Prediction of cause-specific disability-adjusted life years in China from 2018 through 2021: a systematic analysis

Impact of chest pain center quality control indicators on mortality risk in ST-segment elevation myocardial infarction patients: a study based on Killip classification

Background

Despite the crucial role of Chest pain centers (CPCs) in acute myocardial infarction (AMI) management, China's mortality rate for ST-segment elevation myocardial infarction (STEMI) has remained stagnant. This study evaluates the influence of CPC quality control indicators on mortality risk in STEMI patients receiving primary percutaneous coronary intervention (PPCI) during the COVID-19 pandemic.

Methods

A cohort of 664 consecutive STEMI patients undergoing PPCI from 2020 to 2022 was analyzed using Cox proportional hazards regression models. The cohort was stratified by Killip classification at admission (Class 1: n = 402, Class ≥2: n = 262).

Results

At a median follow-up of 17 months, 35 deaths were recorded. In Class ≥2, longer door-to-balloon (D-to-B) time, PCI informed consent time, catheterization laboratory activation time, and diagnosis-to-loading dose dual antiplatelet therapy (DAPT) time were associated with increased mortality risk. In Class 1, consultation time (notice to arrival) under 10 min reduced death risk. In Class ≥2, PCI informed consent time under 20 min decreased mortality risk.

Conclusion

CPC quality control metrics affect STEMI mortality based on Killip class. Key factors include time indicators and standardization of CPC management. The study provides guidance for quality care during COVID-19.

A more than four-fold sex-specific difference of autism spectrum disorders and the possible contribution of pesticide usage in China 1990-2030

Autism spectrum disorders (ASDs) are prevalent in children and adolescents and disproportionately affect males, and the main contributing factors underlying male vulnerability remain widely unknown. Pesticide use is widely reported to be associated with ASD risk, and the cases of pesticide poisoning incidence in rural areas are remarkably higher than those in the urban areas while the prevalence of ASDs in rural areas was higher than that in urban areas and the rate of male pesticide poisoning was significantly higher than female. Thus, pesticide usage may be an important contributing factor for causing sex-specific differences of ASD incidence. ASD burden was analyzed by using the data of ASD number, ASD rate (ASD cases per 100,000 persons) and disability-adjusted life years (DALYs) from 1990 to 2019. The changes from 1990 to 2030 were predicted using autoregressive integrated moving average (ARIMA) in time series forecasting based on the small values of Akaike information criterion and Bayesian information criterion. Finally, the relationship between ASD rate and pesticide usage risk index (PURI) was analyzed via Pearson's correlation coefficient. ASD number, ASD rate and DALYs will be reduced by 45.5% ± 8.2% (t = 9.100 and p = 0.0119), 56.6% ± 10.2% (t = 9.111 and p = 0.0118), and 44.9% ± 7.0% (t = 20.90 and p = 0.0023) from 1990 to 2030 in China. PURI has a strong relationship with ASD rate (rho = 0.953 to 0.988 and p < 0.0001). Pesticide poisoning incidence in males is up to 2-fold higher than that in females. ASD number and DALYs in males are 4-fold higher than those in females. Furthermore, there is growing evidence supporting that males are more susceptible than females to pesticides with sex differences in neurotoxicogenetics. Therefore, pesticide poisoning may be a contributing factor for causing the sex differences of ASD. Much work still needs to be done to confirm that.

Effect of regional cooperative rescue systems based on chest pain centers for patients with acute myocardial infarction in a first-tier city in China

Given the increasing burden of acute myocardial infarction (AMI) in China, regional cooperative rescue systems have been constructed based on chest pain centers (CPCs). This study evaluated the effects of these regional cooperative rescue systems on reperfusion time and prognosis of AMI patients. This study included 1937 AMI patients, divided into two groups according to the date of admission, group A (July 2017-June 2018) and group B (July 2018-June 2019). Reperfusion time, the fatality rate for any cause during hospitalization, and the incidence of major adverse cardiovascular and cerebrovascular events (MACCE) in the 6 months following discharge were compared between the two groups. The proportion of patients treated within the guideline goals for first medical contact to balloon (FMC-to-B) time showed improvement from 40.7% in group A to 50.4% in group B (P = 0.005). The fatality rate for any cause (5.5% vs. 8.0%, P = 0.026) during hospitalization was lower in the B group compared to the A group. Multivariate logistic regression analysis revealed that the fatality rate for any cause (OR 0.614, 95% CI 0.411-0.918, P = 0.017) was significantly lower in group B compared with group A. No significant differences were detected between the two groups for the incidence of MACCE and death for any cause at 6 months using the log-rank test and multivariate Cox regression analysis. The improvement of regional cooperative rescue systems shortened system delays and reduced in-hospital deaths. Although the system has resulted in some substantial improvements, additional improvement is needed.

Trends and Challenges for Population and Health During Population Aging - China, 2015-2050

What is already known about this topic?

As the largest country in the world, China experienced a demographic transition at a historic scale during the past 50 years with extraordinarily associated changes in the age structure of the population, declining fertility rates, accelerating process of population aging, and growing population scale.

What is added by this report?

This study presented future trends of five important population indicators in China. From 2015–2050, China experienced outstanding demographic changes — increases in life expectancy and declines in fertility rate — that have led to population aging. In addition, disability prevalence is growing, and life expectancy with disability is also increasing.

What are the implications for public health practice?

This study provided evidence of healthy life expectancy improvement and disease burden declining, healthy aging, and active aging. Due to the uncertainties of future trends of population structure changes, dynamic evaluations, timely adjustments, and innovations in population health strategy design and management should be strengthened to ensure quality of life under the background of population aging.

Auto-Regressive Integrated Moving Average Model (ARIMA): conceptual and methodological aspects and applicability in infant mortality

Abstract This reflective theoretical article, aims to discuss conceptual and methodological aspects about the applications of time series modeling, in particular, the Integrated Auto-regressive Moving Average model and its applicability in infant mortality. This modeling makes it possible to predict future values using past data, outlining and estimating possible scenarios of the health event, highlighting its magnitude. Due to the persistence of infant mortality as a public health problem, the applicability of this method is useful in the timely and systematic management of child health indicators, in addition to being a method with low operating cost, which in contexts of cost reduction in public healthcare services, becomes a potential management tool. However, there are still gaps in the use of statistical methods in the decision-making and policy-making process in public healthcare, such as the modeling in question. These are methodological (robust statistics), institutional (outdated information systems) and cultural obstacles (devaluation of the data produced, mainly at the local level).

Trends and Challenges for Population Health and Migration - China, 2015-2050

What is already known about this topic?

Along with the quick change of society and health transformation, as well as the continued expansion of urbanization, the health risk and its variation of migrants in China would became more complicated.

What is added by this report?

Although a decreasing net migration flow trend was presented from 2015 to 2050, an increasing pace of aging and younger-age trend of migrants would pose serious challenges for population health in China. Deepening aging trend of migrants contributes to the increment of the disease burden of non-communicable diseases (NCDs) and disabilities, and the upward trend of young-age migrant patients with infectious diseases remain a threat to the future intervention and prevention of infectious diseases.

What are the implications for public health practice?

Health policies to eliminate the adverse effects of migration on population health should pay more attention to meet the health care demands of highly vulnerable migrant populations, such as very older and very young migrants.