Different etiological entities of liver cancer across populations: Implications from age-period-cohort analysis on incidence trends.

BACKGROUND: The incidence of liver cancer has shown different temporal trends across populations, while the underlying reasons remain unclear. METHODS: We examined temporal trends in the incidence of liver cancer in Hong Kong, Sweden, and the United States since the 1970s through 2021 using joinpoint regression and age-period-cohort analysis. RESULTS: The age-standardized incidence rate of liver cancer in Hong Kong steadily decreased (average annual percentage change [AAPC] -2.2%, 95% confidence interval [CI] -2.8% to -1.7% in men; AAPC -2.1%, 95%CI -3.1% to -1.1% in women) in 1983-2020. The rate in Sweden increased on average by 0.8% (95%CI 0.2% to 1.4%) per year in men and was stable in women (AAPC 0.2%, 95%CI -0.9% to 1.4%) in 1970-2021. The rate in the United States increased by 2.1% (95%CI 1.5% to 2.8%) per year in men and by 2.1% (95%CI 1.6% to 2.5%) in women in 1975-2020, but decreasing trends were noted in 2015-2020 (AAPC -6.6%, 95%CI -8.3% to -4.9% in men; AAPC -4.2%, 95%CI -7.5% to -0.5% in women). Stratified analysis by histological type showed such decrease in recent years was limited to hepatocellular carcinoma, rather than intrahepatic cholangiocarcinoma. We observed distinct changes in trends across age groups and different trends across birth cohorts. CONCLUSION: The incidence of liver cancer has decreased in Hong Kong but increased in Sweden and the United States since the 1980s, despite decreasing incidence in the United States since 2015. Such disparities may be explained by different etiology and implementation of preventive measures across populations.

Cancer Survival Trends in Southeastern China, 2011-2021: A Population-Based Study.

Purpose: The 5-year cancer survival rate among Chinese patients is lower than that among patients in developed countries and varies widely across geographic regions. The aim of this study was to analyse the 5-year relative cancer survival rate in southeastern China, between 2011 and 2021. Patients and Methods: We utilised population-based statistics from 12 cancer registries in Fujian, China. Study population data were up to date as of Dec 31, 2019, and survival outcome status was updated as of Dec 31, 2021. We used the ICD-10 and the ICD-O-3 to categorize all cancer cases. We analysed the 5-year relative survival for cancers combined and different cancer types stratified by sex, urban and rural areas, and age. Survival estimates were stratified according to calendar period (2011-13, 2014-15, 2016-18 and 2019-21). Results: Ultimately, a total of 160,294 cancer patients were enrolled in the study. In 2011-13, 2014-15, 2016-18 and 2019-21, the age-standardised 5-year relative survival for cancers combined were 29.1% (95% CI: 28.6-29.7), 31.5% (95% CI: 31.0-32.0), 36.8% (95% CI: 36.4-37.3) and 39.1% (95% CI: 38.7-39.6), respectively. The age-standardised 5-year relative survival for lung, prostate, larynx, colon-rectum, kidney and bone cancers increased 4.3%, 4.0%, 3.8%, 3.4%, 3.4% and 2.70%, respectively. Cancers with high 5-year relative survival rates (>60%) in 2019-21 included thyroid, testis, breast, bladder, cervix, prostate and uterus cancers. The 5-year survival rates in 2019-2021 was higher for females than for males (47.8% vs 32.0%) and higher in urban areas than in rural areas (41.7% vs 37.1%). Relative survival rates decreased with increasing age. Conclusion: The 5-year cancer survival in Fujian Province increased between 2011 and 2021 but remained at a low level. Building a strong primary public health system may be a key step in reducing the cancer burden in Fujian Province.

Association between subjective well-being and all-cause mortality among older adults in China.

BACKGROUND: Although several studies in high-income countries have suggested a positive association between subjective well-being (SWB) and mortality, studies conducted in low- and middle-income countries, such as China, are scarce. The purpose of this study is to examine the association between SWB and all-cause mortality among the older Chinese population. METHODS: Data were from the Chinese Longitudinal Healthy Longevity Survey (CLHLS), a population-based longitudinal cohort study in 22 of 31 provinces in mainland China. A total of 13,282 individuals aged 65 ≥ years who were recruited in 2002 and followed-up until 2018 were included. SWB was assessed with an eight-item tool covering life satisfaction, positive affect (including optimism, happiness, personal control and conscientiousness) and negative affect (including anxiety, loneliness and uselessness). Cox proportional hazards regression methods were carried out to estimate the association between SWB and total mortality, adjusting for a wide range of potential confounders. Subgroup analyses and interaction analyses were further conducted. RESULTS: During the 16.5 years of follow-up, 8459 deaths were identified. Greater SWB was independently associated with a reduced risk of all-cause mortality (adjusted hazard ratio [HR] = 0.85, 95% confidence interval [CI] = 0.81-0.89) after adjustment for age, sex, marital status, education level, place of residence, smoking status, drinking, exercise, diet, BMI, hypertension, diabetes, heart disease, cerebrovascular diseases and cancer. Of the eight individual SWB symptoms, only 2 items, feelings of uselessness (adjusted HR = 0.94, 95% CI = 0.89-0.99) and happiness (adjusted HR = 0.91, 95% CI = 0.86-0.95), were significantly associated with total mortality. Associations remained significant across all subgroups regardless of different characteristics. CONCLUSIONS: Higher SWB overall and 2 certain symptoms (feelings of uselessness and happiness) were independently associated with all-cause mortality risk among older Chinese adults. The association was consistent across different groups, suggesting that promoting a healthier SWB may be beneficial to all older individuals irrespective of their characteristics.

Time Trend of Upper Gastrointestinal Cancer Incidence in China from 1990 to 2019 and Analysis Using an Age-Period-Cohort Model.

The aim of this study was to investigate the upper gastrointestinal cancer incidence trend in China from 1990 to 2019 with Joinpoint software and to evaluate the age effect, cohort effect, and period effect using the age-period-cohort model, with the data obtained from the Global Burden of Disease, Injuries, and Risk Factors Study. The crude incidence rate (CR) of upper gastrointestinal cancer in China increased from 41.48/100,000 in 1990 to 62.64/100,000 in 2019, and the average annual percent change (AAPC) was 1.42 (p < 0.05). The age-standardized incidence rate (ASIR) decreased from 50.77/100,000 to 37.42/100,000, and the AAPC was -1.12 (p < 0.05). The net drift was -0.83 (p < 0.05), and the local drifts in the 35-79 age groups of males and all age groups of females were less than 0 (p < 0.05). The age effect showed that the upper gastrointestinal cancer onset risk gradually increased with age, the period effect was fundamentally manifested as a downward trend in onset risk after 2000, and the cohort effect indicated the decreased onset risk of the overall birth cohort after 1926. The ASIR of upper gastrointestinal cancer in China from 1990 to 2019 showed a downward trend, and the onset risk indicated the age, period, and cohort effects.

Associations between depressive symptoms and sleep duration for predicting cardiovascular disease onset: A prospective cohort study.

BACKGROUND: The joint effects of depressive symptoms and sleep on the risk of cardiovascular disease (CVD) are not well understood. The purpose of this study was to assess the combined impact of depressive symptoms and sleep duration on the incidence of CVD among middle-aged and older Chinese individuals. METHODS: Data were from the China Health and Longitudinal Study conducted in 2013, 2015, and 2018. A total of 9595 participants aged ≥ 45 years without a history of CVD in 2013 were included. Depressive symptoms were measured using the 10-item Center for Epidemiological Studies Depression scale (elevated depressive symptoms cutoff ≥ 10). Average sleep duration was self-reported. Logistic regression analyses adjusted for age, sex, marital status, education and other potential confounders were conducted. RESULTS: In total, 1072 (11.2%) participants reported CVD incidents over the 5-year period. Elevated depressive symptoms (OR = 1.49, 95% CI = 1.30-1.72) and short sleep duration (OR = 1.21, 95% CI = 1.05-1.40) were independently associated with an increased CVD risk in the fully adjusted model. Individuals with short sleep duration/low depressive symptoms (OR = 1.34, 95% CI = 1.12-1.60), short sleep duration/elevated depressive symptoms (OR = 1.70, 95% CI = 1.41-2.50), or long sleep duration/elevated depressive symptoms (OR = 2.13, 95% CI = 1.38-3.27) were more likely to develop CVD than those with normal sleep duration/low depressive symptoms. LIMITATIONS: Depressive symptoms and sleep duration were self-reported. CONCLUSIONS: A stronger risk of CVD was found when depressive symptoms and short or long sleep durations occurred together, suggesting that an integrated approach to sleep and depressive symptoms might be a feasible strategy for the prevention of CVD.

The Effects of a Partially Hydrolyzed Formula with Low Lactose and Probiotics on Mild Gastrointestinal Disorders of Infants: A Single-Armed Clinical Trial.

Partially hydrolyzed formula (pHF) containing low lactose and probiotics may benefit the gastrointestinal health of infants. We aimed to assess the effects of pHF on mild gastrointestinal disorders (MGDs) of infants. In this single-armed trial, 80 full-term infants with MGDs were enrolled and fed a pHF for 14 consecutive days. The primary outcome resulted from the scores of gastrointestinal symptoms reported by parents using a validated Infant Gastrointestinal Symptom Questionnaire (IGSQ) at Day 0 (baseline), Day 7, and Day 14. The total IGSQ scores ranged from 13 to 65. Higher scores indicated worse gastrointestinal symptoms. The IGSQ scores (mean ± SD) decreased from Day 0 (36.0 ± 5.7) to Day 7 (28.7 ± 7.4) and Day 14 (26.5 ± 8.1 (p < 0.001), with corresponding digestive distress prevalence (IGSQ score > 30) decreasing from 87.5% to 35.0% and 28.8% (p < 0.001). In the first three days, vomiting and flatulence scores decreased at Day 1 versus Day 0, and the crying score decreased at Day 2, but no significant changes were observed for fussy and stool characteristics. All growth parameters increased and no parents reported adverse events. In conclusion, feeding with a pHF containing low lactose and probiotics may comfort infants with MGDs, and the comforting effect likely manifests early in the first three days of the feeding interventions. Trial registration: ClinicalTrials.gov NCT04112056.

Erratum: Patients' Attitudes to Unproven Therapies in Treating COVID-19 Merit Evaluation.

[This corrects the article DOI: 10.1016/j.xinn.2020.100028.].

Patients' Attitudes to Unproven Therapies in Treating COVID-19 Merit Evaluation.

Since the outbreak of COVID-19, many randomized controlled trials have been launched to test the efficacy of promising treatments. These trials will offer great promise for future treatment. However, a public health emergency calls for a balance between gathering sound evidence and granting therapeutic access to promising trial drugs as widely as possible. In an electronic survey, we found that 3.9% of the participants preferred to receive an unproven trial drug directly in the hypothetical scenario of mild COVID-19 infection. This percentage increased drastically to 31.1% and 54.2% in the hypothetical scenario of severe and extremely severe infection, respectively. Our survey indicates a likelihood of substantial receptivity of trial drugs among actual patients in severe conditions. From the perspective of deontological ethics, a trial can only be approved when potential benefits of the investigational treatment are presumed to outweigh risks, so compassionate or off-label use of investigational therapies merits evaluation.