were projected to increase primarily due to risk factors for 18 cancers in males and 11 in females, while aging would be associated with the increase in other cancers.

Conclusions and Relevance

In this population-based cohort study of incident cancer in the general population, the cancer landscape in China is evolving, with an increasing incidence primarily due to risk factors in 20 cancers and aging in others. Primary prevention efforts to reduce risk exposure are crucial, and further basic research is needed. Additionally, second prevention efforts are imperative to improve cancer survival, particularly among older individuals.

A Global Decomposition Analysis of the Effect of Population Aging on Disability-Adjusted Life Years Associated with Cardiovascular Disease - 204 Countries and Territories, 1990-2021

What is already known about this topic?

The influence of population aging on the disability-adjusted life years (DALYs) associated with cardiovascular disease (CVD) is acknowledged, yet the magnitude of this impact remains unclear.

What is added by this report?

This research quantified the influence of population aging on CVD DALYs from 1990 to 2021 through decomposition analysis. The findings revealed that the proportion of DALYs attributable to aging varied widely, ranging from ‒77.0% to 148.9% across 204 countries. There was significant variation in the attributed DALY proportions among different countries or territories and types of CVD. Ischemic heart disease and stroke emerged as the leading contributors to DALYs influenced by aging.

What are the implications for public health practice?

Globally, the association of population aging with increased CVD DALYs underscores the critical need for enhancing health systems to cater to the needs of older adults. Mitigating the burden of CVD DALYs linked to demographic aging can be achieved by investing in resources and adjusting fertility policies.

Smoking prevalence among adults in China Mainland and their age of smoking initiation during adolescence: a national cross-sectional study

OBJECTIVES

This study aims to calculate the national prevalence of smoking among Chinese adults and to describe the hazard of smoking initiation by age during their adolescence, as well as the disparities in sex, residence and age groups.

DESIGN

A cross-sectional study.

SETTING

The data were derived from a multistage sampling study conducted in 120 cities in China Mainland.

PARTICIPANTS

A total of 9963 participants aged ≥19 years were included.

PRIMARY OUTCOME MEASURES

Survival analysis was used to quantify the hazards of smoking initiation by a single year of age during adolescence, and the log-rank test was used to compare the hazard curves across subgroups.

RESULTS

The prevalence of current smoking among males and females was 27.7% and 2.0%, respectively, and 56.2% of current smokers began smoking at or before the age of 18. The hazard of smoking initiation during adolescence for females was less than 0.5%, and the hazard for males increased gradually before 14 years of age and increased sharply at age 15 (4.34%), then peaked at age 18 (6.24%). Males in rural experienced a higher hazard of smoking initiation than those in urban (χ2=5.35, p=0.02) and no such difference was found in females. By the age of 18 years, 11.7% of participants (1.8% for females and 23.4% for males) had ever smoked.

CONCLUSIONS

The prevalence of smoking among Chinese adults was lower than once reported. Males experienced higher hazards of smoking initiation at all ages than females. The hazard pattern suggests that the key focus for smoking prevention are males and adolescents aged 15-18 years, and future interventions should be delivered to the right target population at the appropriate time.

E-cigarette use and associated factors among adults aged 18-44 years in China: Findings from an online survey

INTRODUCTION

There needs to be more up-to-date evidence on the prevalence of e-cigarette use among Chinese adults. This study aims to investigate the prevalence and associated factors of e-cigarette use among adults aged 18-44 years in China.

METHODS

Cross-sectional design and convenience sampling were used. The data for this study were obtained from an online survey conducted in mainland China from April to May 2023. The target population was adults aged 18-44 years. Descriptive analysis was employed to report the prevalence of e-cigarette use, while adjusted multivariable logistic regression was performed to examine the association between e-cigarette use and related factors.

RESULTS

A total of 4256 participants were included in this study; 12.9% were current e-cigarette users, 5.9% were frequent users, and 7.0% were occasional users. The descriptive analysis results indicated that males and cigarette users had a higher prevalence of e-cigarette use. Multivariable analysis showed that e-cigarette use was significantly associated with female gender (AOR=0.76, 95% CI: 0.60-0.96), those aged 25-34 years with monthly income 6000-8999 CNY (AOR=2.01; 95% CI: 1.18-3.41), those aged 25-34 years with monthly income ≥9000 CNY (AOR=2.20; 95% CI: 1.26-3.82), college or undergraduate degree (AOR=1.91; 95% CI: 1.22-3.00), urban residence (AOR=1.72; 95% CI: 1.34-2.20), being a current smoker (AOR=3.32; 95% CI: 2.64-4.16), perception of harm (AOR=0.66; 95% CI: 0.60-0.73), and perception of benefit (AOR=2.31; 95% CI: 2.04-2.61).

CONCLUSIONS

The prevalence of current e-cigarette use among adults in China was 12.9% within our sample. In addition to sociodemographic factors, individuals with a higher perception of the harm associated with e-cigarettes were less likely to engage in e-cigarette consumption. Conversely, individuals who perceive the 'benefits' of e-cigarettes more favorably use them. Targeted interventions, such as health education, are recommended to help adults develop a correct understanding of e-cigarettes and lower the prevalence of e-cigarette use.

Trends and future projections of incidence rate and mortality of rheumatoid arthritis in China: a systematic analysis based on GBD 2021 data

This study aims to evaluate the trends in rheumatoid arthritis (RA) in China from 1990 to 2021 by analyzing data from the Global Burden of Disease (GBD) 2021 study and to predict the trends for the next 25 years. Age-standardized incidence rates (ASIR) and age-standardized mortality rates (ASMR) were calculated, and the estimated annual percentage change was used to illustrate differences in age distribution among various populations. Age-period-cohort (APC) analysis and Bayesian APC (BAPC) models were employed to forecast the burden of RA in China from 2022 to 2046. From 1990 to 2021, the ASIR of RA in China increased from 11.6 to 13.7, with a significantly higher ASIR in females than in males. Despite the increase in incidence, the ASMR related to RA decreased from 0.7 to 0.5. Predictions using the BAPC model indicate that the incidence of RA will continue to rise, with an expected ASIR of approximately 16.4 by 2046, and the total number of RA cases is projected to reach around 342,000. In terms of mortality, the ASMR is expected to decline to 0.3 by 2046, although the total number of deaths might reach about 40,000. The incidence of RA in China has significantly increased over the past 30 years. Although the incidence rate and the total number of RA cases may continue to rise in the future, the mortality rate of RA has been consistently declining. Key Points • Over the past 30 years, the incidence of RA in China has significantly increased; although the incidence rate and total number of cases may continue to rise, the mortality rate has been consistently declining.

Mortality and disease burden of oral cancer in China: a time-trend analysis on the China Death Surveillance Database from 2006 to 2021

BACKGROUND

Oral cancer is one of the most common cancers in China and seriously threaten life and health of Chinese people. We analysed the trends and disparities of oral cancer mortality rates and the disease burden of oral cancer in China from 2006 to 2021 to provide a reference for its prevention and control.

METHODS

Annual death data for oral cancer was gleaned from the China Death Surveillance Database. The age-standardized mortality rate (ASMR), annual percentage change (APC), and average APC (AAPC) were used to analyze the trend of mortality. Loss of life expectancy (LLE) and years of life lost (YLL) were adopted to assess disease burden.

RESULTS

From 2006 to 2021, the overall ASMR of oral cancer lightly declined (AAPC: - 0.97%; 95% CI: - 1.89%, - 0.04%), and the similar trend was observed among females (AAPC: - 1.22%; 95% CI: - 1.89%, - 0.55%). The ASMR of males was 2.31-3.16 times higher than that of females per year. The median of LLE for overall, males and females caused by oral cancer from 2006 to 2021 were 0.05, 0.06 and 0.03 years, respectively. There was a decrease of standardized YLL rate from 2006 to 2021 for overall (AAPC: - 1.31%, 95% CI: - 2.24% ~  - 0.37%) and for female (AAPC: - 1.63%, 95% CI: - 2.30% ~  - 0.95%). ASMR in urban areas was 1.02-1.28 times higher than that in rural areas from 2006 to2011, but 0.85-0.97 times lower in urban areas than that in rural areas from 2018 to 2021. The disease burden was higher in urban areas than in rural areas in 2006, whereas the reverse was observed in 2021.

CONCLUSIONS

There are severe health gaps and disparities in trends between sexes and different areas in China. Males and rural populations need to be focused on targeted interventions for the main influencing factors.

Total life expectancy and disability-free life expectancy and differences attributable to cigarettes' smoking among Chinese middle-aged and older adults

OBJECTIVES

Middle-aged and older adults smoking for years are afflicted by smoking-related diseases and functional limitations; however, little is known about the effect of smoking on nonfatal conditions in middle and later life. This study aims to investigate the impact of smoking on both total life expectancy (TLE) and disability-free life expectancy (DFLE) and the variations in such effects by educational level in China.

METHODS

Data were drawn from the China Health and Retirement Longitudinal Study (CHARLS), 2011-2018, with a total sample of 16,859 individuals aged 45 years or older involved in the final analysis. The Activities of Daily Living (ADL) scale was used to measure disability, and the population-based multistate life table method was used to estimate the differences in TLE and DFLE by smoking status and educational attainment.

RESULTS

At baseline, 28.9% of participants were current smokers, 8.5% were former smokers, and 62.6% never smoked. Approximately 5.6% were identified with ADL disability. Both current smokers and former smokers experienced lower TLE and DFLE than never smokers, and such differences were particularly prominent among men. Intriguingly, former smokers manifested a lower DFLE for both sexes and a lower TLE among women, though a longer TLE among men, compared with current smokers. Similar differences in TLE and DFLE by smoking status were observed for groups with different levels of education.

CONCLUSION

Never smokers live longer and healthier than current smokers and persons who quit smoking. Smoking was associated with greater reductions in TLE and DFLE among men. However, educational attainment might not moderate the adverse effect of smoking on both fatal and nonfatal conditions in the context of China. These findings have implications for disability prevention, aged care provision and informing policies of healthy aging for China and elsewhere.

Association between serum cotinine and muscle mass: results from NHANES 2011-2018

PURPOSE

Recently, the detrimental effect of cigarette smoking on muscle metabolism has attracted much attention, but the relationship between cigarette smoking and muscle mass is poorly understood. Thus, this study investigated the association between exposure to cigarette smoke, defined based on serum cotinine, and muscle mass in the US population.

METHODS

We utilized National Health and Nutrition Examination Survey (NHANES) data between 2011 and 2018 for analysis. Data on serum cotinine, muscle mass (quantified by appendicular skeletal muscle mass index, ASMI), and covariates were extracted and analyzed. Weighted multivariate linear regression analyses and smooth curve fittings were performed to investigate the association between serum cotinine and ASMI. Subgroup analyses were stratified by gender, race and smoking status. When nonlinearity was detected, the threshold effects were analyzed using a two-piecewise linear regression model.

RESULTS

In total, 8004 participants were included for analysis. The serum level of cotinine was negatively associated with ASMI in the fully adjusted model. Furthermore, comparing participants in the highest vs. the lowest tertile of serum cotinine, we found that ASMI decreased by 0.135 Kg/m2. In subgroup analysis stratified by gender and race, the association between serum cotinine and ASMI remained significant in all genders and races. In addition, the association remained significant among current and former smokers, but not among those who never smoked. Smooth curve fittings showed nonlinear relationships between serum cotinine and ASMI, with the inflection points identified at 356 ng/mL.

CONCLUSIONS

Our study revealed that serum cotinine was negatively related to muscle mass. This finding improves our understanding of the deleterious effects of cigarette smoking on muscle mass and highlights the importance of smoking cessation for muscle health.

Life Chances, Subjective Perceptions, and Healthy Lifestyles in Older Adults: Longitudinal Evidence From China

OBJECTIVES

Previous studies and theories show that healthy lifestyles are affected by life chances and subjective perceptions. However, it remains unclear how older adults change between different lifestyle profiles as they age. We proposed the healthy lifestyle duality framework and tested it among older Chinese adults using a longitudinal design.

METHODS

Data were obtained from 4 Chinese Longitudinal Healthy Longevity Surveys conducted between 2008 and 2018 (N = 31,445). Latent transition analysis and hierarchical multinomial growth curve models were performed to investigate healthy lifestyle profiles and their associations with life chances and subjective perceptions over time.

RESULTS

Four distinct healthy lifestyle profiles were identified: healthy, risky, low-standard, and mixed groups, and their changes show path dependency. Across 10 years, the proportion of the healthy group ranged from 11.16% to 16.97%. Both life chances and subjective perceptions were longitudinally associated with healthy lifestyles, with age and cohort effects observed.

DISCUSSION

Our findings support the healthy lifestyle duality framework and reveal that life chances and subjective perceptions influence lifestyle changes over time. Public health policies and health intervention programs should adapt to the specific needs of different age groups and generations.

Portable spirometer-based pulmonary function test willingness in China: A nationwide cross-sectional study from the "Happy Breathing Program"

BACKGROUND

Understanding willingness to undergo pulmonary function tests (PFTs) and the factors associated with poor uptake of PFTs is crucial for improving early detection and treatment of chronic obstructive pulmonary disease (COPD). This study aimed to understand willingness to undergo PFTs among high-risk populations and identify any barriers that may contribute to low uptake of PFTs.

METHODS

We collected data from participants in the "Happy Breathing Program" in China. Participants who did not follow physicians' recommendations to undergo PFTs were invited to complete a survey regarding their willingness to undergo PFTs and their reasons for not undergoing PFTs. We estimated the proportion of participants who were willing to undergo PFTs and examined the various reasons for participants to not undergo PFTs. We conducted univariable and multivariable logistic regressions to analyze the impact of individual-level factors on willingness to undergo PFTs.

RESULTS

A total of 8475 participants who had completed the survey on willingness to undergo PFTs were included in this study. Out of these participants, 7660 (90.4%) were willing to undergo PFTs. Among those who were willing to undergo PFTs but actually did not, the main reasons for not doing so were geographical inaccessibility ( n  = 3304, 43.1%) and a lack of trust in primary healthcare institutions ( n  = 2809, 36.7%). Among the 815 participants who were unwilling to undergo PFTs, over half ( n  = 447, 54.8%) believed that they did not have health problems and would only consider PFTs when they felt unwell. In the multivariable regression, individuals who were ≤54 years old, residing in rural townships, with a secondary educational level, with medical reimbursement, still working, with occupational exposure to dust, and aware of the abbreviation "COPD" were more willing to undergo PFTs.

CONCLUSIONS

Willingness to undergo PFTs was high among high-risk populations. Policymakers may consider implementing strategies such as providing financial incentives, promoting education, and establishing community-based programs to enhance the utilization of PFTs.

Effects of acupuncture and nicotine patch on smoking: a multicenter, randomized, controlled, double-blind clinical trial

Aims

To evaluate the effects of acupuncture and/or nicotine patches on smoking cessation.

Methods

Eighty-eight participants were randomly allocated into four groups: acupuncture combined with nicotine patch (ACNP), acupuncture combined with sham nicotine patch (ACSNP), sham acupuncture combined with nicotine patch (SACNP), and sham acupuncture combined with sham nicotine patch (SACSNP). The primary outcome was self-reported smoking abstinence verified with expiratory Carbon Monoxide (CO) after 8 weeks of treatment. The modified Fagerstrom Test for Nicotine Dependence (FTND) score, Minnesota Nicotine Withdrawal Scale (MNWS), and the Brief Questionnaire of Smoking Urge (QSU-Brief) score were used as secondary indicators. SPSS 26.0 and Prism 9 software were used for statistical analyses.

Results

Seventy-eight participants completed the study. There were no significant differences in patient characteristics at baseline across the four groups. At the end of treatment, there was a statistically significant difference (χ2  = 8.492, p = 0.037) in abstaining rates among the four groups. However, there were no significant differences in the reduction in the number of cigarettes smoked daily (p = 0.111), expiratory CO (p = 0.071), FTND score (p = 0.313), and MNWS score (p = 0.088) among the four groups. There was a statistically significant difference in QUS-Brief score changes among the four groups (p = 0.005). There was no statistically significant interaction between acupuncture and nicotine patch.

Conclusion

Acupuncture combined with nicotine replacement patch therapy was more effective for smoking cessation than acupuncture alone or nicotine replacement patch alone. No adverse reactions were found in the acupuncture treatment process.

Clinical trial registration

http://www.chictr.org.cn/showproj.aspx?proj=61969, identifier ChiCTR2100042912.

Effects of different exercise interventions on cardiopulmonary function in male tobacco-dependent college students

This study investigated the effects of different exercise interventions on cardiopulmonary function in male tobacco-dependent college students. Forty-five male tobacco-dependent college students were recruited as the tobacco-dependent (TB) group, and 45 non-tobacco-dependent college students were recruited as the control group. The TB group was randomly assigned to three subgroups: non-exercise (NE), high-intensity interval training (HIIT), and moderate-intensity continuous training (MICT). The HIIT and MICT groups underwent a 10-week exercise training, while the NE group received no intervention. Cardiac parameters, including maximal oxygen uptake (VO2max), heart rate max (HRmax), and heart rate reserve (HRR), and pulmonary indicators, including forced vital capacity (FVC), forced expiratory volume in one second (FEV1), vital capacity (VC), maximum ventilation volume (MVV), and peak expiratory flow (PEF) were investigated. The results showed that the TB group had significantly lower cardiopulmonary function than the control group. The degree of tobacco dependence was negatively correlated with VO2max, FVC, FEV1, FEV1/FVC, and MVV. Furthermore, both HIIT and MICT training improved cardiopulmonary function. HIIT training exhibited superior efficacy compared to MICT in improving HRmax, HRR, FVC, FEV1, FEV1/FVC, and PEF. In conclusion, tobacco dependence adversely affects cardiopulmonary function in male college students. Both HIIT and MICT effectively improved cardiopulmonary function, with HIIT showing superior efficacy.

The effect of active and passive smoking during pregnancy on birth outcomes: A cohort study in Shanghai

INTRODUCTION

China is the largest tobacco consumer in the world, and tobacco poses a serious threat to the health of pregnant women. However, there are relatively few domestic studies on smoking during pregnancy and childbirth outcomes among pregnant women. The purpose of this study was to analyze the effect of active and passive smoking on pregnant women and their pregnancy outcomes, providing evidence and recommendations for intervention measures.

METHODS

This was a cohort study in Shanghai from April 2021 to September 2023. According to the smoking status of pregnant women, they were divided into three groups: active smokers, passive smokers and non-smokers. A self-designed questionnaire was utilized to conduct the survey, and their pregnancy outcomes were tracked and followed up.

RESULTS

A total of 3446 pregnant women were included in this study, among which 2.1% were active smokers, 43.5% were passive smokers, and 54.4% were non-smokers. The average age of the pregnant women was 29.9 years, and 41.2% had a university degree or higher. The education level of active smokers and passive smokers was significantly lower than that of non-smokers (p<0.05).The average gestational age of non-smokers was 38.6 weeks, and the birth weight was 3283.2 g, which was higher than those of active smokers and passive smokers (p<0.05). Logistic regression analysis showed that passive smoking increased the likelihood of preterm birth (AOR=1.38; 95% CI: 1.05-1.81), low birth weight (AOR=1.53; 95% CI: 1.10-2.12), and intrauterine growth restriction (AOR=1.35; 95% CI: 1.02-1.79), while active smoking increased the likelihood of preterm birth (AOR=2.98; 95% CI: 1.50-5.90), low birth weight (AOR=4.29; 95% CI: 2.07-8.88), intrauterine growth restriction (AOR=2.70; 95% CI: 1.37-5.33) , and birth defects (AOR=2.66; 95% CI: 1.00-6.97).

CONCLUSIONS

Our findings illustrate that active and passive smoking can lead to adverse pregnancy outcomes. This study provides data on the relationship between smoking during pregnancy and delivery outcomes among pregnant women. In the future, we need more effective strategies to protect pregnant women from the harm of tobacco.

Population-wide impact of a pragmatic program to identify and manage individuals at high-risk of cardiovascular disease: a cluster randomized trial in 120 villages from Northern China

Objectives

To explore the population-wide impacts of an evidence-based high-risk strategy for prevention of cardiovascular diseases in resource-poor populations.

Methods

A cluster randomized controlled trial was conducted among 120 villages in rural China, with 60 on intervention and 60 on usual care as controls, for 2 years. The intervention emphasized training village doctors to identify high-risk individuals and administering standardized treatments focusing on hypertension management. A random sample of 20 men aged ≥50 years and 20 women aged ≥60 years was drawn from each village before randomization for the baseline survey, and another independent random sample with the same age and sex distribution was drawn at 2 years for the post-intervention survey. The primary outcome was the population mean systolic blood pressure (SBP). Secondary outcomes included the proportions of patients who received regular primary care, antihypertensive medications, aspirin, or lifestyle advice.

Results

A total of 5,654 high cardiovascular risk individuals were identified and managed by village doctors in intervention villages for 15 months on average, with mean SBP lowered by 19.8 mmHg and the proportion with blood pressure under control increased from 22.1% to 72.7%. The primary analysis of the two independent samples (5,050 and 4,887 participants each) showed that population-wide mean SBP in intervention villages did not differ from that in control villages at 2 years (mean difference = 1.0 mmHg, 95% CI: -2.19, 4.26; P = 0.528), though almost all secondary outcomes concerning primary care indicators significantly increased in intervention villages.

Conclusions

In our study, the pragmatic cardiovascular risk management program targeting on high-risk individuals significantly improved the quality of primary care. However, its impact on population blood pressure level and the burden of hypertension-related diseases appeared very limited.

Clinical Trial Registration

ClinicalTrial.gov identifier, NCT01259700.

Prevalence of cigarette use and addiction among Chinese females by age and province: Findings from nationwide China Health Literacy Survey during 2018-19

BACKGROUND

The prevalence of cigarette smoking among women is significantly different from that of men, however, cigarette use by women is little known. The study aims to describe cigarette use prevalence and patterns among Chinese females by age and province.

METHODS

This study was based on the 2018 China Health Literacy Survey (2018 CHLS), a nationally representative cross-sectional study, and our analysis included 43,319 female participants aged 20-69 with valid data. The prevalence of cigarette use was estimated overall by sociodemographic factors and weighted based on the census population data. The logistic regression model was conducted to estimate adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for the risk factors associated with cigarette use and dependency.

RESULTS

In China, the estimated female current cigarette use prevalence was 1.85%, with over half of the population suffering from tobacco dependence (7.34 million). Jilin Province has the highest cigarette prevalence among women (10.59%), while Fujian Province has the lowest (0.27%). Participants over 60 years old (aOR=1.61, 95%CI=1.20-2.14), single (aOR=1.54, 95%CI=1.07-2.21), with primary education (aOR=1.93, 95%CI=1.47-2.52) were more likely to smoke. The age of smoking initiation among women intergenerational advanced, and compared to the cigarette users without tobacco dependence, those who have tobacco dependence start smoking earlier in all age groups (25.69 years vs. 19.36 years, p<0.001).

CONCLUSIONS

The cigarette use prevalence among Chinese women was 1.85%, and there are significant differences among provinces. We noted a trend of women initiating smoking at increasingly younger ages, particularly among those with tobacco dependence.

Disease burden of Parkinson's disease in China and its provinces from 1990 to 2021: findings from the global burden of disease study 2021

Background

Parkinson's disease (PD) has become a public health concern with global ageing. However, comprehensive assessments of the temporal and geographical trend of PD disease burden in China remain insufficient. This study aimed to examine the burden of PD by age, gender, and geographical region in China during 1990-2021.

Methods

Using data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021, we analysed the incidence, prevalence, mortality, and DALY burden of PD in 33 Chinese provinces/regions. We compared the national figure with the global average and the corresponding estimates from the G20 countries. The estimated annual percentage change (EAPC) was used to quantify the temporal trends of PD burden during 1990-2021. We further assessed the PD burden by age and gender during 1990-2021. We used a decomposition analysis to investigate the changes in the number of new cases, patients, and deaths of PD during 1990-2021.

Findings

In 2021, China recorded the highest age-standardised incidence and prevalence of PD among the G20 countries, at 24.3 per 100,000 and 245.7 per 100,000, respectively, figures that were much higher than the global average. During 1990-2021, the age-standardised incidence of PD in China increased by 89.7%, and the age-standardised prevalence by 167.8%, both marking the largest increases among the G20 countries. In contrast, the age-standardised mortality for PD has significantly decreased since 1990, whereas the age-standardised DALY rate for PD has remained relatively unchanged since 1990. The PD burden gradually increased with age, especially in the elderly population aged ≥65 years. During 1990-2021, the burden in males consistently surpassed that in females, with the gender difference widening over time. The increase in new cases and patients of PD was primarily driven by changes in age-specific rates, while the rise in PD-related deaths was largely attributable to population ageing. The disease burden of PD varied considerably across the Chinese provinces. In 2021, age-standardised incidence and prevalence of PD were generally higher in China's southeastern coastal regions than in the western regions, and age-standardised DALY rates were higher in the northern regions than in other regions.

Interpretation

The disease burden of PD in China has consistently risen over the past three decades, particularly among elderly men. The increasing causative factors and population aging highlight the need for enhancing public health intervention and resource allocation, especially in etiological research, early diagnosis, preventive strategies, and region-specific management for PD.

Funding

Ministry of Science and Technology of the People's Republic of China (2022YFC2304900, 2022YFC2505100); National Key R&D Program of China (2022YFC2505100, 2022YFC2505103, 2018YFC1315300); Outstanding Young Scholars Support Program (grant number: 3111500001); Epidemiology modeling and risk assessment (grant number: 20200344), and Xi'an Jiaotong University Young Scholar Support Grant (grant number: YX6J004).

Early smoking lead to worse prognosis of COPD patients: a real world study

BACKGROUND

Smoking remains a major risk factor for the development and progression of chronic obstructive pulmonary disease (COPD). Due to the adolescent smoking associated with worse health state, the age, at which an individual started smoking, might play a key role in shaping the trajectory of COPD development and the severity.

METHODS

We conducted an observational study from September 2016 through January 2023 of eligible patients hospitalized with COPD. Patients who started smoking during the alveolar development stage (ADS, smoking initiation ≤ 24 years old) were defined as early smoking patients, and patients who started smoking after ADS (smoking initiation > 24 years old) were defined as late smoking patients. We collected demographic and clinical data characterizing the patients and documented their condition from hospital discharge to follow-up. The primary endpoints were short-term (within one year), 3-year, and long-term (beyond 3 years) all-cause mortality after discharge.

RESULTS

Among 697 COPD patients, early smoking patients had a lower smoking cessation rate (P < 0.001) and a higher smoking index (P < 0.001) than late smoking patients. Although adjusted smoking index, early smoking patients still had poorer lung function (P = 0.023), thicker left ventricular diameters (P = 0.003), higher frequency of triple therapy use during stable stage (P = 0.049), and more acute exacerbations in the past year before enrollment (P < 0.05). Survival analysis showed that they had a higher risk of death after discharge within three years (P = 0.004) and beyond three years (P < 0.001). Furthermore, even in early smoking COPD patients who quit smoking after adjusting the smoking index had poorer lung function (P < 0.05) and thicker left ventricular diameters (P = 0.003), and survival analysis also showed that they had a higher long-term mortality rate (P = 0.010) and shorter survival time (P = 0.0128).

CONCLUSION

Early smoking COPD patients exhibited multiple adverse clinical outcomes, including heavy cigarette addiction, compromised pulmonary function, augmented left ventricular diameter, and elevated mortality risk. Additional, smoking cessation could not bring enough improvement of health state in early smoking COPD patients as late smoking COPD patients. Consequently, early intervention and specialized cessation approaches for younger smokers are of paramount importance in this context.

Exposure to and Appeal of Tobacco Ads and Displays in China: A Qualitative Exploration of Chinese Youth Perceptions

INTRODUCTION

Adolescents are uniquely vulnerable to nicotine addiction, and smoking is common among male adolescents in China. Although China implemented a ban on cigarette and e-cigarette advertising in public places, Chinese youth remain exposed to this marketing, which may contribute to future use.

AIMS AND METHODS

From December 2021 to January 2022, we conducted 20 online focus group discussions with 119 adolescents in 10 Chinese cities to explore sources of tobacco marketing exposure, defined as exposure to cigarette and e-cigarette ads and product displays, and what features made marketing attractive.

RESULTS

All groups discussed exposure to tobacco ads/displays in public places, including locations near their home or school. Nearly all groups discussed that exposure to online tobacco ads was common, particularly exposure to e-cigarette commercial ads and posts made by classmates or friends selling e-cigarettes. Most groups identified how eye-catching colors, imagery, product packaging, and price promotions featured in e-cigarette ads/displays attracted their attention.

CONCLUSIONS

Results suggest Chinese adolescents are exposed to cigarette and e-cigarette ads and displays, many of which are placed in youth-friendly locations and contain youth-appealing features.

IMPLICATIONS

Only a handful of studies have examined the influence of cigarette and e-cigarette advertising on youth in the context of China. Prior research has established the relationship between youth exposure to tobacco marketing and increased susceptibility to future use. Our findings emphasize the importance of effectively enforcing and expanding restrictions on cigarette and e-cigarette marketing in order to protect youth from exposure and future smoking/vaping initiation.

Preliminary Efficacy of a Cognitive Behavioral Therapy-Based Smartphone App for Smoking Cessation in China: Randomized Controlled Pilot Trial

BACKGROUND

The overall prevalence of cigarette smokers in China is very high, and China's total cigarette consumption makes up more than 40% of the world's consumption. In view of the lack of smoking cessation services and social support in China and the effectiveness of mobile phone apps for quitting smoking in other countries, we carried out a smartphone app-based smoking cessation trial in China.

OBJECTIVE

This study aimed to evaluate the efficacy of a cognitive behavioral therapy (CBT)-based smoking cessation smartphone app among smokers seeking treatment in China.

METHODS

We conducted a randomized controlled, web-based pilot clinical trial in China between February 23 and June 27, 2021. Eligible participants were randomly assigned to the smoking cessation app intervention group or the control group in a ratio of 1:1. The intervention group received the CBT smoking cessation intervention using a smartphone app, and the control group received a "thank you" message. The intervention was 4 weeks long, and the patients were followed up for 4 weeks. The primary outcome was self-reported continuous smoking abstinence at week 4 after the quit date. The secondary outcomes included self-reported 7-day point prevalence of smoking abstinence; reduction of the number of cigarettes smoked per day at weeks 1, 2, 3, and 4; and program acceptability.

RESULTS

A total of 973 people were recruited to quit smoking, of whom 262 completed basic information, 56 were excluded, and 206 were randomized and included in the final analysis. There were 189 (91.7%) men and 17 (8.3%) women, with an average age of 34.46 (SD 7.53) years and an average daily smoking rate of 15.93 (SD 7.10) cigarettes/day. We found 30 (29.7%) of the 101 participants in the intervention group and 7 (6.7%) of the 105 participants in the control group reported continuous smoking cessation after the quit date at week 4 (odds ratio 5.92, 95% CI 3.78-9.26; P<.001). The 7-day point prevalence abstinence rate of the intervention group varied from 42.6% (43/101) to 46.5% (47/101) after 1, 2, 3, and 4 weeks, while the control group varied from 18.1% (19/105) to 26.7% (28/105). Compared to the control group, continued smokers consumed 1.5-3.0 fewer cigarettes per day in the intervention group. The overall program got positive user feedback with a high satisfaction rate (66/87, 76%) and an average Mobile Application Rating Scale user version score of 3.46.

CONCLUSIONS

Our pilot study provided preliminary evidence that the CBT-based smoking cessation smartphone app led to improved smoking quit rates versus control in Chinese smokers. The study demonstrated the CBT-based smartphone app may be an effective and feasible digital treatment model to help smokers quit, which may improve smoking cessation service quality and accessibility in China.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04421170; https://clinicaltrials.gov/study/NCT04421170.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.1136/bmjopen-2020-041985.

Mortality from cerebrovascular diseases in China: Exploration of recent and future trends

BACKGROUND

Cerebrovascular disease (CVD) ranks among the foremost factors responsible for mortality on a global scale. The mortality patterns of CVDs and temporal trends in China need to be well-illustrated and updated.

METHODS

We collected mortality data on patients with CVD from Chinese Center for Disease Control and Prevention's Disease Surveillance Points (CDC-DSP) system. The mortality of CVD in 2020 was described by age, sex, residence, and region. The temporal trend from 2013 to 2019 was evaluated using joinpoint regression, and estimated rates of decline were extrapolated until 2030 using time series models.

RESULTS

In 2019, the age-standardized mortality in China (ASMRC) per 100,000 individuals was 113.2. The ASMRC for males (137.7/10 5 ) and rural areas (123.0/10 5 ) were both higher when stratified by gender and urban/rural residence. The central region had the highest mortality (126.5/10 5 ), the western region had a slightly lower mortality (123.5/10 5 ), and the eastern region had the lowest mortality (97.3/10 5 ). The age-specific mortality showed an accelerated upward trend from aged 55-59 years, with maximum mortality observed in individuals over 85 years of age. The age-standardized mortality of CVD decreased by 2.43% (95% confidence interval, 1.02-3.81%) annually from 2013 to 2019. Notably, the age-specific mortality of CVD increased from 2013 to 2019 for the age group of over 85 years. In 2020, both the absolute number of CVD cases and the crude mortality of CVD have increased compared to their values in 2019. The estimated total deaths due to CVD were estimated to reach 2.3 million in 2025 and 2.4 million in 2030.

CONCLUSION

The heightened focus on the burden of CVD among males, rural areas, the central and western of China, and individuals aged 75 years and above has emerged as a pivotal determinant in further decreasing mortalities, consequently presenting novel challenges to strategies for disease prevention and control.

Mortality burden and future projections of major risk factors for esophageal cancer in China from 1990 to 2019

OBJECTIVE

This study, based on Global Burden of Disease (GBD) data, aimed to report the long-term trend in mortality rates caused by risk factors for esophageal cancer (EC) in China from 1990 to 2019 and predict the burden of EC mortality caused by these risk factors over the next 15 years.

METHODS

We examined six risk factors that influenced EC mortality rates in China and their respective rankings. Furthermore, we analyzed the number of deaths and crude mortality rates (CMR) caused by these risk factors for both sexes and different age groups. Age-standardized mortality rates (ASMR) and the number of deaths across all age groups were also analyzed. Finally, we utilized the Bayesian Age-Period-Cohort (BAPC) model to predict the trends in ASMR burden caused by these risk factors in the future.

RESULTS

From 1990 to 2019, the percentage changes in ASMR for EC caused by the six risk factors in China were as follows: smoking (- 33.4%), alcohol consumption (- 23.0%), low fruit intake (- 73.6%), low vegetable intake (- 96.0%), high Body Mass Index (BMI) (25.1%), and tobacco chewing (- 32.8%). In 2019, the top three risk factors contributing to EC ASMR in China were smoking, alcohol consumption, and high BMI. Overall, the ASMR for EC in China fluctuated and declined from 1990 to 2019. The most common risk factors for males were smoking and alcohol consumption, while low fruit intake and high BMI were the most common risk factors for females. The impact of these risk factors on EC mortality increased with age, except for the elderly population. BAPC analysis indicated that the influence of these risk factors on ASMR was expected to remain relatively stable in the next 15 years, suggesting a continued significant burden of EC.

CONCLUSION

The projected burden of EC mortality in China was expected to continue increasing steadily over the next 15 years, highlighting the pressing need for disease control measures. To alleviate this burden, targeted prevention and control policies addressing risk factors for EC such as smoking, alcohol consumption, and high BMI are necessary.

Environmental factors affecting the risk of generalization for ocular-onset myasthenia gravis: a nationwide cohort study

BACKGROUND

The environmental effects on the prognosis of ocular myasthenia gravis (OMG) remain largely unexplored.

AIM

To investigate the association between specific environmental factors and the generalization of OMG.

DESIGN

The cohort study was conducted in China based on a nationwide multicenter database.

METHODS

Adult patients with OMG at onset, who were followed up for at least 2 years until May 2022, were included. We collected data on demographic and clinical factors, as well as environmental factors, including latitude, socioeconomic status (per capita disposable income [PDI] at provincial level and education) and smoking. The study outcome was the time to the development of generalized myasthenia gravis (GMG). Cox models were employed to examine the association between environmental exposures and generalization. Restricted cubic spline was used to model the association of latitude with generalization risk.

RESULTS

A total of 1396 participants were included. During a median follow-up of 5.15 (interquartile range [IQR] 3.37-9.03) years, 735 patients developed GMG within a median of 5.69 (IQR 1.10-15.66) years. Latitude of 20-50°N showed a U-shaped relation with generalization risk, with the lowest risk at around 30°N; both higher and lower latitudes were associated with the increased risk (P for non-linearity <0.001). Living in areas with lower PDI had 1.28-2.11 times higher risk of generalization. No significant association was observed with education or smoking.

CONCLUSIONS

Latitude and provincial-level PDI were associated with the generalization of OMG in China. Further studies are warranted to validate our findings and investigate their potential applications in clinical practice and health policy.

Roles of Androgen Receptor Signaling in Urothelial Carcinoma

Preclinical and clinical data suggest that androgen receptor signaling strongly contributes to bladder cancer development. The roles of the androgen receptor in bladder carcinogenesis have obvious implications for understanding the strong male sex bias in this disease and for potential therapeutic strategies as well. In this review, we summarize what is known about androgen receptor signaling in urothelial carcinoma as well as in tumor-infiltrating immune cells, reviewing preclinical and clinical data. We also highlight clinical trial efforts in this area.

Changing trends in disease burden of lung cancer in China from 1990-2019 and following 15-year prediction

BACKGROUND

As lung cancer becomes a primary source of death in China, investigation on incidence rate, death rate, and disability-adjusted life years (DALYs) is of great significance to optimize prevention measures and allocation of healthcare resources.

METHODS

We utilized data from the Global Burden of Disease (GBD) database to evaluate the incidence rate, death rate, and DALYs of lung cancer in China from 1990 to 2019. Analysis of lung cancer risk factor-related death rate and DALYs was performed. Age-standardized rates (ASR) and estimated annual percentage change (EAPC) were calculated. The incidence trend of lung cancer from 2020 to 2034 was predicted by the Nordpred age-period-cohort (APC) model.

RESULTS

Age-standardized incidence rate (ASIR) increased from 30.2/100000 (95 % UI 26.2-34.3) in 1990 to 41.7/100000 (95 % UI 35.2-48.8) in 2019, and EAPC was 1.33 (95 % CI 1.16-1.49). From 1990 to 2019, men were noted for the highest incidence rate, death rate, and DALYs rate across three age groups (15-49 years, 50-69 years, and over 70). During this period, the ASIR of lung cancer in females was always lower than that in males. The predominant risk factors of lung cancer were smoking, air pollution, and diet, among which smoking was the most significant one. The analysis results showed that new cases and deaths may increase in the following 15 years since 2020 in the context of lung cancer.

CONCLUSION

Faced with the heavy burden of lung cancer, China must issue corresponding policies and roll out prevention avenues against smoking and air pollution.

Very tall female young adults tended to be smokers: A large-scale exploratory cross-sectional survey of 26,405 college students in China

OBJECTIVE

This study investigated the sex-specific prevalence of smoking (past 30 days) and the associations with height among university/college students.

PARTICIPANTS

25,405 (11,579/14,826 males/females) college students in Xi'an China.

METHODS

A cross-sectional, self-administered survey.

RESULTS

The male and female prevalence of smoking (past 30 days) was 32.9% and 7.4%, respectively. The prevalence of smoking of the male height groups ranged from 29.8% to 36.9%; only the ≥188 cm height group showed significantly higher prevalence than the reference group (i.e., 173-177cm; 33.0%). The female prevalence of smoking was 4.0-8.2% in the ≤170cm groups and increased to 12.3% in the 171-175 cm group and 36.1% in the ≥176 cm group, while it was 6.5% for the reference group (161-165 cm).

CONCLUSIONS

This exploratory study firstly revealed the significantly higher prevalence of smoking among the "tallest" height groups, especially among females. Future studies are warranted to confirm such findings and explore related mechanisms.

Updated disease distributions, risk factors, and trends of laryngeal cancer: a global analysis of cancer registries

BACKGROUND

Though the laryngeal cancer only has 1% of the total cancer cases and related deaths, it is a type of head and neck cancers with the highest prevalence. This study aims to investigate the epidemiological trend of laryngeal cancer with updated data on the global distribution of the disease burden.

MATERIALS AND METHODS

The incidence and mortality rate of laryngeal cancer was extracted from GLOBOCAN (2020), Cancer Incidence in Five Continents series I-X, WHO mortality database , the Nordic Cancer Registries , and the Surveillance, Epidemiology, and End Results Program. The Global Health data exchanges for the prevalence of its associated risk factors. A Joinpoint regression analysis was used to calculate Average Annual Percentage Change (AAPC).

RESULTS

The age-standardised rate (ASR) of laryngeal cancer incidence and mortality were 2.0 and 1.0 per 100 000 worldwide. The Caribbean (ASR=4.0) and Central and Eastern Europe (ASR=3.6) had the highest incidence and mortality rate. Incidence and risk factors associated with laryngeal cancer included tobacco usage, alcohol consumption, poor diet, obesity, diabetes, hypertension, and lipid disorders. There was an overall decreasing trend in incidence, especially for males, but an increasing incidence was observed in female populations and younger subjects.

CONCLUSIONS

As overall global trends of laryngeal cancer have been decreasing, especially for the male population, this could possibly be attributed to reduced tobacco use and alcohol consumption. Decrease in mortality may be due to improved diagnostic methods and accessibility to treatment, yet disparity in trend remains potentially because of differences in the level of access to surgical care. Disparities in temporal trends across countries may require further research and exploration to determine other underlying factors influencing this.

Cancer burden and risk in the Chinese population aged 55 years and above: A systematic analysis and comparison with the USA and Western Europe

Background

We analysed the cancer burden among elderly Chinese people over the age of 55 years and compared them to USA and Western Europe to explore the cancer model in China.

Methods

We retrieved data on 29 cancers with 34 risk factors from the 2019 Global Burden of Disease database to evaluate the cancer burden in Chinese elderly individuals aged 55 years and older. We then used the age-standardised incidence rate (ASIR), age-standardised death rate (ASDR), age-standardised disability-adjusted life year (DALY) rate, and average annual percentage change (AAPC) to compare the characteristics and change trend of cancers among China, USA, and Western Europe.

Results

In 2019, the number of incident cases of 29 cancers among people aged 55 years and above in China increased more than 3-fold compared to 1990, while the number of deaths and DALYs approximately doubled. We also found that the cancer population in China was ageing; meanwhile, the cancer burden became significantly higher for men than for women, and the gap between men and women had widened. Cancers with the highest cancer DALYs were lung cancer (13 444 500; 95% uncertainty interval (UI) = 11 307 100, 15 853 700), stomach cancer (7 303 900; 95% UI = 6 094 600, 8 586 500), oesophageal cancer (4 633 500; 95% UI = 3 642 500, 5 601 200), colon and rectum cancer (4 386 500; 95% UI = 3 769 500, 5 067 200), liver cancer (2 915 100, 95% UI = 2 456 300, 3 463 900), and pancreatic cancer (2 028 400; 95% UI = 1 725 000, 2 354 900). Compared with 1990, the DALY rate and incidence rate of stomach cancer, oesophageal cancer, and liver cancer had markedly decreased. The DALY rate and incidence rate of lung, colon, rectum, and pancreatic cancer had increased significantly, as did the incidence rate of breast cancer in women. Smoking and diet were the top two cancer risk factors, and the impact of ambient particulate matter pollution on cancer increased each year. The overall 29 cancers age-standardised DALY rate and ASDR in China, USA, and Western Europe were similar, and all showed downward trend in the past 30 years. Compared with the USA and Western Europe, the age-standardised DALY rate of liver, nasopharyngeal, oesophageal, stomach, and cervical cancers in China was more prominent. The age-standardised DALY rate of lung cancer and colon and rectum cancer decreased annually in Western Europe and the USA, but increased in China.

Conclusions

Over the past 30 years, China had made progress in controlling stomach, oesophageal, and liver cancer. However, lung, colon, rectum, pancreatic, and breast cancers had become more prevalent, having risen alongside economic development. The risks of smoking and dietary were major issues that need to be addressed urgently. The cancer situation in China remains serious; future cancer prevention efforts need to balance economic development with people's physical health, identify key groups, improve the health environment of residents and guide them to live a healthy life, and expand the scope of cancer screening.

Smoking cessation in Chinese patients undergoing thoracic surgery: A multicenter prospective observational study

INTRODUCTION

The multicenter CHAMPION study aimed to assess the impact of smoking cessation on post-operative complications (PCs) and smoking cessation patterns in Chinese patients undergoing lung surgery.

METHODS

Patients undergoing elective lung surgery were prospectively enrolled from three major tertiary centers in China. Patients were categorized as smokers or quitters before surgery. Baseline characteristics and smoking status were analyzed. The incidence of PCs and pulmonary PCs (PPCs), smoking relapse rate, and causes within six months post-operatively were investigated. The questionnaire was conducted in all patients and 30 healthcare professionals (HCPs), regarding the awareness and effectiveness of smoking cessation methods.

RESULTS

Of the 276 enrolled patients, 213 (77.2%) were smokers and 63 (22.8%) were quitters; 76.4% were diagnosed with primary lung cancer. PCs occurred in 13.8% of patients, with similar proportions in smokers (14.1%) and quitters (12.7%). PPCs occurred in 9.8% of patients with no significant differences between smokers and quitters (9.4% vs 11.1%, p=0.70). At six months, 9.2% of patients relapsed, with a lower rate in quitters compared to smokers (3.3% vs 11.0%, p=0.01). HCPs exhibited higher awareness of smoking cessation methods than patients. Perceived effectiveness of smoking cessation methods from the patients were low.

CONCLUSIONS

In patients undergoing lung surgery with a low risk of PCs, active smoking does not significantly increase the risk of PCs or PPCs relative to quitters, suggesting that there is likely no need to postpone lung surgery for those who have not yet quit smoking. However, further large-scale studies are necessary to confirm these findings.