Impact of PD-L1 gene polymorphisms and interactions with cooking with solid fuel exposure on tuberculosis.

Introduction Given that PD-L1 is a crucial immune checkpoint in regulating T cell responses, the aim of this study was to explore the impact of PD-L1 gene polymorphism and its interaction with cooking with solid fuel on susceptibility to tuberculosis (TB) in Chinese Han populations. Methods A total of 503 TB patients and 494 healthy controls were enrolled in this case-control study. Mass spectrometry (MS) technology was applied to genotype rs2297136 and rs4143815 of PD-L1 genes. The associations between SNPs and TB were assessed using unconditional logistic regression analysis. Marginal structural linear odds models were used to estimate the gene-environment interactions. Results Compared with genotype CC, genotypes GG and CG + GG at rs4143815 locus were significantly associated with susceptibility to TB (OR: 3.074 and 1.506, respectively, P<0.05). However, no statistical association was found between rs2297136 SNP and TB risk. Moreover, the relative excess risk of interaction (RERI) between rs4143815 of the PD-L1 gene and cooking with solid fuel was 2.365 (95% CI 1.922,2.809), suggesting positive interactions with TB susceptibility. Conclusion The rs4143815 polymorphism of the PD-L1 gene was associated with susceptibility to TB in Chinese Han populations. There were significantly positive interactions between rs4143815 and cooking with solid fuel.

Association between weekend catch-up sleep and depressive symptoms in American adults: Finding from NHANES 2017-2020.

BACKGROUND: The effect of weekend catch-up sleep (WCS) on depressive symptoms is inconsistent among different populations, with limited evidence in Americans. Therefore, we aimed to investigate the association between WCS and depressive symptoms in American adults. METHODS: We recruited 7719 participants from the National Health and Nutrition Examination Survey (NHANES) 2017-2020. Information on sleep duration and depressive symptoms were assessed by several self-reported questions and Patient Health Questionnaire-9 (PHQ-9), respectively. Then, WCS duration was calculated as weekend sleep duration minus weekday sleep duration, and WCS was further defined as WCS duration >0 h. Survey designed regression analyses were used to assess the association of WCS and depressive symptoms. RESULTS: In fully adjusted multivariate logistic regression models, the odds ratio (95 % confidence interval) for depressive symptoms and the ß (95 % confidence interval) for PHQ-9 score in response to WCS were 0.746 (0.462, 1.204; P = 0.218) and -0.429 (-0.900, 0.042; P = 0.073), respectively. Besides, the smooth relationship presented L-shaped, and only WCS duration of 0-2 h was statistically significantly associated with depressive symptoms or PHQ-9 score. Subgroup analyses showed that the negative associations were stronger among men, adults younger than 65 years, and those with short weekday sleep duration (P for interaction <0.05). LIMITATIONS: The cross-sectional design limits the capability for causal relationship between WCS and depressive symptoms. CONCLUSIONS: This study suggests that moderate WCS is associated with reduced odds of depressive symptoms, which provides additional epidemiological evidence for the effects of sleep on depressive symptoms.

Association of aerobic and muscle-strengthening physical activity with all-cause and cardiovascular disease mortality among adults with type 2 diabetes: A prospective cohort of US adults.

OBJECTIVE: To investigate the relationship of moderate physical activity (MPA), vigorous physical activity (VPA), and muscle strengthening activity (MSA), independently and jointly, with all-cause, cardiovascular disease (CVD), and non-CVD mortality in individuals with type 2 diabetes (T2D). MATERIAL AND METHODS: This cohort study included 47,538 adults with T2D and 561,963 adults without T2D from the National Health Interview Survey 1997-2018 who provided data on self-reported physical activity (PA). Mortality data were obtained from the National Death Index through 2019. Cox regression was used to estimate hazard ratio (HR) and 95% confidence interval (CI). RESULTS: In analyses mutually adjusted, versus no MPA adults with T2D, performing the recommendations of MPA (150-299 min/week) associated with lower all-cause mortality (HR, 0.72; 95% CI, 0.66-0.78), CVD mortality (HR, 0.68; 95% CI, 0.58-0.79), and non-CVD mortality (HR, 0.72; 95% CI, 0.65-0.79). Similar benefits were observed in those meeting recommendations for VPA and MSA. Higher levels of PA beyond current recommendations may provide a few additional benefits without adverse effects on mortality risk, regardless of diabetes onset age, duration of diabetes, and medication status. The joint analysis indicates that combining MSA with aerobic PA could further lower mortality risk, and lowest all-cause mortality was observed among individuals engaging in either 75-150 min/week of VPA and 1 time/week of MSA (HR, 0.30; 95% CI, 0.13-0.70) or 150-299 min/week of MPA and 1 time/week of MSA (HR, 0.33; 95% CI, 0.20-0.55). CONCLUSION: Our study supports the current PA guidelines and suggests that there may be limited benefits gained from exercising beyond recommended levels in adults with T2D, combining recommended levels of aerobic and resistance exercises could yield the greatest benefits.

Pathological migrating intramural hematoma in stenting for carotid artery dissection: A ten-year consecutive cohort study.

OBJECTIVE: To study the phenomenon, incidence and management of pathological migrating intramural hematoma in stenting for carotid artery dissection. METHODS: We consecutively enrolled CAD patients with stenting treatment over 10-year period, and retrospectively analyzed the pathological migrating intramural hematoma (PMIH) incidence of these CAD patients. Besides, we also explored the related factors with PMIH and provided an appropriate management strategy. RESULTS: A total of 67 CAD underwent stenting. PMIH occurred in 7 cases (10.4%). The median time from onset of symptoms to stenting was 5 days (3 to 11 days). There were 4 cases of PMIH in the proximal segment of stent and 3 cases of PMIH in the distal segment of stent. All the patients presented with new stenosis and no patient presented with dissecting aneurysm. Through proper management, none of the patients had occurred clinical complications. CONCLUSION: Pathological migrating intramural hematoma phenomenon exists in the stenting for carotid artery dissection, rescue angioplasty or stenting is needed for early treatment of moderate and severe stenosis due to migrating intramural hematoma on preventing further ischemic events.

Polymorphisms in PI3K/AKT genes and gene­smoking interaction are associated with susceptibility to tuberculosis.

BACKGROUND: Phosphatidylinositol 3-kinase (PI3K) and protein kinase B (AKT) are involved in the clearance of Mycobacterium tuberculosis (MTB) by macrophages. AIM: This study aimed to investigate the effects of polymorphisms in the PI3K/AKT genes and the gene-smoking interaction on susceptibility to TB. METHODS: This case-control study used stratified sampling to randomly select 503 TB patients and 494 control subjects. Logistic regression analysis was used to determine the association between the polymorphisms and TB. Simultaneously, the marginal structure linear dominance model was used to estimate the gene-smoking interaction. RESULTS: Genotypes GA (OR 1.562), AA (OR 2.282), and GA + AA (OR 1.650) at rs3730089 of the PI3KR1 gene were significantly associated with the risk to develop TB. Genotypes AG (OR 1.460), GG (OR 2.785), and AG + GG (OR 1.622) at rs1130233 of the AKT1 gene were significantly associated with the risk to develop TB. In addition, the relative excess risk of interaction (RERI) between rs3730089 and smoking was 0.9608 (95% CI: 0.5959, 1.3256, p < 0.05), which suggests a positive interaction. CONCLUSION: We conclude that rs3730089 and rs1130233 are associated with susceptibility to TB, and there was positive interaction between rs3730089 and smoking on susceptibility to TB.

Hypotension and cognitive impairment among the elderly: Evidence from the CLHLS.

BACKGROUND: While high blood pressure has been linked to cognitive impairment, the relationship between low blood pressure, especially hypotension, and cognitive impairment has not been well studied. Therefore, this study aimed to assess the prevalence of hypotension and cognitive impairment in the seniors of China, and the association between hypotension and cognitive function impairment. METHODS: The data was derived from the 2018 wave of the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Systolic blood pressures (SBP) and diastolic blood pressures (DBP) were measured by objective examination. The Chinese version of the Mini-Mental State Examination (CMMSE) was used to evaluate the cognitive impairment of the elderly. Generalized linear models were conducted to evaluate the association of hypotension with cognitive impairment. RESULTS: The prevalence of hypotension and cognitive impairment in the Chinese elderly were 0.76% and 22.06%, respectively. Participants with hypotension, lower SBP, and lower DBP, had odds ratios of 1.62, 1.38, and 1.48 for cognitive impairment, respectively. Besides, the CMMSE scores decreased by 2.08, 0.86, and 1.08 in the elderly with hypotension, lower SBP, and DBP, compared with those with non-hypotension, higher SBP, and DBP, respectively. Subgroup analyses showed that the association of cognitive impairment with hypotension was stronger in Chinese elderly who had decreased activity of daily living. Moreover, there was statistical evidence of a nonlinear dose-response relationship of SBP and DBP with cognitive impairment (Pnonlinear < 0.05). CONCLUSION: Hypotension was a potential risk factor for cognitive impairment of the Chinese elderly, especially for those having decreased activity of daily living. Blood pressure management should be conducted to prevent them from cognitive impairment.

Global, regional, and national time trends in incidence for migraine, from 1990 to 2019: an age-period-cohort analysis for the GBD 2019.

BACKGROUND: The majority of epidemiological studies on migraine have been conducted in a specific country or region, and there is a lack of globally comparable data. We aim to report the latest information on global migraine incidence overview trends from 1990 to 2019. METHODS: In this study, the available data were obtained from the Global Burden of Disease 2019. We present temporal trends in migraine for the world and its 204 countries and territories over the past 30 years. Meanwhile, an age-period-cohort model be used to estimate net drifts (overall annual percentage change), local drifts (annual percentage change in each age group), longitudinal age curves (expected longitudinal age-specific rate), and period (cohort) relative risks. RESULTS: In 2019, the global incidence of migraine increased to 87.6 million (95% UI: 76.6, 98.7), with an increase of 40.1% compared to 1990. India, China, United States of America, and Indonesia had the highest number of incidences, accounting for 43.6% of incidences globally. Females experienced a higher incidence than males, the highest incidence rate was observed in the 10-14 age group. However, there was a gradual transition in the age distribution of incidence from teenagers to middle-aged populations. The net drift of incidence rate ranged from 3.45% (95% CI: 2.38, 4.54) in high-middle Socio-demographic Index (SDI) regions to -4.02% (95% CI: -4.79, -3.18) in low SDI regions, 9 of 204 countries showed increasing trends (net drifts and its 95% CI were > 0) in incidence rate. The age-period-cohort analysis results showed that the relative risk of incidence rate generally showed unfavorable trends over time and in successively birth cohorts among high-, high-middle-, and middle SDI regions, but low-middle- and low-SDI regions keep stable. CONCLUSIONS: Migraine is still an important contributor to the global burden of neurological disorders worldwide. Temporal trends in migraine incidence are not commensurate with socioeconomic development and vary widely across countries. Both sexes and all age groups should get healthcare to address the growing migraine population, especially adolescents and females.

Maternal Body Mass Index, Gestational Weight Gain, and Risk of Cancer in Offspring: A Systematic Review and Meta-Analysis.

Background: Mounting evidence suggests that maternal obesity and gestational weight gain (GWG) may increase the risk of cancer in their offspring; however, results are inconsistent. The purpose of this research is to determine the association between maternal body mass index (BMI) and GWG and the risk of cancer in offspring through a systematic and comprehensive meta-analysis. Methods: A systematic literature search of several databases was conducted on 1 October 2022 to identify relevant studies. The quality of the included studies was evaluated using the Newcastle-Ottawa scale. The overall risk estimates were pooled using a random-effects meta-analysis. Results: Twenty-two studies with more than 8 million participants were included. An increased risk of total cancer was found in offspring whose mothers had a high GWG (odds ratio [OR]: 1.10; 95% CI: 1.01-1.19; p: 0.040) but not in offspring whose mothers had a low GWG (OR: 1.06; 95% CI: 0.96-1.17; p: 0.030), when compared with offspring whose mothers had a suitable GWG. In addition, no statistically significant association was found between maternal underweight (OR: 1.05; 95% CI: 0.97-1.13; p: 0.630), overweight/obesity (OR: 1.07; 95% CI: 0.99-1.16; p: 0.020), and risk of total cancer in offspring. Conclusions: Our study proposes evidence that maternal BMI and GWG may be associated with the risk of cancer in offspring, although statistical significance was found only for high GWG. Further well-designed research is required to clarify the potential relevance of maternal BMI and GWG on offspring cancer, especially for specific cancers.

Causal association of the brain structure with the susceptibility, hospitalization, and severity of COVID-19: A large-scale genetic correlation study.

Brain structure is related to its ability to resist external pathogens. Furthermore, there are several abnormal anatomical brain events and central system symptoms associated with COVID-19. This study, which was conducted based on genetic variables, aimed to identify the causal association between brain structure and COVID-19 phenotypes. We performed a two-sample bidirectional Mendelian randomization analysis using genetic variables obtained from large genome-wide association studies as instruments to identify the potential causal effects of various brain imaging-derived phenotypes (BIDPs) traits on susceptibility, hospitalisation, and severity of COVID-19. We explored the genetic correlations of 1325 BIDPs with the susceptibility, hospitalisation, and severity of COVID-19 using Linkage Disequilibrium Score Regression. We observed a causal relationship between increased cortical thickness of the left inferior temporal area and an increased risk of increased COVID-19 infection (p = 4.29 × 10-4) and hospitalisation (p = 3.67 × 10-3). Moreover, the larger total surface area of the whole brain was negatively correlated with the risk of hospitalisation for COVID-19. Furthermore, there was a significant causal association between increased cerebrospinal fluid volume and decreased severity of COVID-19 (p = 3.74 × 10-3). In a conclusion, we provide new insights into the causal association between BIDPs and COVID-19 phenotypes, which may help elucidate the aetiology of COVID-19.

Disease burden and attributable risk factors of neonatal disorders and their specific causes in China from 1990 to 2019 and its prediction to 2024.

BACKGROUND: Neonatal health is a cornerstone for the healthy development of the next generation and a driving force for the progress of population and society in the future. Updated information on the burden of neonatal disorders (NDs) are of great importance for evidence-based health care planning in China, whereas such an estimate has been lacking at national level. This study aims to estimate the temporal trends and the attributable burdens of selected risk factors of NDs and their specific causes in China from 1990 to 2019, and to predict the possible trends between 2020 and 2024. METHODS: Data was explored from the Global Burden of Disease study (GBD) 2019. Six measures were used: incidence, mortality, prevalence, disability-adjusted life years (DALYs), years lived with disability (YLDs), and years of life lost (YLLs). Absolute numbers and age-standardized rates (with 95% uncertainty intervals) were calculated. The specific causes of NDs mainly included neonatal preterm birth (NPB), neonatal encephalopathy due to birth asphyxia and trauma (NE), neonatal sepsis and other neonatal infections (NS), and hemolytic disease and other neonatal jaundice (HD). An autoregressive integrated moving average (ARIMA) model was used to forecast disease burden from 2020 to 2024. RESULTS: There were notable decreasing trends in the number of deaths (84.3%), incidence (30.3%), DALYs (73.5%) and YLLs (84.3%), while increasing trends in the number of prevalence (102.3%) and YLDs (172.7%) from 1990 to 2019, respectively. The corresponding age-standardized rates changed by -74.9%, 0.1%, -65.8%, -74.9%, 86.8% and 155.1%, respectively. Four specific causes of NDs followed some similar and different patterns. The prediction results of the ARIMA model shown that all measures still maintained the original trends in the next five years. Low birth weight, short gestation, ambient particulate matter pollution and household air pollution from solid fuels were the four leading risk factors. CONCLUSION: The health burden due to NDs is declining and is likely to continue to decline in the future in China. Delaying the increasing burden of disability may be the next target of concern. Targeted prevention and control strategies for specific causes of NDs are urgently needed to reduce the disease burden.

Effect of hypertensive disorders of pregnancy on pubertal development in daughters and sons: a systematic review and meta-analysis.

Hypertensive disorders of pregnancy (HDP) are a major cause of maternal and offspring morbidity and mortality worldwide. Several studies in recent years have focused on the link between HDP and pubertal development in offspring. The goal of this study was to synthesize the published literature on the effect of HDP on pubertal development in offspring by a systematic review and meta-analysis (PROSPERO 2021: CRD42020148736). A systematic literature search of several databases was conducted through December 2021, focusing on studies reporting pubertal development in offspring of women with and without HDP exposure. Primary outcomes of interest included offspring body mass index (BMI), height, waist and hip circumference, fat mass, pubarche, thelarche, and age at menarche. A total of 21 studies were finally included. Significantly higher values of BMI (SMD: 0.16 [0.11, 0.22]; p < 0.01) and waist circumference (SMD: 0.21 [0.14, 0.29]; p < 0.01) were found in offspring exposed to maternal HDP. In addition, a tendency of the early development of secondary sexual characteristics only in daughters was presented in offspring whose mothers were diagnosed with HDP. The findings imply a possible effect of HDP on pubertal development in offspring, especially for their BMI and waist circumference, which highlights the importance of focusing on adolescent developmental abnormalities in offspring exposed to HDP.

Embolic Stroke Associated With a Pulmonary Arteriovenous Fistula: An Unignorable Rare Causes of Stroke.

INTRODUCTION: Here, we described a patient with ischemic stroke due to embolism, through an isolated pulmonary arteriovenous fistula (PAVF). Our case could be a paradigm of embolic stroke of undetermined source (ESUS) with an uncommon cause, providing an etiologic investigation process in addition to diagnostic pitfalls and pearls, eventually raising neurologists' ability to treat ESUS. CASE REPORT: A 37-year-old right-handed woman presented to our emergency department with sudden onset left upper limb and lower limb weakness. She denied a past medical history of hypertension, diabetes, heart diseases, and other cerebrovascular disease risk factors, and she is without a family history of stroke, previous trauma, toxic exposure, or drug use. On admission, her physical and neurological examinations were negative, except for left-sided hemiparesis. Her routine evaluations, serum autoantibody testing, and digital subtraction angiography were negative. Subsequent diffusion-weighted brain magnetic resonance imaging demonstrated acute infarction in the right frontoparietal lobe. To find the etiology of this case, more detailed examinations were performed. Finally, she was diagnosed with ESUS, which was caused by the PAVF. CONCLUSIONS: This case raises the awareness of a potential important emboligenic mechanism, the existence of an isolated PAVF as a right-to-left shunt in patients with a stroke of unknown origin should not be overlooked, even if a PAVF is not suggested by the initial physical findings or chest x-ray.

The association of iron status, supplement iron in the first-trimester pregnancy with gestational diabetes mellitus: A nested case-control study.

AIMS: The objective of this study was to examine whether the level of iron and iron supplements in the first-trimester pregnancy is associated with gestational diabetes mellitus (GDM). METHODS: This was a nested case-control study using data from an established cohort in the Hunan Provincial Maternal and Child Health Hospital (HPMCHH) in South China. A total of 119 patients with GDM and 238 controls were enrolled in the study. Iron status indicators were tested in early pregnancy. Information on iron supplements use was collected by questionnaires. Binary logistic regression was used to obtain odds ratio (OR). The relative excess risk of interaction (RERI) was applied to evaluate the interaction. RESULTS: We observed that pregnant women with normal ferritin levels (≥30 ng/ml) and iron supplements were associated with a 3.701-fold increased risk of GDM (OR: 3.701, 95% CI: 1.689-8.112) compared with the ferritin <30 ng/ml and without iron supplements group. Similarly, pregnant women with normal serum iron (SI) levels (≥9 µmol/L) and iron supplements were associated with a 5.447-fold increased risk of GDM (OR: 5.447, 95% CI: 2.246-13.209) compared with the SI < 9 µmol/L and without iron supplement group. We found an additive interaction between ferritin and iron supplements on the presence of GDM (RERI: 1.164, 95%CI: 0.333-1.994) and SI and iron supplements on the risk of GDM (RERI: 6.375, 95%CI: 4.494-8.256). CONCLUSION: Pregnant women with normal ferritin or SI levels and iron supplements could significantly increase the risks for GDM.

The risk of congenital heart defects associated with corticosteroids use during the first trimester of pregnancy: a systematic review and meta-analysis.

BACKGROUND: Prior studies have suggested that maternal corticosteroids exposure during the first trimester may be associated with an increased risk of congenital heart defects (CHDs) in offspring. However, the findings are discrepant. Moreover, a complete overview of the existing data in the literature is lacking. Our objective was to identify whether such an association exists. METHODS AND RESULTS: Relevant studies were identified via searching PubMed, Web of Science, Embase, Chinese databases, and the Cochrane Library databases (search date July 15, 2021) and through checking the reference lists of retrieved articles. The overall pooled risk estimate was calculated using random-effect models. We used the GRADE approach to assess the overall strength of the evidence and the Newcastle-Ottawa Scale to assess study quality. Subgroup analyses were performed to evaluate the association within studies or samples with different characteristics. Sensitivity analyses were performed to assess the robustness of the results. Nine studies involving 1,901,599 participants were included in the final analysis. All studies were evaluated as high quality. In the meta-analysis, no statistically significant association was found between maternal corticosteroids exposure during the first trimester and increased risk of CHDs in offspring (OR = 1.06, 95% CI: 1.00-1.13, P = 0.06, low certainty of evidence). Additionally, we also did not find significant differences in subgroup analyses of corticosteroids exposure patterns, including oral corticosteroids exposure (OR = 1.23, 95% CI: 1.00-1.52), ointment corticosteroids exposure (OR = 1.03, 95% CI: 0.90-1.19), inhalation corticosteroids exposure (OR = 1.06, 95% CI: 0.96-1.17), topical corticosteroids or systemic corticosteroids exposure (OR = 0.95, 95% CI: 0.79-1.15), and nasal corticosteroids exposure (OR = 1.12, 95% CI: 0.80-1.57). CONCLUSIONS: Our study does not find an association between maternal corticosteroids exposure during the first trimester and offspring CHDs. However, the existing evidence is of low quality; thus, long-term prospective cohort studies are warranted to verify the safety of corticosteroids in this population, with adequate adjustments for confounding variables.

Association between dietary inflammatory index and oral cancer risk: A systematic review and dose-response meta-analysis.

Background: Dietary inflammatory index (DII) has been suggested to be associated with oral cancer risk. However, a quantitative comprehensive assessment of the dose-response relationship has not been reported. We performed a meta-analysis to clarify the risk of oral cancer with DII. Methods: We searched PubMed, Embase, Cochrane Library, and Web of Science databases for relevant articles published up to 1 March 2022. Fixed- or random-effects models were utilized to estimate the pooled odds ratio (OR) of oral cancer with DII, as appropriate. Restricted cubic splines were used to model the dose-response relationship. Results: We included five case-control studies involving 1,278 cases and 5,137 controls in the meta-analysis. Risk of oral cancer was increased by 135% with the highest versus lowest DII level [OR: 2.35, 95% confidence interval (CI): 1.88-2.94], and 79% with higher versus lower DII level (OR: 1.79, 95% CI: 1.49-2.15). We found no evidence of a nonlinear dose-response association of DII with oral cancer (pnon-linearity = 0.752), and the risk was increased by 17% (OR: 1.17, 95% CI: 1.05-1.30) with 1 unit increment in DII score. Conclusion: This meta-analysis suggested that a higher DII score was associated with increased risk of oral cancer. Therefore, reducing pro-inflammatory components and promoting anti-inflammatory components of diet may be effective in the prevention of oral cancer.

Effects of Maternal Pre-Pregnancy BMI and Gestational Weight Gain on the Development of Preeclampsia and Its Phenotypes: A Prospective Cohort Study in China.

Preeclampsia (PE) is a common and serious pregnancy-specific disorder, which is closely linked with adverse maternal and neonatal outcomes. This study aimed to evaluate whether maternal pre-pregnancy body mass index (BMI) and gestational weight gain (GWG) was associated with preeclampsia and its phenotypes. In this prospective study, 32,531 women with singleton pregnancies were finally included. Compared with women with normal pre-pregnancy BMI, women with overweight and obesity were at increased risk of PE (RR = 1.62, 95%CI: 1.57−1.66; RR = 2.04, 95%CI: 1.97−2.11, respectively), while those who were underweight had a lower risk of PE (RR = 0.84, 95%CI: 0.81−0.88). When compared with women who gained adequate GWG, pregnant women with inadequate GWG and excessive GWG had an increased risk of PE (RR = 1.15, 95%CI: 1.12−1.19; RR = 1.56, 95%CI: 1.52−1.60, respectively). The observed increased risk was generally similar for mild-, severe-, early- and late-onset PE, and the reduced risk was similar for severe- and late-onset PE. No significant interactions between GWG and pre-pregnancy BMI on the risk of PE were identified (p-interaction > 0.05). In conclusion, pre-pregnancy overweight or obesity and excessive GWG have established risk factors for PE, and that the potential risk may vary according to PE phenotypes. Moreover, the synergistic effect that may exist between pre-pregnancy BMI and GWG.

Time Trends in the Incidence of Spinal Pain in China, 1990 to 2019 and Its Prediction to 2030: The Global Burden of Disease Study 2019.

BACKGROUND: With increasing life expectancy in China, the associated burden of low back and neck pain (spinal pain) on the healthcare system increases, posing a substantial public health challenge. This study aimed to investigate trends in spinal pain incidence across China from 1990 to 2019 and to predict incidence trends between 2020 and 2030. METHODS: Data were derived from the Global Burden of Disease Study (GBD) 2019. The annual percentage change (APC) and average annual percentage change (AAPC) between 1990 and 2019 were calculated using Joinpoint regression analysis. The effects of age, period, and cohort on spinal pain were estimated by an age-period-cohort model. An autoregressive integrated moving average (ARIMA) model was used to forecast incidence trends from 2020 to 2030. RESULTS: From 1990 to 2019, the age-standardized incidence rate (ASIR) of low back pain (LBP) significantly decreased in both male and female subjects, while the ASIR of neck pain (NP) slightly increased regardless of sex. Joinpoint regression analysis showed that the incidence rates of LBP decreased in all age groups, and incidence rates of NP increased after 45 years old among men and women. The age effects showed that the relative risks (RR) of LBP incidence increased with age, and the group aged 40-49 years had the highest RR for NP incidence, regardless of sex. Period effects showed that the risk of NP continuously increased with increasing time periods, but not in LBP. The cohort effect showed a continuously decreasing trend in later birth cohorts. The prediction results of the ARIMA model show that the ASIR of NP in both male and female subjects in China shows an increasing trend in the next 10 years, and the ASIR of LBP increased in male but decreased in female subjects. CONCLUSION: Spinal pain has remained a major public health burden over the past 30 years in China and will likely increase further with population aging. Therefore, spinal pain should be a priority for future research on prevention and therapy, and is especially critical as the aging population increases in China.