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1.
Artigo em Inglês | MEDLINE | ID: mdl-33849956

RESUMO

OBJECTIVES: The study aimed to investigate the association between maternal body mass index (BMI) in early pregnancy and children's intellectual disability (ID) risk in the absence of chromosomal disorders, neurofibromatosis and tuberous sclerosis, taking adverse birth outcomes, maternal hypertension/diabetes and maternal socioeconomic status into consideration. METHODS: We conducted a cohort study of singletons without common genetic defects born in Sweden during 1992-2006, and followed them from birth until 31 December 2014 (n=1 186 836). Cox proportional hazards models were used to analyse the association between maternal BMI in early pregnancy and the risk of offspring's ID. RESULTS: The risk of ID was higher in children born to mothers who were underweight (HR=1.21, 95% CI=1.07 to 1.36), overweight (HR=1.28, 95% CI=1.21 to 1.34) or had obesity class I (HR=1.63, 95% CI=1.53 to 1.74), obesity class II (HR=2.08, 95% CI=1.88 to 2.30) and obesity class III (HR=2.31, 95% CI=1.46 to 3.65) than in children born to normal weight mothers. Results remained consistent after excluding children with adverse birth outcome or born to mothers with gestational hypertension/diabetes. Analysis stratified by maternal education and annual household income showed that the association between maternal underweight and children's ID risk was attenuated among children of mothers with tertiary education or with high income. CONCLUSIONS: Our findings suggest that maternal underweight or overweight/obesity in early pregnancy was associated with the development of ID in their offspring. This association was independent of the effect of adverse birth outcomes and maternal hypertension/diabetes. High socioeconomic status may attenuate the risk of ID among children of underweight mothers. This study highlights the importance of improving health education before conception to reduce children's ID risk.

2.
Artigo em Inglês | MEDLINE | ID: mdl-33770169

RESUMO

PURPOSE: Previous epidemiological evidence showed that type 2 diabetes (T2D) is related with gout. However, the causality and the direction of this association are still not definitely elucidated. We aimed to investigate bidirectional associations of T2D and glycemic traits with serum urate concentrations and gout using a Mendelian randomization (MR) approach. METHODS: Summary statistics from the large-scale genome-wide association studies conducted for T2D (Ncase=62,892, Ncontrol=596,424), fasting glucose (N=133,010), fasting insulin (N=133,010), hemoglobinA1c (N=123,665), homeostasis model assessment of insulin resistance (N=46,186), urate (N=110,347) and gout (Ncase=2,115, Ncontrol=67,259) among participants of European ancestry were analyzed. For each trait of interest, independent genome-wide significant (p<5×10 -8) single nucleotide polymorphisms were selected as instrumental variables. The inverse-variance weighted method was used for the primary analyses. RESULTS: Genetic predisposition to higher risk of T2D (beta=0.042; 95% CI=0.016-0.068; p=0.002) and higher levels of fasting insulin (beta=0.756; 95% CI=0.408-1.102; p=1.96e-05) were significantly associated with increased serum urate concentrations. Moreover, we found suggestively significant evidence supporting a causal role of fasting insulin on risk of developing gout (OR=3.06; 95% CI=0.88-10.61; p=0.078). In the reverse direction analysis, both genetic predisposition to urate and gout were not associated with T2D and any of four glycemic traits being investigated. CONCLUSIONS: This study provides supportive evidence on causal associations of T2D and fasting insulin with serum urate concentrations, and suggestive association of fasting insulin with risk of gout. Future research is required to examine the underlying biological mechanisms on such relationships.

3.
Am J Epidemiol ; 2021 Mar 17.
Artigo em Inglês | MEDLINE | ID: mdl-33728442

RESUMO

Present shift work has been associated with coronary heart disease (CHD) among employed workers, but it remains unclear whether shift work in the past is still associated with CHD in retired workers. We recruited 21,802 retired workers in Shiyan, China in 2008-2010 and 2013, and followed them up for CHD events to December 31, 2018. Retired workers with longer duration of past shift work had higher CHD risks (hazard ratios for those with ≤5.0, 5.25 to 10.0, 10.5 to 20.0, and >20.0 years of past shift work were 1.05 (95% confidence interval: 0.94, 1.16), 1.08 (0.94, 1.25), 1.23 (1.07, 1.42), and 1.28 (1.08, 1.51)). The association was substantially higher among services or sales workers than among manufacturing or manual labor workers (hazard ratio for every 5-year increase in past shift work, 1.11 (95% confidence interval: 1.05, 1.16) versus 1.02 (0.98, 1.06)). Moreover, the risk was lower among those who were physically active than their inactive counterparts (P for interaction, 0.019). Longer duration of past shift work was associated with higher risk of incident CHD among retired workers, especially those from services or sales sectors. Physical exercise might be beneficial in reducing the excess risk.

4.
Clin Nutr ; 2021 Jan 27.
Artigo em Inglês | MEDLINE | ID: mdl-33581953

RESUMO

BACKGROUND & AIMS: Although fruits and vegetable consumption has been shown to be associated with lower risks of mortality, cancers, and cardiovascular disease (CVD), there are limited data from China on the shape of the association. This study aimed to quantify the relationship between levels of fruit, vegetable, and legume consumption with the risk of major CVD, CVD mortality, cancer incidence, cancer mortality, and all-cause mortality. METHODS: In the baseline survey, participants attended 1 of 115 (45 urban and 70 rural) communities from 12 provinces to complete a standardized questionnaire, and undergo a physical examination between 2005 and 2009, and were followed up till 2017 (for the current analysis). Diet was assessed through in-person interviews by using validated food-frequency questionnaires. The clinical outcomes were adjudicated centrally by trained physicians using standardized definitions. Cox frailty models were used to explore the associations between fruit, vegetable, and legume consumption with the risk of all-cause, CVD, and cancer mortality. RESULTS: A total of 41 243 participants were eligible for inclusion in the analyses. The average combined average daily intake of fruit, vegetable, and legume was 2.97 [standard deviation (SD) 1.22] servings per day. During a median follow-up of 8.9 years [interquartile range (IQR) 6.7-9.9 years], we recorded 1893 major CVDs, 794 cancer events, and 1324 deaths, with 411 CVD deaths and 429 cancer deaths. In the models adjusted for age, sex, and center (random effect), a higher total intake of fruit, vegetable, and legume was inversely associated with CVD mortality, cancer incidence, cancer mortality, and all-cause mortality. After adjusting for additional covariates, the associations were evidently attenuated and only the association with all-cause mortality (hazard ratio [HR] trend 0.92, 95% CI 0.86-0.98, p trend = 0.021) remained significant, with a non-significant trend for major CVD (HR trend 1.02, 95% CI 0.97-1.08, p trend = 0.449), CVD mortality (HR trend 0.94, 95% CI 0.84-1.06, p trend = 0.301), cancer incidence (HR trend 0.97, 95% CI 0.89-1.06, p trend = 0.540), or cancer mortality (HR trend 0.92, 95% CI 0.82-1.04, p trend = 0.174). Compared with the reference group, the risk of all-cause mortality was the lowest for four to five servings of total daily intake of fruit, vegetable, and legume (HR 0.73, 95% CI 0.55-0.97), and did not show a further decrease for the higher intake group. Separately, fruit intake was associated with a lower risk of all-cause mortality (HR trend 0.92, 95% CI 0.86-0.99, p trend = 0.020) and legume intake was associated with a lower risk of major CVD (HR trend 0.95, 95% CI 0.90-0.99, p trend = 0.028) and all-cause mortality (HR trend 0.94, 95% CI 0.89-0.99, p trend = 0.020) in the fully adjusted models. CONCLUSIONS: This prospective study suggests that Chinese people with daily consumption of four to five servings (equivalent to 500-625 g/day) of fruit, vegetable, and legume demonstrated the lowest mortality, which conveys an encouraging message to the public that lifestyle modification to increase fruit, vegetable, and legume intakes may have greater beneficial effects on reducing all-cause mortality.

5.
Angiology ; 72(1): 78-85, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32812445

RESUMO

The smoker's paradox refers to an increased risk of adverse clinical outcomes after smoking cessation in patients with coronary artery disease. The mechanisms involved are controversial. The present study evaluated the effect of delay in smoking cessation on clinical outcomes among patients after percutaneous coronary intervention (PCI) stratified by diabetes mellitus (DM). Patients included in this study came from an established Fu Wai hospital PCI cohort. Smoking behavior was recorded; clinical end points included all-cause mortality and repeat revascularization. The analyses were based on 8489 smokers who underwent PCI. Patients with and without DM were examined separately. Multivariable model analysis suggested that smoking cessation was associated with significant lower all-cause mortality both for non-DM and DM patients. The smoking paradox was observed for revascularization. However, the increased risk of repeat revascularization correlated with quitting time among non-DM patients only, especially if they stopped smoking late (>90 days) after their index procedure (adjusted hazard ratio, 3.40; 95% CI: 2.45-4.72). In conclusion, smoking cessation is associated with a lower mortality rate for PCI patients. However, the relative benefit on repeated revascularization was only observed among non-DM patients if they quit smoking early.


Assuntos
Doença da Artéria Coronariana/terapia , Diabetes Mellitus/epidemiologia , Intervenção Coronária Percutânea , Abandono do Hábito de Fumar , Estudos de Coortes , Doença da Artéria Coronariana/mortalidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Fumantes , Fatores de Tempo
6.
J Hypertens ; 2020 Nov 11.
Artigo em Inglês | MEDLINE | ID: mdl-33186328

RESUMO

OBJECTIVE: The association between indoor air pollution resulting from household solid fuel use for heating and cooking with hypertension or blood pressure (BP) remains less clear. This study aims to rectify these knowledge gaps in a large Chinese population. METHODS: During 2005-2009, 44 007 individuals aged 35-70 years with complete information on household solid fuel use for cooking and heating were recruited from 279 urban and rural communities of 12 centers. Solid fuel referred to charcoal, coal, wood, agriculture crop, animal dung or shrub. Annual concentration of ambient atmospheric particulate matter that have a diameter of less than 2.5 µm for all communities was collected. Generalized linear mixed models using community as the random effect were performed to estimate the association with hypertension prevalence or BP after considering ambient atmospheric particulate matter that have a diameter of less than 2.5 µm and a comprehensive set of potential confounding factors at the individual and household level. RESULTS: A total of 47.6 and 61.2% of participants used household solid fuel for heating and cooking, respectively. Solid fuel use for heating was not associated with an increase in hypertension prevalence (adjusted odds ratio = 1.08, 95% confident interval: 0.98, 1.20) or elevated SBP (0.62 mmHg, 95% confident interval: -0.24, 1.48). No association was found between solid fuel for cooking and hypertension or BP, and no additional risk was observed among participants who had both exposures to solid fuel for heating and cooking compared with those used for heating only. CONCLUSION: The current large Chinese study revealed a statistically insignificant increase in the association between solid fuel use for heating and hypertension prevalence or BP. As this cross-sectional study has its inherent limitation on causality, findings from this study would have to be confirmed by prospective cohort studies.

7.
Lancet Planet Health ; 4(10): e451-e462, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-33038319

RESUMO

BACKGROUND: Approximately 2·8 billion people are exposed to household air pollution from cooking with polluting fuels. Few monitoring studies have systematically measured health-damaging air pollutant (ie, fine particulate matter [PM2·5] and black carbon) concentrations from a wide range of cooking fuels across diverse populations. This multinational study aimed to assess the magnitude of kitchen concentrations and personal exposures to PM2·5 and black carbon in rural communities with a wide range of cooking environments. METHODS: As part of the Prospective Urban and Rural Epidemiological (PURE) cohort, the PURE-AIR study was done in 120 rural communities in eight countries (Bangladesh, Chile, China, Colombia, India, Pakistan, Tanzania, and Zimbabwe). Data were collected from 2541 households and from 998 individuals (442 men and 556 women). Gravimetric (or filter-based) 48 h kitchen and personal PM2·5 measurements were collected. Light absorbance (10-5m-1) of the PM2·5 filters, a proxy for black carbon concentrations, was calculated via an image-based reflectance method. Surveys of household characteristics and cooking patterns were collected before and after the 48 h monitoring period. FINDINGS: Monitoring of household air pollution for the PURE-AIR study was done from June, 2017, to September, 2019. A mean PM2·5 kitchen concentration gradient emerged across primary cooking fuels: gas (45 µg/m3 [95% CI 43-48]), electricity (53 µg/m3 [47-60]), coal (68 µg/m3 [61-77]), charcoal (92 µg/m3 [58-146]), agricultural or crop waste (106 µg/m3 [91-125]), wood (109 µg/m3 [102-118]), animal dung (224 µg/m3 [197-254]), and shrubs or grass (276 µg/m3 [223-342]). Among households cooking primarily with wood, average PM2·5 concentrations varied ten-fold (range: 40-380 µg/m3). Fuel stacking was prevalent (981 [39%] of 2541 households); using wood as a primary cooking fuel with clean secondary cooking fuels (eg, gas) was associated with 50% lower PM2·5 and black carbon concentrations than using only wood as a primary cooking fuel. Similar average PM2·5 personal exposures between women (67 µg/m3 [95% CI 62-72]) and men (62 [58-67]) were observed. Nearly equivalent average personal exposure to kitchen exposure ratios were observed for PM2·5 (0·79 [95% 0·71-0·88] for men and 0·82 [0·74-0·91] for women) and black carbon (0·64 [0·45-0·92] for men and 0·68 [0·46-1·02] for women). INTERPRETATION: Using clean primary fuels substantially lowers kitchen PM2·5 concentrations. Importantly, average kitchen and personal PM2·5 measurements for all primary fuel types exceeded WHO's Interim Target-1 (35 µg/m3 annual average), highlighting the need for comprehensive pollution mitigation strategies. FUNDING: Canadian Institutes for Health Research, National Institutes of Health.

8.
Health Qual Life Outcomes ; 18(1): 339, 2020 Oct 12.
Artigo em Inglês | MEDLINE | ID: mdl-33046101

RESUMO

PURPOSE: To explore the association of academic performance and general health status with health-related quality of life (HRQoL) in school-aged children and adolescents in China. METHODS: In this cross-sectional study conducted in 2018, students (grade 4-12) were randomly chosen from primary and high schools in Nanjing, China. HRQoL, the outcome measure, was recorded using the Child Health Utility 9D, while self-rated academic performance and general health were the independent variables. Mixed-effects regression models were applied to compute mean difference (MD) and 95% confidence interval (CI) of HRQoL utility score between students with different levels of academic performance and general health. RESULTS: Totally, 4388 participants completed the study, with a response rate of 97.6%. The mean HRQoL utility score was 0.78 (SD: 0.17). After adjustment for socio-demographic attributes, physical activity, sedentary behavior, dietary patterns, body weight status and class-level clustering effects, students with fair (MD = 0.048, 95% CI 0.019, 0.078) and good (MD = 0.082, 95% CI 0.053, 0.112) self-rated academic performance reported higher HRQoL utility scores than those with poor academic performance, respectively. Meanwhile, students with fair (MD = 0.119, 95% CI 0.083, 0.154) and good (MD = 0.183, 95% CI 0.148, 0.218) self-assessed general health also recorded higher HRQoL utility scores than those with poor health, separately. Consistent findings were observed for participants by gender, school type and residential location. CONCLUSIONS: Both self-rated academic performance and general health status were positively associated with HRQoL among Chinese students, and such relationships were independent of lifestyle-related behaviors and body weight status.

9.
Occup Environ Med ; 2020 Oct 28.
Artigo em Inglês | MEDLINE | ID: mdl-33115922

RESUMO

OBJECTIVES: We evaluated the risk of lung cancer associated with ever working as a painter, duration of employment and type of painter by histological subtype as well as joint effects with smoking, within the SYNERGY project. METHODS: Data were pooled from 16 participating case-control studies conducted internationally. Detailed individual occupational and smoking histories were available for 19 369 lung cancer cases (684 ever employed as painters) and 23 674 age-matched and sex-matched controls (532 painters). Multivariable unconditional logistic regression models were adjusted for age, sex, centre, cigarette pack-years, time-since-smoking cessation and lifetime work in other jobs that entailed exposure to lung carcinogens. RESULTS: Ever having worked as a painter was associated with an increased risk of lung cancer in men (OR 1.30; 95% CI 1.13 to 1.50). The association was strongest for construction and repair painters and the risk was elevated for all histological subtypes, although more evident for small cell and squamous cell lung cancer than for adenocarcinoma and large cell carcinoma. There was evidence of interaction on the additive scale between smoking and employment as a painter (relative excess risk due to interaction >0). CONCLUSIONS: Our results by type/industry of painter may aid future identification of causative agents or exposure scenarios to develop evidence-based practices for reducing harmful exposures in painters.

10.
Epigenetics ; : 1-15, 2020 Sep 24.
Artigo em Inglês | MEDLINE | ID: mdl-32970968

RESUMO

Age-related DNA methylation is a potential mechanism contributing to breast cancer development. Studies of primarily Caucasian women have identified many CpG sites of age-related methylation in non-diseased breast tissue possibly driving cancer development over time. There is a paucity of studies involving Asian women whose ages at breast cancer onset are usually younger than Caucasians. We identified the 181 most consistent age-related methylation events in non-diseased breast tissue across published studies. Age-related methylation events were measured in adjacent normal and breast tumour tissue in an exclusively Asian population at the previously identified age-related methylation sites. Age-related methylation was found in 118 probes in adjacent normal breast tissue. Methylation of 99% of these sites was increased with age and predominantly located on CpG islands in promoter regions. To ascertain biological relevance to breast cancer, we focused on the 37 sites with overall higher methylation in tumour compared to adjacent normal samples. Some sites positively related to age, including AQP5 and CORO6, inversely correlated with gene expression. Several others have known involvement in suppression of carcinogenesis including GPC5 and SST, suggesting that perturbation of epigenetic regulation at these sites due to ageing may contribute to the progression of carcinogenesis. This study highlights an age-related methylation landscape in non-tumour tissue, consistent not just across studies, but also across different populations. We present candidate age-related methylation sites warranting further investigation as potential epigenetic drivers of breast cancer. They may serve as potential targets of site-specific demethylation intervention strategies for the prevention of age-related breast cancer.

11.
BMC Geriatr ; 20(1): 357, 2020 09 21.
Artigo em Inglês | MEDLINE | ID: mdl-32958037

RESUMO

BACKGROUND: While sleep duration has been shown to be associated with health outcomes, few studies have been conducted among the oldest old. In addition, the impact of sleep duration on quality of dying is unknown. We aimed to evaluate how sleep duration affects all-cause mortality and quality of dying in people aged 80 + . METHODS: This community-based longitudinal study was performed by using data from 15,048 individuals aged ≥80 with information on sleep duration in the Chinese Longitudinal Healthy Longevity Survey. Cox and logistic regression models with penalized splines were applied to explore the shape of the association between sleep duration and all-cause mortality and poor quality of dying respectively and identify the interval of sleep duration resulting in the lowest risk of both. RESULTS: During a median follow-up of 3.1 years, 11,582 deaths including 4116 individuals who experienced poor quality of dying were recorded. Sleep duration showed a U-shaped association with all-cause mortality and sleeping about 8 h had the minimum risk of death; a J-shaped association was found between sleep duration and poor quality of dying. Compared with sleep duration of 7-9 h, the adjusted hazard ratio of total deaths was 1.08 (95% CI 1.03-1.13) for short duration (< 7 h) and 1.12 (95% CI 1.07-1.17) for long duration (> 9 h); the adjusted odds ratio of poor QOD was 1.10 (95% CI 1.01-1.21) for long duration, but this association was restricted to those with baseline unhealthy status (P-interaction = 0.04). CONCLUSIONS: Sleeping a little longer may be better for individuals over 80 years old, and sleep duration of 7-9 h per day is optimal for both survival and good quality of life near death.

12.
Lancet Planet Health ; 4(6): e235-e245, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32559440

RESUMO

BACKGROUND: Most studies of long-term exposure to outdoor fine particulate matter (PM2·5) and cardiovascular disease are from high-income countries with relatively low PM2·5 concentrations. It is unclear whether risks are similar in low-income and middle-income countries (LMICs) and how outdoor PM2·5 contributes to the global burden of cardiovascular disease. In our analysis of the Prospective Urban and Rural Epidemiology (PURE) study, we aimed to investigate the association between long-term exposure to PM2·5 concentrations and cardiovascular disease in a large cohort of adults from 21 high-income, middle-income, and low-income countries. METHODS: In this multinational, prospective cohort study, we studied 157 436 adults aged 35-70 years who were enrolled in the PURE study in countries with ambient PM2·5 estimates, for whom follow-up data were available. Cox proportional hazard frailty models were used to estimate the associations between long-term mean community outdoor PM2·5 concentrations and cardiovascular disease events (fatal and non-fatal), cardiovascular disease mortality, and other non-accidental mortality. FINDINGS: Between Jan 1, 2003, and July 14, 2018, 157 436 adults from 747 communities in 21 high-income, middle-income, and low-income countries were enrolled and followed up, of whom 140 020 participants resided in LMICs. During a median follow-up period of 9·3 years (IQR 7·8-10·8; corresponding to 1·4 million person-years), we documented 9996 non-accidental deaths, of which 3219 were attributed to cardiovascular disease. 9152 (5·8%) of 157 436 participants had cardiovascular disease events (fatal and non-fatal incident cardiovascular disease), including 4083 myocardial infarctions and 4139 strokes. Mean 3-year PM2·5 at cohort baseline was 47·5 µg/m3 (range 6-140). In models adjusted for individual, household, and geographical factors, a 10 µg/m3 increase in PM2·5 was associated with increased risk for cardiovascular disease events (hazard ratio 1·05 [95% CI 1·03-1·07]), myocardial infarction (1·03 [1·00-1·05]), stroke (1·07 [1·04-1·10]), and cardiovascular disease mortality (1·03 [1·00-1·05]). Results were similar for LMICs and communities with high PM2·5 concentrations (>35 µg/m3). The population attributable fraction for PM2·5 in the PURE cohort was 13·9% (95% CI 8·8-18·6) for cardiovascular disease events, 8·4% (0·0-15·4) for myocardial infarction, 19·6% (13·0-25·8) for stroke, and 8·3% (0·0-15·2) for cardiovascular disease mortality. We identified no consistent associations between PM2·5 and risk for non-cardiovascular disease deaths. INTERPRETATION: Long-term outdoor PM2·5 concentrations were associated with increased risks of cardiovascular disease in adults aged 35-70 years. Air pollution is an important global risk factor for cardiovascular disease and a need exists to reduce air pollution concentrations, especially in LMICs, where air pollution levels are highest. FUNDING: Full funding sources are listed at the end of the paper (see Acknowledgments).

13.
Horm Cancer ; 11(3-4): 191-199, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32494968

RESUMO

Previous studies reported heterogeneous associations between obesity and reproductive-related breast cancer risk factors and breast cancer intrinsic subtypes; however, few studies have been conducted in Asian populations. Here, we aimed to examine whether risks associated with established breast cancer risk factors varied by breast cancer subtypes in Chinese women. We conducted a hospital-based case-control study in Hong Kong, including a total of 2169 Chinese women. Unconditional polytomous logistic regression models were used to calculate adjusted odds ratios (AORs) and 95% confidence intervals(95%CIs) to estimate relative risks associated with examined risk factors in case-control analyses and to test for heterogeneity across breast cancer subtypes in case-case analyses. In case-case analyses, compared with luminal A patients, luminal B (AOR = 1.76, 95% CI = 1.07-2.88), HER2 overexpressing (AOR = 3.40, 95% CI = 1.56-7.39), and triple negative (TNBC, AOR = 2.39, 95% CI = 1.18-4.82) patients were more likely to be postmenopausal. In case-control analyses, reduced risks associated with parity and younger age at first birth were only seen for luminal A and B cases especially among postmenopausal women, whereas having ≥ 3 children was associated with increased risk for HER2 overexpressing and TNBC among premenopausal women. Obesity was associated with increased risk for all subtypes. We found heterogeneous associations between parity-related risk factors by menopausal status and breast cancer subtypes among Chinese patients, which is similar to those observed in Western populations. Interestingly, obesity was associated with increased breast cancer risk regardless of menopausal status or subtypes, except for premenopausal luminal patients, which appears to be unique in Asian populations.

14.
BMJ Glob Health ; 5(2): e002040, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32133191

RESUMO

Background: Non-communicable diseases (NCDs) are the leading cause of death globally. In 2014, the United Nations committed to reducing premature mortality from NCDs, including by reducing the burden of healthcare costs. Since 2014, the Prospective Urban and Rural Epidemiology (PURE) Study has been collecting health expenditure data from households with NCDs in 18 countries. Methods: Using data from the PURE Study, we estimated risk of catastrophic health spending and impoverishment among households with at least one person with NCDs (cardiovascular disease, diabetes, kidney disease, cancer and respiratory diseases; n=17 435), with hypertension only (a leading risk factor for NCDs; n=11 831) or with neither (n=22 654) by country income group: high-income countries (Canada and Sweden), upper middle income countries (UMICs: Brazil, Chile, Malaysia, Poland, South Africa and Turkey), lower middle income countries (LMICs: the Philippines, Colombia, India, Iran and the Occupied Palestinian Territory) and low-income countries (LICs: Bangladesh, Pakistan, Zimbabwe and Tanzania) and China. Results: The prevalence of catastrophic spending and impoverishment is highest among households with NCDs in LMICs and China. After adjusting for covariates that might drive health expenditure, the absolute risk of catastrophic spending is higher in households with NCDs compared with no NCDs in LMICs (risk difference=1.71%; 95% CI 0.75 to 2.67), UMICs (0.82%; 95% CI 0.37 to 1.27) and China (7.52%; 95% CI 5.88 to 9.16). A similar pattern is observed in UMICs and China for impoverishment. A high proportion of those with NCDs in LICs, especially women (38.7% compared with 12.6% in men), reported not taking medication due to costs. Conclusions: Our findings show that financial protection from healthcare costs for people with NCDs is inadequate, particularly in LMICs and China. While the burden of NCD care may appear greatest in LMICs and China, the burden in LICs may be masked by care foregone due to costs. The high proportion of women reporting foregone care due to cost may in part explain gender inequality in treatment of NCDs.

15.
Am J Epidemiol ; 189(5): 375-383, 2020 05 05.
Artigo em Inglês | MEDLINE | ID: mdl-31845721

RESUMO

Organophosphates (OPs) are the most heavily used pesticides in China. The Chinese population, including preconceptional women, is highly exposed, yet little is known regarding the associations between OP exposure and menstruation in humans. We conducted a cross-sectional analysis in women preparing for pregnancy to investigate the relationship between biomarkers of OP exposure and menstrual cycle characteristics. From 2013 to 2015, 627 women visiting free preconception-care clinics at 2 maternity hospitals in Shanghai, China, were included. Information on menstrual cycle characteristics was obtained through questionnaires. OP exposure was assessed by measuring urine concentrations of 6 dialkylphosphate metabolites (dimethylphosphate, dimethylthiophosphate, dimethyldithiophosphate, diethylphosphate, diethylthiophosphate, and diethyldithiophosphate). The relationship between concentrations of dialkylphosphate metabolites and menstrual cycle characteristics was analyzed using multiple linear regression models and logistic regression models. Log-transformed levels of diethyl phosphate metabolites (the sum of diethylphosphate and diethylthiophosphate levels) were related to a higher risk of irregularity of menstrual cycles (adjusted odds ratio = 2.36, 95% confidence interval: 1.28, 4.34). Subjects with a higher concentration of diethyl phosphate metabolites (log-transformed) had a shorter duration of menstrual bleeding (adjusted ß = -0.33, 95% confidence interval: -0.64, -0.02). The findings suggest that OP exposure may be associated with alterations in menstrual function in preconceptional women.


Assuntos
Poluentes Ambientais/urina , Ciclo Menstrual/efeitos dos fármacos , Organofosfatos/urina , Praguicidas/urina , Cuidado Pré-Concepcional , Adulto , China , Poluentes Ambientais/toxicidade , Monitoramento Epidemiológico , Feminino , Humanos , Entrevistas como Assunto , Modelos Estatísticos , Organofosfatos/toxicidade , Praguicidas/toxicidade
16.
Breast Cancer Res ; 21(1): 147, 2019 12 19.
Artigo em Inglês | MEDLINE | ID: mdl-31856876

RESUMO

BACKGROUND: Heterogeneity of immune gene expression patterns of luminal breast cancer (BC), which is clinically heterogeneous and overall considered as low immunogenic, has not been well studied especially in non-European populations. Here, we aimed at characterizing the immune gene expression profile of luminal BC in an Asian population and associating it with patient characteristics and tumor genomic features. METHODS: We performed immune gene expression profiling of tumor and adjacent normal tissue in 92 luminal BC patients from Hong Kong using RNA-sequencing data and used unsupervised consensus clustering to stratify tumors. We then used luminal patients from The Cancer Genome Atlas (TCGA, N = 564) and a Korean breast cancer study (KBC, N = 112) as replication datasets. RESULTS: Based on the expression of 130 immune-related genes, luminal tumors were stratified into three distinct immune subtypes. Tumors in one subtype showed higher level of tumor-infiltrating lymphocytes (TILs), characterized by T cell gene activation, higher expression of immune checkpoint genes, higher nonsynonymous mutation burden, and higher APOBEC-signature mutations, compared with other luminal tumors. The high-TIL subtype was also associated with lower ESR1/ESR2 expression ratio and increasing body mass index. The comparison of the immune profile in tumor and matched normal tissue suggested a tumor-derived activation of specific immune responses, which was only seen in high-TIL patients. Tumors in a second subtype were characterized by increased expression of interferon-stimulated genes and enrichment for TP53 somatic mutations. The presence of three immune subtypes within luminal BC was replicated in TCGA and KBC, although the pattern was more similar in Asian populations. The germline APOBEC3B deletion polymorphism, which is prevalent in East Asian populations and was previously linked to immune activation, was not associated with immune subtypes in our study. This result does not support the hypothesis that the germline APOBEC3B deletion polymorphism is the driving force for immune activation in breast tumors in Asian populations. CONCLUSION: Our findings suggest that immune gene expression and associated genomic features could be useful to further stratify luminal BC beyond the current luminal A/B classification and a subset of luminal BC patients may benefit from checkpoint immunotherapy, at least in Asian populations.


Assuntos
Neoplasias da Mama/etiologia , Neoplasias da Mama/patologia , Perfilação da Expressão Gênica , Imunidade/genética , Transcriptoma , Biomarcadores Tumorais , Biologia Computacional/métodos , Feminino , Regulação Neoplásica da Expressão Gênica , Humanos , Linfócitos do Interstício Tumoral/imunologia , Linfócitos do Interstício Tumoral/metabolismo , Linfócitos do Interstício Tumoral/patologia , Mutação , Reprodutibilidade dos Testes , Microambiente Tumoral
17.
Sci Rep ; 9(1): 12684, 2019 09 03.
Artigo em Inglês | MEDLINE | ID: mdl-31481730

RESUMO

Coffee contains caffeine and diterpenes that were associated with decreased breast cancer risk, but results remained inconsistent. The study purpose was to investigate the associations between coffee products and breast cancer risk among Hong Kong Chinese women. We conducted a hospital-based case-control study in three public hospitals. 2169 Chinese women aged 24-84 years old were interviewed using a standardized questionnaire with questions asking types, cups and duration on coffee drinking. We used unconditional multivariate logistic regression to calculate the adjusted odds ratio (AOR) and 95% confidence interval (95% CI) for breast cancer risk with different coffee products. 238 (20.6%) cases and 179 (17.7%) controls are habitual coffee drinkers. No association was found between overall coffee drinking and breast cancer risk. Compared to the non-habitual coffee drinkers, women who consumed instant coffee (AOR = 1.50, 95% CI = 1.10-2.03) were significantly associated with an increased breast cancer risk. Women who drank brewed coffee (AOR = 0.48, 95% CI = 0.28-0.82) were negatively associated with breast cancer risk. A positive association between instant coffee and breast cancer risk was observed, contradicted to the outcomes of drinking brewed coffee. Larger studies are warranted to ascertain the role of different types of coffee products in breast cancer risk.


Assuntos
Neoplasias da Mama/prevenção & controle , Cafeína/uso terapêutico , Café/química , Diterpenos/uso terapêutico , Adulto , Idoso , Idoso de 80 Anos ou mais , Grupo com Ancestrais do Continente Asiático , Neoplasias da Mama/epidemiologia , Neoplasias da Mama/patologia , Estudos de Casos e Controles , Café/metabolismo , Feminino , Hong Kong/epidemiologia , Hospitais Públicos , Humanos , Modelos Logísticos , Pessoa de Meia-Idade , Razão de Chances , Risco , Adulto Jovem
18.
J Am Heart Assoc ; 8(16): e010870, 2019 08 20.
Artigo em Inglês | MEDLINE | ID: mdl-31394972

RESUMO

Background The predictive value of adiposity indices and the newly developed index for cardiometabolic risk factors and cardiovascular diseases (CVDs) remains unclear in the Chinese population. This study aimed to compare the predictive value of A Body Shape Index with other 5 conventional obesity-related anthropometric indices (body mass index, waist circumference, hip circumference, waist-to-hip ratio, waist-to-height ratio) in Chinese population. Methods and Results A total of 44 048 participants in the study were derived from the baseline data of the PURE-China (Prospective Urban and Rural Epidemiology) study in China. All participants' anthropometric parameters, CVDs, and risk factors (dyslipidemia, abnormal blood pressure, and hyperglycemia) were collected by standard procedures. Multivariable logistic regression models and receiver operator characteristic curve analysis were used to evaluate the predictive values of obesity-related anthropometric indices to the cardiometabolic risk factors and CVDs. A positive association was observed between each anthropometric index and cardiometabolic risk factors and CVDs in all models (P<0.001). Compared with other anthropometric indices (body mass index, waist circumference, hip circumference, waist-to-hip ratio, and A Body Shape Index), waist-to-height ratio had significantly higher areas under the curve (AUCs) for predicting dyslipidemia (AUCs: 0.646, sensitivity: 65%, specificity: 44%), hyperglycemia (AUCs: 0.595, sensitivity: 60%, specificity: 45%), and CVDs (AUCs: 0.619, sensitivity: 59%, specificity: 41%). Waist circumference showed the best prediction for abnormal blood pressure (AUCs: 0.671, sensitivity: 66%, specificity: 40%) compared with other anthropometric indices. However, the new body shape index did not show a better prediction to either cardiometabolic risk factors or CVDs than that of any other traditional obesity-related indices. Conclusions Waist-to-height ratio appeared to be the best indicator for dyslipidemia, hyperglycemia, and CVDs, while waist circumference had a better prediction for abnormal blood pressure.


Assuntos
Índice de Massa Corporal , Doenças Cardiovasculares/epidemiologia , Dislipidemias/epidemiologia , Hiperglicemia/epidemiologia , Hipertensão/epidemiologia , Obesidade Abdominal/epidemiologia , Relação Cintura-Quadril , Adulto , Antropometria , Arritmias Cardíacas/epidemiologia , Cardiomiopatias/epidemiologia , China/epidemiologia , Doença das Coronárias/epidemiologia , Feminino , Insuficiência Cardíaca/epidemiologia , Doenças das Valvas Cardíacas/epidemiologia , Quadril , Humanos , Masculino , Pessoa de Meia-Idade , Miocardite/epidemiologia , Obesidade/epidemiologia , Fatores de Risco , Circunferência da Cintura , Razão Cintura-Estatura
19.
Occup Environ Med ; 76(10): 758-764, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31439688

RESUMO

OBJECTIVES: Experimental studies suggested that bisphenol A (BPA) exposure increased the risk of metabolic syndrome (MetS) through the mechanism of insulin resistance. All previous epidemiological studies of BPA and MetS were cross-sectional studies, and their findings were mixed. This study aims to provide further evidence on the association between urinary BPA and risk of MetS using a prospective cohort study in China. METHODS: The study population was from the Shenzhen Night shift workers' cohort. A total of 1227 male workers were recruited from the baseline survey in 2013 and then followed until 2017. Modified Adult Treatment Panel III criteria were used to identify the cases of MetS. Urinary BPA concentration was assessed using high-performance liquid chromatography-tandem mass spectrometry, and it was categorised into three subgroups by tertiles to obtain the adjusted HR (aHR) and 95% CI using Cox proportional hazard model. RESULTS: During 4 years of follow-up, 200 subjects developed MetS. Compared with the lowest urinary BPA subgroup, a weakly increased risk of MetS was suggested among those with the middle (aHR=1.19, 95% CI 0.87 to 1.63) and high level of urinary BPA (aHR=1.16, 95% CI 0.84 to 1.59); however, the significant association with MetS was restricted primarily to the smokers, showing a positive gradient with urinary BPA (middle level: aHR=2.40, 95% CI 1.13 to 5.08; high level: aHR=2.87, 95% CI 1.38 to 5.98; p trend= 0.010). CONCLUSION: This prospective cohort study provided further evidence that exposure to BPA may increase the risk of MetS, and this association was further positively modified by cigarette smoking.


Assuntos
Compostos Benzidrílicos/urina , Síndrome Metabólica/epidemiologia , Fenóis/urina , Adulto , China/epidemiologia , Fumar Cigarros , Estudos de Coortes , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
20.
Ecotoxicol Environ Saf ; 182: 109419, 2019 Oct 30.
Artigo em Inglês | MEDLINE | ID: mdl-31301591

RESUMO

Parabens are a kind of preservatives widely used in cosmetic and personal care products and ubiquitously detected in the environment. However, little is known on human exposure to these chemicals. Our study mainly investigated the urinary parabens in adults from South China to evaluate the cumulative risk of paraben exposure. A total of 562 urine samples were collected from adult workers for the determination of methyl paraben (MeP), ethyl paraben (EtP), propyl paraben (PrP), butyl paraben, and benzyl parabens. High detection frequencies (≥98%) were observed for MeP, EtP, and PrP with median concentrations of 8.88, 5.11, and 1.44 µg/L, respectively. Urinary parabens was 4.5-46.2 fold higher in urine of females than those in males. Urinary MeP was associated with alcohol drinking and a history of tumor, while urinary PrP was negatively associated with education levels of the subjects. There were not significant associations between urinary concentrations of parabens and body mass index, which indicated that obesity was not associated with paraben exposure. Also, parabens did not correlate with human dietary habits. Although the total estimated daily intake (TEDI) of the major compound MeP and EtP in adult workers was lower than the acceptable daily intake (ADI), the TEDI of PrP exceed the ADI for a very few subjects, especially for females and low-educated ones, suggesting potential health risks.


Assuntos
Exposição Ambiental/estatística & dados numéricos , Poluentes Ambientais/urina , Parabenos/metabolismo , Adulto , China , Cosméticos/metabolismo , Exposição Ambiental/análise , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade , Conservantes Farmacêuticos/metabolismo
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