Geographical heterogeneity in the disease characteristics and management of patients with inflammatory bowel disease, the preliminary results of a Chinese database for IBD (CHASE-IBD)

Background

The incidence of inflammatory bowel disease (IBD) is rapidly increasing in China, a vast country with significant geographical differences. The socioeconomic status of Eastern China is significantly higher than that of Western China.

Objectives

This study aimed to describe the geographical heterogeneity in the characteristics and management of patients with IBD in both Eastern and Western China.

Design

This was a multicenter, cross-sectional study.

Methods

Patients with IBD with ages ⩾18 years up to 18 January 2023 were included in the analysis from the Chinese database for IBD. Logistic regression was used to identify risk factors associated with surgeries among patients with IBD.

Results

Among 8305 patients with IBD, the ratio of ulcerative colitis (UC) to Crohn's disease (CD) was 4.13 and 0.33 in Western and Eastern China, respectively. The median age at diagnosis of UC and CD was 40.69 and 28.58 years, respectively. There was a male predominance among patients with UC (54.3%) and CD (68.0%). The two regions exhibited a similar distribution of disease locations in UC. However, Western China had a higher proportion of L2 involvement (30.0% versus 19.1%) and more advanced disease behavior (B2 and B3) (48.8% versus 39.8%) than Eastern China. Patients with IBD in Western China received more 5-aminosalicylic acid and corticosteroids and fewer immunomodulators and biologicals. In terms of surgical risk, Eastern China [versus Western China, odds ratios (OR): 5.36, 95% confidence intervals (CI): 2.96-9.68] was associated with a higher risk of surgery in UC, while Western China (versus Eastern China, OR: 3.39, 95% CI: 2.37-4.86) was associated with a higher risk of surgery in CD.

Conclusion

Geographical heterogeneity exists in the disease characteristics and management of IBD in Eastern and Western China. These findings have the potential to guide the formulation of location-specific strategies aimed at enhancing the long-term outcomes of patients with IBD.

Optimal temperature of vegetation productivity and its linkage with climate and elevation on the Tibetan Plateau

Vegetation productivity first increases and then decreases with temperature; and temperature corresponding to the maximum productivity is called optimal temperature (T_opt ). In this study, we used satellite derived near-infrared reflectance of vegetation (NIR_v ) data to map T_opt of vegetation productivity at the spatial resolution of 0.1° on the Tibetan Plateau (TP), one of most sensitive regions in the climate system. The average T_opt of non-forest vegetation on the TP is about 14.7°C, significantly lower than the T_opt value used in current ecosystem models. A remarkable geographical heterogeneity in T_opt is observed over the TP. Higher T_opt values generally appear in the north-eastern TP, while the south-western TP has relatively lower T_opt (<10°C), in line with the difference of climate conditions and topography across different regions. Spatially, T_opt tends to decrease by 0.41°C per 100 m increase in elevation, faster than the elevational elapse rate of growing season temperature, implying a potential CO₂ regulation of T_opt in addition to temperature acclimation. T_opt increases by 0.66°C for each 1°C of rising mean annual temperature as a result of vegetation acclimation to climate change. However, at least at the decadal scale, there is no significant change in T_opt between 2000s and 2010s, suggesting that the T_opt climate acclimation may not keep up with the warming rate. Finally, future (2091-2100) warming could be close to and even surpass T_opt on the TP under different RCP scenarios without considering potential climate acclimation. Our analyses imply that the temperature tipping point when the impact of future warming shifts from positive to negative on the TP is greatly overestimated by current vegetation models. Future research needs to include varying thermal and CO₂ acclimation effects on T_opt across different time scales in vegetation models.

The Impact of Ambient Temperature on Childhood HFMD Incidence in Inland and Coastal Area: A Two-City Study in Shandong Province, China

Hand, foot and mouth disease (HFMD) has been a substantial burden throughout the Asia-Pacific countries over the past decades. For the purposes of disease prevention and climate change health impact assessment, it is important to understand the temperature-disease association for HFMD in different geographical locations. This study aims to assess the impact of temperature on HFMD incidence in an inland city and a coastal city and investigate the heterogeneity of temperature-disease associations. Daily morbidity data and meteorological variables of the study areas were collected for the period from 2007 to 2012. A total of 108,377 HFMD cases were included in this study. A distributed lag non-linear model (DLNM) with Poisson distribution was used to examine the nonlinear lagged effects of daily mean temperature on HFMD incidence. After controlling potential confounders, temperature showed significant association with HFMD incidence and the two cities demonstrated different impact modes ( I2= 96.1%; p < 0.01). The results highlight the effect of temperature on HFMD incidence and the impact pattern may be modified by geographical localities. Our findings can be a practical reference for the early warning and intervention strategies of HFMD.

Mapping mental health service access: achieving equity through quality improvement

BACKGROUND

Improving access to psychological therapies (IAPTs) services deliver evidence-based care to people with depression and anxiety. A quality improvement (QI) initiative was undertaken by an IAPT service to improve referrals providing an opportunity to evaluate equitable access.

METHODS

QI methodologies were used by the clinical team to improve referrals to the service. The collection of geo-coded data allowed referrals to be mapped to small geographical areas according to deprivation.

RESULTS

A total of 6078 patients were referred to the IAPT service during the period of analysis and mapped to 120 unique lower super output areas (LSOAs). The average weekly referral rate rose from 17 during the baseline phase to 43 during the QI implementation phase. Spatial analysis demonstrated all 15 of the high deprivation/low referral LSOAs were converted to high deprivation/high or medium referral LSOAs following the QI initiative.

CONCLUSION

This work highlights the importance of QI in developing clinical services aligned to the needs of the population through the analysis of routine data matched to health needs. Mapping can be utilized to communicate complex information to inform the planning and organization of clinical service delivery and evaluate the progress and sustainability of QI initiatives.