[Spatial clustering analysis and trend of liver cancer death rate in Shandong province, 1970-2013].

Objective: To explore the spatial clustering and trend of liver cancer mortality in different counties of Shandong province from 1970 to 2013, and provide scientific basis for the development of liver cancer prevention and control plan. Methods: Cancer mortality data were obtained from Shandong Death Registration System and three national death cause surveys in China. Mortality rate and age adjusted mortality rate were used to describe the trend of liver cancer in different years. Difference decomposing method was applied to estimate the contribution of demographic and non-demographic factors to the change of mortality. Software ArcGIS 10.2 was used for spatial analysis, and software SaTScan 9.4 was used for spatial clustering analysis on liver cancer mortality. Results: From 2011 to 2013, the crude mortality rate of liver cancer (29.89/100 000) in Shandong increased by 208.00% and 35.37% respectively compared with that during 1970-1974 (9.72/100 000) and 1990-1992 (22.08/100 000) and was similar to that during 2004-2005 (30.44/100 000). While age standardized mortality rate (ASMR) increased first and then decreased. The ASMR during 2011-2013 (12.62/100 000) increased by 60.97% compared with that during 1970-1974 and decreased by 22.38% and 21.81% compared with that during 1990-1992 and 2004-2005, respectively. According to the difference decomposition analysis on liver cancer mortality in different years, the contribution of population factors to the liver cancer mortality rate increased from 3.38% during 1990-1992 to 29.36% during 2004-2005 and 46.16% during 2011-2013. However, the contribution of non-population factors to the increase of liver cancer mortality decreased. According to the spatial distribution of liver cancer mortality, the crude mortality rate of liver cancer in different counties were quite different, ranging from 9.33/100 000 to 65.33/100 000. Using the spatial scanning statistical software to analyze the spatial clustering of liver cancer mortality, multi areas with high mortality rate of liver cancer were found, and they were mainly distributed in Jiaodong peninsula from 2011 to 2013, covering 20 counties (cities, districts) in Qingdao, Yantai and Weihai. The risk of liver cancer mortality in this area was 1.54 times higher than that in other areas. The spatial clustering distribution of liver cancer mortality during 1970-1974 was significantly different from that during 2011-2013, the areas with high mortality rate during 1970-1974 were mainly distributed in central and western Shandong. Conclusions: There were significant temporal and spatial distribution changes in the mortality rate of liver cancer in Shandong from 1970 to 2013. According to these trends and their geographical and spatial distribution, we should further explore the risk factors of liver cancer, and formulate feasible and area specific prevention and control measures for liver cancer.

[Trend of mortality and decomposition on malignant tumors in Shandong province, 1970-2013].

Objective: To describe the mortality trend of major malignant tumors in Shandong province, from 1970 to 2013. Methods: Data related to cancer mortality were obtained from the Shandong Death Registration System and three nationwide retrospective cause-of-death surveys. Trends of overall mortality and major causes of death were described using the indicators as: mortality rates and age-standardized mortality rates, through comparing the three large-scale mortality surveys in Shandong province. Difference decomposing method was applied to estimate the contribution of demographic and non-demographic factors for the change of mortality. Results: From 1970 to 2013, the crude mortality rate of malignant tumors in Shandong was increasing. The age standard mortality rate was increasing and then decreasing. The composition of cancer deaths in the all-cause-deaths was seen increasing and then decreasing as well. Both demographic and non-demographic factors contributed to the increase of crude cancer mortality rate. With the gradual increase of the proportion of population, its role exceeded the non-demographic factors. The age-standardized mortality rate of malignant tumors in 2011-2013 was lower than that in 2004-2005. Lung cancer mortality rose from the fifth to the first place, with an increase of 6.81 times from 1970-1974 to 2011-2013. Ranking of gastric cancer mortality dropped from first to the third place, with esophageal cancer dropped from second to the fourth. After adjusted by China's standard population in 1964, the mortality rate of lung cancer was still rapidly increasing, but the age-standardized mortality rates of esophageal cancer was gradually decreasing. The crude and age-standardized mortality rates of cervical cancer showed a rapid downward trend, reduced 87.00% and 93.00% respectively from 1970-1974 to 2011-2013. Conclusions: Malignant tumors were still major threats to the residents of Shandong province. The changing trend of different malignant tumors presented an inconsistent nature which called for different intervention strategies be carried out, accordingly.

[Analysis on epidemiological and temporal-spatial distribution characteristics of hemorrhagic fever with renal syndrome in Shandong province, 2010-2016].

Objective: To analyze the epidemiological and temporal-spatial distribution characteristics of hemorrhagic fever with renal syndrome (HFRS) in Shandong province during 2010-2016 and provide references for developing prevention and control measures. Methods: Based on the data of Infectious Disease Reporting Information System in China, the incidence and temporal-spatial distribution of HFRS in Shandong from 2010 to 2016 were analyzed by spatial autocorrelation and space-time scan statistics. Results: A total of 9 114 HFRS cases were reported in Shandong during this period. The cases were mainly distributed in age group 30-70 years, and the male to female ratio of the cases was 2.63 ∶ 1. Most cases were farmers. The higher incidence rate was reported in southeastern Shandong, while the lower incidence rate was reported in northwestern Shandong. Among the epidemic periods, the highest incidence rate was 1.87/100 000 in 2013. The results of spatial autocorrelation and space-time scanning indicated that the high-high clusters of HFRS were concentrated in southeastern Shandong and then spread to central Shandong. The cluster mainly occurred from the end of 2011 to the first half of 2015. Both the incidence rate and the cluster decreased in 2016. Conclusions: The epidemic and cluster of HFRS still existed in Shandong from 2010 to 2016. The key areas for the prevention and control of HFRS were in southeastern and central Shandong.

[Application of State Space model in the evaluation of the prevention and control for mumps].

Objective: To analyze the epidemiological characteristics of mumps in 2012 and 2014, and to explore the preventive effect of the second dose of mumps-containing vaccine (MuCV) in mumps in Shandong province. Methods: On the basis of certain model assumptions, a Space State model was formulated. Iterated Filter was applied to the epidemic model to estimate the parameters. Results: The basic reproduction number (R(0)) for children in schools was 4.49 (95%CI: 4.30-4.67) and 2.50 (95%CI: 2.38-2.61) respectively for the year of 2012 and 2014. Conclusions: Space State model seems suitable for mumps prevalence description. The policy of 2-dose MuCV can effectively reduce the number of total patients. Children in schools are the key to reduce the mumps.

[Association between hematocrit and risk of incident hypertension: a cohort study].

Objective: To explore the association between hematocrit level and risk of incident hypertension. Method: Subjects who participated at least two times routine health check-up in Health Management Center of Shandong Province Hospital between January 2005 and January 2010 were eligible for inclusion. After excluding participants with known hypertension and other related diseases, a prospective cohort with 20 606 subjects (female: 8 218, male: 12 388) was established. Cox-proportional hazard model was used to assess the association between hematocrit and the development of hypertension for female and male respectively. Results: During the 51 352 person-years of follow-up, newly developed hypertension was confirmed in 3 695 cases. For female, the age-adjusted hazard ratios (95%CI) for incident hypertension were 1.00 (reference), 1.06(0.86-1.29), 1.37(1.14-1.65), 1.60(1.34-1.92), respectively (P for trend<0.000 1) through the 3 quartiles of hematocrit levels.After adjusting multiple factors (age, smoking, drinking habit, physical activity, body mass index(BMI), systolic blood pressure, fasting blood glucose, serum creatinine, high-density lipoprotein, gamma-glutamyl transferase, white blood count), the hazard ratios (95%CI) were 1.00(reference), 1.05(0.85-1.29), 1.25(1.03-1.51), and 1.22(1.00-1.48), respectively (P for trend=0.016 9). For male, the hazard ratio (the highest vs. the lowest hematocrit level) after adjusting age or age and life style factors (smoking, drinking habit, physical activity) was 1.23 (1.11-1.37), 1.21(1.09-1.35), respectively. Other analyses of relationship hematocrit with incident hypertension were not statistically significant in male. Conclusions: Higher hematocrit level is associated with higher risk of incident hypertension, especially in female.

Association of haemorrhagic fever with renal syndrome and weather factors in Junan County, China: a case-crossover study.

Haemorrhagic fever with renal syndrome (HFRS) is a type of vector-borne zoonosis sensitive to climate change. To explore the short-term effect of air temperature and amount of precipitation on HFRS incidence, a total of 13 722 clinically confirmed HFRS cases from January 1977 to December 2001 in Junan County, China were included in this study. According to symmetric bidirectional case-crossover design, the hazard period (the three calendar months preceding the month when the case was diagnosed) and the control period (the same calendar month of the year before and the year after the hazard period) matched and conditional logistic regression was used to examine the effect of monthly mean temperature and precipitation on the risk of HFRS. The results showed the facilitating climatic conditions for HFRS included: condition with moderate mean air temperature (10-25 °C) and abundant precipitation (>120 mm) 3 months before [odds ratio (OR) 1·346, 95% confidence interval (CI) 1·191-1·522] and 2 months before (OR 1·193, 95% CI 1·063-1·339); and condition with temperature >25 °C and abundant precipitation (>120 mm) 3 months before (OR 1·17, 95% CI 1·004-1·363). Temperature of 10-25 °C and moderate precipitation (10-120 mm) in the current month was the most favourable condition for HFRS incidence.