Long-Term Exposure to PM2.5 and Mortality: A Cohort Study in China.

We investigated the association of long-term exposure to atmospheric PM2.5 with non-accidental and cause-specific mortality in Yinzhou, China. From July 2015 to January 2018, a total of 29,564 individuals aged ≥ 40 years in Yinzhou were recruited for a prospective cohort study. We used the Cox proportional-hazards model to analyze the relationship of the 2-year average concentration of PM2.5 prior to the baseline with non-accidental and cause-specific mortality. The median PM2.5 concentration was 36.51 µg/m3 (range: 25.57-45.40 µg/m3). In model 4, the hazard ratios per 10 µg/m3 increment in PM2.5 were 1.25 (95%CI: 1.04-1.50) for non-accidental mortality and 1.38 (95%CI:1.02-1.86) for cardiovascular disease mortality. We observed no associations between PM2.5 and deaths from respiratory disease or cancer. In the subgroup analysis, interactions were observed between PM2.5 and age, as well as preventive measures on hazy days. The observed association between long-term exposure to atmospheric PM2.5 at a relatively moderate concentration and the risk of non-accidental and cardiovascular disease mortality among middle-aged and elderly Chinese adults could provide evidence for government decision-makers to revise environmental policies towards a more stringent standard.

Age at diagnosis modifies associations of type 2 diabetes with cancer incidence and mortality: a retrospective matched-cohort study.

AIMS/HYPOTHESIS: The age-specific associations between type 2 diabetes and cancer risk are not fully understood. The aim of this study was to assess how age at diagnosis modifies the associations between type 2 diabetes and cancer risk. METHODS: We used data from the Yinzhou Health Information System, and included 42,279 individuals who were newly diagnosed with type 2 diabetes between 2010 and 2014, as well as 166,010 age- and sex-matched control individuals without diabetes who were selected randomly from the electronic health records of the entire population. Patients were divided into four age groups according to age at diagnosis: <50, 50-59, 60-69 and ≥70 years. Stratified Cox proportional hazards regression models, with age as the time scale, were used to estimate the HRs and 95% CIs for the associations of type 2 diabetes with the risks of overall and site-specific cancers. Population-attributable fractions were also calculated for outcomes associated with type 2 diabetes. RESULTS: During median follow-up periods of 9.20 and 9.32 years, we identified 15,729 incident cancer cases and 5383 cancer deaths, respectively. Patients diagnosed with type 2 diabetes before 50 years of age had the highest relative risks of cancer incidence and mortality, with HRs (95% CI) of 1.35 (1.20, 1.52) for overall cancer incidence, 1.39 (1.11, 1.73) for gastrointestinal cancer incidence, 2.02 (1.50, 2.71) for overall cancer mortality, and 2.82 (1.91, 4.18) for gastrointestinal cancer mortality. Risk estimates decreased gradually with each decade increase in diagnostic age. The population-attributable fractions for overall cancer and gastrointestinal cancer mortality also decreased with increasing age. CONCLUSIONS/INTERPRETATION: The associations of type 2 diabetes with cancer incidence and mortality varied by age at diagnosis, with a higher relative risk among patients who were diagnosed at a younger age.

Long-term exposure to ambient air pollution and incidence of depression: A population-based cohort study in China.

BACKGROUND: Long-term exposure to ambient air pollution was linked to depression incidence, although the results were limited and inconsistent. OBJECTIVES: To investigate the effects of long-term air pollution exposure on depression risk prospectively in China. METHODS: The present study used data from Yinzhou Cohort on adults without depression at baseline, and followed up until April 2020. Two-year moving average concentrations of particulate matter with a diameter ≤ 2.5 µm (PM2.5), ≤10 µm (PM10) and nitrogen dioxide (NO2) were measured using land-use regression (LUR) models for each participant. Depression cases were ascertained using the Health Information System (HIS) of the local health administration by linking the unique identifiers. We conducted Cox regression models with time-varying exposures to estimate the hazard ratios (HRs) and 95% confidence intervals (95% CIs) of depression with each pollutant, after adjusting for a sequence of individual covariates as demographic characteristics, lifestyles, and comorbidity. Besides, physical activity, baseline potential depressive symptoms, cancer status, COVID-19 pandemic, different outcome definitions and air pollution exposure windows were considered in sensitivity analyses. RESULTS: Among the 30,712 adults with a mean age of 62.22 ± 11.25, 1024 incident depression cases were identified over totaling 98,619 person-years of observation. Interquartile range increments of the air pollutants were associated with increased risks of depression, and the corresponding HRs were 1.59 (95%CI: 1.46, 1.72) for PM2.5, 1.49 (95%CI: 1.35, 1.64) for PM10 and 1.58 (95%CI: 1.42, 1.77) for NO2. Subgroup analyses suggested that participants without taking any protective measures towards air pollution were more susceptible. The results remained robust in all sensitivity analyses. CONCLUSIONS: Long-term exposure to ambient air pollution was identified as a risk factor for depression onset. Strategies to reduce air pollution are necessary to decrease the disease burden of depression.

HDL-C, longitudinal change and risk of mortality in a Chinese cohort study.

BACKGROUND AND AIMS: High-density lipoprotein cholesterol (HDL-C) concentration and variability are both important factors of cardiovascular disease (CVD) and mortality. We aimed to explore the associations of HDL-C and longitudinal change in HDL-C with risk of mortality. METHODS AND RESULTS: We recruited a total of 69,163 participants aged ≥40 years and had medical examination records of HDL-C during 2010-2014 from the Yinzhou District, Ningbo, China. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox proportional hazards regression models. We observed a non-linear association of HDL-C with risks of non-accidental and CVD mortality. Compared with the moderate concentration group (1.4-1.6 mmol/L), HDL-C <1 mmol/L was associated with a higher risk of non-accidental mortality (HR: 1.13 (95% CI: 1.01-1.27)) and both HDL-C <1 mmol/L and ≥2 mmol/L were associated with a higher risk of CVD mortality (HRs: 1.23 (95% CI: 1.01-1.50) and 1.37 (95% CI: 1.03-1.82), respectively). Compared with the stable group ([-0.1, +0.1 mmol/L]), a large decrease ([-0.5, -0.3 mmol/L]) and very large decrease (<-0.5 mmol/L) in HDL-C were associated with a higher risk of non-accidental mortality (HRs: 1.40 (95% CI: 1.21-1.63) and 1.78 (95% CI: 1.44-2.20), respectively). Similar results were observed for CVD mortality and cancer mortality. CONCLUSION: Extremely low or high HDL-C and a large decrease or very large decrease in HDL-C were associated with a higher risk of cause-specific mortality. Monitoring of HDL-C may have utility in identifying individuals at higher risk of mortality.

Low LDL-C levels are associated with risk of mortality in a Chinese cohort study.

BACKGROUND AND AIMS: Although low-density lipoprotein cholesterol (LDL-C) has been considered as a risk factor of atherosclerotic cardiovascular disease, limited studies can be available to evaluate the association of LDL-C with risk of mortality in the general population. This study aimed to examine the association of LDL-C level with risk of mortality using a propensity-score weighting method in a Chinese population, based on the health examination data. METHODS: We performed a retrospective cohort study with 65,517 participants aged 40 years or older in Ningbo city, Zhejiang. LDL-C levels were categorized as five groups according to the Chinese dyslipidemia guidelines in adults. To minimize potential biases resulting from a complex array of covariates, we implemented a generalized boosted model to generate propensity-score weights on covariates. Then, we used Cox proportional hazard regression models with all-cause and cause-specific mortality as the dependent variables to estimate hazard ratios (HRs) and 95% confidence intervals (95% CIs). RESULTS: During the 439,186.5 person years of follow-up, 2403 deaths occurred. Compared with the median LDL-C group (100-130 mg/dL), subjects with extremely low LDL-C levels (group 1) had a higher risk of deaths from all-cause (HR = 2.53, 95% CI:1.80-3.53), CVD (HR = 1.84, 95% CI: 1.28-2.61), ischemic stroke (HR = 2.29, 95% CI:1.32-3.94), hemorrhagic stroke (HR = 3.49, 95% CI: 1.57-7.85), and cancer (HR = 2.12, 95% CI: 1.04-4.31) while the corresponding HRs in LDL-C group 2 were relatively lower than that in group 1. CONCLUSIONS: Low LDL-C levels were associated with an increased risk of all-cause, CVD, ischemic stroke, hemorrhagic stroke, and cancer mortality in the Chinese population.

[A case-control study on the relationship between nutrition and gastric cancer in islanders].

OBJECTIVE: To study the association between nutritional factors and gastric cancer in islanders. METHODS: A population-based case-control study on diet and gastric cancer was carried out in Zhoushan islands, China. 103 cases of gastric cancer newly diagnosed in 2001 and 133 controls frequency-matched by age, sex, and islands of residence among residents in Zhoushan were included in the study. Dietary intake was estimated using a constructed food frequency questionnaire. Total calories and 15 nutrients were calculated according to the food composition table and their adjusted odds ratios (OR) and 95% confidence intervals (CI) were estimated by gender using unconditional logistic regression models. RESULTS: Increased risks of gastric cancer were associated with protein (ORQ4 vs. Q1=10.3; P for linear trend=0.01), saturated fat (ORQ4 vs. Q1=3.24), and cholesterol (ORQ4 vs. Q1=2.76) particularly among males. Among females, carbohydrate was a significant high-risk nutrient (ORQ4 vs. Q1=14.8; P for linear trend=0.024). In both sexes, all cases reported a significantly higher daily intake of natrium mainly from salts than controls. An inversed association with the risk of gastric cancer was seen in vitamin A and vitamin C. CONCLUSION: The findings from this study provided information about the role of specific nutrients in the etiology of gastric cancer. High intakes of protein, saturated fat, cholesterol, sodium and poor intakes of vitamin A and C could increase the risk of gastric cancer.

[Study on the relationship between smoking, alcohol intake and hyperlipidemia in fishermen].

OBJECTIVE: To identify the relationship between smoking, alcohol intake and hyperlipidemia in fishermen. METHODS: 115 fishermen were randomly recruited and divided into case and control groups according to the result of blood lipoprotein. A questionnaire was used to record general information and the history of smoking and alcohol intake. Statistics were gathered to compare the difference of lipoprotein and apolipoprotein level between exposure and control groups and to calculate the OR value of smoking and alcohol intake. RESULTS: The OR of smoking was 3.417 (95% CI: 1.132 - 10.308), with significant dosage-effect relationship between smoking index and hyperlipidemia. The serum low density lipoprotein-cholesterol (LDL-C) and apolipoprotein (apo) B levels in smoking group was higher than that of control group. The OR value of alcohol intake at early age (early than 20) were 3.275 (95% CI: 1.249 - 8.580) and 4.016 (95% CI: 1.475 - 10.952) respectively. The LDL-C, apoB, the serum total cholesterol (TC)/high density lipoprotein-cholesterol (HDL-C) levels in alcohol abuse group were higher than that of control group. CONCLUSION: Smoking and alcohol abuse were important risk factors of hyperlipidemia, through changing the level of LDL-C and apoB. There was synergistic action between smoking and alcohol abuse in the development of hyperlipidemia.