Short sleep duration associated with the incidence of cardio-cerebral vascular disease: a prospective cohort study in Shanghai, China.

IMPORTANCE: Sleep duration plays an important role in predicting CCVD incidence, and have implications for reducing the burden of CCVD. However, the association between sleep duration and predicted cardio-cerebral vascular diseases (CCVD) risk remains to be fully understood. OBJECTIVE: To investigate the effects of sleep duration on the development of CCVD among Chinese community residents. DESIGN: A prospective cohort study. The baseline survey was conducted from January 2013 to July 2013. The cohort has been followed until December 31, 2016 using a combination of in-person interviews and record linkages with the vital registry of Pudong New Area, Shanghai, China. SUBJECTS: A total of 8245 Chinese community residents were initially enrolled in the cohort. Of those, 6298 underwent the follow-up examination. EXPOSURE: Self-reported sleep duration and sleep quality were obtained via the questionnaire. Sleep duration was divided into five categories: ≤5, 6, 7, 8, or ≥ 9 h per day. MAIN OUTCOME(S) AND MEASURE(S): CCVD, Coronary heart disease (CHD) and Stroke occurrence, Hazard ratios (HRs) and 95% confidence intervals (95% CIs) were calculated using Fine-Gray proportional subdistribution hazards models. RESULTS: During a median follow-up of 3.00 years (IQR 2.92-3.08), we observed 370 participants have had incident CCVD events, of whom 230 had CHDs, 169 had strokes, and 29 had both. After adjustment for relevant confounders, short sleepers (≤ 5 h) had 83% higher risk of total CCVD incidence (HR: 1.83; 95% CI: 1.32-2.54), 82% higher risk of CHD incidence (HR: 1.82; 95% CI: 1.21-2.75), and 82% higher risk of stroke incidence (HR: 1.82; 95% CI: 1.12-2.98) in contrast to the reference group (7 h). Some of these U-shaped relationships varied by age, and were more pronounced in individuals aged < 65 years. Individuals who slept ≤ 5 h per day with baseline hypertension had the highest risk of CCVD incidence (HR: 3.38, 95% CI 2.08-5.48), CHD incidence (HR: 3.11, 95% CI 1.75-5.53), and stroke incidence (HR: 4.33, 95% CI 1.90-9.86), compared with those sleep 7 h and without baseline hypertension. CONCLUSIONS: Short sleep duration is independently associated with greater incidence of CCVD, CHD and stroke.

Prospective cohort studies underscore the association of abnormal glycemic measures with all-cause and cause-specific mortalities.

The role of fasting plasma glucose (FPG), glycated hemoglobin (HbA1c), and triglyceride-glucose index (TyG index) in predicting all-cause and cause-specific mortalities remains elusive. This study included 384,420 adults from the Shanghai cohort and the UK Biobank (UKB) cohort. After multivariable adjustment in the Cox models, FPG ≥7.0 mmol/L or HbA1c ≥ 6.5% increased the risk of all-cause mortality, FPG ≥5.6 mmol/L or HbA1c ≥ 6.5% increased CVD-related mortality, and higher or lower TyG index increased all-cause and CVD-related mortalities in the Shanghai cohort; FPG ≥5.6 mmol/L, HbA1c ≥ 5.7%, TyG index <8.31 or ≥9.08 increased the risks of all-cause, CVD-related, and cancer-related mortalities in the UKB cohort. FPG or HbA1c increased the discrimination of the conventional risk model in predicting all-cause and CVD-related mortalities in both cohorts. Thus, increased levels of FPG and HbA1c and U-shaped TyG index increase the risks of all-cause especially CVD-related mortalities.

The Impact of a Health Forecasting Service on the Visits and Costs in Outpatient and Emergency Departments for COPD Patients - Shanghai Municipality, China, October 2019-April 2020.

WHAT IS ALREADY KNOWN ON THIS TOPIC?: The morbidity and mortality of chronic obstructive pulmonary disease (COPD) is associated with adverse weather and air pollution. However, COPD patients are not able to be alerted in advance of high risk environments. WHAT IS ADDED BY THIS REPORT?: This prospective controlled trial conducted in Pudong New Area of Shanghai from October 2019 to April 2020 provided evidence of COPD risk forecasting service on the reductions in visits and costs of COPD patients in outpatient and emergency departments in China for the first time. WHAT ARE THE IMPLICATIONS FOR PUBLIC HEALTH PRACTICE?: This study suggests that COPD risk forecasting service could be integrated into existing COPD management in public health to improve the health and economic outcomes.

Glucose Intolerance and Cancer Risk: A Community-Based Prospective Cohort Study in Shanghai, China.

BACKGROUND: Cancer becomes the leading cause of premature death in China. Primary objective of this study was to determine the major risk factors especially glucose intolerance for cancer prophylaxis. METHODS: A cluster sampling method was applied to enroll 10,657 community-based adults aged 15-92 years in Shanghai, China in 2013. A structured questionnaire and physical examination were applied in baseline survey. Prediabetes was diagnosed using 75-g oral glucose tolerance test. After excluding 1433 subjects including 224 diagnosed with cancer before and 1 year after baseline survey, the remaining 9,224 subjects were followed-up to December 31, 2020. RESULTS: A total of 502 new cancer cases were diagnosed. The cancer incidence was 10.29, 9.20, and 5.95/1,000 person-years in diabetes patients, those with prediabetes, and healthy participants, respectively (p<0.001). The multivariate Cox regression analysis indicated that age, prediabetes and diabetes, were associated with an increased risk of cancer in those <65 years, the hazard ratios (95% confidence interval) for prediabetes and diabetes were, 1.49(1.09-2.02) and 1.51(1.12-2.02), respectively. Glucose intolerance (prediabetes and diabetes) were associated with increased risks of stomach cancer, colorectal cancer, and kidney cancer in those <65 years. Anti-diabetic medications reduced the risk of cancer caused by diabetes. The multivariate Cox analysis showed that age, male, <9 years of education, and current smoking were associated with increased risks of cancer in those ≥65 years independently. CONCLUSIONS: Glucose intolerance is the prominent cancer risk factor in adults <65 years. Lifestyle intervention and medications to treat glucose intolerance help prevent cancer in this population.

Association of interarm blood pressure difference with cardio-cerebral vascular disease: A community-based, cross-sectional study.

Interarm blood pressure difference (IAD) is a risk factor for peripheral artery disease and cardio-cerebral vascular disease (CCVD). The current study examines the association of IAD with stroke and coronary heart disease in a Chinese community. A cross-sectional study was conducted in Pudong New Area in Shanghai, China. A total of 10 657 residents aged 15 years and older were randomly selected through three-stage sampling. Volunteers had systolic and diastolic blood pressure (BP) measured in both arms at recruitment, and IAD was defined in both arms as the absolute difference in BP. Medical records of study participants were reviewed by investigators to confirm measurements. Logistic regression models were used to assess the association between systolic interarm blood pressure difference (sIAD) and diastolic interarm blood pressure difference (dIAD) with stroke and coronary heart disease. Compared with dIAD <5 mm Hg, the multivariate adjusted odds ratio (OR) of stroke prevalence was 1.357 (95% CI 0.725-2.542, P = 0.034) for dIAD ≥20 mm Hg and 1.702 (95% CI1.025-2.828, P = 0.040) for dIAD between 15 and 19 mm Hg, and the multivariate adjusted OR of coronary heart disease prevalence was 1.726 (95% CI 1.093-2.726, P = 0.019) for dIAD ≥20 mm Hg and 1.498 (95% CI 0.993-2.261, P = 0.044) for dIAD between 15 and 19 mm Hg. The relationship between cardio-cerebral vascular disease and dIAD was significant in a Chinese community population. Further cohort studies are needed to investigate the association of different levels of IAD with the incidence of cardiovascular and cerebrovascular diseases and subsequent mortality.

Optimal hemoglobin A1C cutoff value for diabetes mellitus and pre-diabetes in Pudong New Area, Shanghai, China.

AIMS: Due to the diversity of the Chinese population, it requires considerable research to evaluate HbA1c diagnostic threshold for diagnosis of hyperglycemia. METHODS: We included 7909 subjects aged ≥15 without known diabetes from the baseline of Pudong community cohort in 2013. Participants took oral glucose tolerance test (OGTT) and HbA1c assay. Receiver operating characteristic curve determined the HbA1c threshold in the diagnosis of hyperglycemia. RESULTS: The optimal HbA1C threshold for diagnosing newly diagnosed diabetes (NDD) and pre-diabetes in this population was 6.0% (AUC=0.798, 95%CI: 0.779-0.818) and 5.6% (AUC=0.655, 95%CI: 0.638-0.671). When compared with elderly age group (≥70 years), HbA1c for detecting NDD performed better in youth (15-39 years: P=0.003, 40-49 years: P<0.001). There were 13.81% and 13.34% of participants would be newly detected as NDD and pre-diabetes via HbA1c criteria; meanwhile 3.20% and 15.52% diagnosed as NDD and pre-diabetes by OGTT criteria would be missed diagnosis. CONCLUSIONS: The optimal HbA1c thresholds for NDD and pre-diabetes were lower than ADA criteria. It is necessary to carefully consider whether choose HbA1c as a diagnostic criterion or combine two diagnostic standards. Age-specific diagnostic thresholds should be considered when HbA1c was recommended as diagnostic standard.

Sex-specific associations between extreme sleep duration and prevalence of cardio-cerebral vascular disease: a community-based cross-sectional study.

BACKGROUND: Most previous studies on sleep duration and cardio-cerebral vascular disease (CCVD) association have not adequately controlled for many confounders. The current study prospectively examined the association of sleep duration with CCVD prevalence in a Chinese community population; cardiovascular risk factors, chronic diseases, and sleep quality were taken into consideration. METHODS: A cross-sectional study conducted in Pudong New Area of Shanghai, China. Through three-stage sampling, 10,657 adults aged ≥15 years were randomly selected. Self-reported sleep duration and CCVD prevalence were obtained using a structured questionnaire. Medical records of the subjects were reviewed by investigators for further confirmation. Relationships between sleep duration and CCVD prevalence were examined using logistic regression models. RESULTS: Compared to midrange sleep duration (7 h), the multivariate-adjusted OR of CCVD prevalence was 1.550 (95% CI 1.192-2.017) for sleeping 5 h, 1.427 (95% CI 0.983-2.072) for sleeping <5 h. A similar situation also prevailed in coronary heart disease (CHD) prevalence: the multivariate-adjusted OR of stroke prevalence was 2.130 (95% CI 1.338-3.389) for sleeping >9 h. In an analysis stratified by sex, participants with a long sleep duration (>9 h) demonstrated significantly increased prevalence (OR = 3.623, 95% CI 1.862-7.052) for stroke only in men. CONCLUSIONS: The relationship between extreme sleep durations and CCVD were influenced by sex in a Chinese community population. Further studies are needed to investigate the mechanisms of the association between extreme sleep duration and CCVD, as well as sex-specificity in the relationship.

[Estimates and prediction on incidence, mortality and prevalence of brain and neurologic tumors in China, 2008].

OBJECTIVE: To estimate the incidence, mortality and 5-year prevalence of brain and neurologic tumors in China, 2008. METHODS: Data from 36 cancer registries in China and from the Third National Death Survey in China were used to estimate the incidence, mortality and 5-year prevalence of brain and neurologic tumors in 2008, using the mathematical models. Prediction on the incidence, and mortality of brain and neurologic tumors in the next 20 years was also carried out. RESULTS: In 2008, the incidence of brain and neurologic tumors in China was 66 454 (2.4%) and the incidence rate of age-standardized was 4.4/100 000, ranking tenth among all the cancers. The mortality of brain and neurologic tumors in China was 45 573 (2.3%), with mortality rate as 3.0/100 000, which ranked seventh among all the cancers. The 5-year prevalence of brain and neurologic tumors in China was 91 449 (2.0%) and the proportion was 8.6/100 000, which ranked twelfth among all the cancers. Incidence rates of brain and neurologic tumors in all the age groups were similar in both sexes, but the rate of incidence increased faster before 40 years old and slowed down thereafter. In the next 20 years, data from the prediction showed that the incidence and mortality of brain and neurologic tumors in China would gradually increase. CONCLUSION: The burden of brain and neurologic tumors was increasing continuously.

[Estimates and prediction of prostate cancer incidence, mortality and prevalence in China, 2008].

OBJECTIVE: To estimate the incidence, mortality and 5-year prevalence of prostate cancer in China, in 2008. METHODS: Data from 36 cancer registries and the Third National Death Survey in China (2004-2005) was used to estimate the incidence, mortality and 5-year prevalence rates of prostate cancer in China in 2008. Mathematical models were used to predict the incidence and mortality of prostate cancer in the next 20 years. RESULTS: In 2008, the incidence of prostate cancer was 33 802 (2.1%), with the incidence rate as 4.3/100 000, which ranked the eighth among all the male cancers. Mortality of prostate cancer in China was 14 297 (1.2%) with the mortality rate of 1.8/100 000, which ranked eleventh among all the male cancers. The 5-year prevalence rate of prostate cancer in China was 75 535 (3.5%) with the proportion of 13.8/100 000, ranking the seventh among all the male cancers. The incidence and mortality of prostate cancer in men before the age of 60 maintained at a low level, but rose rapidly after the age of 60. Data on prediction showed that the incidence and mortality of prostate cancer in China would gradually increase in the next 20 years. CONCLUSION: Both incidence and mortality of prostate cancer in China would keep increasing in the future. Prevention and control programs for prostate cancer should be strengthened.