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CN 34-1304/R ISSN 1674-3679

Current Articles

2025, Volume 29,  Issue 4

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Principles of Infectious Disease Prevention and Control
Progress in tuberculosis prevention and control
CHEN Cheng, LIU Jiongya, SUN Zheng, CHEN Chi, WU Wenjuan, LIU Qiao, ZHU Limei, LU Wei
2025, 29(4): 373-377. doi: 10.16462/j.cnki.zhjbkz.2025.04.001
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Tuberculosis (TB), as a major global public health issue, continues to pose a severe threat to human life and health. In 2023, it was estimated that approximately 10.8 million new TB cases occurred globally, with an incidence rate of 134 per 100 000 population. To achieve the END TB strategy by 2035, countries worldwide have implemented various measures in recent years, including enhancing TB surveillance and reporting, improving diagnostic capabilities, promoting effective treatment, strengthening vaccination efforts, and conducting public health education. These efforts have effectively curbed the spread of TB. This article reviews the current epidemiological situation of TB, diagnostic and treatment technologies, and prevention strategies by referencing literature, guidelines, expert consensus, and technical standards, aiming to provide a reference for TB prevention and control.
Original Articles
Trend of lower respiratory infections burden and age-period-cohort analysis of Chinese residents from 1990 to 2021
WANG Yan, DING Xiao, HAN Ruiyang, FENG Wenjia, CHEN Junli, MA Anning
2025, 29(4): 378-386. doi: 10.16462/j.cnki.zhjbkz.2025.04.002
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  Objective  To analyze the trends in the burden of lower respiratory infections (LRIs) among Chinese residents from 1990 to 2021, and to provide a reference for developing and adjusting prevention strategies as well as evaluating the effectiveness of control measures.  Methods  Using data from the global burden of disease study 2021 (GBD 2021) on LRIs among Chinese residents from 1990 to 2021, a descriptive analysis was conducted based on incidence, mortality, and disability-adjusted life year (DALY). Joinpoint regression models were used to analyze trends in disease burden, while age-period-cohort models were employed to assess the effects of age, period, and cohort on mortality rates.  Results  From 1990 to 2021, age-standardized incidence rates (ASIR), age-standardized mortality rates (ASMR), and age-standardized DALY rates (ASDR) for LRIs in China showed a declining trend, decreasing by 47.93%, 76.87%, and 88.89%, with average annual percentage changes (AAPC) of-2.12% (95% CI:-2.20%--2.04%),-4.77% (95% CI:-5.14%--4.40%), and-6.96% (95% CI:-7.24%--6.68%), respectively. The burden of LRIs remained high among those aged 70 and above, while it was lowest among the 15-<50 age group. The risk of death from LRIs decreased with increasing age.   Conclusions  From 1990 to 2021, the overall disease burden of LRIs in China declined, but the burden remained significant among children aged 0-<5 years and adults aged 70 and above. Mortality risk was influenced by age, period, and cohort effects.
A latent class analysis of cognitive impairment in the elderly in China and its influencing factors
LIN Lu, HE Pingping, QIU Sihui, QIU Xiaohui, CHEN Jiangping, WANG Jin
2025, 29(4): 386-392. doi: 10.16462/j.cnki.zhjbkz.2025.04.003
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  Objective  To explore the latent categories of cognitive impairment in the elderly in China and identify its influencing factors, providing a reference for the effective identification of cognitive impairment in older adults.  Methods  Data from the 2018 Chinese longitudinal healthy longevity survey (CLHLS) released in April 2020 were used, a latent profile analysis was employed to identify the categories of cognitive impairment among the elderly, and multiple logistic regression analysis was used to explore the influencing factors of these categories.  Results  A total of 8 913 elderly individuals aged 65 years and above were included in the study. Significant heterogeneity in cognitive impairment was observed, and three distinct patterns emerged: no or mild cognitive impairment (85.5%), moderate cognitive impairment (6.5%), and severe cognitive impairment (8.0%). The results of the multivariate logistic regression analysis showed that age (OR=0.128, 95% CI: 0.089-0.184), sleep duration(OR=0.799, 95% CI: 0.667-0.956), years of education(OR=2.132, 95% CI: 1.025-4.434), self-rated health(OR=1.832, 95% CI: 1.449-2.316), physical exercise(OR=2.236, 95% CI: 1.751-2.855), marital status (OR=2.266, 95% CI: 1.772-2.899), depression(OR=0.829, 95% CI: 0.619-1.112), anxiety(OR=0.757, 95% CI: 0.579-0.989), alcohol (OR=1.576, 95% CI: 1.125-2.208), and childhood hunger(OR=0.755, 95% CI: 0.605-0.941) were all influencing factors of cognitive impairment in the elderly, and these were statistically significant (all P<0.05).  Conclusions  Cognitive impairment among the elderly in China is most severe in terms of reaction time and memory loss, followed by impairments in language, comprehension, and self-coordination abilities. These impairments are influenced by multiple factors, suggesting that healthcare professionals need to adopt more targeted interventions to improve cognitive function in the elderly.
The effect of mental abuse on depression among older adults: the mediating role of loneliness and the moderating role of social participation
WANG Yingying, LIU Lan, CHEN Gong
2025, 29(4): 393-398. doi: 10.16462/j.cnki.zhjbkz.2025.04.004
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  Objective  To explore the effects and pathways of mental abuse on depression in the elderly.  Methods  Based on data from 2018 China longitudinal aging social survey (CLASS), this study involved 9 896 people aged 60 and over, used linear regression, propensity matching, and moderated mediating effect to analyze the effect of mental abuse on depression, as well as the mediating role of loneliness and the moderating role of social participation.  Results  Among 9 896 individuals aged ≥60 years, the older adults who suffered from mental abuse tended to have higher depression scores (β=1.346, 95% CI: 1.031-1.661) and worse mental health status. Loneliness played a mediating role between mental abuse and depression, with an indirect effect value of 0.495, accounting for 43.57% of the total effect. The degree of social participation played a moderating role in the relationship between mental abuse and loneliness (β=-0.049 5, P<0.001) and also loneliness and depression (β=-0.043 1, P<0.001). The mediating effect of loneliness in the relationship between mental abuse and depression of the elderly was gradually weakened with the increase of social participation.  Conclusions  The incidence of mental abuse among the elderly is relatively high and can positively predict depression score. Mental abuse can affect depression in the elderly through loneliness, and the mediating model is moderated by social participation.
Association between atherogenic index of plasma trajectories and non-alcoholic fatty liver disease in the elderly population
WU Xinri, CHEN Quan, ZHANG Caiqin, HONG Xin
2025, 29(4): 399-405. doi: 10.16462/j.cnki.zhjbkz.2025.04.005
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  Objective  To investigate the association between atherogenic index of plasma (AIP) trajectory and non-alcoholic fatty liver disease (NAFLD) in the elderly population.  Methods  A study cohort of 28 535 elderly people who met the inclusion criteria were selected from six years (2018-2023) of consecutive health examination data in Nanjing. The trajectory of AIP over the years from 2018 to 2021 by gender was constructed using the SAS Proc Traj program. The incidence of NAFLD in each trajectory group for male and female subjects were compared. A Cox regression model was used to analyze the association between distinct trajectory groups and the risk of NAFLD.  Results  Three AIP trajectory groups were identified for both males and females, namely the low-stable group, the moderate-stable group, and the high-stable group. The study revealed that the incidence of NAFLD was the highest in the high-stable group (29.44% in women and 14.35% in men). After adjusting for confounders such as age and BMI, etc., the risk of NAFLD incidence in the moderate-stable and high-stable AIP group was 1.824 times (95% CI: 1.514-2.196) and 2.323 times (95% CI: 1.815-2.972) that of the low-stable group in men, respectively, and 1.657 times (95% CI: 1.483-1.852) and 2.189 times (95% CI: 1.876-2.555) in women (all P<0.001).   Conclusions  A high AIP level is a risk factor for the development of NAFLD, and the risk of developing NAFLD increases with the elevation of AIP.
Relationship between healthy lifestyle behaviours and all-cause mortality and cardiovascular disease mortality among the population in Central China
LI Chenhui, WANG Chunqi, ZHANG Xingyi, HUANG Tianshu, ZHAO Dongyuan, ZHAO Yun, CHEN Xianhua, ZHU Mengyao, ZOU Haili, LI Xi, ZHONG Hui
2025, 29(4): 406-413. doi: 10.16462/j.cnki.zhjbkz.2025.04.006
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  Objective  To explore the relationship between the state of adherence, associated factors, and the correlation with cardiovascular and all-cause mortality of four healthy lifestyle behaviours in Central China.  Methods  This study was conducted on individuals agedbetween 35 and 75 from 24 project sites in Central China who were part of the early screening and comprehensive intervention program for cardiovascular disease high-risk (abbreviation high risk screening program) populations from September 2015 to November 2019. Four healthy lifestyle behaviours were investigated, including non-smoking, none or moderate alcohol use, sufficient leisure time physical activity, and healthy diet. Multivariate logistic regression analysis was used to explore the correlation between population characteristics and healthy lifestyles. The association between healthy lifestyles and all-cause and cardiovascular mortality was analyzed utilizing a multivariate Cox proportional hazards regression model.  Results  Among 117 158 participants, 72.8% were non-smokers, 95.6% had none or moderate alcohol use, 25.0% had sufficient leisure time physical activity, 8.8% had healthy diet, and only 2.7% had all the four healthy lifestyle behaviours. Adherence rate was lower than known for North China (4.66%). Multifactorial Cox regression analyses correcting for sex, age, occupation, educational level, household income, marital status, social health insurance, and residential history showed that those who adhered to adequate physical activity during a median follow-up of 1.6 years had lower all-cause mortality (HR=0.83, 95% CI: 0.72-0.96) and cardiovascular mortality (HR=0.62, 95% CI: 0.48-0.79). Those with annual incomes >50 000 yuan had low rates of adherence to none or moderate alcohol use (OR=0.82, 95% CI: 0.72-0.94) and healthy diet (OR=0.63, 95% CI: 0.58-0.69) compared to those with lower incomes.  Conclusions  Adherence to healthy lifestyle behaviours in Central China is far from ideal. It is clear that the greater the variety of adherence to a healthy lifestyle, the lower the corresponding risk of all-cause mortality or cardiovascular mortality.With regional characteristics, there is a negative correlation between adherence to none or moderate alcohol use and healthy diet among people with higher income levels.Targeted health promotion strategies to this region are urgently needed.
Study on the association between serum uric acid to creatinine ratio and metabolic syndrome and its components among aged 35-74 years Zhuang minority residents in Guangxi
WEI Yuxia, QIU Xiaoqiang, ZENG Xiaoyun, SU Li, HUANG Dongping, LIU Shun, XIE Yihong
2025, 29(4): 413-420. doi: 10.16462/j.cnki.zhjbkz.2025.04.007
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  Objective  To explore the association between serum uric acid to creatinine ratio (SUA/Cr) and metabolic syndrome (MS) and the number of its components among aged 35-74 years Zhuang residents in Guangxi, providing scientific evidences for the management and intervention of MS.  Methods  The baseline data of Guangxi ethnic minorities cohort of chronic diseases in 2018-2019 was collected using structure questionnaire, physical examination and biochemical test. Kruskal-Wallis rank sum test, binomial and multinomial logistic regression model were used in data analysis. The dose-response relationship between SUA level, SUA/Cr, and the risk of MS was evaluated using restricted cubic spline.  Results  A total of 11 134 Zhuang adults were included, with the mean age of 55.3 years, of which 55.3% were females. The prevalence rate of MS was 23.1%, with a significantly higher prevalence rate in females compared to males (25.4% vs 20.2%, P < 0.001). The prevalence rate of MS was 20.2%, 33.0%, 38.0%, and 46.3% in the SUA ≤420, > 420- < 480, 480- < 540、and ≥540 μmol/L groups, respectively. After controlling for potential confounding factors, there was a dose-response relationship between SUA level, SUA/Cr and the risk of MS. The effects of SUA, SUA/Cr on MS components increased with the level of SUA and SUA/Cr increased. In the group with a higher number of MS components, the same SUA or SUA/Cr had a more significant effect (P < 0.001).  Conclusions  The levels of SUA and SUA/Cr are important influencing factors of MS and its components in Zhuang residents. In the future, health education and management of hyperuricemia, MS and its components should be strengthened to control SUA at an ideal level.
Construction of the mortality prognostic model for patients with coronary heart disease combined with chronic heart failure based on a semi-parametric smooth error accelerate failure time model
LI Jing, TIAN Jing, YANG Hong, YAN Jingjing, WANG Yajing, ZHANG Yanbo
2025, 29(4): 421-430. doi: 10.16462/j.cnki.zhjbkz.2025.04.008
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  Objective  This study introduced a semi-parametric smooth error accelerated failure time (AFT) model to construct mortality prognostic models for patients with coronary heart disease (CHD) combined with chronic heart failure (CHF).  Methods  This study included 3 980 patients diagnosed with CHD combined with CHF from two hospitals in Shanxi Province between January 2014 and April 2019. Traditional AFT models (with 8 time distributions) and a smoothed error AFT model were applied to construct one- and three-year mortality risk models. The optimal model was determined based on the Akaike information criterion (AIC).  Results  The lognormal AFT model consistently demonstrated the lowest AIC value. The AIC value of the smoothed error AFT model was close to the lowest, indicating good model fit and simplicity. The variables selected by the two optimal models were consistent. For the one-year survival outcomes, elevated N-terminal pro-B-type natriuretic peptide (NT-proBNP), New York heart association (NYHA) class Ⅳ, decreased albumin levels, elevated heart rate, and decreased sodium levels [all with time ratios (TR) < 1, P < 0.05] were associated with reduced patient survival times. Conversely, treatment with lipid lowering, overweight, and decreased heart rate (all with TR>1, P < 0.05) were associated with extended survival times. For the three-year survival outcome, elevated NT-proBNP levels, older age, elevated age-adjusted Charlson comorbidity index, NYHA class Ⅳ, decreased albumin levels, elevated heart rate, and prolonged QRS duration (all with TR < 1, P < 0.05) were associated with reduced survival times. In addition, lipid lowering therapy, overweight or obesity, and decreased heart rate (all with TR>1, P<0.05) were associated with extended survival times.  Conclusions  This study uses a semi-parametric smooth error AFT model to indentify the influencing factors of patients survival over 1 and 3 years, aiding in the identification of high-risk individuals and enabling early intervention to improve patient prognosis.
Spatial epidemiological analysis of esophageal cancer mortality in Anhui Province from 2018 to 2020
ZHANG Shaohua, XING Xiuya, XU Qinghua, SU Hong
2025, 29(4): 431-436. doi: 10.16462/j.cnki.zhjbkz.2025.04.009
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  Objective  To explore the spatial epidemiological characteristics of esophageal carcinoma mortality in Anhui from 2018 to 2020 through spatial epidemiological analysis, so as to determine the key areas of esophageal carcinoma mortality.  Methods  The surveillance records of esophageal carcinoma death from 2018 to 2020 were collected. The Kriging spatial interpolation method was used to draw the geographical distribution map of esophageal carcinoma mortality. The spatial autocorrelation analysis was performed to explore the spatial distribution regularities of esophageal carcinoma mortality in Anhui Province. The spatio-temporal scan statistic was used to explore the aggregation areas of esophageal carcinoma mortality.  Results  The crude mortality and age-standardized mortality of esophageal carcinoma in Anhui Province between 2018 and 2020 were 14.92/100 000 and 10.39/100 000 respectively. The mortality of males was higher than that of females in each of these three years (all P < 0.05). The spatial autocorrelation analysis showed that the spatial distribution of esophageal carcinoma mortality in Anhui had the feature of aggregation (Moran's I=0.54, Z=8.84, P < 0.001). The aggregation areas were mainly Lujiang County, Zongyang County and Tongcheng City on the eastern side of Dabie Mountain. The key aggregation areas were the same for females and males. Spatio-temporal scan showed that there were three key aggregation areas of esophageal carcinoma mortality in Anhui (all P < 0.05).  Conclusions  There are significant differences in the mortality rate of esophageal cancer in Anhui Province among different regions and populations, and there are high-mortality aggregation areas, which are mainly distributed on the eastern side of the Dabie Mountains.
A cross-sectional study on the association between blood inflammation-related indicators and gastric cancer in middle-aged and elderly people in Wuxi
SHEN Fang, ZHU Xia, LIU Jia, ZHU Meng, WANG Lu, JIN Guangfu
2025, 29(4): 437-442. doi: 10.16462/j.cnki.zhjbkz.2025.04.010
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  Objective  To investigate whether blood inflammation-related indicators are correlated with the prevalence of gastric cancer.  Methods  Questionnaire information and blood routine test data were collected at baseline from participants aged 45 years and older in the Taihu biobank of tumour biomarkers (TBTB) from 2020 to 2021. The correlation between blood inflammation-related indicators, including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SII), derived neutrophil-to-lymphocyte ratio (dNLR), and neutrophil-to-lymphocyte and platelet ratio (NLPR), and the prevalence as well as the course of gastric cancer were analyzed using multiple linear regression within a cross-sectional study design.  Results  A total of 284 886 subjects were included in this study, including 1 920 gastric cancer cases. Compared with non-gastric cancer patients, gastric cancer patients had lower levels of NLR (β=-0.09, 95% CI: -0.14--0.04), SII (β=-0.13, 95% CI: -0.18--0.09) and dNLR (β=-0.07, 95% CI: -0.12--0.03), while gastric cancer patients have higher levels of PLR (β=0.10, 95% CI: 0.06-0.15). In addition, the levels of NLR (β=0.185, 95% CI: 0.098-0.273), PLR (β=0.243, 95% CI: 0.151-0.335), SII (β=0.207, 95% CI: 0.116-0.298), dNLR (β=0.156, 95% CI: 0.071-0.242) and NLPR (β=0.093, 95% CI: 0.004-0.182) all increased with the prolongation of the gastric cancer course.  Conclusions  In middle-aged and elderly people of Wuxi, the blood inflammation levels of gastric cancer patients are generally lower than those of non-gastric cancer patients. Moreover, as the course of gastric cancer progresses, there is an increase in blood inflammation-related indicators among gastric cancer patients.
Analysis of mitochondrial DNA copy bumber and the risk of female reproductive diseases from the perspective of two-sample Mendelian randomization
HOU Yaqi, GONG Wanli, WANG Yue, YU Qi
2025, 29(4): 442-448. doi: 10.16462/j.cnki.zhjbkz.2025.04.011
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  Objective  The study aims to investigate the causal relationship between mitochondrial DNA copy number (mtDNAcn) and various female reproductive system diseases, including cervical cancer, ovarian cancer, endometrial cancer, cervical polyps, polycystic ovary syndrome (PCOS), ovarian cysts, premature ovarian failure (POF), endometriosis, and uterine fibroids.  Methods  ln this study, female reproductive system diseases published in the Open GWAS database from 2015 to 2023 and FinnGen database from 2023 were selected as outcomes. A two-sample Mendelian randomization study was conducted by inverse variance weighted (IVW) method, and supplemented by weighted median analysis and MR-Egger regression analysis. Tests for horizontal pleiotropy and heterogeneity were conducted to ensure the stability of the results, and reverse analysis was also performed.  Results  Genetically predicted mtDNAcn was not associated with the risk of cervical cancer (OR=1.001, 95% CI: 0.999-1.004), ovarian cancer (OR=0.989, 95% CI: 0.702-1.394), endometrial cancer (OR=0.894, 95% CI: 0.610-1.309), cervical polyps (OR=0.999, 95% CI: 0.996-1.001), PCOS(OR=0.735, 95% CI: 0.497-1.085), ovarian cysts (OR=1.103, 95% CI: 0.917-1.327), POF (OR=1.061, 95% CI: 0.461-2.443), endometriosis (OR=1.165, 95% CI: 0.951-1.425), or uterine fibroids (OR=1.001, 95% CI: 0.997-1.006) (all P>0.05). Reverse analysis revealed an association between ovarian cysts and increased mtDNAcn levels (P=0.002), with no evidence of heterogeneity or pleiotropy.  Conclusions  Ovarian cysts are associated with an increase in mtDNAcn. The results suggest that mtDNAcn may serve as a potential biomarker for ovarian cysts, providing new insights and methods for early diagnosis and monitoring of the disease.
Health economic evaluation of co-administration of 13-valent pneumococcal polysaccharide conjugate vaccine and diphtheria tetanus pertussis in children based on a decision tree-Markov model
WANG Qiuyue, SUN Xinrui, YANG Fan, WANG Qi, WANG Lei, WEI Sheng, JIANG Hongwei
2025, 29(4): 448-454. doi: 10.16462/j.cnki.zhjbkz.2025.04.012
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  Objective  To access the cost-effectiveness and cost-utility of the co-administration strategy of domestically produced 13-valent pneumococcal polysaccharide conjugate vaccine (PCV13) and diphtheria tetanus pertussis (DTaP)vaccine within the immunization program co-administration strategy.  Methods  A decision tree-Markov model was constructed using Treeage Pro 2022 to simulate a birth cohort of 100 000 newborns. The study evaluated the health economic value of the co-administration strategy of PCV13 and DTaP compared to the strategy of PCV13 vaccination alone.  Results  When implementing the co-administration strategy PCV13 and DTaP with full-dose primary immunization coverage rates of PCV13 reached 40% and 80%, the incremental cost of preventing per case was 5 537.8 yuan and 5 425.8 yuan, respectively. The incremental cost of increasing per quality-adjusted life years (QALYs) was 365 068.2 yuan, 354 648.8 yuan, respectively.  Conclusions  The PCV13 and DTaP co-administration strategy in children is considered cost-effective.
Influencing factors of anxiety among junior high school students in Henan Province: relative dominance analysis
YANG Yinmei, FENG Haiyang, MENG Enhui, WU Xiaoman, ZHAO Weijia, GAO Yongji, MIAO Yudong, WU Jian
2025, 29(4): 455-460. doi: 10.16462/j.cnki.zhjbkz.2025.04.013
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  Objective  To explore the priority of magnitude of influencing factors on anxiety and to provide references for improving anxiety among junior high school students.  Methods  A cross-sectional study was conducted from April to May in 2023, using stratified random cluster sampling in Zhengzhou and Shangqiu Cities of Henan Province. The adolescent self-rating life events check list, the Connor-Davidson resilience scale, the school connectedness scale, the parent-child cohesion questionnaire, the self-esteem scale, and the generalized anxiety disorder scale were used to assess the levels of negative life events, psychological resilience, school connectedness, parent-child cohesion, self-esteem, and anxiety among 8 176 junior high school students. Logistic regression analysis was used to explore the influencing factors of anxiety, and the dominance analysis was used to explore the priority of magnitude of influencing factors.  Results  The detection rate of anxiety among junior high school students was 16.3%. Logistic regression analysis showed that being male (OR=0.819, 95% CI: 0.709-0.947), living in rural area (OR=0.691, 95% CI: 0.589-0.811), having a middle level of family economy (OR=0.742, 95% CI: 0.577-0.954), school connectedness (OR=0.969, 95% CI: 0.958-0.980), parent-child cohesion (OR=0.987, 95% CI: 0.978-0.996) and self-esteem (OR =0.876, 95% CI: 0.862-0.890) were protective factors, while being in the ninth grade (OR=1.476, 95% CI: 1.237-1.761), experiencing high levels of academic burden (OR=1.899, 95% CI: 1.298-2.779) and negative life events (OR=1.047, 95% CI: 1.041-1.052) were risk factors of anxiety among junior high school students (all P < 0.05). Dominance analysis found that the predictor variables exhibited complete dominance, in the order of self-esteem, negative life events, school connectedness, and parent-child cohesion, respectively.  Conclusions  The detection rate of anxiety among junior high school students was high. Anxiety among junior high school students can be alleviated by improving self-esteem, school connectedness and parent-child cohesion, as well as reducing the negative impact of negative life events.
Application of counterfactual explanation framework in predictive models for treatment outcomes in acute exacerbation of chronic obstractive pulmonary disease patients
YUAN Yiwei, HE Hangzhi, HU Xiaojuan, DONG Tao, JIN Jie, ZHAO Hui, ZHANG Yanbo
2025, 29(4): 461-467. doi: 10.16462/j.cnki.zhjbkz.2025.04.014
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  Objective  For inpatients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD), a machine learning (ML) model combined with Counterfactual Explanation Framework was developed to accurately predict treatment outcomes and provide clinical decision support.  Methods  A total of 3 046 patients hospitalized for AECOPD at the Second Hospital of Shanxi Medical University from 2012 to 2020 were selected. The outcome variable was defined as whether the patient recovered and was discharged within the median length of hospitalization. Five ML models were constructed and compared for performance. The optimal model was then explained using counterfactual framework, which provided actionable intervention plans.  Results  The categorical boosting (CatBoost) model exhibited the best overall performance, with area under the receiver operating characteristic curve (AUC) of 0.748, accuracy of 68.4%, precision of 70.6%, recall of 69.1%, F1 score of 69.8%, and Brier score of 20.4%. The calibration curve was close to the diagonal. The counterfactual explanation framework visually elucidated the prognostic mechanisms in patients, with the generated actionable intervention strategies providing clinicians with decision support to optimize hospitalization efficacy for AECOPD cases.  Conclusions  Using only routine electronic medical record data, the CatBoost-based prediction model predicts hospitalization outcomes for AECOPD patients. By incorporating the counterfactual explanation framework, personalized intervention plans can be provided for clinicians, offering reliable support for clinical decision-making.
Reviews
Actively respond to the international research progress of "superagers" in the context of aging
LIU Weiyu, LIANG Lizhong, ZENG Yongtian, LIU Zhou, ZENG Zhirong
2025, 29(4): 468-472. doi: 10.16462/j.cnki.zhjbkz.2025.04.015
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With the intensification of population aging, health issues such as cognitive decline in the elderly have had a profound impact on both their physical and mental well-being, as well as their overall quality of life. Against this backdrop, the group of "superagers" individuals has garnered significant attention from the academic community. These individuals excel in episodic memory and demonstrate at least average performance in non-episodic memory tasks compared to their peers. While research on the "superagers" is relatively well-developed internationally, there is still a lack of such research in China. Investigating the "superagers" is of considerable significance for preventing cognitive decline and promoting healthy aging in the elderly population of China. This paper draws on international research findings and advocates for the integration of research on cognitive and physical health, while addressing the current challenges in this area, in order to promote the physical and mental well-being of the elderly in China.
Short Reports
Risk assessment of early pregnancy depression based on automated retinal image analysis technology
ZHANG Daqian, QU Yimin, XU Zhongying, LI Zuowei, MA Haihui, YE Qi, JIANG Yu
2025, 29(4): 473-480. doi: 10.16462/j.cnki.zhjbkz.2025.04.016
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  Objective  This study aimed to explore the use of machine learning-based retinal image analysis techniques for risk assessment of early pregnancy depression.  Methods  From May 2023 to May 2024, a total of 936 pregnant women were recruited at Tongzhou District Maternal and Child Health Hospital, Beijing. Bilateral retinal images were captured during their first trimester of pregnancy, and maternal depressive symptoms were assessed using the Chinese version of the Edinburgh postnatal depression scale (EPDS). A case-control matching was performed with an age difference of ±2 years, maintaining a ratio between 1∶1 and 1∶4. Conventional retinal features were calculated using automated retinal image analysis techniques, and specific image features related to early pregnancy depression were extracted using a convolutional neural network model. Modeling was conducted using a logistic regression model, with model performance evaluated via ten-fold cross-validation.  Results  A total of 449 subjects were included in the analysis, with 92 cases in the early pregnancy depression group. The retinal venous branching angle (69.36±2.17) and venous branching coefficient (0.83±0.01) in the depression group were both lower than those in the non-depression group (69.95±2.00, t=2.47, P=0.014; 0.84±0.01, t=2.56, P=0.011). The area under the receiver operating characteristic curve for the risk assessment model based on retinal features was 0.995 (95% CI: 0.990-0.999), with a sensitivity of 0.978, a specificity of 0.958.  Conclusions  Automated retinal image analysis techniques can accurately identify early pregnancy depression, providing strong support for early intervention and treatment.
Characterization of nasopharyngeal cancer incidence in Qidong, Jiangsu Province, 1972-2021
WANG Jun, CHEN Yongsheng, ZHU Jian
2025, 29(4): 481-486. doi: 10.16462/j.cnki.zhjbkz.2025.04.017
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Abstract:
  Objective  To analyze the prevalence trend of nasopharyngeal cancer (NPC) incidence in Qidong, Jiangsu Province, from 1972 to 2021, and to provide scientific basis for the prevention and control of nasopharyngeal cancer.  Methods  The crude incidence rate (CR), age-standardized rate by Segi′s world standard population (ASR-W), 35- < 65-year-old truncated rate and 0- < 75-year-old cumulative incidence rate were calculated from 1972 to 2021. The age-period-cohort model was used to analyze the age, period and cohort effects of incidence in nasopharyngeal cancer Joinpoint regression was performed by using Joinpoint 4.9.1.0 software to calculate the annual percentage change (APC) and average annual percentage change (AAPC) of incidence in nasopharyngeal cancer.  Results  From 1972 to 2021, Qidong had a total of 1 283 cases of nasopharyngeal cancer. The CR, ASR-W, the truncated rate of 35- < 65 and cumulative rate of 0- < 75 were 2.29/105, 1.65/105, 3.62/105 and 0.18%, respectively. There were 870 cases in male, with CR and ASR-W of 3.15/105 and 2.34/105. In female, there were 413 cases, with CR and ASR-W of 1.45/105 and 0.99/105. Age-period-cohort model showed that age and period effect were the important factors for nasopharyngeal cancer incidence, and the differences were all statistically significant, while cohort effect has no statistically significant. The AAPCs for the both gender, male and female of ASR-W of nasopharyngeal cancer in Qidong from 1972-2021 were 0.14% (95% CI: -0.53%-0.81%, t=0.40), -0.24% (95% CI: -0.86%-0.38%, t=-0.76) and 0.39% (95% CI: -0.89%-1.70%, t=0.60), respectively. None of the differences in trend changes were statistically significant.  Conclusions  There is no obvious trend in the standardized incidence rate of nasopharyngeal cancer in the past 50 years in Qidong, while has a definite upward trend over the last 20 years. And there are gender and age differences, with the incidence rate of males higher than that of females. The standard incidence is greatly affected by aging, with a high incidence rate in the middle-aged and elderly population. Thus, attention should be paid to prevention and treatment of nasopharyngeal cancer in the middle-aged and elderly population and in males as well as health education.
Common influences on chemotherapy-related symptom clusters in cancer patients
MA Dianyu, RONG Xiangxia, SU Chunyan, TONG Jingjing, HONG Shikai, LU Tianya
2025, 29(4): 487-491. doi: 10.16462/j.cnki.zhjbkz.2025.04.018
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Abstract:
  Objective  To explore the common influencing factors of chemotherapy-related symptom clusters across different types of cancer.  Methods  A total of 546 cancer patients (lung cancer, breast cancer, and colorectal cancer) who received chemotherapy the First Affiliated Hospital of Anhui University of Science and Technology from 2022 to 2023 were selected as study subjects. The Anderson Symptom Assessment Scale (MDASI-C) was used to assess the severity of 19 common cancer-related symptoms in the past 24 hours. Patients with an average MDASI-C score ≥7 were classified into the high-symptom group, and those with a score < 7 were into the low-symptom group.  Results  Univariate analysis revealed that the severity of chemotherapy-related symptom clusters in patients with different cancer types was significantly associated with factors such as gender, age, education level, monthly income per capita, exercise frequency, BMI, time since diagnosis, hemoglobin levels, red blood cell count, blood sodium, and blood potassium (all P < 0.10). After conducting a multivariate logistic regression analysis on all three cancer types, it was found that primary school and below (OR=0.44, 95% CI: 0.27-0.74), low BMI (OR=0.93, 95% CI: 0.88-0.98), and low hemoglobin levels (OR=0.98, 95% CI: 0.97-0.99) were associated with an increased risk of chemotherapy-related symptom clusters.  Conclusions  Low education level, low BMI, and low hemoglobin levels are significant risk factors for chemotherapy-related symptom clusters in cancer patients. Targeted preventive measures should be implemented before chemotherapy to improve the quality of life of patients after treatment.
Analysis of sexual behavior among students in Yunnan Province from 2010 to 2023
SONG Lijun, XIAO Minyang, WANG Xiaowen, FU Liru, LI Xuehua, NIU Jin, ZHANG Zuyang
2025, 29(4): 492-496. doi: 10.16462/j.cnki.zhjbkz.2024.04.019
Abstract(519) HTML (458) PDF(51)
Abstract:
  Objective  To understand the present status and trends of youth sexual behavior among students in Yunnan Province, as well as to analyze the prevalence of sexually transmitted disease infection among students.  Methods  From April to June, an annual cross-sectional survey was conducted at two designated national-level sentinel sites for young students in Yunnan Province. The survey utilizes a multi-stage random sampling method to select young students for anonymous questionnaire surveys. Blood samples were also collected for human immunodeficiency virus (HIV), syphilis, and hepatitis virus C (HCV) antibody testing.  Results  From 2010 to 2023, a total of 22 753 young students were surveyed. The acquired immune deficiency syndrome (AIDS) positive rate was 0.01%, the syphilis positive rate was 0.04%, and the HCV positive rate was 0.01%. The average rate of acquired immune deficiency syndrome knowledge awareness was 88.6%, with females having a higher awareness rate than males (x2 =14.137, P < 0.001). Among the participants, 12.3% reported having sexual experience, with males reporting a higher rate than females (x2 =1 279.14, P < 0.001). The proportion of students who had engaged in sexual behavior increased for both genders (all P < 0.001). The average age of first sexual intercourse was (19.5±1.9) years old. Among those who had sexual partners, 95.0% were heterosexual lovers, and 71.5% reported using condoms. Of the students who had engaged in sexual activity in the past year, 43.6% had regular partners, 20.0% had casual partners, 1.5% had commercial partners, and 1.3% had homosexual partners. The proportion of individuals who had undergone HIV testing and knew the results in the past year averaged 10.5%, showing an increasing trend year by year (xtrend2=659.509, P < 0.01).  Conclusions  The proportion of students engaging in sexual behavior is increasing year by year in Yunnan Province, but the usage of condoms remains low. Additionally, the coverage rate of HIV testing among this population is not high. It is recommended to increase the promotion of sexually transmitted disease prevention knowledge among young students and raise their awareness of safe sexual behavior. It is also important to students who engage in unsafe sexual behavior to actively seek HIV counseling and testing services.

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