Breast cancer incidence and mortality in a transitioning Chinese population: current and future trends

Parallel Session 1 - Population Health & Policy: no. S3Conference Theme: Translating Health Research into Policy and Practice for Health of the PopulationBACKGROUND: Projections of future trends in cancer incidence and mortality are important for public health planning. Moreover, as the most economically developed city in China, Hong Kong may provide a sentinel for a substantial proportion of the global population. OBJECTIVES: To model and evaluate recent trends in breast cancer incidence and mortality in Hong Kong, and to project the trends on short to medium terms, which have significant implications on future burdens on our health care …published_or_final_versio

Cost-effectiveness of Helicobacter pylori screening and treatment for gastric cancer in Hong Kong: a decision analytic approach

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Disease burden of breast cancer in Hong Kong: an exploration of trends for screening policy and resource allocation

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Hand hygiene and risk of influenza virus infections in the community: a systematic review and meta-analysis

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Towards informed decisions on breast cancer screening: Development and pilot testing of a decision aid for Chinese women

OBJECTIVE: To pilot-test a novel, self-use breast cancer (BC) screening decision aid (DA) targeting Hong Kong (HK) Chinese women at average risk of BC. METHODS: Women were recruited through a population-based telephone survey using random digit dialling between October 2013 and January 2014. Eligible participants completed our baseline survey and then received the DA by post. Participants (n=90) completed follow-up telephone interviews one month later. RESULTS: Most participants thought that all/most DA content was presented clearly (86.7%), and was useful in helping women make screening-related decisions (88.9%). It also achieved its expected impact of improving informed decision-making and increasing shared-participation preference without increasing participants' anxiety levels. Participants showed a modest non-statistical increase in their screening knowledge scores. Older women rated the perceived severity of a BC diagnosis as significantly lower, and more educated women reported significantly lower perceived anxiety about the disease. CONCLUSION: Our DA appears acceptable and feasible for self-use by HK Chinese women who need to make an informed decision about BC screening without increasing overall anxiety levels. PRACTICE IMPLICATIONS: This study supports the potential of self-use DAs for cancer screening-related decision support in a Chinese population. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.postprin

Trends in mortality from septicaemia and pneumonia with economic development: An age-period-cohort analysis

Background: Hong Kong population has experienced drastic changes in its economic development in the 1940s. Taking advantage of Hong Kong's unique demographic and socioeconomic history, characterized by massive, punctuated migration waves from Southern China, and recent, rapid transition from a pre-industrialized society to the first ethnic Chinese community reaching "first world" status over the last 60 years (i.e., in two or three generations), we examined the longitudinal trends in infection related mortality including septicemia compared to trends in non-bacterial pneumonia to generate hypotheses for further testing in other recently transitioned economies and to provide generalized aetiological insights on how economic transition affects infection-related mortality. Methods: We used deaths from septicemia and pneumonia not specified as bacterial, and population figures in Hong Kong from 1976-2005. We fitted age-period-cohort models to decompose septicemia and non-bacterial pneumonia mortality rates into age, period and cohort effects. Results: Septicaemia-related deaths increased exponentially with age, with a downturn by period. The birth cohort curves had downward inflections in both sexes in the 1940s, with a steeper deceleration for women. Non-bacterial pneumonia-related deaths also increased exponentially with age, but the birth cohort patterns showed no downturns for those born in the 1940s. Conclusion: The observed changes appeared to suggest that better early life conditions may enable better development of adaptive immunity, thus enhancing immunity against bacterial infections, with greater benefits for women than men. Given the interaction between the immune system and the gonadotropic axis, these observations are compatible with the hypothesis that upregulation of the gonadotropic axis underlies some of the changes in disease patterns with economic development. © 2012 Wong et al.published_or_final_versio

Generalised cost-effectiveness analysis for breast cancer prevention and care in Hong Kong Chinese

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Age-period-cohort projections of ischaemic heart disease mortality by socio-economic position in a rapidly transitioning Chinese population

Background:With economic development and population aging, ischaemic heart disease (IHD) is becoming a leading cause of mortality with widening inequalities in China. To forewarn the trends in China we projected IHD trends in the most economically developed part of China, i.e., Hong Kong.Methods:Based on sex-specific IHD mortality rates from 1976 to 2005, we projected mortality rates by neighborhood-level socio-economic position (i.e., low- or high-income groups) to 2020 in Hong Kong using Poisson age-period-cohort models with autoregressive priors.Results:In the low-income group, age-standardized IHD mortality rates among women declined from 33.3 deaths in 1976-1980 to 19.7 per 100,000 in 2016-2020 (from 55.5 deaths to 34.2 per 100,000 among men). The rates in the high-income group were initially higher in both sexes, particularly among men, but this had reversed by the end of the study periods. The rates declined faster for the high-income group than for the low-income group in both sexes. The rates were projected to decline faster in the high-income group, such that by the end of the projection period the high-income group would have lower IHD mortality rates, particularly for women. Birth cohort effects varied with sex, with a marked upturn in IHD mortality around 1945, i.e., for the first generation of men to grow up in a more economically developed environment. There was no such upturn in women. Birth cohort effects were the main drivers of change in IHD mortality rates.Conclusion:IHD mortality rates are declining in Hong Kong and are projected to continue to do so, even taking into account greater vulnerability for the first generation of men born into a more developed environment. At the same time social disparities in IHD have reversed and are widening, partly as a result of a cohort effect, with corresponding implications for prevention. © 2013 Wong et al.published_or_final_versio

Optimizing resource allocation for breast cancer prevention and care among Hong Kong Chinese women: a generalized cost-effectiveness analysis

Conference Theme: Translating Health Research into Policy and Practice for Health of the PopulationPoster Presentations: Delivery of Health Services: no. P42-Ab0048BACKGROUND AND OBJECTIVES: Recommendations about funding of interventions through the full spectrum of the disease have often been made in isolation or been derived in separate single intervention analyses. We primarily evaluated and optimized budgetary allocations by comparing cost-effectiveness data for the selected preventive and management strategies throughout the disease course for breast cancer in HK Chinese women …published_or_final_versio

Methods for monitoring influenza surveillance data

Background: A variety of Serfling-type statistical algorithms requiring long series of historical data, exclusively from temperate climate zones, have been proposed for automated monitoring of influenza sentinel surveillance data. We evaluated three alternative statistical approaches where alert thresholds are based on recent data in both temperate and subtropical regions. Methods: We compared time series, regression, and cumulative sum (CUSUM) models on empirical data from Hong Kong and the US using a composite index (range = 0-1) consisting of the key outcomes of sensitivity, specificity, and time to detection (lag). The index was calculated based on alarms generated within the first 2 or 4 weeks of the peak season. Results: We found that the time series model was optimal in the Hong Kong setting, while both the time series and CUSUM models worked equally well on US data. For alarms generated within the first 2 weeks (4 weeks) of the peak season in Hong Kong, the maximum values of the index were: time series 0.77 (0.86); regression 0.75 (0.82); CUSUM 0.56 (0.75). In the US data the maximum values of the index were: time series 0.81 (0.95); regression 0.81 (0.91); CUSUM 0.90 (0.94). Conclusions: Automated influenza surveillance methods based on short-term data, including time series and CUSUM models, can generate sensitive, specific, and timely alerts, and can offer a useful alternative to Serfling-like methods that rely on long-term, historically based thresholds. © Copyright 2006 Oxford University Press.postprin