Trihalomethanes in global drinking water: Distributions, risk assessments, and attributable disease burden of bladder cancer.

This study aimed to assess the global spatiotemporal variations of trihalomethanes (THMs) in drinking water, evaluate their cancer and non-cancer risks, and THM-attributable bladder cancer burden. THM concentrations in drinking water around fifty years on a global scale were integrated. Health risks were assessed using Monte Carlo simulations and attributable bladder cancer burden was estimated by comparative risk assessment methodology. The results showed that global mean THM concentrations in drinking water significantly decreased from 78.37 µg/L (1973-1983) to 51.99 µg/L (1984-2004) and to 21.90 µg/L (after 2004). The lifestage-integrative cancer risk and hazard index of THMs through all exposure pathways were acceptable with the average level of 6.45 × 10-5 and 7.63 × 10-2, respectively. The global attributable disability adjusted of life years (DALYs) and the age-standardized DALYs rate (ASDR) dropped by 16% and 56% from 1990-1994 to 2015-2019, respectively. A big decline in the attributable ASDR was observed in the United Kingdom (62%) and the United States (27%), while China experienced a nearly 3-fold increase due to the expanded water supply coverage and increased life expectancy. However, China also benefited from the spread of chlorination, which helped reduce nearly 90% of unsafe-water-caused mortality from 1998 to 2018.

Factors influencing catastrophic health expenditure of households with people with diabetes in Northwest China-an example from Gansu Province.

BACKGROUND: Diabetes is a chronic non-communicable disease that causes a substantial economic burden on diabetic suffers and their households. The aim of this study was to explore the prevalence, equity, and determinants of catastrophic health expenditure (CHE) among households with people with diabetes in Northwest China. METHODS: A total of 3,000 households were included in the 6th Health services survey in Gansu Province, China of which 270 households with people with diabetes. The equity of CHE was evaluated by concentration curve and concentration index (CI). We adopted the Pareto chart to analyze the main economic intervals of the occurrence of CHE. Finally, we combined the decision tree and logistic model and analyzed the determinants of the occurrence of CHE. RESULTS: The incidence of CHE at 15%, 25% and 40% were 75.19%, 58.89% and 35.19%, respectively. CHE tended to occur in households with a lower economic level, with the phenomenon being more pronounced at Z = 40%. The Pareto chart showed that households in the group with an annual per capita income of 0-740 USD (0-5,000 Chinese Yuan) were most likely to experience CHE. Both decision tree and logistic models suggested that economic level, comorbidities, and small household size were potential risk factors. In addition, the decision tree model also suggested the interaction between the influencing factor of health checks in the past 12 months and the number of chronic diseases. CONCLUSIONS: In summary, Households with people with diabetes were more likely to incur CHE. It is essential to focus on low- and middle-income households with people with diabetes, strengthen the management of patients with diabetes, and provide timely health interventions to reduce the occurrence of chronic comorbidity and the risk of CHE in households.

Research on Early Identification Model of Intravenous Immunoglobulin Resistant Kawasaki Disease Based on Gradient Boosting Decision Tree.

BACKGROUND: To construct a predictive model for intravenous immunoglobulin (IVIG) resistant Kawasaki disease (KD) based on the gradient boosting decision tree (GBDT), so as to early identify children with IVIG resistance and actively take additional treatment to prevent adverse events. METHODS: The case data of KD children hospitalized in the Pediatric Department of Lanzhou University Second Hospital from October 2015 to July 2020 were collected. All KD patients were divided into IVIG responsive group and IVIG resistant group. GBDT was used to explore the influencing factors of IVIG-resistant KD and to construct a prediction model. Then compared with previous models, the optimal model was selected. RESULTS: In the process of GBDT model construction, 80% of the data were used as the test set, and 20% of the data were used as the validation set. Among them, the verification set was used to adjust the hyperparameters in GDBT learning. The model performed best with a hyperparameter tree depth of 5. The area under the curve of the GBDT model constructed based on the best parameters was 0.87 (95% CI: 0.85-0.90), the sensitivity was 72.62%, the specificity was 89.04%, and the accuracy was 61.65%. The contribution degree of each feature value to the model was total bilirubin, albumin, C-reactive protein, fever time, and Na in order. CONCLUSION: The GBDT model is more suitable for the prediction of IVIG-resistant KD in this study area.

Exposures to volatile organic compounds, serum vitamin D, and kidney function: association and interaction assessment in the US adult population.

The relationships of exposures to volatile organic compounds (VOCs) with vitamin D and kidney function remain unclear. Our analyses included 6070 adults from 2003 to 2010 survey cycles of the National Health and Nutrition Examination Survey to explore associations of six VOCs with serum vitamin D, albumin-to-creatinine ratio (ACR), and estimated glomerular filtration rate (eGFR). The results suggested that dibromochloromethane was positively associated with ACR, and chloroform was inversely associated with ACR. U-shaped associations of toluene, m-/p-xylene, bromodichloromethane, and 1,4-dichlorobenzene with ACR were observed. Toluene, m-/p-xylene, and 1,4-dichlorobenzene were associated with eGFR in U-shaped manners, while bromodichloromethane and chloroform were inversely associated with eGFR. Elevation in 1,4-dichlorobenzene was associated with decrease in vitamin D, while chloroform and m-/p-xylene were in U-shaped associations with vitamin D. VOCs mixture was U-shaped associated with ACR, inversely associated with eGFR, and inversely associated with vitamin D. Vitamin D was in a U-shaped association with ACR. Vitamin D significantly interacted with VOCs on the two kidney parameters. In the US adult population, exposures to VOCs were associated with kidney function and serum vitamin D level decline, and the serum vitamin D may have interaction effects with VOCs exposures on kidney function.