Most previous genome-wide association studies (GWAS) of depression have used data from individuals of European descent. This limits the understanding of the underlying biology of depression and raises questions about the transferability of findings between populations.
To prospectively examine the association between tea consumption and the risk of ischaemic heart disease (IHD).
Methods
Prospective study using the China Kadoorie Biobank; participants from 10 areas across China were enrolled during 2004–2008 and followed up until 31 December 2013. After excluding participants with cancer, heart disease and stroke at baseline, the present study included 199 293 men and 288 082 women aged 30–79 years at baseline. Information on IHD incidence was collected through disease registries and the new national health insurance databases.
Results
During a median follow-up of 7.2 years, we documented 24 665 (7.19 cases/1000 person-years) incident IHD cases and 3959 (1.13 cases/1000 person-years) major coronary events (MCEs). Tea consumption was associated with reduced risk of IHD and MCE. In the whole cohort, compared with participants who never consumed tea during the past 12 months, the multivariable-adjusted HRs and 95% CIs for less than daily and daily tea consumers were 0.97 (0.94 to 1.00) and 0.92 (0.88 to 0.95) for IHD, 0.92 (0.85 to 1.00) and 0.90 (0.82 to 0.99) for MCE. No linear trends in the HRs across the amount of tea were observed in daily consumers for IHD and MCE (PLinear >0.05). The inverse association between tea consumption and IHD was stronger in rural (PInteraction 0.006 for IHD, <0.001 for MCE), non-obese (PInteraction 0.012 for MCE) and non-diabetes participants (PInteraction 0.004 for IHD).
Conclusions
In this large prospective study, daily tea consumption was associated with a reduced risk of IHD.
Background: Severe acute respiratory syndrome (SARS) is a newly discovered disease caused by a novel coronavirus. The present study studied the longitudinal profile of antibodies against SARS‐coronavirus (SARS‐CoV) in SARS patients and evaluated the clinical significance of these antibodies. Methods: Two methods, ELISA and indirect immunofluorescent assay, were used for the detection of the anti‐SARS‐CoV IgG and IgM in 335 serial sera from 98 SARS patients. In 18 patients, serum antibody profiles were investigated and antibody neutralization tests were performed from 7 to 720 days after the onset of symptoms. Results: The ratios of positive IgG/IgM by ELISA were 0/0, 45.4/39.4, 88.6/71.4, 96/88, 100/48.6, 100/30.9, 100/17.1, 100/0 per cent, respectively, on 1–7, 8–14, 15–21, 22–28, 29–60, 61–90, 91–180 and 181–720 days after the onset of symptoms. Antibodies were not detected within the first 7 days of illness, but IgG titre increased dramatically on day 15, reaching a peak on day 60, and remained high until day 180 from when it declined gradually until day 720. IgM was detected on day 15 and rapidly reached a peak, then declined gradually until it was undetectable on day 180. Neutralizing viral antibodies were demonstrated in the convalescence sera from SARS patients. Conclusion: The persistence of detectable IgG antibodies and neutralizing viral antibodies for up to 720 days suggest that SARS patients may be protected from recurrent SARS‐CoV infection for up to 2 years.
Abstract Absolute risks of stroke are typically estimated using measurements of cardiovascular disease risk factors recorded at a single visit. However, the comparative utility of single versus sequential risk factor measurements for stroke prediction is unclear. Risk factors were recorded on three separate visits on 13,753 individuals in the prospective China Kadoorie Biobank. All participants were stroke-free at baseline (2004–2008), first resurvey (2008), and second resurvey (2013–2014), and were followed-up for incident cases of first stroke in the 3 years following the second resurvey. To reflect the models currently used in clinical practice, sex-specific Cox models were developed to estimate 3-year risks of stroke using single measurements recorded at second resurvey and were retrospectively applied to risk factor data from previous visits. Temporal trends in the Cox-generated risk estimates from 2004 to 2014 were analyzed using linear mixed effects models. To assess the value of more flexible machine learning approaches and the incorporation of longitudinal data, we developed gradient boosted tree (GBT) models for 3-year prediction of stroke using both single measurements and sequential measurements of risk factor inputs. Overall, Cox-generated estimates for 3-year stroke risk increased by 0.3% per annum in men and 0.2% per annum in women, but varied substantially between individuals. The risk estimates at second resurvey were highly correlated with the annual increase of risk for each individual (men: r = 0.91, women: r = 0.89), and performance of the longitudinal GBT models was comparable with both Cox and GBT models that considered measurements from only a single visit (AUCs: 0.779–0.811 in men, 0.724–0.756 in women). These results provide support for current clinical guidelines, which recommend using risk factor measurements recorded at a single visit for stroke prediction.
Little evidence from large-scale cohort studies exists about the relationship of solid fuel use with hospitalization and mortality from major respiratory diseases.To examine the associations of solid fuel use and risks of acute and chronic respiratory diseases.A cohort study of 277,838 Chinese never-smokers with no prior major chronic diseases at baseline. During 9 years of follow-up, 19,823 first hospitalization episodes or deaths from major respiratory diseases, including 10,553 chronic lower respiratory disease (CLRD), 4,398 chronic obstructive pulmonary disease (COPD), and 7,324 acute lower respiratory infection (ALRI), were recorded. Cox regression yielded adjusted hazard ratios (HRs) for disease risks associated with self-reported primary cooking fuel use.Overall, 91% of participants reported regular cooking, with 52% using solid fuels. Compared with clean fuel users, solid fuel users had an adjusted HR of 1.36 (95% confidence interval, 1.32-1.40) for major respiratory diseases, whereas those who switched from solid to clean fuels had a weaker HR (1.14, 1.10-1.17). The HRs were higher in wood (1.37, 1.33-1.41) than coal users (1.22, 1.15-1.29) and in those with prolonged use (≥40 yr, 1.54, 1.48-1.60; <20 yr, 1.32, 1.26-1.39), but lower among those who used ventilated than nonventilated cookstoves (1.22, 1.19-1.25 vs. 1.29, 1.24-1.35). For CLRD, COPD, and ALRI, the HRs associated with solid fuel use were 1.47 (1.41-1.52), 1.10 (1.03-1.18), and 1.16 (1.09-1.23), respectively.Among Chinese adults, solid fuel use for cooking was associated with higher risks of major respiratory disease admissions and death, and switching to clean fuels or use of ventilated cookstoves had lower risk than not switching.
Abstract Alcohol consumption accounts for ~3 million annual deaths worldwide, but uncertainty persists about its relationships with many diseases. We investigated the associations of alcohol consumption with 207 diseases in the 12-year China Kadoorie Biobank of >512,000 adults (41% men), including 168,050 genotyped for ALDH2 - rs671 and ADH1B - rs1229984 , with >1.1 million ICD-10 coded hospitalized events. At baseline, 33% of men drank alcohol regularly. Among men, alcohol intake was positively associated with 61 diseases, including 33 not defined by the World Health Organization as alcohol-related, such as cataract ( n = 2,028; hazard ratio 1.21; 95% confidence interval 1.09–1.33, per 280 g per week) and gout ( n = 402; 1.57, 1.33–1.86). Genotype-predicted mean alcohol intake was positively associated with established ( n = 28,564; 1.14, 1.09–1.20) and new alcohol-associated ( n = 16,138; 1.06, 1.01–1.12) diseases, and with specific diseases such as liver cirrhosis ( n = 499; 2.30, 1.58–3.35), stroke ( n = 12,176; 1.38, 1.27–1.49) and gout ( n = 338; 2.33, 1.49–3.62), but not ischemic heart disease ( n = 8,408; 1.04, 0.94–1.14). Among women, 2% drank alcohol resulting in low power to assess associations of self-reported alcohol intake with disease risks, but genetic findings in women suggested the excess male risks were not due to pleiotropic genotypic effects. Among Chinese men, alcohol consumption increased multiple disease risks, highlighting the need to strengthen preventive measures to reduce alcohol intake.
BackgroundHospitals in China are classified into tiers (1, 2 or 3), with the largest (tier 3) having more equipment and specialist staff. Differential health insurance cost-sharing by hospital tier (lower deductibles and higher reimbursement rates in lower tiers) was introduced to reduce overcrowding in higher tier hospitals, promote use of lower tier hospitals, and limit escalating healthcare costs. However, little is known about the effects of differential cost-sharing in health insurance schemes on choice of hospital tiers.MethodsIn a 9-year follow-up of a prospective study of 0.5 M adults from 10 areas in China, we examined the associations between differential health insurance cost-sharing and choice of hospital tiers for patients with a first hospitalisation for stroke or ischaemic heart disease (IHD) in 2009–2017. Analyses were performed separately in urban areas (stroke: n = 20,302; IHD: n = 19,283) and rural areas (stroke: n = 21,130; IHD: n = 17,890), using conditional logit models and adjusting for individual socioeconomic and health characteristics.FindingsAbout 64–68% of stroke and IHD cases in urban areas and 27–29% in rural areas chose tier 3 hospitals. In urban areas, higher reimbursement rates in each tier and lower tier 3 deductibles were associated with a greater likelihood of choosing their respective hospital tiers. In rural areas, the effects of cost-sharing were modest, suggesting a greater contribution of other factors. Higher socioeconomic status and greater disease severity were associated with a greater likelihood of seeking care in higher tier hospitals in urban and rural areas.InterpretationPatient choice of hospital tiers for treatment of stroke and IHD in China was influenced by differential cost-sharing in urban areas, but not in rural areas. Further strategies are required to incentivise appropriate health seeking behaviour and promote more efficient hospital use.FundingWellcome Trust, Medical Research Council, British Heart Foundation, Cancer Research UK, Kadoorie Charitable Foundation, China Ministry of Science and Technology, and National Natural Science Foundation of China.
Background: Disability weights (DWs) is basically pivotal parameter for disease burden calculation and to quantify the severity of health states from disease sequela. This study aimed to conduct a big survey and construct national and subnational DWs in mainland China and its provinces, and evaluate if the characteristics of age, sex, disease experience status, etc. have an impact on the valuation of these DWs.Methods: We conducted a web-based survey to assess DWs for 206 health states in 31 Chinese provinces in 2020-2021. We used two versions of DW questionnaire. The first version consisted of 16 paired comparison (PC) and 3 population health equivalence (PHE) questions; the second included 3 PC and 4 PHE questions. The health states that were depicted in the PC and PHE questions were randomly assigned to each respondent. The PC data was analyzed by probit regression analysis, and the regression results were anchored by results from the PHE responses on the DW scale units between 0 (no loss of health) and 1 (loss equivalent to death). The Pearson correlation analysis was performed for the probit coefficients between provinces and within province by participants’ characteristics.Findings: We considered 468 541 nationally representative respondents. The national DWs were bounded by mild distance vision impairment or mild anemia (0·009 [95% UI 0·0003-0·057]) and severe heroin and other opioid dependence (0·752, 0·640-0·841). In subnational analysis, we observed good PC responses and high correlations by province compared with the national data (p < 0·001): the lowest DW in distance vision mild impairment or mild anemia ranged from 0·008 (Henan and Ningxia) to 0·013 (Xinjiang) and the highest DW in severe heroin and other opioid dependence with a range of 0·693 (Henan)-0·813(Ningxia). Most of Chinese DWs for diabetes and digestive and genitourinary disease, mental, behavioural, and substance use disorders, hearing and vision loss, and disfigurement were larger than the GBD 2013 DW. The liner regression showed health states with mobility, mental and pain symptoms were significantly associated with lower DW in China compared with GBD 2013 and Japan; pain and sensory symptom with a higher Japanese DW than GBD 2013. Despite there are considerable disagreement, the DWs from the three regions are all highly correlated (p < 0·001). we put insights in other factors that might impact the valuation and found a slightly lower correlation of the probit coefficients between provinces (range rs: 0·980–0·997) than between medical background (rs = 0·985), profession (range rs = 0·987-0·998), income levels (range rs: 0·991–0·998), age groups (range rs: 0·992–0·998), educational level (rs: 0·991), sex (rs = 0·997) and disease status (rs = 0·998) (p< 0·001). Importantly, within province the lowest correlations of the probit coefficients were between low and high income level (range rs: 0·847–0·985, p < 0·001).Interpretation: This study created an empirical basis for national and subnational DW measurement in China. The considerable differences suggest that there might be contextual differences in evaluating the severity of health states between GBD regions and China, even among Asian countries. Apart from contextual differences, we found variations between income levels in health valuation within province, thus the effect of income level might be considered into valuating the severity of disease sequela.Funding Information: This work was supported by the National Key Research and Development Program of China [grant numbers 2018YFC1315302], the National Natural Science Foundation of China [grant number 81773552], and Wuhan Medical Research Program of Joint Fund of Hubei Health Committee [grant number WJ2019H304].Declaration of Interests: All other authors declare no competing interests.Ethics Approval Statement: This study was approved by the Ethics Committee of Medical Department of Wuhan University (2019YF2055), and a waiver of written informed consent obtained from participants prior to web-based survey participation was approved.
Background Lean body mass has been identified as a key determinant of left ventricular mass and wall thickness. However, the importance of lean body mass or other body-size measures as normative determinants of carotid intima-media thickness (cIMT), a widely used early indicator of atherosclerosis, has not been well established. Methods and Results Carotid artery ultrasound measurements of cIMT and carotid artery plaque burden (derived from plaque number and maximum size) and measurements of body size, including height, body mass index, weight, body fat proportion, and lean body mass ([1-body fat proportion]×weight), were recorded in 25 020 participants from 10 regions of China. Analyses were restricted to a healthy younger subset (n=6617) defined as never or long-term ex-regular smokers aged <60 years (mean age, 50) without previous ischemic heart disease, stroke, diabetes mellitus, or hypertension and with plasma non-high-density lipoprotein cholesterol <4 mmol/L. Among these 6617 participants, 86% were women (because most men smoked) and 9% had carotid artery plaque. In both women and men separately, lean body mass was strongly positively associated with cIMT, but was not associated with plaque burden: overall, each 10 kg higher lean body mass was associated with a 0.03 (95% CI, 0.03-0.04) mm higher cIMT (P=5×10
Tobacco smoking is estimated to account for more than 1 million annual deaths in China, and the epidemic continues to increase in men. Large nationwide prospective studies linked to different health records can help to periodically assess disease burden attributed to smoking. We aimed to examine associations of smoking with incidence of and mortality from an extensive range of diseases in China.We analysed data from the prospective China Kadoorie Biobank, which recruited 512 726 adults aged 30-79 years, of whom 210 201 were men and 302 525 were women. Participants who had no major disabilities were identified through local residential records in 100-150 administrative units, which were randomly selected by use of multistage cluster sampling, from each of the ten diverse study areas of China. They were invited and recruited between June 25, 2004, and July 15, 2008. Upon study entry, trained health workers administered a questionnaire assessing detailed smoking behaviours and other key characteristics (eg, sociodemographics, lifestyle, and medical history). Participants were followed up via electronic record linkages to death and disease registries and health insurance databases, from baseline to Jan 1, 2018. During a median 11-year follow-up (IQR 10-12), 285 542 (55·7%) participants were ever hospitalised, 48 869 (9·5%) died, and 5252 (1·0%) were lost to follow-up during the age-at-risk of 35-84 years. Cox regression yielded hazard ratios (HRs) associating smoking with disease incidence and mortality, adjusting for multiple testing.At baseline, 74·3% of men and 3·2% of women (overall 32·4%) ever smoked regularly. During follow-up, 1 137 603 International Classification of Diseases, 10th revision (ICD-10)-coded incident events occurred, involving 476 distinct conditions and 85 causes of death, each with at least 100 cases. Compared with never-regular smokers, ever-regular smokers had significantly higher risks for nine of 18 ICD-10 chapters examined at age-at-risk of 35-84 years. For individual conditions, smokers had significantly higher risks of 56 diseases (50 for men and 24 for women) and 22 causes of death (17 for men and nine for women). Among men, ever-regular smokers had an HR of 1·09 (95% CI 1·08-1·11) for any disease incidence when compared with never-regular smokers, and significantly more episodes and longer duration of hospitalisation, particularly those due to cancer and respiratory diseases. For overall mortality, the HRs were greater in men from urban areas than in men from rural areas (1·50 [1·42-1·58] vs 1·25 [1·20-1·30]). Among men from urban areas who began smoking at younger than 18 years, the HRs were 2·06 (1·89-2·24) for overall mortality and 1·32 (1·27-1·37) for any disease incidence. In this population, 19·6% of male (24·3% of men residing in urban settings and 16·2% of men residing in rural settings) and 2·8% of female deaths were attributed to ever-regular smoking.Among Chinese adults, smoking was associated with higher risks of morbidity and mortality from a wide range of diseases. Among men, the future smoking-attributed disease burden will increase further, highlighting a pressing need for reducing consumption through widespread cessation and uptake prevention.British Heart Foundation, Cancer Research UK, Chinese Ministry of Science and Technology, Kadoorie Charitable Foundation, UK Medical Research Council, National Natural Science Foundation of China, Wellcome Trust.
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