Objective To assess the appropriateness of Barthel Index (BI) and Modified Rankin Scales (MRS) used as long-term outcome measures in a stroke data register and to investigate the correlation between cutoff points of the two scales in different stroke patients with and without disability. Methods Nine hundred and twelve patients were registered prospectively. BI and MRS were evaluated at the end of 1, 3, 6 and 12 months after stroke onset. The distribution, ceiling effects and floor effects of the two scales were evaluated. A logistic regression model was established to investigate correlation of cutoff points of BI and MRS. Results There were a total of 2 829 evaluation points of BI and MRS. The percentages of patients reaching the maximum scores of BI at the end of 3, 6 and 12 months (54.8％, 62.2％ and 68.3％, respectively) were higher than those of MRS. There was significant correlation between the two scales (Spearman’s correlation coefficient 0.887, P＜0.05), when MRS scores of ≤1 and ≤2 were taken as cutoff points, the corresponding cutoff points of BI score were ≥90 and ≥85, respectively. Conclusions BI has significant ceiling effects when used as long-term outcome measurement in a stroke data register. There was significant correlation between BI and MRS scores. In future clinical studies, an MRS score ≤2 or BI score ≥85 could be used as cutoff points in predicting stroke patients with and without disability.
Objective To analyze the burden of cardiovascular diseases (CVDs) and its trend attributed to household air pollution (HAP) from solid fuels in China from 1990 to 2019. Methods Using the data derived from the Global Burden of Disease Study 2019 (GBD 2019), including mortality rates, disability-adjusted life years (DALY), age-standardized mortality rates, age-standardized DALY rates, annual percentage change (APC), and average annual percentage change rate (AAPC), we analyzed the CVD burden and its trend attributed to HAP in China from 1990 to 2019. Results In 2019, HAP in China resulted in 227 000 deaths and 5 182 200 DALYs of CVD; the mortality rate attributed to HAP was 15.96 per 100 000, and the DALY rate was 364.34 per 100 000. In 2019, the age-standardized mortality and DALY rates in China were 12.52 and 262.65 per 100 000, respectively, which were lower than the rates globally, and the rates for males were higher than those for females (13.90 vs. 11.32 per 100 000, 291.76 vs. 234.50 per 100 000). In 2019, both mortality and DALY rates attributed to HAP increased with age, peaking in the age groups of 95 plus and 85-89, respectively. From 1990 to 2019 in China, both age-standardized mortality and DALY rates of CVD attributed to HAP showed a downward trend over time. The average annual percentage change rate (AAPC) of the age-standardized mortality rate was −6.0% (95%CI: −6.2% to −5.8%), and the APCC of the age-standardized DALY rate was −5.8% (95%CI: −6.1% to −5.6%). The burden of the CVD subclass also showed a downward trend. Conclusion From 1990 to 2019, the burden of CVD attributed to HAP from solid fuels in China shows a significant downward trend, with sex and age differences. Females and the elderly are the key groups of disease burden, so effective interventions should be taken for these groups.
ObjectiveTo systematically review the disease burden and epidemiological characteristics of diabetes mellitus in Chinese population, and to provide references for health resources allocation and health policy making. MethodsDatabases such as PubMed, EMbase, CNKI, VIP and WanFang Data were searched for studies investigating disease burden of diabetes mellitus in Chinese population up to January 1st, 2014. According to the inclusion and exclusion criteria, two researchers screened literature, exacted data, and assessed methodological quality of included studies. Statistical analysis was performed with the data of diabetes associated population, mortality and disease burden were analyzed. ResultsA total of 39 studies were included, one of which was not included for further qualitative analysis due to low quality. The results of qualitative analysis involving 38 studies showed that, since 1980, the prevalence of diabetes increased rapidly in China, especially in the younger age group. The disease burden of woman was higher than that of man; it was slightly higher in the city than in the countryside; but the gap between urban and rural areas was gradually narrowed. Disease burdens in Eastern, Central and Western regions orderly decreased, all of which were all at high levels. ConclusionThe disease burden of diabetes mellitus in China is seriously high and the prevention and control work is very hard. It is necessary to rationally and effectively allocate health resources based on different health demands in different regions among urban-rural and age groups; to reduce the burden in the elderly; and to pay more attention to the young age population at the same time. Besides, the emphasis of prevention should be placed on suppressing the increase of prevalence of diabetes mellitus and reducing disease burden due to its complications.
Objective To analyze the trends and influencing factors of rheumatoid arthritis disease burden in mainland China from 1990 to 2021 and predict its disease burden over the next 15 years. MethodsData on RA incidence, prevalence, mortality, and disability-adjusted life years (DALYs) in mainland China were extracted from the Global Burden of Disease Study 2021 (GBD 2021). Joinpoint regression was used to analyze temporal trends, while an age-period-cohort model assessed age, period, and birth cohort effects. Decomposition analysis explored the contributions of population aging, population growth, and epidemiological changes. An ARIMA model was applied to predict future disease burden. ResultsFrom 1990 to 2021, the number of RA cases in mainland China increased by 93.5% (incidence), 133% (prevalence), 115% (deaths), and 107% (DALYs), though age-standardized rates showed smaller changes. The disease burden was significantly higher in women than in men, with sex-specific peaks in onset and prevalence. Joinpoint regression revealed rising age-standardized incidence and prevalence rates (AAPC=0.54% and 0.51%, respectively) but declining mortality (AAPC=−0.78%). Cohort effects indicated higher RA risk in later-born populations (RR=1.53 for the 2012 cohort). Decomposition analysis identified population growth as the primary driver of increased burden. Projections suggested that by 2036, the age-standardized incidence and prevalence would rise to 13.92/100 000 and 248.84/100 000, respectively, while DALYs rates might decline to 42.09/100 000. ConclusionThe RA disease burden in mainland China is driven by both population aging and epidemiological factors, with notable sex disparities and cohort effects. Targeted interventions for high-risk populations, optimized healthcare resource allocation, and further research on influencing factors are needed to develop precise prevention and control strategies.
ObjectiveTo compare the disability conditions in different elderly populations in Sichuan province in order to get baseline data for further analyses in the future. MethodFrom October 2011 to August 2012, face-to-face interviews were performed by trained investigators in different elderly populations from urban communities, rural communities, acute care wards and rehabilitation wards. The main content of the investigation was the Elderly Disability Assessment Scale (EDAS). ResultsTotally, 1406 subjects were interviewed, among which, 1387 subjects completed the questionnaires. The response rate was 98.7%. The mean age of the participants was (73.8±8.2) years old. Elderly people dwelling in rural areas had a highest disability rate (81.4%), while the correspondent rate in subjects in acute care wards, rehabilitation wards, and urban community were 79.2%, 64.5%, and 53.8%, respectively (P<0.001). In each population, the disability rate increased with age. In the whole sample, most disabled subjects were of mild disability (80.5%). However, those in acute care wards or rehabilitation wards were more likely to have severe or profound disability. ConclusionsThe disability rate and the severity of disability increase with age in different elderly populations in Sichuan province, although most of them are of mild disability. The disability rate is conspicuously higher in the elderly dwelling in rural areas.
ObjectiveTo identify primary osteoporosis patients’ function and environment status based on International Classification of Functioning, Disability and Health (ICF) and provide evidence to clinical treatment, rehabilitation therapy and rehabilitation nursing.MethodsA questionnaire survey was conducted among osteoporosis patients hospitalized in the Center of rehabilitation Medicine of West China Hospital of SiChuan University, from May 2017 to December 2019. The research design was based on a cross-sectional survey. ICF was applied to simplify the core classification set, and a convenient sampling method was adopted.ResultsA total of 240 patients were investigated. All of the patients’ function showed limitation but different level. Meanwhile, including Walking (D450), Sensation of pain(B280), Structure of trunk (S760), Lifting and carrying objects (D430), Mobility of joint function (B710), the proportion of injuries were more than 90%, most of which the limitation level were light and moderate injuries indicating 5%-49% injuries; more than 50% pointed the three parts of environment factors were facilitative factors including Products or substances for personal consumption (E110), Health professionals (E355), Health services, systems and policies (E580), of which the proportion of Health services, systems and policies (E580) were highest.ConclusionOsteoporosis has a significant effect on patients’ function, we should develop clinical treatment, rehabilitation therapy, rehabilitation nursing based on the current evaluation of function.
ObjectivesTo systematically review the disease burden and epidemiological characteristics of tuberculosis in the Chinese population, and to provide reference for health resources allocation and health policy making.MethodsDatabases such as PubMed, EMbase, CNKI, VIP and WanFang Data were searched for studies investigating disease burden of tuberculosis in Chinese population from inception to August 1st, 2017. Two researchers independently screened literature, exacted data and assessed methodological quality of included studies. Statistical analysis was performed on data of tuberculosis associated population, mortality and disease burden.ResultsA total of 40 studies were included. The results of qualitative analysis showed that, since 1990, the prevalence of tuberculosis and its disease burden in China decreased year by year. However, the disease burden per patient and the total economic burden in China showed an increasing trend, and the economical disease burden increased 1.6 times from 1993 to 2003. The disease burden of men was higher than that of women, and it was higher in the countryside than in the city. In 2004, the ratio of YLL per thousand people in rural and urban areas was 2.18, and the ratio was 1.29 in 2014. Additionally, the disease burden decreased gradually in western, central and eastern regions. In 2014, compared with 2004, YLL decreased by 1.11, while the central and eastern regions were 0.48 and 0.25, respectively. The gap between the gender, the urban and rural areas and the regions was not as significant as in previous.ConclusionsThe disease burden of tuberculosis in China is seriously high and the tuberculosis prevention and control work should take into consideration the epidemiological characteristics of tuberculosis and the trends of the disease burden. It is necessary to rationally and effectively implement health intervention programs and allocate health resources based on different health demands in different regions and age groups to reduce the morbidity and mortality, and to pay more attention to drug-resistant tuberculosis. Besides, the emphasis of prevention should be placed on reducing disease burden in the elderly and strengthening prevention in the young population.
ObjectiveTo analyze the epidemiological burden and change trend of five sexually transmitted infections (STIs) in China from 1990 to 2019. MethodsThe estimated numbers and standardized rates of STIs incidence, prevalence, and disability-adjusted life years (DALY) in China and other regions were obtained from the Global Burden of Disease Study 2019. The epidemic burden and change trend of STIs in China were compared and evaluated. ResultsIn 2019, STIs affected about 242 million people in China, resulting in 173 million new cases and 350 000 person years of DALY losses. Compared with 1990, the prevalence and incidence of STIs increased by 59.75% and 30.02%, respectively, and the number of DALY decreased by 35.19%. From 1990 to 2019, the incidence rate of chlamydia infection and gonococcal infection in the young and middle-aged group (aged 15-49 years) showed an upward trend; in addition, the DALY rate of genital herpes and trichomoniasis also increased. Among the 5 STIs, the disease burden caused by trichomoniasis infection in women was much higher than that in men. With the increase in the socio-demographic index (SDI), the burden of STIs in China gradually decreased. After the SDI exceeded 0.65, the decline rate of standardized DALY rate sharply increased. ConclusionThe disease burden of STIs in China shows a downward trend from 1990 to 2019, and the disease burden of the young and middle-aged group (aged 15-49 years) is the most significant, especially in trichomoniasis and chlamydia infection.
Objective The aim of this study was to describe the trends in the burden of breast cancer in women of all ages in China from 1990 to 2021, compare it with the global burden of breast cancer in women, and predict the burden of disease in the next 15 years. Methods Based on the open data of the Global Burden of Disease (GBD) in 2021, the incidence, prevalence, mortality and disability-adjusted life years (DALYs) of breast cancer among women in China and the world were analyzed. Joinpoint was used to calculate annual percentage change (APC) and average annual percentage change (AAPC) to reflect the changing trend of disease burden. An autoregressive composite moving average (ARIMA) model was used to predict the disease burden of breast cancer in women from 2022 to 2036. Results From 1990 to 2021, the age-standardized incidence rate (ASIR) and age-standardized prevalence rate (ASPR) of female breast cancer in China showed an increasing trend, with an average annual increase of 2.400 7% and 2.334 8%, respectively, and the age-standardized mortality rate (ASMR) and age-standardized DALYs rate (ASDR) showed a decreasing trend. The average annual decline was 0.290 0% and 0.198 3%, respectively. Meanwhile, ASIR and ASPR of global female breast cancer also showed an increasing trend, with an average annual increase of 0.474 9% and 0.3445 2% respectively, while ASMR and ASDR showed a decreasing trend, with an average annual decrease of 0.425 2% and 0.321 8% respectively. Among them, there were differences in the impact of age on the burden of female breast cancer. The peak of ASIR and ASPR appeared in the age group of 50 to 69 years old, and generally increased with the increase of age, and then decreased when reaching the peak. ASMR and ASDR increased with age. In the following 15 years, the prevalence of breast cancer in women in China and globally showed an increasing trend, while the mortality rate showed a decreasing trend. Conclusion From the analysis of the disease burden from 1990 to 2021, breast cancer has a huge harm to women, and the incidence of young and middle-aged women is high, the death rate of middle-aged and elderly women is high, and the disease time is long, which brings a heavy psychological and economic burden to patients and society. From the trend forecast for the next 15 years, the prevalence of breast cancer in women in China and the world will increase, while the mortality rate will decrease slightly, but the decrease is not large, which will bring huge public health challenges and put higher requirements on the prevention and control of the disease. To reduce the disease burden of breast cancer, comprehensive strategies for disease control are needed, including prevention of risk factors at the primary care level, screening of at-risk populations, and quality medical services.
ObjectiveTo explore the clinical efficacy of percutaneous endoscopic interlaminar discectomy (PEID) and interlaminar fenestration discectomy in the treatment of lumbar (L) 5-Sacral (S) 1 lumbar disc herniation (LDH).MethodsLDH patients were retrospectively included from January 2016 to Januray 2018. And the patients were divided into the PEID group and the fenestration group according to their choice of different surgical methods. The operation time, intra-operative blood loss, and bed rest time in the two groups were recorded. The preoperative and postoperative [1 week, 1 month, 3 months, and last follow-up (>12 months)] Visual Analogue Score (VAS) of the lumbago and leg pain between the two groups were compared; the preoperative and postoperative [1 week, and last follow-up (>12 months)] Oswestry Disability Index (ODI) and also the postoperative [(>12 months)] therapeutic effect (modified MacNab) between the two groups were compared.ResultsA total of 66 patients were included, with 31 in the PEID group and 35 in the fenestration group. There was no significant difference in age, gender and course of disease between the two groups (P>0.05). There were leakage of cerebrospinal fluid and transient lumbago, leg pain and numbness, which were worse than those before operation in the PEID group (1 and 1 patient, respectively) and the fenestration group (2 and 3 patients, respectively). There were statistically significant differences between the PEID group and the fenestration group, in the operative time [(90.65±9.98) vs. (66.23±16.50) minutes], intra-operative blood loss [(51.77±18.64) vs. (184.29±78.38) mL], and bed time [(2.87±0.92) vs. (7.49±1.20) d] (t=−7.365, t’=−9.697, t=−17.374, P<0.001). There was no significant difference in the preoperative VAS score (lumbar-leg pain) and ODI index, and the ODI index at each postoperative time point, between the two groups (P>0.05). VAS score (lumbago) and VAS score (leg pain) in the PEID group at each postoperative time point were lower than those in the fenestration group (P<0.05); VAS scores (leg pain) at other time points were not statistically significant between the two groups (P > 0.05). VAS (lumbar-leg pain) score and ODI index at each postoperative time point were lower than those before the surgery. The was no statistically significant difference in the PEID group (90.32%) and fenestration group (85.71%) in the excellent rate (χ2=0.328, P=0.713).ConclusionsPEID has less surgical trauma, less bleeding, short bed rest, fast recovery, and better relief of postoperative lumbago symptoms. It is worthy of further promotion in clinical work.