Integrating machine learning and artificial intelligence in life-course epidemiology: pathways to innovative public health solutions.

The integration of machine learning (ML) and artificial intelligence (AI) techniques in life-course epidemiology offers remarkable opportunities to advance our understanding of the complex interplay between biological, social, and environmental factors that shape health trajectories across the lifespan. This perspective summarizes the current applications, discusses future potential and challenges, and provides recommendations for harnessing ML and AI technologies to develop innovative public health solutions. ML and AI have been increasingly applied in epidemiological studies, demonstrating their ability to handle large, complex datasets, identify intricate patterns and associations, integrate multiple and multimodal data types, improve predictive accuracy, and enhance causal inference methods. In life-course epidemiology, these techniques can help identify sensitive periods and critical windows for intervention, model complex interactions between risk factors, predict individual and population-level disease risk trajectories, and strengthen causal inference in observational studies. By leveraging the five principles of life-course research proposed by Elder and Shanahan-lifespan development, agency, time and place, timing, and linked lives-we discuss a framework for applying ML and AI to uncover novel insights and inform targeted interventions. However, the successful integration of these technologies faces challenges related to data quality, model interpretability, bias, privacy, and equity. To fully realize the potential of ML and AI in life-course epidemiology, fostering interdisciplinary collaborations, developing standardized guidelines, advocating for their integration in public health decision-making, prioritizing fairness, and investing in training and capacity building are essential. By responsibly harnessing the power of ML and AI, we can take significant steps towards creating healthier and more equitable futures across the life course.

Sex-Specific Differences in the Progression of Huntington's Disease Symptoms - A National Study in China.

INTRODUCTION: Huntington's disease (HD) is a rare, inherited neurodegenerative disorder. Despite extensive research on symptom progression and sex differences in Western populations, little is known about these aspects within the Chinese context. The objective of this study was to investigate the temporal trends of symptoms in individuals with HD in China. METHODS: A nationwide cross-sectional study was conducted in Chinese individuals diagnosed with HD. Symptom progression over time, encompassing physical, psychiatric, and cognitive symptoms, was self-reported. We calculated the proportions of individuals who currently had each symptom by disease duration, and tested corresponding temporal trends by linear regression analyses. RESULTS: A total of 269 individuals diagnosed with HD were included. Specific symptoms were found to progress more significantly in males compared to females over time, including psychotic symptoms (p = 0.007), urinary incontinence (p = 0.013), reduced concentration (p = 0.005), font alteration (p = 0.029), atypical facial expression (p = 0.037), and suicidal ideation (p = 0.047). In terms of cognitive and psychiatric symptoms, no significant temporal trends were identified in females, while males demonstrated significant increasing trends, with reduced concentration (p = 0.005) and psychotic symptoms (p = 0.007) standing out. CONCLUSIONS: This study emphasizes the existence of sex-specific symptom progression in HD within the Chinese population, underscoring the importance of considering sex in clinical practice. Further research should investigate the mechanisms behind these differences and explore tailored treatment options.

Economic Burden of Huntington's Disease in China: Results from a National-Wide Cross-Sectional Study.

BACKGROUND: Huntington's disease (HD) poses a significant socio-economic burden globally. Existing research on HD's economic burden predominantly comes from Western settings, leaving a gap in data from Asian countries. This study aimed to assess the economic burden of HD in China and identify cost-driving factors. METHODS: This study used data from a 2019 nationwide cross-sectional survey of individuals affected by rare diseases in China. Data included socio-demographic characteristics, income, disease stage, health and social insurance coverage status, treatment-seeking behaviour, and costs. Logistic regression and linear regression were used to explore potential contributors to treatment-seeking behaviour and associated costs. RESULTS: Of the 269 individuals with HD included in this study, 80.6% were actively seeking treatment. The average annual direct medical cost, direct non-medical cost, and indirect cost were 3,265.65, 805.82, and 801.97 Euros, respectively. Compared to participants with early-stage HD, those with middle- or advanced-stage HD reported higher direct medical costs (coefficient 1,612.70, 95% confidence interval [CI]: [141.92, 3,083.48] and 2,398.58, 95% CI: [791.16, 4,006.00], respectively). However, the disease stage was not significantly associated with direct non-medical costs or indirect costs. CONCLUSIONS: This study provides crucial insights into the economic burden of HD in China. It emphasises a need for targeted policies that better cater to the financial needs of HD patients.

Weight-adjusted waist index as a practical predictor for diabetes, cardiovascular disease, and non-accidental mortality risk.

BACKGROUND AND AIM: Identifying a more suitable marker among various measures of adiposity, demonstrating strong associations and predictive ability for clinical use, remains a topic of debate. Weight-adjusted waist index (WWI) has been proposed as a novel index of adiposity, yet its exploration is limited, especially in Chinese populations. This study seeks to examine the associations between body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), waist-to-height ratio (WHTR), weight-adjusted waist index (WWI), waist circumference divided by body mass to the power of 0.333 (WC/M0.333), visceral adiposity index (VAI), lipid accumulation product (LAP), and the incidence of diabetes, cardiovascular disease, and non-accidental mortality in Chinese populations. Furthermore, our goal is to compare the respective predictive values of these measures for these health outcomes. METHODS AND RESULTS: This prospective cohort study included 21,750 subjects with a 9-year follow-up period. Cox proportional hazard models were used to investigate the relationship between eight anthropometric indexes and the incidence of diabetes, cardiovascular disease, and non-accidental mortality. The predictive value of these eight indexes was compared using the area under the curve metric. Significant positive associations were found between WWI and the risk of diabetes. Using the first quartile (Q1) of WWI as the reference group, hazard ratios with 95% confidence intervals for the risk of diabetes were 1.58 (0.98-2.55) for Q2, 2.18 (1.34-3.35) for Q3, and 2.27 (1.41-3.67) for Q4. Significant associations were observed with the highest quartile of WWI for the risk of cardiovascular disease [Q2: HR 1.45 (95% CI 1.06-1.98); Q3: 1.33 (0.97-1.83); Q4: 1.55 (1.13-2.14)] and risk of non-accidental mortality [Q2: 0.94 (0.80-1.11); Q3: 1.24 (1.04-1.48); Q4: 1.44 (1.16-1.79)]. Receiver operating characteristic analysis revealed that WWI exhibited superior discrimination and accuracy in predicting cardiovascular disease and non-accidental mortality compared to other adiposity indexes (BMI, WC, WHR, WHTR, WC/M0.333, VAI, and LAP). CONCLUSION: WWI exhibited the most robust and consistent association with the incidence of cardiovascular disease and non-accidental mortality. Given its simplicity and widespread use, WWI emerges as a novel and practical predictor of diabetes, cardiovascular disease, and non-accidental mortality among the eight adiposity indexes investigated in this study.

Cardiorespiratory fitness and metabolic risk in Chinese population: evidence from a prospective cohort study.

BACKGROUND: Studies on the association between estimated cardiorespiratory fitness (CRF) and changes in metabolic risk in the Chinese population are limited. This study aims to examine the associations between CRF and changes in metabolic risk. SUBJECTS AND METHODS: We included 4,862 and 2,700 participants recruited from 28 provinces in the China Health and Retirement Longitudinal Study (CHARLS) in the baseline (Wave 1) and follow-up (Wave 4) analyses, respectively. CRF was calculated using sex-specific longitudinal non-exercise equations. Metabolic indicators included systolic blood pressure (SBP), diastolic blood pressure (DBP), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), and fasting plasma glucose (FPG) levels. The metabolic score was calculated as the number of changes in the above metabolic indicators above the 75th percentile of the distribution of changes (equal to or below the 25th percentile for HDL-C). RESULTS: In the baseline analysis, CRF was negatively associated with SBP, DBP, TG, and FPG, and positively correlated with HDL-C after adjusting for age, smoking status, and drinking status (all P < 0.0001) in both males and females. In the follow-up analysis, higher baseline CRF was significantly related to a decrease in SBP, DBP, TG, FPG, and metabolic score (all P < 0.0005), and increased HDL-C (P < 0.0001) after further adjustment for corresponding baseline metabolic indicators. The associations remained significant after stratification by sex, except for the changes in HDL-C levels in females. Furthermore, improved CRF was associated with favorable changes in DBP, TG, HDL-C, FPG, and metabolic scores in all populations and males. Significant associations between changes in CRF and DBP, TG, and FPG levels were found in females. CONCLUSION: Higher baseline CRF and improved CRF were associated with favorable changes in metabolic indicators.

Perceived discrimination and mental health among female migrant domestic workers in Hong Kong: A sequential explanatory mixed-methods study.

OBJECTIVES: Female migrant domestic workers (MDW), often unemployed in their home country, are household workers that migrate abroad for better wages. Although poor employment conditions have shown detrimental effects on MDWs health, the mental health effect of perceived discrimination remains understudied among MDWs. This mixed-methods study seeks to (a) assess the association between perceived discrimination and mental health among female MDWs and (b) explore in-depth the common ways MDWs experience discrimination. METHOD: A cross-sectional self-administered survey (n = 1965) was conducted among Filipino and Indonesian MDWs from August 2020 to August 2021 in Hong Kong. A multivariable logistic regression model, controlling for background characteristics, assessed associations between perceived discrimination with anxiety and depression. Qualitative semistructured interviews were then conducted (n = 20) to provide in-depth information about perceived discrimination. Thematic analysis was used to identify the contexts and types of discrimination experienced. RESULTS: Among survey respondents, 60.4% reported ever experiencing discrimination, and 10.5% reported often/always feeling discriminated against. Of MDWs, 18.1% and 31.5% were classified with anxiety and depression, respectively. MDWs reporting higher frequency of discrimination were at increased risk of anxiety (ORadj: 2.30-6.60) and depression (ORadj: 2.06-5.91). In-depth interviews revealed that perceived discrimination inside the workplace (from overwork, lack of autonomy, and employer-imposed restrictions) and outside the workplace (from MDW policies) had strong effects on MDWs' mental health. CONCLUSIONS: Increased availability to mental health services should be considered. To improve MDW mental health, policymakers may also regulate maximum weekly working hours and ensure minimum standards for living environments. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Estimated cardiorespiratory fitness and incident risk of cardiovascular disease in China.

BACKGROUND: Limited evidence is available on the association between estimated cardiorespiratory fitness (e-CRF) and incidence of cardiovascular disease (CVD) in Chinese population. METHODS: A total of 10,507 adults including 5084 men (48.4%) and 5423 (51.6%) women with a median age of 56.0 (25% quantile: 49, 75% quantile 63) years from the China Health and Retirement Longitudinal Study (CHARLS) was recruited in 2011 as baseline. The CVD incident events were followed-up until 2018. e-CRF was calculated from sex-specific longitudinal non-exercise equations and further grouped into quartiles. Cox proportional models were used to calculate hazard ratio (HR) and 95% confidence interval (CI) for incidence risks of CVD, heart disease and stroke. RESULTS: During a median follow-up of 7 years, a total of 1862 CVD, 1409 heart disease and 612 stroke events occurred. In fully adjusted models, each one MET increment of e-CRF was associated with lower risk of CVD (HR = 0.91, 95%CI = 0.85-0.96 for males, HR = 0.87, 95%CI = 0.81-0.94 for females). Compared with the Quartile (Q)1 group, the HRs (95%CI) of the Q2, Q3 and Q4 groups were 0.84 (0.63-1.03), 0.72 (0.57-0.91) and 0.66 (0.51-0.87) for CVD in males. Females had HRs of 0.79 (0.66-0.96) in Q2, 0.71 (0.57-0.88) in Q3 and 0.58 (0.45-0.75) in Q4 for CVD. The associations between e-CRF and heart disease and stroke were slightly weaker than that for CVD in both males and females. CONCLUSIONS: Higher e-CRF decreases the incident risk of CVD, heart disease and stroke.

Association between the hearing aid and mental health outcomes in people with hearing impairment: A case-control study among 28 European countries.

BACKGROUND: Hearing loss affects over 1.5 billion individuals globally, with significant implications for mental health. This study investigates the association between hearing aid use and mental health outcomes, by particularly focusing on depression and unmet mental health needs (UMHN), across a diverse international sample. METHODS: Utilizing data from the third wave of the European Health Interview Survey (EHIS), this study involved 17,660 participants with hearing impairment from 28 countries. The study examined the association between hearing aid use and mental health outcomes, including the likelihood of moderate and severe depression and UMHN due to lack of contact with general practitioners (GPs) and mental health specialists. Logistic regression models, adjusted for socio-demographic characteristics, health risk behaviours, and other relevant variables, were employed. Inverse probability weights were used to mitigate potential selection bias. RESULTS: Hearing aid usage was associated with significantly lower likelihoods of moderate depression (Odds Ratio [OR] = 0.58, 95%CI = [0.54, 0.63]) and severe depression (OR = 0.61, 95%CI = [0.55, 0.69]), compared to non-usage. Hearing aid usage was also associated with reduced UMHN due to lack of GP contact for moderate (OR = 0.82, 95%CI = [0.75, 0.89]) and severe depression (OR = 0.75, 95%CI = [0.59, 0.95]). The depression risk reductions were greater among females and higher-educated subgroups but lower in individuals aged ≥65 years. Income level and rurality also impacted UMHN due to the lack of GP contact. No associations were found between hearing aids and UMHN due to the lack of mental health specialist contact. CONCLUSIONS: Hearing aid adoption showed protective associations against mood disorders and lowered unmet primary mental healthcare needs. Tailoring intervention strategies to vulnerable sociodemographic profiles could optimize mental health benefits among those with hearing loss. Integrating hearing health services within mental healthcare delivery frameworks is vital amidst the rising global burden.

Who is being targeted by alcohol social media marketing? A study of Chinese young adults in Hong Kong.

INTRODUCTION: Due to the widespread use of social media by young adults, the alcohol industry has been increasingly using social media marketing (SMM) to target potential customers. This study examines the prevalence and factors associated with past-month exposure to alcohol SMM among young Chinese adults, a group with rapidly increasing uptake of alcohol consumption. METHODS: An anonymous, random telephone survey was conducted between June and August 2021 on Hong Kong Chinese residents between 18 and 34 years old (n = 675). RESULTS: Of respondents, 52.3% reported past-month exposure to alcohol SMM (68.6% of past-month drinkers and 48.0% of non-past-month drinkers, p < 0.05) while 71.6% reported exposure to non-SMM alcohol marketing. Direct alcohol SMM exposure was reported by 40.9% (e.g., business-to-consumer postings, alcohol banner ads) while 27.4% of respondents reported exposure to indirect alcohol SMM marketing (e.g., shared/'liked' alcohol brand posts). Of those exposed to alcohol SMM, 13.7-15.5% reported that the various forms indirect alcohol SMM influenced them to drink more (vs. 6.2-8.9% for direct alcohol SMM). Being male, lower-income, university educated and spirits/cocktail drinker were independently associated with exposure to direct alcohol SMM (ORmv 1.71-3.14). Past-month exposure to indirect alcohol SMM was independently associated with lower income, not working full-time and drinking any type of alcohol (ORmv 1.59-4.44). DISCUSSION AND CONCLUSION: The comparative effectiveness of indirect SMM on influencing young adults drinking intentions may be a form of peer endorsement of drinking. The pervasiveness of alcohol SMM and lack of alcohol SMM policies may indicate the need for greater alcohol marketing regulation in this region.

Patterns of the Health and Economic Burden of 33 Rare Diseases in China: Nationwide Web-Based Study.

BACKGROUND: Rare diseases (RDs) affect millions of individuals collectively worldwide, contributing to significant burdens on patients and families in various aspects. However, there is a lack of evidence on the underlying patterns of burdens among diverse RDs for informing targeted social and health policies to address the unmet needs of this vulnerable population. OBJECTIVE: This study aimed to examine the underlying patterns of the health and economic burden of 33 different RDs in China and identify the potential determinants. METHODS: A nationwide internet-based cross-sectional survey was conducted in China between 2019 and 2020. Physical and mental health burden was measured by health-related quality of life. Economic burden was evaluated based on the proportions of direct medical, direct nonmedical, and indirect costs relative to household income. We used cluster analysis to identify patterns of health and economic burdens and conducted multinomial logistic regression to explore potential predictors of cluster membership. RESULTS: The study included 8454 adults and 8491 children affected by 33 RDs. The following 3 clusters were identified: "extremely high burden" (representing 92/8454, 1.1% and 19/8491, 0.2% of adult and pediatric patients, respectively), "overall high burden" (5933/8454, 70.2% and 4864/8491, 57.3%, respectively), and "overall low burden" (2429/8454, 28.7% and 3608/8491, 42.5%, respectively). Wilson disease, Marfan syndrome, and Langerhans cell histiocytosis more likely resulted in an "extremely high burden" than others. Poverty was significantly associated with being in this extremely high burden group. Diseases causing neuromuscular symptoms and requiring long-term treatment (eg, amyotrophic lateral sclerosis, spinocerebellar ataxia, and Dravet syndrome) were prevalent in the "overall high burden" group. Key predictors of this group included older age, lower socioeconomic status, diagnostic delay, and comorbidity. CONCLUSIONS: This study provides novel and valuable evidence on the burden of RDs in developing regions like China. The findings reveal significant disparities in the impact of RDs, emphasizing the need for targeted health care interventions and policies.

Social support and medication adherence among adult myasthenia gravis patients in China: the mediating role of mental health and self-efficacy.

BACKGROUND: Myasthenia gravis (MG), a rare chronic neuromuscular disorder, is characterized by progressive physical decline and requires long-term pharmacological treatment. Due to the decline of physical and social abilities, MG patients are in great need of social support, including tangible and emotional support. This study aims to examine the association between social support and medication adherence and the possible mediating effects of mental health and self-efficacy among MG patients. METHODS: A cross-sectional analysis of a nationwide MG registry was conducted on 865 patients under oral medication treatment in China between June and July 2022. Validated scales were used to measure the respondent's mental distress (Four-item Patient Health Questionnaire), social support (Modified Medical Outcomes Study Social Support Scale), self-efficacy for medication use (Self-efficacy for Appropriate Medication Use Scale), and medication adherence (Morisky Medication Adherence Scale, MMAS). RESULTS: The association between social support and medication adherence and possible mediating effects of mental distress and self-efficacy were tested by structural equation model, with significant demographic and disease-related factors adjusted. The respondents showed a very low level of medication adherence (71.2% poor adherence; 1.4% high adherence; mean MMAS = 4.65). The level of social support was positively associated with medication adherence, and such association was fully mediated by two indirect pathways: through self-efficacy (ß = 0.07, proportion mediated = 63.8%); and through mental distress and then self-efficacy (ß = 0.01, proportion mediated = 6.7%). CONCLUSION: Provision of social support and interventions on mental health with emphasis on improving self-efficacy for medication use may effectively improve medication adherence among MG patients.

Feasibility of introducing effective alcohol harms reduction strategies in a low regulation region: A qualitative study from Hong Kong.

To counter the harms of excessive alcohol use, the World Health Organization (WHO) outlined a series of alcohol policy recommendations, including the most cost-effective "Best Buys". This study aims to obtain key stakeholder views on feasibility of implementing various publicly endorsed alcohol policies in Hong Kong, a relatively low alcohol consumption region with few extant alcohol regulations. Between 2019 and 2021, we conducted semi-structured interviews with stakeholders involved in alcohol policy adoption and implementation. Interviewees included hospitality/alcohol sales workers (n = 13) and government officers (n = 4). The stakeholders noted that although WHO advocacy facilitated local policy considerations, the adoption of stringent measures was challenged by low political priority due to the low visibility of harms. For implementing strategies, the stakeholders cited alignment with social norms as a major facilitator, whereas law enforcement difficulties and resistance from industry/business sectors were viewed as major obstacles. There was a general belief that population-level alcohol policies would be effective for certain groups of drinkers but would also harm the local economy and detract from Hong Kong's image as a "world city". Hong Kong may not be ready to adopt a wide range of highly restrictive population-level alcohol policies. Local governments should carefully consider contextual factors when following international recommendations.

Metabolic health and adiposity transitions and risks of type 2 diabetes and cardiovascular diseases: a systematic review and meta-analysis.

BACKGROUND: Metabolic health status and levels of adiposity are prone to change over time. Mixed results have been reported regarding the extent by which changes in metabolic health and weight affect cardiometabolic risks. This systematic review and meta-analysis aims to examine the association between transitions in metabolic health and adiposity status on risk of incident type 2 diabetes (T2DM) and cardiovascular disease (CVD) events. METHODS: A systematic literature search was conducted on MEDLINE and EMBASE through August 2022 for prospective cohort studies examining transitions in metabolic health and adiposity status and risk of incident T2DM and CVDs without restrictions on language or publication status. Meta-analysis was performed to summarize hazard ratios for T2DM and composite CVD events separately using random-effects model. RESULTS: A total of 17 studies were included. Compared to stable metabolically healthy status, transition to metabolically unhealthy status significantly increased the risk of incident T2DM and composite CVD events among individuals with normal weight and individuals with overweight/obesity. Compared to stable metabolically unhealthy status, transition to metabolically healthy status significantly lowered the risk among individuals with normal weight and individuals with overweight/obesity. When metabolic health status remained unchanged, progression from normal weight to overweight/obesity significantly increased risk of CVDs but not risk of T2DM. CONCLUSION: The impact of change in metabolic health on the risks of T2DM and CVD is more prominent than that of change to body mass index category. Obesity treatment should consider prioritizing improvement in metabolic health parameters over focusing on the extent of weight loss only.

Impacts of organic loading rate and hydraulic retention time on organics degradation, interspecies interactions and functional traits in thermophilic anaerobic co-digestion of food waste and sewage sludge.

This study provided novel insights into the effects of organic loading rate (OLR) and hydraulic retention time (HRT) on thermophilic anaerobic co-digestion of food waste and sewage sludge. The obtained maximum methane (CH4) yield of 328 ± 4 mL CH4/g CODfed at HRT of 15 days (OLR = 5.8 g VS/L/d) was partly attributable to the enhanced acidogenesis, acetogenesis, and methanogenesis phases. The increased key enzyme activities, particularly acetate kinase (improved by 5.2-fold), providing substantial methanogenic substrates for efficient CH4 production. The functional syntrophs that were related to syntrophic decarboxylation, novel acetate oxidation & reductive acetyl-CoA, and ß-oxidation pathways could drive trophic interactions with methanogens. This markedly stimulated hydrogenotrophic Methanoculleus thermophilus metabolism and concomitantly enriched mixotrophic Methanosarcina thermophila. The distinctive cross-feeding interspecies interactions significantly affected the assembly and dynamics of thermophilic consortia. These findings shed light on the physicochemical and microbial mechanisms of HRT- and OLR-dependent enhancement of methanogenesis.

Healthy lifestyle scores associate with incidence of type 2 diabetes mediated by uric acid.

BACKGROUND: Whether and to what extent serum uric acid (SUA) mediates the association between combined lifestyle behaviors and type 2 diabetes mellitus (T2DM) remain unclear. This study aimed to investigate the role of SUA in the relationship between healthy lifestyle scores (HLS) and the incidence of T2DM. METHODS: This prospective study used data from Zhejiang Metabolic Syndrome cohort. A HLS (5-point scale including healthy waist circumference (WC), never smoking, high physical activity, healthy diet and moderate alcohol intake) was estimated in 13,919 participants, who had SUA at baseline examination in 2009-2014, and were followed-up to 2021-2022 to ascertain incident of T2DM. Cox proportional hazards models and mediation analysis were used to examine the associations between HLS, SUA and T2DM. RESULTS: We included 13,919 participants aged 18 years or older without diabetes at baseline (mean age 54.6 [SD 13.9] years, 58.7% female). During a median follow-up of 9.94 years, 645 cases of T2DM occurred. Compared with participants with a poor HLS, those with 4-5 low-risk lifestyle factors showed a 60% reduction in the risk of developing T2DM (adjusted HR, 0.40; 95% CI: 0.28-0.57). Further, the population-attributable risk percent (95% CI) of T2DM for poor adherence to the overall healthy lifestyle (< 4 low-risk factors) was 43.24% (30.02%, 56.46%). The HLS was inversely associated with SUA level. With per score increased in HLS, the beta (95% CI) of SUA (log transformed) was - 0.03 (- 0.03, - 0.02), and the odds ratio (95% CI) of hyperuricemia was 0.82 (0.77, 0.86). The relationship between the HLS and risk of T2DM was mediated by SUA with a 13.06% mediation effect. There was no significant combined effect of HLS and SUA on risk of T2DM (P = 0.097). CONCLUSIONS: The relationship between overall healthy lifestyle behaviors and T2DM was reconfirmed and the association appeared to be mediated by SUA. The mediation effect of baseline SUA was more pronounced among women who were below 60 years old.

Combined Effect of Healthy Lifestyle Factors and Risks of Colorectal Adenoma, Colorectal Cancer, and Colorectal Cancer Mortality: Systematic Review and Meta-Analysis.

Background: In addition to adiposity, lifestyle factors such as poor diet, low physical activity, alcohol intake and smoking are noted to be associated with the development of colorectal cancer (CRC). This study aims to investigate the association and dose-response relationship between adherence to a healthy lifestyle and CRC risk. Methods: A systematic literature search was conducted in MEDLINE and EMBASE for studies examining multiple lifestyle factors with risk of CRC, incident colorectal adenoma (CRA), and CRC-specific mortality through June 2021 without restrictions on language or study design. Meta-analysis was performed to pool hazard ratios using random-effects model. Subgroup analyses were performed based upon study and sample characteristics. Random-effects dose-response analysis was also conducted for CRC risk to assess the effect of each additional healthy lifestyle factor. Results: A total of 28 studies (18 cohort studies, eight case-control studies, and two cross-sectional study) were included. When comparing subjects with the healthiest lifestyle to those with the least healthy lifestyle, the pooled HR was statistically significant for CRC (0.52, 95% CI 0.44-0.63), colon cancer (0.54, 95% CI 0.44-0.67), rectal cancer (0.51, 95% CI 0.37-0.70), CRA (0.39, 95% CI 0.29-0.53), and CRC-specific mortality (0.65, 95% CI 0.52-0.81). The pooled HR for CRC was 0.91 (95% CI: 0.88-0.94) for each increase in the number of healthy lifestyles. The inverse association between healthy lifestyle and CRC risk was consistently observed in all subgroups (HR ranging from 0.26 to 0.86). Conclusions: Adoption of a higher number of healthy lifestyles is associated with lower risk of CRC, CRA, and CRC-specific mortality. Promoting healthy lifestyle could reduce the burden of CRC. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=231398, identifier CRD42021231398.

Selling World Health Organization's Alcohol "Best Buys" and Other Recommended Interventions in an Urban Chinese Population: Public Acceptability of Alcohol Harms Reduction Strategies in Hong Kong.

Background: To counter the harms caused by alcohol use, the World Health Organization (WHO) outlined a series of evidence-based recommendations, including the highly cost-effective "Best Buys" recommendations. While many Western countries have been actively introducing alcohol harms reduction strategies, it is unclear whether these cost-effective policies would be publicly acceptable in Asian regions with traditionally low alcohol consumption. This study examines the public acceptability of WHO-recommended alcohol harms reduction strategies in an Asian city with few extant alcohol regulations. Methods: A cross-sectional telephone survey of Hong Kong Chinese residents aged 18-74 (n = 4,000) was conducted from January to August 2018. Respondents were asked about their perceptions of various WHO-recommended strategies and consequences of their implementation. After reducing the strategies into several policy categories by principal component analysis, multivariable linear regression was performed to identify factors associated with endorsement of the various policies. Results: Among the "Best Buys", introduction of moderate beer/wine taxes (68.7%) and shortened alcohol retail hours (51.9%) were the most supported while bans on event sponsorships (19.5%) and public drinking events (17.7%) were the least popular. Strategies targeting young drinkers were particularly highly supported. Males, younger adults, Non-abstainers, and those who believed in drinking's social benefits were less likely to endorse stringent control measures (p < 0.05). Adults with higher household income were less supportive, partially due to concerns about infringements on local economy, lifestyles, and economic freedom. Women and older people were generally more supportive, partially because they perceived these policies would lower alcohol-related harms. Conclusion: In order to reduce barriers to implementing WHO-recommended strategies in the region, it is imperative to increase awareness of alcohol-related harms and to strengthen beliefs in the effectiveness of these countermeasures, especially among men, young adults, and drinkers.

Dynamic Status of SII and SIRI Alters the Risk of Cardiovascular Diseases: Evidence from Kailuan Cohort Study.

Background: Two novel systemic inflammation indices, SII and SIRI, are associated with increased risk of cardiovascular diseases (CVD). However, SII and SIRI are prone to change over time and the association between changeable status and long-term outcome risk remains to be uncovered. This study aims to examine the association between the dynamic status of SII and SIRI and risk of CVD. Methods: This prospective study included a total of 45,809 subjects without MI, stroke and cancer prior to or in 2010 (baseline of this study). The dynamic status of SII and SIRI during 2006, 2008, and 2010 was assessed by dynamic trajectories (primary exposure), annual increase, and average value. The outcome was CVD incidence during 8.6 years' follow-up. Multiple Cox regression models were used to calculate the adjusted hazard ratios (HRs) and confidence intervals (95% CIs). Results: Four dynamic trajectories of SII and SIRI were identified as follows: low stable pattern, moderate stable pattern, increase pattern, and decrease pattern. For SII, compared with "low stable pattern", after controlling confounders and level of SII in 2006, adjusted HRs were 1.24 (95% CI = 1.02-1.51) for "increase pattern" and 1.11 (95% CI = 1.00-1.23) for "moderate-stable pattern" while the association was not significant for "decrease pattern". Additionally, the highest group of annual SII increase and average SII had respective HR of 1.20 (95% CI = 1.05-1.37) and 1.32 (95% CI = 1.13-1.55). The results were consistent for SIRI. "Increase pattern" and "moderate stable pattern" increased the risk of CVD by 38% (HR = 1.38, 95% CI = 1.17-1.63) and 12% (HR = 1.12, 95% CI = 1.01-1.25), while no significant association was found for "decrease pattern". The highest group of annual SIRI increase and average SIRI had respective HR of 1.25 (95% CI = 1.09-1.44) and 1.39 (95% CI = 1.19-1.63). Conclusion: Dynamic status of SII and SIRI was significantly associated with risk of CVD, which highlighted that we should focus on the dynamic change of SII and SIRI.

First- and second-hand alcohol-related harms among urban Chinese: A population-based study from Hong Kong.

INTRODUCTION: Alcohol consumption has been steadily increasing in East Asia, however, there is comparatively little regional data of alcohol-related harms. This study examines the alcohol-related harms prevalence and risk factors in Hong Kong, a high population density city with limited alcohol regulation. METHODS: A cross-sectional telephone survey was conducted in 2019 on Chinese adults aged 18-74 (n = 3200). Respondents were asked about various past-year first-hand drinking harms (after one's own drinking), second-hand harms (harms from other people's drinking) and views of neighbourhood alcohol outlet regulation. RESULTS: Of drinkers, 21.1% reported first-hand alcohol harms, with physical/mental health harms (15.7%) most commonly reported. Younger-aged drinkers (adjusted odds ratios [AOR] 2.64, 95% confidence interval [CI] 1.63, 4.48) and heavy drinkers (AOR 2.34, 95% CI 1.55, 3.55) were more likely to report first-hand harms. Of the sample, 18.2% experienced past-year second-hand harms, with public harms (12.9%) most commonly reported. Young age (AOR 1.88, 95% CI 1.43, 2.49), higher education (AOR 1.44, 95% CI 1.13, 1.83), past-year binge drinking (AOR 4.29, 95% CI 3.04, 6.05) and communal living (AOR 2.04, 95% CI 1.13, 3.75) predicted greater likelihood of second-hand alcohol harms. Higher neighbourhood alcohol outlet density was not associated with any first-hand harms and only significantly predicted being inconvenienced by drinkers. Although victims of second-hand alcohol harms were more supportive of regulating outlet density, 93.3% of respondents were opposed to such policies. DISCUSSION AND CONCLUSIONS: Although high levels of alcohol-related harms were not reported by Hong Kong adults, regulations should target young drinkers and binge drinkers who are most likely to experience drinking-related harms.