Bidirectional association between falls and multimorbidity in middle-aged and elderly Chinese adults: a national longitudinal study.

This study explores the bidirectional association between multimorbidity and falls in Chinese middle-aged and elderly adults. Participants aged 45 and above from the China Health and Retirement Longitudinal Study were included. Binary logistic regression assessed the impact of chronic conditions on fall incidence (stage I), while multinomial logistic regression examined the relationship between baseline falls and multimorbidity (stage II). The fully adjusted odds ratios (ORs) for one, two, or three or more chronic conditions were 1.34, 1.65, and 2.02, respectively. Among participants without baseline falls, 28.61% developed two or more chronic conditions during follow-up, compared to 37.4% of those with a history of falls. Fully adjusted ORs for one, two, or three or more chronic conditions in those with a history of falls were 1.21, 1.38 and 1.70, respectively. The bidirectional relationship held in sensitivity and subgroup analyses. A bidirectional relationship exists between multimorbidity and falls in Chinese middle-aged and elderly adults. Strengthening chronic condition screening and treatment in primary healthcare may reduce falls risk, and prioritizing fall prevention and intervention in daily life is recommended.

Nomogram incorporating log odds of positive lymph nodes improves prognostic prediction for ovarian serous carcinoma: a real-world retrospective cohort study.

OBJECTIVES: Ovarian serous carcinoma (OSC) is a major cause of gynaecological cancer death, yet there is a lack of reliable prognostic models. To address this, we developed and validated a nomogram based on conventional clinical characteristics and log odds of positive lymph nodes (LODDS) to predict the prognosis of OSC patients. SETTING: A Real-World Retrospective Cohort Study from the Surveillance, Epidemiology and End Results programme. PARTICIPANTS: We obtained data on 4192 patients diagnosed with OSC between 2010 and 2015. Eligibility criteria included specific diagnostic codes, OSC being the primary malignant tumour and age at diagnosis over 18 years. Exclusion criteria were missing information on various factors and unknown cause of death or survival time. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome were overall survival (OS) and ovarian cancer-specific survival (OCSS). RESULTS: For OS and OCSS outcomes, we selected 7 and 5 variables, respectively, to establish the nomogram. In the training and validation cohorts, the C index for OS or OCSS was 0.716 or 0.718 and 0.731 or 0.733, respectively, with a 3-year time-dependent area under the curve (AUC) of 0.745 or 0.751 and a 5-year time-dependent AUC of 0.742 or 0.751. Calibration curves demonstrated excellent consistency between predicted and observed outcomes. The Net Reclassification Index, integrated discrimination improvement and decision curve analysis curves indicated that our nomogram performed better than the International Federation of Gynaecology and Obstetrics (FIGO) staging system in predicting OS and OCSS for OSC patients in both the training and validation cohorts. CONCLUSION: Our nomogram, which includes LODDS, offers higher accuracy and reliability than the FIGO staging system and can predict overall and OCSS in OSC patients.

Chronic non-communicable diseases: Hainan prospective cohort study.

PURPOSE: The Hainan Cohort was established to investigate the incidence, morbidity and mortality of non-communicable diseases and their risk factors in the community population. PARTICIPANTS: The baseline investigation of the Hainan Cohort study was initiated in five main areas of Hainan, China, from June 2018 to October 2020. A multistage cluster random-sampling method was used to obtain samples from the general population. Baseline assessments included a questionnaire survey, physical examination, blood and urine sample collection, and laboratory measurements, and outdoor environmental data were obtained. FINDINGS TO DATA: A total of 14 443 participants aged 35-74 years were recruited at baseline, with a participation rate of 90.1%. The mean age of the participants was 48.8 years; 51.8% were men, and 83.7% had a secondary school or higher education. The crude prevalence of diabetes, coronary heart disease, stroke, hypertension, hyperuricaemia, chronic bronchitis, pulmonary tuberculosis, asthma, cancer, chronic hepatitis and metabolic syndrome were 8.6%, 9.2%, 2.0%, 37.1%, 7.1%, 2.3%, 1.4%, 2.1%, 4.1%, 2.2% and 14.5%, respectively. FUTURE PLANS: The Hainan Cohort is a dynamic cohort with no end date. All participants will be monitored annually for cause-specific mortality and morbidity until death. Long-term follow-up will be conducted every 5 years. The baseline population is considered to expand in the next wave of follow-up, depending on the availability of funding support.

The synergy between diurnal temperature range and calcium concentration help to predict hospital mortality in patients with acute myocardial infarction.

Epidemiological studies have suggested that cold is an important contributor to acute cardiovascular events and mortality. However, little is known about the Diurnal Temperature Range (DTR) impact on mortality of the patients with myocardial infarction. Calcium ions (Ca2+) play a vital role in the human body, such as cardiac electrophysiology and contraction. To investigate whether DTR on admission moderates the association between serum calcium and in-hospital mortality in patients with acute myocardial infarction (AMI). This retrospective study enrolled consecutive adult patients with AMI at a single center in China (2003-2012). Patients were divided into four groups (Ca-Q1-4) according to serum calcium concentration quartiles. Multivariate logistic regression modeling was used to assess whether DTR moderated the association between serum calcium and in-hospital mortality. The predictive value of serum calcium was evaluated by receiver operating characteristic (ROC) curve and net reclassification improvement (NRI) analyses. The study included 3780 patients. In-hospital mortality was 4.97% (188/3780). DTR moderated the association between serum calcium and in-hospital mortality (P-interaction = 0.020). Patients with low serum calcium in the highest DTR quartile exhibited an increased risk of in-hospital mortality (odds ratio for Ca-Q4 vs. Ca-Q1, 0.03; 95% confidence interval [95% CI], 0.01-0.20). In the highest DTR quartile, adding serum calcium concentration to the risk factor model increased the area under the ROC curve (0.81 vs. 0.76; P < 0.001) and increased NRI by 20.2% (95% CI 7.5-32.9; P = 0.001). Low serum calcium was an independent risk factor for in-hospital mortality in patients with AMI, and this association was moderated by DTR. Careful attention should be paid to patients with low serum calcium who experience a higher DTR on admission.

Evaluation of Risk Factors for Chronic Obstructive Pulmonary Disease in the Middle-Aged and Elderly Rural Population of Northeast China Using Logistic Regression and Principal Component Analysis.

Purpose: To investigate the environmental, immune, and inflammatory factors associated with chronic obstructive pulmonary disease (COPD) in middle-aged and older Chinese individuals. Patients and Methods: A community-based case-control study was conducted among 471 patients with COPD and 485 controls. The information on COPD of the participants was collected through face-to-face interviews, and serum samples were measured at the laboratory. The main risk factors for COPD were analyzed using principal component analysis (PCA) and logistic regression. Results: Nine hundred and fifty-six respondents were included in the analysis. The results of the PCA-logistic regression analysis showed significant differences in the environmental factors, medical history, and serum C-reactive protein (CRP) levels between patients and controls. COPD was markedly more usual in those with smoking index >200 (OR, 1.42; 95% CI, 1.28-1.57); exposure to outdoor straw burning (OR, 1.64; 95% CI, 1.47-1.83); use of coal, wood, and straw indoors (OR, 2.31; 95% CI, 1.92-2.78); history of respiratory disease and coronary heart disease (OR, 3.58; 95% CI, 3.12-4.10), congestive heart failure (OR, 1.23; 95% CI, 1.09-1.38), and cerebrovascular disease (OR, 1.15; 95% CI,1.02-1.31); and higher serum level of CRP (OR, 1.20; 95% CI, 1.11-1.30). Compared to the logistic regression analysis, PCA logistic regression analysis identified more important risk factors for COPD. Conclusion: PCA-logistic regression analysis was first utilized to explore the influencing factors among rural residents in Northeast China Environmental aged 40 years and above, it was found that environmental factors, medical history, and serum CRP levels mainly affected the prevalence of COPD.

Role of Serum Creatinine Levels in Prognostic Risk Stratification of Prostate Cancer Patients.

BACKGROUND Studies on the relationship between serum creatinine and the prognosis of prostate cancer have been very limited. The aim of this study was to investigate the role of serum creatinine in the prognostic risk stratification of patients with prostate cancer. MATERIAL AND METHODS We identified 1134 eligible patients from the "Prostate Cancer Data Set" in the National Clinical Medical Science Data Center. Patients with prostate cancer were divided high- and low-risk prognostic groups according to prostate-specific antigen levels and Gleason scores and were divided into 5 groups according to serum creatinine quintile: Q1 (<70.1 umol/L), Q2 (70.1-76.8 umol/L), Q3 (76.8-83.4 umol/L), Q4 (83.4-92.1 umol/L), and Q5 (>92.1 umol/L). Multivariate logistic regression and a multiple restricted cubic spline method were used to evaluate the relationship between serum creatinine level and the level of prostate cancer prognostic risk. RESULTS Of the 1134 patients with prostate cancer, 134 (11.8%) had a high-risk prognosis. Compared with the Q2 group (the reference group), the lowest serum creatinine levels in the Q1 group and the highest serum creatinine levels in groups Q5, Q3, and Q4 were associated with a high-risk prognosis, and this association remained significant after adjusting for confounders. The multiple restricted cubic spline regression model showed the relationship between serum creatinine level and high-risk prognosis was U-shaped. CONCLUSIONS Serum creatinine level was an independent predictor of high-risk prognosis. Controlling serum creatinine levels between 70.1 and 76.8 umol/L in patients with prostatic cancer may benefit the prognosis of patients with prostatic cancer.

Relationship Between C-Reactive Protein and Respiratory Diseases in Patients with Type 2 Diabetic Retinopathy.

BACKGROUND The aim of this study was to explore the relationship between C-reactive protein (CRP) and respiratory diseases in patients with diabetic retinopathy. MATERIAL AND METHODS We identified 855 patients with diabetic retinopathy who met the inclusion criteria from the "Diabetes Complications Data Set" in the National Population Health Data Center. We divided patients into 3 groups according to CRP tertiles: Q1 (<0.3 mg/dL), Q2 (0.3-0.35 mg/dL), and Q3 (>0.35 mg/dL). A multivariate logistic regression model was used to evaluate the relationship between CRP and respiratory diseases. The area under the receiver operating characteristic (ROC) curve was used to investigate the independent predictive effect of CRP on respiratory diseases. RESULTS Of the 855 patients with diabetic retinopathy, 137 (16%) had respiratory diseases. Prevalence of respiratory diseases gradually increased with an increase in CRP level (P for trend=0.001). With CRP as a continuous variable in the logistic regression model adjusted for confounding factors (model 3), the odds ratio (OR) per 1 standard deviation increment of CRP was 1.25 (95% CI 1.07-1.45, P=0.004). When the lowest CRP tertile group was used as the reference group, the OR of the highest CRP tertile group was 1.99 (95% CI 1.22-1.3.26, P=0.006). Adding CRP to the risk factor model increased the area under the ROC curve (0.68 vs 0.65, P=0.017). Subgroup analysis showed that the relationship between CRP and respiratory diseases had no potential heterogeneity among subgroups. CONCLUSIONS CRP can be used as an effective biomarker in predicting risk of respiratory diseases in patients with diabetic retinopathy.

Usefulness of Serum Calcium in the Risk Stratification of Midterm Mortality among Patients with Acute Coronary Syndrome.

Serum calcium has been reported to be a predictor of short-term prognosis; however, evidence regarding its association with midterm mortality is scarce. We investigated the association between serum calcium levels at admission and midterm mortality in a retrospective cohort of 2594 consecutive patients with acute coronary syndrome (ACS) who presented to the First Affiliated Hospital of Harbin Medical University from November 2014 to December 2016. Patients were assigned to 4 groups according to the quartiles of serum calcium levels (Ca-Q1-4) and were followed longitudinally for the time to all-cause death. During a median follow-up period of 21.8 months (17.5∼29.5, IQR), 124 patients died (4.8%) of all causes. Kaplan-Meier curves showed that the incidence of midterm mortality differed significantly (log-rank P=0.038) among the quartiles of serum calcium levels at admission. After adjustment for the confounders that were significant in the univariate analysis, the hazard ratios for the lowest quartile of serum calcium was 1.86 (95% CI, 1.05-3.31; P=0.033), compared with the third quartile (reference group). A multiple restricted cubic spline regression model suggested a reverse J-shaped association between serum calcium levels and midterm mortality, and the lowest risk of mortality was associated with approximately 2.32 mmol/l of serum calcium. In conclusion, the serum calcium level is an independent predictor of all-cause midterm mortality among ACS patients. Patients with abnormal serum calcium levels at admission need more targeted treatments.

Interankle Systolic Blood Pressure Difference Is a Marker of Prevalent Stroke in Chinese Adults: A Cross-Sectional Study.

This cross-sectional study carried out from November 2014 to December 2014 aimed to determine whether the interankle systolic blood pressure (SBP) difference is an independent marker of prevalent stroke. Simultaneous four-limb blood pressure measurements (oscillometric devices) and calculated SBP difference between the lower limbs were collected from 1485 participants aged 35 years and older. Questionnaires about traditional stroke risk factors were completed. Interankle SBP difference ≥7 mm Hg was independently associated with a history of stroke after adjusting for traditional stroke risk factors (odds ratio, 1.64; 95% confidence interval, 1.53-3.59; P=.0123). Net reclassification improvement analysis showed that adding the interankle SBP difference to traditional risk factors improved the predictive ability for stroke risk by 18.5% (P<.001). In conclusion, an interankle SBP difference ≥7 mm Hg could be an independent marker of stroke history in Chinese adults. It could offer an extra benefit in identifying individuals with risk of stroke beyond conventional clinical features.

The Association of Four-Limb Blood Pressure with History of Stroke in Chinese Adults: A Cross-Sectional Study.

OBJECTIVE: We investigated the association of ankle-brachial blood pressure index (ABI), interarm blood pressure (BP) difference and interankle BP difference, obtained by simultaneous four-limb BP measurement, with history of stroke in a Chinese adult population. METHODS: This cross-sectional study included 1485 participants aged ≥35 years in the framework of the China Hypertension Survey. We performed simultaneous four-limb BP measurement using oscillometric devices with the participants in the supine position and calculated ABI and interarm/interankle BP differences between the 4 limbs. Logistic regression analysis was used to estimate the association of these BP parameters and other factors with a history of stroke. RESULTS: In univariate analyses, participants with ABI <0.9, interarm BP difference ≥15 mmHg, and interankle BP difference ≥10 mmHg had a higher prevalence of stroke than those without (p < 0.0001, p = 0.0152, p = 0.002, respectively). Multiple logistic regression analyses suggested, ABI <0.9 was independently associated with a history of stroke after adjustment for interarm BP difference ≥15 mmHg, interankle BP difference ≥10 mmHg, and traditional risk factors for stroke (p = 0.001). An interankle BP difference ≥10 mmHg was associated with prior stroke after the two variables of hypertension and ABI were removed from the logistic regression model (p = 0.0142). Net reclassification improvement analysis showed that inclusion of interankle BP difference ≥10 mmHg to the independent risk factors (age, family history of stroke, hypertension, and ABI) improved net reclassification by 11.92%. CONCLUSION: ABI <0.9 is an independent risk factor for stroke prevalence in Chinese adults and it just detected a small propotion of paticipants. The addition of interankle BP difference ≥10 mmHg to the independent risk factors for stroke may improve the prediction of stroke.