Background: The aim of this study was to evaluate whether stage at cancer diagnosis differed according to patient economic status.
Methods: A total of 10,528 patients with cancer of the stomach, colorectum, breast, or cervix, which are target organs of the Korean National Cancer Screening Program (NCSP; fully implemented in 2005) were extracted from population-based cancer registries. The patients were classified into four groups based on socioeconomic status (SES), as determined using their National Health Insurance (NHI) monthly premium at the time of cancer diagnosis. Cancer stage at diagnosis was defined as early (in situ/local) or late stage (regional/distant) based on the Surveillance, Epidemiology, and End Results (SEER) summary stage. Multivariable logistic regression analysis was performed to estimate the risk of non-local stage using age, residential area, and community deprivation index as covariates.
Results: The lowest SES subjects showed significantly higher risks of being diagnosed at a later stage for stomach, colorectal, and female breast cancer, but not for cervical cancer, compared with the highest SES subjects. The estimated ORs were 1.28 (95% CI, 1.10–1.49), 1.29 (95% CI, 1.03–1.61), and 1.35 (95% CI, 1.02–1.81) in the lowest SES subjects with stomach, colorectal, and breast cancer, respectively.
Conclusions: In conclusion, later stage diagnoses of stomach, colon, and female breast cancer are still associated with SES in Korea in the era of the NCSP for the lower SES population.
Background: Cigarette smoking has been reported to be associated with an increased risk of leukemia. Most epidemiological evidence on the association between cigarette smoking and leukemia risk is from studies conducted in Western populations, however, and evidence from Asian populations is scarce.
Methods: We conducted a large-scale population-based cohort study of 96,992 Japanese subjects (46,493 men and 50,499 women; age 40–69 years at baseline) with an average 18.3 years of follow-up, during which we identified 90 cases of acute myeloid leukemia (AML), 19 of acute lymphoblastic leukemia (ALL), and 28 of chronic myeloid leukemia (CML). Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using a Cox regression model adjusted for potential confounders.
Results: When we adjusted for age, sex, and study area, our findings showed no significant association or increasing dose–response relationship between risk of AML and cigarette smoking overall. However, after further adjustment for body mass index and occupation, current smokers with more than 30 pack-years of cigarette smoking had a significantly increased risk of AML compared to never smokers among men (HR 2.21; 95% CI, 1.01–4.83). This increased risk was not clear among women.
Conclusions: Our results suggest that cigarette smoking increases the risk of AML in Japanese men. The associations of smoking with AML among women, and with CML and ALL among men and women, should be assessed in future studies.
Background: The aim of this study was to investigate patient characteristics on admission to hospital that increase the risk of subsequent mechanical ventilation (MV) use for patients with Guillain–Barré syndrome (GBS).
Methods: We extracted data from the Japanese Diagnosis Procedure Combination (DPC) database for 4132 GBS patients admitted to hospital. Clinical characteristics of GBS patients with and without MV were compared. Multivariate logistic regression analyses were performed to estimate the odds ratios (ORs) and 95% confidence intervals (CIs) for the associations of requirement for MV with coexisting infectious diseases, after adjustment for potential confounding variables, age, sex, hospital type, and ambulance transportation.
Results: In total, 281 patients required MV, and 493 patients had coexisting respiratory diseases on admission. After adjustment for covariates and stratification by coexisting respiratory diseases, multivariate logistic regression analysis revealed that coexisting cytomegaloviral (CMV) disease (OR 8.81; 95% CI, 2.34–33.1) and herpes simplex viral (HSV) infections (OR 4.83; 95% CI, 1.16–20.1) were significantly associated with the requirement for MV in the group without coexisting respiratory diseases.
Conclusion: Our findings suggest that coexisting CMV and HSV infections on admission might be significantly associated with increased risk of respiratory failure in GBS patients.
Background: Large-scale outbreaks of measles occurred in 2013 and 2014 in rural Guangxi, a region in Southwest China with high coverage for measles-containing vaccine (MCV). This study aimed to estimate the timely vaccination coverage, the timely-and-complete vaccination coverage, and the median delay period for MCV among children aged 18–54 months in rural Guangxi.
Methods: Based on quartiles of measles incidence during 2011–2013, a stratified three-stage cluster survey was conducted from June through August 2015. Using weighted estimation and finite population correction, vaccination coverage and 95% confidence intervals (CIs) were calculated. Weighted Kaplan–Meier analyses were used to estimate the median delay periods for the first (MCV1) and second (MCV2) doses of the vaccine.
Results: A total of 1216 children were surveyed. The timely vaccination coverage rate was 58.4% (95% CI, 54.9%–62.0%) for MCV1, and 76.9% (95% CI, 73.6%–80.0%) for MCV2. The timely-and-complete vaccination coverage rate was 47.4% (95% CI, 44.0%–51.0%). The median delay period was 32 (95% CI, 27–38) days for MCV1, and 159 (95% CI, 118–195) days for MCV2.
Conclusions: The timeliness and completeness of measles vaccination was low, and the median delay period was long among children in rural Guangxi. Incorporating the timeliness and completeness into official routine vaccination coverage statistics may help appraise the coverage of vaccination in China.
Background: High body mass index (BMI) has been reported as a risk factor for cardiovascular events in Western countries, while low BMI has been reported as a risk factor for cardiovascular death in Asian countries, including Japan. Although stroke is a major cause of death and disability in Japan, few cohort studies have examined the association between BMI and stroke incidence in Japan. This study aimed to examine the association between BMI and stroke incidence using prospective data from Japanese community residents.
Methods: Data were analyzed from 12,490 participants in the Jichi Medical School Cohort Study. Participants were categorized into five BMI groups: ≤18.5, 18.6–21.9, 22.0–24.9, 25.0–29.9, and ≥30.0 kg/m2. Multivariate-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using the Cox proportional hazard model. The group with a BMI of 22.0–24.9 kg/m2 was used as the reference category.
Results: During mean follow-up of 10.8 years, 395 participants (207 men and 188 women) experienced stroke, including 249 cerebral infarctions and 92 cerebral hemorrhages. Men with a BMI ≤18.5 kg/m2 (HR 2.11; 95% CI, 1.17–3.82) and women with a BMI ≥30.0 kg/m2 (HR 2.25; 95% CI, 1.28–5.08) were at significantly higher risk for all-stroke. Men with a BMI ≤18.5 kg/m2 were at significantly higher risk for cerebral infarction (HR 2.15; 95% CI, 1.07–4.33).
Conclusions: The association between BMI and stroke incidence observed in this population was different than those previously reported: low BMI was a risk factor for all-stroke and cerebral infarction in men, while high BMI was a risk factor for all-stroke in women.
Background: Although open-ended dietary assessment methods, such as weighed food records (WFRs), are generally considered to be comparable, differences between procedures may influence outcome when WFRs are conducted independently. In this paper, we assess the procedures of WFRs in two studies to describe their dietary assessment procedures and compare the subsequent outcomes.
Methods: WFRs of 12 days (3 days for four seasons) were conducted as reference methods for intake data, in accordance with the study protocol, among a subsample of participants of two large cohort studies. We compared the WFR procedures descriptively. We also compared some dietary intake variables, such as the frequency of foods and dishes and contributing foods, to determine whether there were differences in the portion size distribution and intra- and inter-individual variation in nutrient intakes caused by the difference in procedures.
Results: General procedures of the dietary records were conducted in accordance with the National Health and Nutrition Survey and were the same for both studies. Differences were seen in 1) selection of multiple days (non-consecutive days versus consecutive days); and 2) survey sheet recording method (individual versus family participation). However, the foods contributing to intake of energy and selected nutrients, the portion size distribution, and intra- and inter-individual variation in nutrient intakes were similar between the two studies.
Conclusion: Our comparison of WFR procedures in two independent studies revealed several differences. Notwithstanding these procedural differences, however, the subsequent outcomes were similar.
Background: How weight perception influences weight-related knowledge, attitudes, and behaviors in Chinese children is unknown. We investigated self-perception of body weight and its correlates, and analyzed the relationship between weight perception and weight-related knowledge, attitudes, and behaviors in children in Guangzhou, China.
Methods: We assessed self-reported weight perception, weight-related knowledge, attitudes, and behaviors in 3752 children aged 7–12 years. Underweight or overweight was defined using the Chinese criteria based on body mass index (BMI). Binary logistic regression analyses were performed to assess correlates of weight underestimation.
Results: In total, 27.3% of children underestimated and 6.7% overestimated their weight status. Weight underestimation was common among normal-weight (34.1%) and overweight children (25.3%). Older age, female sex, and child BMI z-score were negatively associated with normal-weight children's underestimation, whereas older age, paternal obesity, maternal obesity, and child BMI z-score were negatively associated with overweight children's underestimation. Correct answers on weight-related knowledge questions ranged from 81.5% to 98.6% and did not differ by weight perception within BMI categories. Although negative perceivers (i.e., those who perceived themselves as underweight or overweight) had a higher intention to change weight, they behaved more unhealthily on fruit intake, breakfast, screen time, and daily moderate-to-vigorous physical activities time than counterparts.
Conclusion: Weight underestimation was prevalent in normal-weight and overweight children in Guangzhou. Negative perceivers had stronger willingness to change weight but tended to behave more unhealthily on certain behaviors than positive perceivers. Childhood obesity interventions should incorporate health education and practical support to promote healthy eating and physical activity.