Evaluating ChatGPT-4.0's data analytic proficiency in epidemiological studies: A comparative analysis with SAS, SPSS, and R.

Background: OpenAI's Chat Generative Pre-trained Transformer 4.0 (ChatGPT-4), an emerging artificial intelligence (AI)-based large language model (LLM), has been receiving increasing attention from the medical research community for its innovative 'Data Analyst' feature. We aimed to compare the capabilities of ChatGPT-4 against traditional biostatistical software (i.e. SAS, SPSS, R) in statistically analysing epidemiological research data. Methods: We used a data set from the China Health and Nutrition Survey, comprising 9317 participants and 29 variables (e.g. gender, age, educational level, marital status, income, occupation, weekly working hours, survival status). Two researchers independently evaluated the data analysis capabilities of GPT-4's 'Data Analyst' feature against SAS, SPSS, and R across three commonly used epidemiological analysis methods: Descriptive statistics, intergroup analysis, and correlation analysis. We used an internally developed evaluation scale to assess and compare the consistency of results, analytical efficiency of coding or operations, user-friendliness, and overall performance between ChatGPT-4, SAS, SPSS, and R. Results: In descriptive statistics, ChatGPT-4 showed high consistency of results, greater analytical efficiency of code or operations, and more intuitive user-friendliness compared to SAS, SPSS, and R. In intergroup comparisons and correlational analyses, despite minor discrepancies in statistical outcomes for certain analysis tasks with SAS, SPSS, and R, ChatGPT-4 maintained high analytical efficiency and exceptional user-friendliness. Thus, employing ChatGPT-4 can significantly lower the operational threshold for conducting epidemiological data analysis while maintaining consistency with traditional biostatistical software's outcome, requiring only specific, clear analysis instructions without any additional operations or code writing. Conclusions: We found ChatGPT-4 to be a powerful auxiliary tool for statistical analysis in epidemiological research. However, it showed limitations in result consistency and in applying more advanced statistical methods. Therefore, we advocate for the use of ChatGPT-4 in supporting researchers with intermediate experience in data analysis. With AI technologies like LLMs advancing rapidly, their integration with data analysis platforms promises to lower operational barriers, thereby enabling researchers to dedicate greater focus to the nuanced interpretation of analysis results. This development is likely to significantly advance epidemiological and medical research.

Short working hours and perceived stress: Findings from a population-based nationwide study.

Background: Evidence on the potential negative health effects of short working hours remains limited. This study aimed to investigate the association between short working hours and perceived stress in a population-based sample from China. Methods: This cross-sectional study included 4368 participants aged 18-65 years from the China Health and Nutrition Surveys (CHNS) 2015. Working hours were categorized into <35, 35-40, 41-54, and ≥55 h/week. Perceived stress was assessed using the Perceived Stress Scale-14 (PSS-14). Results: Of the 4368 participants, 817 (18.7 %) reported short working hours (<35 h/week) and 1817 (41.6 %) reported perceived stress. Short working hours were associated with higher perceived stress compared to standard working hours (35-40 h/week) (Adjusted odds ratios (AOR) = 1.25, 95 % confidential intervals (CI): 1.04-1.51). Stratified analysis showed that short working hours were significantly associated with more perceived stress in subjects aged 36-50 years (AOR = 1.43, 95 % CI: 1.16-1.70), while long working hours (≥55 h/week) were significantly related to less perceived stress among low-income subjects (AOR = 0.56, 95 % CI: 0.33-0.94). Reduced income partially mediated the effects of short working hours on perceived stress (indirect effects = -0.002, 95 % CI: -0.007∼-0.001). Conclusion: Reduced working hours may be associated with increased risk of perceived stress in China, particularly among people aged 36-50 years and those with low income. Reduced income may be a possible reason for the increased perceived stress caused by short working hours. Future longitudinal studies are needed to examine these relationships and to explore mechanisms.

Long working hours and all-cause mortality in China: A 26-year follow-up study.

OBJECTIVES: The relationship between long working hours and the risk of mortality has been debated in various countries. This study aimed to investigate the association between long working hours and all-cause mortality in a large population-based cohort in China. METHODS: This retrospective cohort study (N=10 269) used a large, nationally representative data set [the China Health and Nutrition Surveys (CHNS)] from 1989 to 2015. Long working hours (≥55 hours per week) were compared to standard working hours (35-40 hours per week). The outcome measure was all-cause mortality. Hazard ratio (HR) for all-cause mortality was calculated from Cox proportional hazards regression models, with stratified analyses to assess differences in mortality risk among subgroups. RESULTS: Among the participants, 411 deaths (3.52 per 1000 person-years) occurred during a median follow-up of 11.0 (range 4.0-18.0) years. After adjusting for covariates, long working hours were associated with a significantly increased risk of all-cause mortality [HR 1.49, 95% confidence intervals (CI) 1.02-2.18]. Stratified analyses revealed that this association was present only among men (HR 1.78, 95% CI 1.15-2.75) and smoking participants (HR 1.57, 95% CI 1.05-2.57). CONCLUSION: This study provides evidence of an association between long working hours and all-cause mortality, which is specifically observed among men and smokers. Targeted interventions should be implemented to reduce excessive working hours and identify individuals at elevated risk, with support from labor organizations, policymakers, and employers.

Mental health burden for the public affected by the COVID-19 outbreak in China: Who will be the high-risk group?

In December, 2019, an outbreak of respiratory illness caused by Coronavirus disease 2019 (COVID-19) emerged in Wuhan, China and spread rapidly to other parts of China and around the world. We aimed to identify high-risk groups whose mental health conditions were vulnerable to the COVID-19 outbreak. Data were collected from 7,236 self-selected participants measured by anxiety symptoms, depressive symptoms, and sleep quality. The overall prevalence of anxiety symptoms, depressive symptoms, and poor sleep quality were 35.1%, 20.1%, and 18.2%, respectively. People aged < 35 years reported a higher prevalence of anxiety symptoms and depressive symptoms than people aged ≥ 35 years. Healthcare workers have the highest rate of poor sleep compared to other occupations. Healthcare workers/younger people who spent a high level of time (≥ 3 hours/day) had a particular higher prevalence of anxiety symptoms than in those who spent less time (< 1 hours/day and 1-2 hours/day) on the outbreak. During the COVID-19 outbreak, healthcare workers and younger people were at an especially high-risk of displaying psychological impact when they spent too much time thinking about the outbreak. Continuous monitoring of the psychological consequences for high-risk population should become routine as part of targeted interventions during times of crisis.I.

Association Between Incorrect Posture and Adolescent Idiopathic Scoliosis Among Chinese Adolescents: Findings From a Large-Scale Population-Based Study.

Objectives: Adolescent idiopathic scoliosis (AIS) affects between 1 and 4% of adolescents, and severe curvature may be related to their adverse long-term outcomes. However, whether the change in body appearance is related to AIS remains largely unclear. We aimed to explore the association between incorrect posture and AIS among Chinese adolescents. Methods: Data were collected from a population-based (595,057) school scoliosis screening program in China. A sample of 3,871 adolescents was classified as cases with a diagnosed radiological lateral Cobb angle ≥10°, and 3,987 control subjects with a Cobb angle <10° were randomly selected from the screening system. Adolescents were accessed with demographic information and incorrect posture measured by visual inspection of physical signs, Adam's forward bending test (FBT), and the angle of trunk rotation (ATR). Logistic regression (LR) models were used to examine the associations. Results: Multivariate LR showed that shoulder-height difference, scapula tilt, lumbar concave, and pelvic tilt were associated with AIS. Adolescents with angle of thoracic rotation ≥5° [adjusted odds ratio (AOR) = 5.33-14.67, P < 0.001], thoracolumbar rotation ≥5° (AOR = 4.61-5.79, P < 0.001), or lumbar rotation ≥5° (AOR = 7.49-7.85, P < 0.001) were at especially higher risk for AIS than those with ATR <5°. Conclusions: Incorrect posture may be the potential risk factor for developing AIS, and ATR ≥5° was an important indicator for predicting the occurrence of scoliosis. Early monitoring of incorrect posture for school adolescents should be considered as a routine intervention to effectively identify the progress of scoliosis.

Predicting Adolescent Idiopathic Scoliosis among Chinese Children and Adolescents.

OBJECTIVE: Adolescent idiopathic scoliosis (AIS) affects 1%-4% of adolescents in the early stages of puberty, but there is still no effective prediction method. This study aimed to establish a prediction model and validated the accuracy and efficacy of this model in predicting the occurrence of AIS. METHODS: Data was collected from a population-based school scoliosis screening program for AIS in China. A sample of 884 children and adolescents with the radiological lateral Cobb angle ≥ 10° was classified as an AIS case, and 895 non-AIS subjects with a Cobb angle < 10° were randomly selected from the screening system. All selected subjects were screened by visual inspection of clinical signs, the Adam's forward-bending test (FBT), and the measurement of angle of trunk rotation (ATR). LR and receiver operating characteristic (ROC) curves were used to preliminarily screen the influential factors, and LR models with different adjusted weights were established to predict the occurrence of AIS. RESULTS: Multivariate LR and ROC curves indicated that angle of thoracic rotation (adjusted odds ratios (AOR) = 5.18 - 10.06), angle of thoracolumbar rotation (AOR = 4.67 - 7.22), angle of lumbar rotation (AOR = 6.97 - 8.09), scapular tilt (area under the curve (AUC) = 0.77, 95% CI: 0.75-0.80), shoulder-height difference, lumbar concave, and pelvic tilt were the risk predictors for AIS. LR models with different adjusted weights (by AOR, AUC, and AOR+AUC) performed similarly in predicting the occurrence of AIS compared with multivariate LR. The sensitivity (82.55%-83.27%), specificity (82.59%-83.33%), Youden's index (0.65-0.67), positive predictive value (82.85%-83.58%), negative predictive value (82.29%-83.03%), and total accuracy (82.57%-83.30%) manifested that LR could accurately identify patients with AIS. CONCLUSIONS: LR model is a relatively high accurate and feasible method for predicting AIS. Increased performance of LR models using clinically relevant variables offers the potential to early identify high-risk groups of AIS.

Chinese mental health burden during the COVID-19 pandemic.

We aimed to assess the Chinese mental health burden during the COVID-19 pandemic. Data were collected from 7,236 participants assessed with anxiety disorders, depressive symptoms, and poor sleep . The overall prevalence of anxiety disorders, depressive symptoms, sleep quality were 35.1%, 20.1%, 18.2%, respectively. Younger people reported a higher prevalence of anxiety disorders and depressive symptoms than older people (P < 0.001). Compared with other occupation, healthcare workers have the highest rate of poor sleep quality (P < 0.001). We identified a major mental health burden of the public during the COVID-19 pandemic outbreak in China. Younger people and healthcare workers were at high risk for mental illness.

Generalized anxiety disorder, depressive symptoms and sleep quality during COVID-19 outbreak in China: a web-based cross-sectional survey.

China has been severely affected by Coronavirus Disease 2019(COVID-19) since December, 2019. We aimed to assess the mental health burden of Chinese public during the outbreak, and to explore the potential influence factors. Using a web-based cross-sectional survey, we collected data from 7,236 self-selected volunteers assessed with demographic information, COVID-19 related knowledge, generalized anxiety disorder (GAD), depressive symptoms, and sleep quality. The overall prevalence of GAD, depressive symptoms, and sleep quality of the public were 35.1%, 20.1%, and 18.2%, respectively. Younger people reported a significantly higher prevalence of GAD and depressive symptoms than older people. Compared with other occupational group, healthcare workers were more likely to have poor sleep quality. Multivariate logistic regression showed that age (< 35 years) and time spent focusing on the COVID-19 (≥ 3 hours per day) were associated with GAD, and healthcare workers were at high risk for poor sleep quality. Our study identified a major mental health burden of the public during the COVID-19 outbreak. Younger people, people spending too much time thinking about the outbreak, and healthcare workers were at high risk of mental illness. Continuous surveillance of the psychological consequences for outbreaks should become routine as part of preparedness efforts worldwide.

Prevalence of Incorrect Posture among Children and Adolescents: Finding from a Large Population-Based Study in China.

Evidence showed that bad posture in adulthood is often formed from the childhood, and individuals with severe incorrect posture may be associated with the progress of scoliosis. We aimed to estimate the prevalence of incorrect posture in Chinese children and adolescents and to describe the epidemiological findings stratified by the demographic characteristics. A total of 595,057 students were screened; the overall prevalence of incorrect posture in children and adolescents was 65.3%, and around 3.7% of the students were referred to radiography. Girls had a higher prevalence of incorrect posture than boys, students aged >10 years accounted for a higher rate of incorrect posture than students aged <10 years. We found that Chinese children and adolescents had a high prevalence of incorrect posture, with girls and older students being an especially high-risk group. Early interventions targeted for students with incorrect posture are urgently needed.

Gender differences in the associations between types of childhood maltreatment and sleep disturbance among Chinese adolescents.

BACKGROUND: To explore the association between different types of childhood maltreatment and sleep disturbance among Chinese adolescents, with a particular focus on gender differences. METHODS: A cross-sectional study was conducted in 7 randomly selected provinces of China via the 2015 School-Based Chinese Adolescents Health Survey. Questionnaires from 153,547 students were completed and were eligible for this study. The Chinese Version of the Pittsburgh Sleep Quality Index (CPSQI) and Childhood Trauma Questionnaire-Short Form (CTQ-SF) were used to assess sleep disturbance and childhood maltreatment, respectively. RESULTS: The prevalence of sleep disturbance among adolescents in China was 21.6%. A significantly increased risk of sleep disturbance was associated with physical abuse (aOR=1.22, 95% CI=1.21-1.24), emotional abuse (aOR=1.15, 95% CI=1.14-1.15), sexual abuse (aOR=1.16, 95% CI=1.15-1.18), physical neglect (aOR=1.04, 95% CI=1.03-1.05), and emotional neglect (aOR=1.03, 95% CI=1.02-1.03). A significant dose-response relationship was found between cumulative childhood maltreatment experiences and sleep disturbance. The interaction terms (between physical abuse/emotional abuse/sexual abuse/physical neglect/emotional neglect/number of childhood traumas and gender) were significantly associated with sleep disturbance. Further stratification analyses by gender showed that girls who reported experiencing one or more of these five types of childhood maltreatment had a higher risk of sleep disturbance than boys. LIMITATIONS: The study only included school students, and the cross-sectional design limited our ability to make causal inferences. CONCLUSIONS: The study findings suggest that childhood maltreatment increases the risk of sleep disturbance in adolescents. Furthermore, exposure to single and multiple types of childhood maltreatment predicts lower sleep quality in girls.

Role of sleep quality in mediating the relationship between sexual minority status and suicidal behavior among Chinese adolescents.

BACKGROUND: Studies suggest that sexual minority adolescents experience higher rates of sleep disturbance than their heterosexual peers, and disturbed sleep is a well-known risk factor for suicidality. This study aimed to explore whether sleep quality had mediating effects on the relationship between sexual minority status and suicidal behavior in Chinese adolescents. METHODS: We analyzed data collected from 7th to 12th graders from seven randomly selected provinces of People's Republic of China in the 2015 School-Based Chinese Adolescents Health Survey. The 123,459 students who completed questionnaires regarding sexual attraction, the Pittsburgh Sleep Quality Index, past-year suicidal ideation, and past-year suicide attempts were included in our study (response rate: 95.9%). RESULTS: After adjustment for covariates, sexual minority status was associated with suicidal ideation (adjusted odds ratio =1.82, 95% CI=1.69-1.95) and suicide attempts (adjusted odds ratio =2.16, 95% CI=1.82-2.56). Sleep quality partially mediated the effects of sexual minority status on suicidal ideation (standardized ß estimate=0.009, 95% CI=0.007-0.012) and suicide attempts (standardized ß estimate=0.004, 95% CI=0.003-0.005). CONCLUSION: Poor sleep quality partially explained the increased risk of suicidality for Chinese sexual minority adolescents. To prevent subsequent suicidality, suicide interventions targeting sexual minorities should be made, with a focus on their disparities in sleep disturbance and sleep health promotion.

Chinese Sexual Minority Male Adolescents' Suicidality and Body Mass Index.

Excess weight status may increase the risk of suicidality among sexual minority females, but few studies have examined this suicidality disparity in sexual minority males. This study examined the association between sexual minority status and suicide attempts in Chinese male adolescents and tested whether body mass index (BMI) had a moderating effect on that association. Data were collected from 7th to 12th graders from seven randomly selected provinces of China in the 2015 School-Based Chinese Adolescents Health Survey. In total, 72,409 male students completed the questionnaires regarding sexual attraction, self-reported weight and height, and suicide attempts. After adjustment for covariates, sexual minority status was associated with suicide attempts among male students (AOR = 1.74, 95% CI = 1.57⁻1.93). Stratification analyses showed that BMI category moderated this association; compared with the results before stratification analyses, sexual minority males who were obese had increased risk of suicide attempts (AOR = 2.15, 95% CI = 1.09⁻4.24), sexual minority males who were overweight had reduced odds of suicide attempts (AOR = 1.40, 95% CI = 1.01⁻1.92), and no significant association change was found in sexual minority males who were underweight (AOR = 1.82, 95% CI = 1.43⁻2.33). Our study indicated that BMI moderated the risk of suicide attempts in sexual minority males. Suicide prevention targeting sexual minority males should be focused on weight status disparity and the creation of a positive climate to reduce minority stressors due to body image.

Sexual minority status and suicidal behaviour among Chinese adolescents: a nationally representative cross-sectional study.

OBJECTIVES: Suicidality among sexual minority adolescents has generated worldwide concern in recent decades, and previous Western studies have demonstrated that sexual minority status is associated with adolescent suicidality. However, whether this association exists in Chinese adolescents remains largely unknown. This study aimed to estimate the associations between sexual minority status and suicidal behaviour among Chinese adolescents. DESIGN: Cross-sectional survey. SETTING: A total of 506 high schools in 7 provinces of China. PARTICIPANTS: A total of 150 822 students in grades 7-12 who completed the questionnaires (response rate of 95.9%) were included. MAIN OUTCOME MEASURES: Suicidal ideation and suicide attempts were used to measure suicidal behaviour, and sexual attraction (opposite sex, same sex or both sex) was used as a measure for sexual minority status. RESULTS: Of the 150 822 adolescents analysed, 4.1% self-reported as sexual minorities and 17.3% were unsure. Compared with heterosexual and unsure adolescents, same-sex romantic attraction (SSA) and both-sex romantic attraction (BSA) adolescents reported a higher prevalence of past-year suicidal ideation (SSA: 21.6% for males and 30.4% for females; BSA: 34.7% for males and 42.3% for females) and suicide attempts (SSA: 6.9% for males and 8.9% for females; BSA: 12.2% for males and 10.9% for females). After adjustment for covariates, SSA and BSA adolescents were more likely to have past-year suicidal ideation and suicide attempts than their heterosexual and unsure peers. BSA adolescents reported the highest risk of suicidal ideation (males: adjusted OR (AOR) 2.42, 95% CI 2.03 to 2.88; females: AOR 2.61, 95% CI 2.41 to 2.82) and suicide attempts (males: AOR 3.83, 95% CI 2.85 to 5.14; females: AOR 2.59, 95% CI 2.19 to 3.06). CONCLUSIONS: Our study suggested that Chinese sexual minority adolescents were at increased risk of suicidality, and those with BSA had an especially high risk in this population. These findings emphasised the urgent need to develop targeted interventions to effectively address suicide-related problems among Chinese sexual minority adolescents.

Association between sexual minority status and suicidal behavior among Chinese adolescents: A moderated mediation model.

BACKGROUND: Evidence shows sexual minority adolescents have a higher risk of suicidality than their heterosexual peers due to minority stressors or lack of social support, but it remains unclear how the combined effects of these influence factors impact suicidality in this population. In this study, we examine whether school victimization mediates association between sexual minority status and suicidal behavior of adolescents and explore whether such mediation is moderated by interpersonal relationships. METHODS: We sampled a large nationally representative dataset comprising data collected from 7th to 12th graders (the 2015 School-based Chinese Adolescents Health Survey) using a multistage, stratified-cluster, random-sampling method. Our sample consisted of 123,459 students who completed questionnaires regarding their sexual minority status, suicidal ideation, suicide attempts, school victimization, classmate relations, and teacher-classmate relations. RESULTS: Using a moderated mediation model, we found that school victimization mediated the effects of sexual minority status on suicidal ideation (indirect effect = 0.0296, 95% confidence intervals (CI) = 0.0259-0.0333) and suicide attempts (indirect effect = 0.0086, 95% CI = 0.0074-0.0100). These indirect effects were moderated by interpersonal relationships, and a greater effect was seen among sexual minority students with poor classmate or teacher-classmate relations. LIMITATIONS: Our study sample included only students attending school, and interpretation of the direction of the observed associations is limited due to the cross-sectional design. CONCLUSIONS: Interpersonal relationships moderate the indirect effects of school victimization on association between sexual minority status and suicidal behavior. Early intervention addressing school violence combined with improving the quality of relationships with school peers would help prevent suicidality in sexual minority adolescents.

The mediating effects of depressive symptoms on the association of childhood maltreatment with non-medical use of prescription drugs.

BACKGROUND: Childhood maltreatment might increase the risk of subsequent drug use behavior, and depressive symptoms have been reported to be associated both childhood maltreatment and non-medical use of prescription drugs (NMUPD). This large-scale study aimed to test the mediating effects of depressive symptoms on the association of childhood maltreatment with NMUPD among Chinese adolescents. METHODS: A secondary analysis of the cross-sectional data collected from 7th to 12th graders who were sampled using a multistage, stratified cluster, random sampling method in the 2015 School-based Chinese Adolescents Health Survey. There were 24,457 students who were invited to participate and 23,039 students' questionnaires were completed and qualified for our survey (response rate: 94.2%). RESULTS: In the adjusted models without mediation, the results showed that students who reported that they had experienced emotional abuse were at a higher risk of past year use and past month use of opioids (past year: Adjusted OR [AOR] = 1.07, 95% CI = 1.05-1.10; past month: AOR = 1.08, 95% CI = 1.06-1.10) and sedatives (past year: AOR = 1.06, 95% CI = 1.03-1.08; past month: AOR = 1.15, 95% CI = 1.13-1.16). The results of mediation analyses demonstrated that there were significant standardized indirect effects of emotional abuse on opioids use and sedatives use through depressive symptoms, respectively (P < 0.001). LIMITATIONS: Our study sample only included school students, and causal inference could not be examined due to the cross-sectional design. CONCLUSIONS: Depressive symptoms play a significant mediator role on the association of childhood maltreatment with NMUPD. Interventions targeted at adolescents who are involved in NMUPD should pay attention to their histories of childhood maltreatment.