RESUMO
Background Few studies have been conducted on the associations of dietary habits with the risks of high normal blood pressure and hypertension in employees of chemical companies in northwest China. Objective To understand the excess intakes of red meat, offal, and salt, the current status of high normal blood pressure and hypertension detection among employees of a large chemical company in Gansu, China, and to analyze the relationships between different dietary habits and the risks of high normal blood pressure and hypertension. Methods A large state-owned chemical enterprise in Gansu Province was selected and 914 employees were recruited by age-stratified random sampling. A set of questionnaires and health examination were adopted for the survey. χ2 test was used to compare dietary habits. A logistic regression model was used to analyze the relationships between different dietary habits and the risks of high normal blood pressure and hypertension in the chemical enterprise employees after including the factors significantly different in the χ2 test. Results A total of 914 workers completed the survey. Significant differences were found in the distribution of normal blood pressure, high normal blood pressure, and hypertension among the participants grouped by gender, age, body mass index (BMI), and family history of hypertension (P < 0.001). The excess intake rates of red meat, offal, and salt were 25.4%, 29.0%, and 62.1%, respectively. Significant differences were found in the distribution of normal blood pressure, high normal blood pressure, and hypertension among the participants grouped by intakes of meat, offal, and salt (P < 0.001). The highest positive rate of high normal blood pressure was detected in the workers with excess intakes of offal and salt (P < 0.001). The prevalence rate of hypertension increased with higher intakes of red meat, offal, and salt (P < 0.001). After adjusting for gender, age, BMI, family history of hypertension, and other factors, the results of logistic regression showed that the risks of high normal blood pressure and hypertension in workers with excess red meat intake were 1.55 (95%CI: 1.00, 2.38) times and 2.88 (95%CI: 1.63, 5.07) times higher than those in workers with low red meat intake respectively. The risks of high normal blood pressure and hypertension in workers with excess offal intake were 1.75 (95%CI: 1.12, 2.72) times and 1.87 (95%CI: 1.01, 3.44) times higher than those in workers with no offal intake respectively. The risks of high normal blood pressure and hypertension in workers with excess salt intake were 1.80 (95%CI: 1.22, 2.65) times and 2.59 (95%CI: 1.63, 4.11) times higher than those in workers with moderate salt intake, respectively. Conclusion Excessive intakes of red meat, offal or salt are common among the chemical enterprise workers. Excess intakes of red meat, offal, and salt are risk factors for both high normal blood pressure and hypertension. The northwest chemical enterprise should further advocate a healthy and reasonable diet among employees, and propose to reduce the intakes of red meat, offal, and salt.
RESUMO
Background: Pembrolizumab is a guideline-recommended, both first- and second-line treatment option for microsatellite-instability-high (MSI-H)/mismatch repair-deficient (dMMR)advanced colorectal cancer patients. The aim of the present study is to investigates the health and economic outcomes of three treatment strategies with or without pembrolizumab in MSI-H/dMMR advanced colorectal cancer to define the best treatment strategy from the perspective of the US payer. Methods: A microsimulation model was developed to estimate the cost and effectiveness of three treatment strategies: 1) pembrolizumab used as first-line, 2) pembrolizumab used as second-line and, 3) chemotherapy. Life years (LYs), quality-adjusted LYs (QALYs) and lifetime costs were estimated. Results: The model projected that patients receiving pembrolizumab in the first-line setting gained 5.579 QALYs; this value was 1.501 and 3.941 QALYs more than that for patients receiving pembrolizumab in the second-line setting and chemotherapy, respectively. First-line pembrolizumab strategy dominated second-line pembrolizumab strategy. Compared with chemotherapy, first-line pembrolizumab strategy yielded an incremental cost of $50613.7, which resulted in an ICER of $13441 per QALY. Conclusion: For patients with MSI-H/dMMR advanced colorectal cancer, reserving pembrolizumab for second-line line use is dominated by its first-line use, and first-line use of pembrolizumab is cost-effective compared with chemotherapy.
