1
|
Chen S, Zhang H, Gao M, Machado DB, Jin H, Scherer N, Sun W, Sha F, Smythe T, Ford TJ, Kuper H. Dose-Dependent Association Between Body Mass Index and Mental Health and Changes Over Time. JAMA Psychiatry 2024; 81:797-806. [PMID: 38748415 PMCID: PMC11097104 DOI: 10.1001/jamapsychiatry.2024.0921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 03/06/2024] [Indexed: 05/18/2024]
Abstract
Importance Overweight and obesity affect 340 million adolescents worldwide and constitute a risk factor for poor mental health. Understanding the association between body mass index (BMI) and mental health in adolescents may help to address rising mental health issues; however, existing studies lack comprehensive evaluations spanning diverse countries and periods. Objective To estimate the association between BMI and mental health and examine changes over time from 2002 to 2018. Design, Setting, and Participants This was a repeated multicountry cross-sectional study conducted between 2002 and 2018 and utilizing data from the Health Behaviour in School-aged Children (HBSC) survey in Europe and North America. The study population consisted of more than 1 million adolescents aged 11 to 15 years, with all surveyed children included in the analysis. Data were analyzed from October 2022 to March 2023. Main Outcomes and Measures Mental health difficulties were measured by an 8-item scale for psychological concerns, scoring from 0 to 32, where a higher score reflects greater psychosomatic issues. BMI was calculated using weight divided by height squared and adjusted for age and sex. Data were fitted by multilevel generalized additive model. Confounders included sex, living with parents, sibling presence, academic pressure, the experience of being bullied, family affluence, screen time, and physical activity. Results Our analysis of 1 036 869 adolescents surveyed from 2002 to 2018, with a mean (SD) age of 13.55 (1.64) years and comprising 527 585 girls (50.9%), revealed a consistent U-shaped association between BMI and mental health. After accounting for confounders, adolescents with low body mass and overweight or obesity had increased psychosomatic symptoms compared to those with healthy weight (unstandardized β, 0.14; 95% CI, 0.08 to 0.19; unstandardized β, 0.27; 95% CI, 0.24 to 0.30; and unstandardized β, 0.62; 95% CI, 0.56 to 0.67, respectively), while adolescents with underweight had fewer symptoms (unstandardized β, -0.18; 95% CI, -0.22 to -0.15). This association was observed across different years, sex, and grade, indicating a broad relevance to adolescent mental health. Compared to 2002, psychosomatic concerns increased significantly in 2006 (unstandardized β, 0.19; 95% CI, 0.11 to 0.26), 2010 (unstandardized β, 0.14; 95% CI, 0.07 to 0.22), 2014 (unstandardized β, 0.48; 95% CI, 0.40 to 0.56), and 2018 (unstandardized β, 0.82; 95% CI, 0.74 to 0.89). Girls reported significantly higher psychosomatic concerns than boys (unstandardized β, 2.27; 95% CI, 2.25 to 2.30). Compared to primary school, psychosomatic concerns rose significantly in middle school (unstandardized β, 1.15; 95% CI, 1.12 to 1.18) and in high school (unstandardized β, 2.12; 95% CI, 2.09 to 2.15). Conclusions and Relevance Our study revealed a U-shaped association between adolescent BMI and mental health, which was consistent across sex and grades and became stronger over time. These insights emphasize the need for targeted interventions addressing body image and mental health, and call for further research into underlying mechanisms.
Collapse
Affiliation(s)
- Shanquan Chen
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Hao Zhang
- School of Public Health, Hangzhou Normal University, Hangzhou, China
| | - Min Gao
- Nuffield Department of Primary Care Health, University of Oxford, Oxford, United Kingdom
- National Institute for Health and Care Research Oxford Health Biomedical Research Centre, Oxford University Hospitals National Health Service Foundation Trust, Oxford, United Kingdom
| | - Daiane Borges Machado
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
- Center of Data and Knowledge Integration for Health, Fiocruz, Salvador, Brazil
| | - Huajie Jin
- Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, United Kingdom
| | - Nathaniel Scherer
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Wei Sun
- School of Public Health, Hangzhou Normal University, Hangzhou, China
| | - Feng Sha
- Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, Guangdong, China
| | - Tracey Smythe
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Stellenbosch University, Cape Town, South Africa
| | - Tamsin J. Ford
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
- Cambridgeshire and Peterborough National Health Service Foundation Trust, Cambridge, United Kingdom
| | - Hannah Kuper
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, United Kingdom
| |
Collapse
|
2
|
Li C, Li X, Li Y, Niu X. The Nonlinear Relationship Between Body Mass Index (BMI) and Perceived Depression in the Chinese Population. Psychol Res Behav Manag 2023; 16:2103-2124. [PMID: 37325255 PMCID: PMC10263158 DOI: 10.2147/prbm.s411112] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 06/01/2023] [Indexed: 06/17/2023] Open
Abstract
Purpose Existing studies on the association between BMI and depression report conflicting results with some demonstrating a positive relationship, while others a negative link or insignificant correlation. Very limited research on the nonlinear relationship between BMI and depression has yet to clarify the reliability and robustness of the potential nonlinearity and whether a more complex association exists. This paper aims to systematically investigate the nonlinear relationship between the two factors applying rigorous statistical methods, as well as explore the heterogeneity of their association. Materials and Methods A large-scale nationally representative dataset, Chinese General Social Survey, is used to empirically analyze the nonlinear relationship between BMI and perceived depression. Various statistical tests are employed to check the robustness of the nonlinearity. Results Results indicate that there is a U-shaped relationship between BMI and perceived depression, with the turning point (25.718) very close to while slightly larger than the upper limit of the range of healthy weight (18.500 ≤ BMI < 25.000) defined by World Health Organization. Both very high and low BMIs are associated with increased risk for depressive disorders. Furthermore, perceived depression is higher at almost all BMI levels among individuals who are older, female, lower educated, unmarried, in rural areas, belonging to ethnic minorities, non-Communist Party of China members, as well as those with lower income and uncovered by social security. In addition, these subgroups have smaller inflection points and their self-rated depression is more sensitive to BMI. Conclusion This paper confirms a significant U-shaped trend in the association between BMI and depression. Therefore, it is important to account for the variations in this relationship across different BMI categories when using BMI to predict depression risk. Besides, this study clarifies the management goals for achieving an appropriate BMI from a mental health perspective and identifies vulnerable subgroups at higher risk of depression.
Collapse
Affiliation(s)
- Chao Li
- Business School, Shandong University, Weihai, People’s Republic of China
| | - Xiang Li
- Business School, Shandong University, Weihai, People’s Republic of China
| | - Yuming Li
- Business School, Shandong University, Weihai, People’s Republic of China
| | - Xiaoru Niu
- School of Mechanical, Electrical & Information Engineering, Shandong University, Weihai, People’s Republic of China
| |
Collapse
|
3
|
Mergo T. Parental Health Outcomes of Children’s Migration: Experimental Evidence from Ethiopia. INTERNATIONAL MIGRATION 2020. [DOI: 10.1111/imig.12703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
4
|
Song JJ, Ku EJ, Kim S, Kim E, Choi YS, Jung HJ. Increased Risk of Psychopathological Abnormalities in Subjects With Unilateral Hearing Loss: A Cross-Sectional Study. Clin Exp Otorhinolaryngol 2020; 14:82-87. [PMID: 32734740 PMCID: PMC7904432 DOI: 10.21053/ceo.2020.00283] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 06/10/2020] [Indexed: 01/08/2023] Open
Abstract
Objectives Although unilateral hearing loss (UHL) has been proven to be associated with educational and behavioral problems, few studies have investigated psychopathological abnormalities in this population. The aim of this study was to evaluate the psychopathological influence of UHL among Korean 19-year-old males. Methods The authors retrospectively compared the objective personality test profiles of 602 subjects with UHL with those of 23,790 peers with normal hearing. All participants in the current study were 19-year-old males who underwent a physical examination and completed the Korean Military Multiphasic Personality Inventory for conscription at the Military Manpower Administration from February 2015 to December 2016. Results Significantly higher scores were found on neurosis scales in the UHL group than in the normal-hearing group (50.9± 10.8 vs. 44.9±6.0 for anxiety; 51.0±10.5 vs. 44.9±5.2 for depression; 51.1±10.4 vs. 45.1±6.81 for somatization, all P<0.001). The psychopathy scales were also significantly higher in the UHL group than in the normal-hearing group (49.3±9.4 vs. 46.3±5.7 for schizophrenia; 51.1±11.2 vs. 44.3±5.8 for personality disorders; 51.1±10.5 vs. 45.7±3.7 for paranoia, all P<0.001). Conclusion Nineteen-year-old males with UHL tended to have more abnormal results on personality tests than controls with normal hearing, suggesting that UHL may be related with a higher risk of psychopathology.
Collapse
Affiliation(s)
- Jae-Jin Song
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Eu Jeong Ku
- Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Seoyoung Kim
- Department of Psychiatry, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Euitae Kim
- Department of Psychiatry, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Young-Seok Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Hahn Jin Jung
- Department of Otorhinolaryngology-Head and Neck Surgery, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| |
Collapse
|
5
|
Rothe N, Steffen J, Penz M, Kirschbaum C, Walther A. Examination of peripheral basal and reactive cortisol levels in major depressive disorder and the burnout syndrome: A systematic review. Neurosci Biobehav Rev 2020; 114:232-270. [DOI: 10.1016/j.neubiorev.2020.02.024] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 01/27/2020] [Accepted: 02/19/2020] [Indexed: 12/15/2022]
|
6
|
Mchiza ZJR, Parker WA, Hossin MZ, Heshmati A, Labadarios D, Falkstedt D, Koupil I. Social and Psychological Predictors of Body Mass Index among South Africans 15 Years and Older: SANHANES-1. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16203919. [PMID: 31618952 PMCID: PMC6843690 DOI: 10.3390/ijerph16203919] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 09/20/2019] [Accepted: 09/21/2019] [Indexed: 12/01/2022]
Abstract
This study investigated how psychological distress and the proxies for social position combine to influence the risk of both underweight and overweight in South Africans aged 15 years and older. This was a cross-sectional study that included 2254 men and 4170 women participating in the first South African National Health and Nutrition Examination Survey (SANHANES-1). An analysis exploring the associations of social and mental health characteristics with body mass index (BMI) was conducted using binary and multinomial logistic regressions. Results suggested that, overall, women had a higher risk of overweight/obesity compared to men (age-adjusted odds ratio [AOR] 4.65; 95% confidence intervals [CI] 3.94–5.50). The gender effect on BMI was smaller in non-African participants (AOR 3.02; 95% CI 2.41–3.79; p-value for interaction = 0.004). Being employed and having a higher level of education were associated with higher risks of overweight and obesity and a lower risk of underweight. Being single or without a spouse and poor mental health were found to increase the odds of being underweight, especially in men. To conclude, there are strong social gradients and important gender and ethnic differences in how BMI is distributed in the South African population.
Collapse
Affiliation(s)
| | - Whadi-Ah Parker
- Social Aspects of Public Health (SAPH), Human Sciences Research Council, Cape Town 8000, South Africa.
| | - Muhammad Zakir Hossin
- Department of Public Health Sciences, Karolinska Institutet, Stockholm SE-171 76, Sweden.
| | - Amy Heshmati
- Department of Public Health Sciences, Stockholm University, Stockholm SE-106 91, Sweden.
- Centre for Health Equity Studies, Stockholm University, Stockholm SE-106 91, Sweden.
| | - Demetre Labadarios
- Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg 7505, South Africa.
| | - Daniel Falkstedt
- Department of Public Health Sciences, Karolinska Institutet, Stockholm SE-171 76, Sweden.
| | - Ilona Koupil
- Department of Public Health Sciences, Karolinska Institutet, Stockholm SE-171 76, Sweden.
- Department of Public Health Sciences, Stockholm University, Stockholm SE-106 91, Sweden.
| |
Collapse
|
7
|
Vittengl JR. Which body shape dimensions and sizes predict depression? J Affect Disord 2019; 250:193-198. [PMID: 30861461 DOI: 10.1016/j.jad.2019.03.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 03/01/2019] [Accepted: 03/04/2019] [Indexed: 01/29/2023]
Abstract
BACKGROUND Obesity is associated with depression, but a common measure of obesity, body mass index (BMI), combines height and weight. Consequently, which body shape dimensions and sizes are most relevant to depression is unclear. METHOD Data were analyzed from the National Health and Nutrition Examination Survey years 2007-2016, focusing on adults age 20 and older who were not pregnant. In this nationally-representative sample (N = 23,739), relations of depressive symptoms with body shape variables were tested, controlling for age, gender, ethnicity, and socioeconomic status. RESULTS Body weight and BMI, but not standing height, predicted depressive symptoms. Adults with relatively high body weight or BMI (roughly the top 30-40% of women or 10% of men) had substantively elevated depressive symptoms (d ≥ 0.20) within genders. BMI ranges predicting elevated depressive symptoms among women (BMI ≥ 30) and men (BMI ≥ 36) were higher than standard overweight and obesity definitions, respectively. LIMITATIONS This observational study was cross-sectional. Future longitudinal and experimental research is needed to clarify potential causal relations between body weight and depression. Other body shape variables may also predict depression. CONCLUSIONS Body weight but not height predicted concurrent risk for depressive symptomatology in the United States. Future research should test whether assessment focused on body weight not adjusted for height, as in BMI, improves depression prevention and treatment.
Collapse
Affiliation(s)
- Jeffrey R Vittengl
- Department of Psychology, Truman State University, 100 East Normal Street, Kirksville, MO 63501-4221, United States.
| |
Collapse
|
8
|
Choi HG, Lim H. Association between BMI for Obesity and Distress about Appearance in Korean Adolescents. J Korean Med Sci 2018; 33:e150. [PMID: 29760607 PMCID: PMC5944214 DOI: 10.3346/jkms.2018.33.e150] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Accepted: 03/13/2018] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Previous research has related obesity to body dissatisfaction and low self-esteem. This study aimed to evaluate this relation between obesity and distress about appearance. METHODS We performed a cross-sectional study using data from the Korea Youth Risk Behavior Web-based Survey for 288,390 participants assessed from 2009 to 2012. The participants were categorized according to body mass index; obese, overweight, healthy weight, and underweight. The relation between obesity and distress was analyzed using simple and multiple logistic regression with complex sampling adjusted for age, sex, region of residence, economic level, parental education level, alcohol consumption, and smoking habits as confounders. RESULTS The adjusted odds ratio (AOR) was higher for participants with obesity (AOR for healthy weight = 1.15 [95% confidence interval {CI}, 1.08-1.22]; AOR for overweight = 1.85 [95% CI, 1.72-1.98]; AOR for obese = 2.45 [95% CI, 2.27-2.64]; reference = underweight, P < 0.001). In males, healthy weight was associated with an AOR below 1 (AOR for healthy weight = 0.92 [95% CI, 0.85-0.99]; AOR for overweight = 1.26 [95% CI, 1.14-1.38]; AOR for obese = 1.66 [95% CI, 1.50-1.84], P < 0.001). In females, higher AORs were associated with obesity (AOR for healthy weight = 1.44 [95% CI, 1.33-1.57]; AOR for overweight = 2.71 [95% CI, 2.45-2.99]; AOR for obese = 3.71 [95% CI, 3.32-4.14], P < 0.001). CONCLUSION Obesity is related to distress about appearance, and the relation is stronger in girls than in boys.
Collapse
Affiliation(s)
- Hyo Geun Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Hyoseob Lim
- Department of Plastic and Reconstructive Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| |
Collapse
|
9
|
Walther A, Philipp M, Lozza N, Ehlert U. Emotional Support, Depressive Symptoms, and Age-Related Alterations in Male Body Composition: Cross-Sectional Findings from the Men's Health 40+ Study. Front Psychol 2017; 8:1075. [PMID: 28706495 PMCID: PMC5489702 DOI: 10.3389/fpsyg.2017.01075] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 06/12/2017] [Indexed: 11/13/2022] Open
Abstract
More depressive symptoms and low emotional support have been related to worse body composition. Body composition significantly deteriorates in aging men. Therefore, we aimed to examine whether high emotional support and low depressive symptoms are associated with better body composition and a decelerated age-related deterioration of body composition in aging men. A cross-sectional analysis including 269 self-reporting healthy men aged between 40 and 75 years living in the German-speaking part of Switzerland was conducted. Participants completed questionnaires on emotional support and depressive symptoms. The depression screening instrument was used to form a group with low (N = 225) and moderate (N = 44) depressive symptoms. Body mass index (BMI) and waist-to-hip ratio (WHR) were measured, and cell proportion (CP), fat mass (FM), and water balance (WB) were obtained using bioelectrical impedance analysis. Age-related associations emerged for WHR, CP, FM, and WB, but not for BMI. Emotional support was negatively associated with BMI, WHR, and WB, and only trend-wise with CP and FM. Group comparisons revealed that more depressive symptoms were associated with lower levels of CP and higher levels of WB. Both emotional support and depressive symptoms were significant moderators of the association between age and specific measures of body composition such as CP, FM, and WB. However, after correction for multiple testing for moderation analyses only the moderation effects of depressive symptoms on the association between age and WB and CP remained significant. Low depressive symptoms were associated with a better body composition as well as a decelerated decline in body composition and the role of emotional support acting as a buffer against age-related deterioration of body composition merits further investigation.
Collapse
Affiliation(s)
- Andreas Walther
- Clinical Psychology and Psychotherapy, University of ZurichZurich, Switzerland.,University Research Priority Program-Dynamics of Healthy Aging, University of ZurichZurich, Switzerland
| | - Michel Philipp
- Psychological Methods, Evaluation and Statistics, University of ZurichZurich, Switzerland
| | - Niclà Lozza
- Clinical Psychology and Psychotherapy, University of ZurichZurich, Switzerland
| | - Ulrike Ehlert
- Clinical Psychology and Psychotherapy, University of ZurichZurich, Switzerland.,University Research Priority Program-Dynamics of Healthy Aging, University of ZurichZurich, Switzerland
| |
Collapse
|
10
|
Qin T, Liu W, Yin M, Shu C, Yan M, Zhang J, Yin P. Body mass index moderates the relationship between C-reactive protein and depressive symptoms: evidence from the China Health and Retirement Longitudinal Study. Sci Rep 2017; 7:39940. [PMID: 28128231 PMCID: PMC5269588 DOI: 10.1038/srep39940] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 11/29/2016] [Indexed: 12/17/2022] Open
Abstract
The present study aimed to investigate the role of abnormal body mass index (BMI, kg/m2) in the depression-CRP (C-reactive protein) relationship in a healthy middle-aged and elderly Chinese population. Analytical samples were drawn from the China Health and Retirement Longitudinal Study (CHARLS), and participants were categorized by different BMI levels. Depressive subtypes were evaluated both at baseline and follow-up using the Center for Epidemiology Studies Depression scale. Hs-CRP and other variables were measured at baseline. Multiple linear regression analyses were used to evaluate the cross-sectional and longitudinal relationship between depression and baseline hs-CRP. Depression was significantly negatively associated with BMI (ρ = −0.077, p < 0.0001), with underweight associated with worse depressive symptoms than other BMI groups. Both cross-sectional and longitudinal associations between serum hs-CRP and depressive subtypes were significantly positive in the underweight group (p < 0.05). However, in the other BMI groups (from normal weight to obesity), the CRP-depression relationship was no longer significant (p > 0.05). The significant relationship between CRP and depression in the underweight group suggested that not only obesity but also a low BMI could explain a substantial portion of the inflammation-depression link.
Collapse
Affiliation(s)
- Tingting Qin
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Wenhua Liu
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Minghui Yin
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Chang Shu
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Mingming Yan
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Jianyuan Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Ping Yin
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| |
Collapse
|