Causal effect of PM1 on morbidity of cause-specific respiratory diseases based on a negative control exposure

Background: Extensive studies have linked PM2.5 and PM10 with respiratory diseases (RD). However, few is known about causal association between PM1 and morbidity of RD. We aimed to assess the causal effects of PM1 on cause-specific RD. Methods: Hospital admission data were obtained for RD during 2014 and 2019 in Beijing, China. Negative control exposure and extreme gradient boosting with SHapley Additive exPlanation was used to explore the causality and contribution between PM1 and RD. Stratified analysis by gender, age, and season was conducted. Results: A total of 1,183,591 admissions for RD were recorded. Per interquartile range (28 μg/m3) uptick in concentration of PM1 corresponded to a 3.08% [95% confidence interval (CI): 1.66%–4.52%] increment in morbidity of total RD. And that was 4.47% (95% CI: 2.46%–6.52%) and 0.15% (95% CI: 1.44%-1.78%), for COPD and asthma, respectively. Significantly positive causal associations were observed for PM1 with total RD and COPD. Females and the elderly had higher effects on total RD, COPD, and asthma only in the warm months (Z = 3.03, P = 0.002; Z = 4.01, P \u3c 0.001; Z = 3.92, P \u3c 0.001; Z = 2.11, P = 0.035; Z = 2.44, P = 0.015). Contribution of PM1 ranked first, second and second for total RD, COPD, and asthma among air pollutants. Conclusion: PM1 was causally associated with increased morbidity of total RD and COPD, but not causally associated with asthma. Females and the elderly were more vulnerable to PM1-associated effects on RD

Acute effect of particulate matter pollution on hospital admissions for cause-specific respiratory diseases among patients with and without type 2 diabetes in Beijing, China, from 2014 to 2020

BACKGROUND: Scientific studies have identified various adverse effects of particulate matter (PM) on respiratory disease (RD) and type 2 diabetes (T2D). However, whether short-term exposure to PM triggers the onset of RD with T2D, compared with RD without T2D, has not been elucidated. METHODS: A two-stage time-series study was conducted to evaluate the acute adverse effects of PM on admission for RD and for RD with and without T2D in Beijing, China, from 2014 to 2020. District-specific effects of PM and PM were estimated using the over-dispersed Poisson generalized addictive model after adjusting for weather conditions, day of the week, and long-term and seasonal trends. Meta-analyses were applied to pool the overall effects on overall and cause-specific RD, while the exposure-response (E-R) curves were evaluated using a cubic regression spline. RESULTS: A total of 1550,154 admission records for RD were retrieved during the study period. Meta-analysis suggested that per interquartile range upticks in the concentration of PM corresponded to 1.91% (95% CI: 1.33-2.49%), 2.16% (95% CI: 1.08-3.25%), and 1.92% (95% CI: 1.46-2.39%) increments in admission for RD, RD with T2D, and RD without T2D, respectively, at lag 0-8 days, lag 8 days, and lag 8 days. The effect size of PM was statistically significantly higher in the T2D group than in the group without T2D (z = 3.98, P \u3c 0.01). The effect sizes of PM were 3.86% (95% CI: 2.48-5.27%), 3.73% (95% CI: 1.72-5.79%), and 3.92% (95% CI: 2.65-5.21%), respectively, at lag 0-13 days, lag 13 days, and lag 13 days, respectively, and no statistically significant difference was observed between T2D groups (z = 0.24, P = 0.81). Significant difference was not observed between T2D groups for the associations of PM and different RD and could be found between three groups for effects of PM on RD without T2D. The E-R curves varied by sex, age and T2D condition subgroups for the associations between PM and daily RD admissions. CONCLUSIONS: Short-term PM exposure was associated with increased RD admission with and without T2D, and the effect size of PM was higher in patients with T2D than those without T2D

The Relationship between Effort-reward Imbalance and Job Stress among Medical Staff in Beijing

Background Medical work is characterized as challenging, tasking and stressful. The effort-reward imbalance (ERI) model suggests that if the organizational environment contributes to ERI, it can negatively affect employees. The investigation of medical staff is an important part of the 6th National Health Services Survey in 2018. The good job satisfaction and work conditions of medical staff are important determinants of service utilization and health improvement for the population. The sense of accomplishment and satisfaction of medical staff is also an important goal of the new healthcare reform. Objective To explore the relationship between ERI and job stress, and provide a reference for reducing the job stress of medical staff. Methods The data for this study were obtained from the results of a sample survey of 4 156 healthcare workers in Beijing during the 6th National Health Services Statistics Survey in 2018. A predictive structural equation model of job stress was constructed and based on ERI questionnaire and job stress questionnaire. Relevant parameters were estimated by using the partial least squares to analyze the relationship between ERI and job stress. Results The valid records for participating in the ERI index calculation were 4 098. According to the ERI index calculation results, 1 333 (32.53%) healthcare workers were in a state of balance between effort and reward, and 2 765 (67.47%) health workers were in a state of imbalance between effort and reward. The results of factor analysis showed that 46.00% of the job stress experienced by medical staff in Beijing can be attributed to ERI model. Extrinsic, intrinsic effort and work reward all had a direct impact on job stress (P<0.001) , the total effect of intrinsic effort was 0.409 (95%CI=0.373 to 0.443) ; the total effect of extrinsic effort was 0.583 (95%CI=0.559 to 0.606) ; the total effect of work reward was -0.199 (95%CI=-0.227 to -0.171) . In addition, the intrinsic effort mediated the impact of extrinsic effort and work rewards on job stress. Conclusion The results of the study support the hypothesis that ERI is an important source of job stress for medical staff in Beijing. Based on the evidence that the intrinsic effort has the greatest impact on job stress, the relevant management system should be improved by health administration and medical institutions to address ERI and reduce the job stress of medical staff

Short‐Term Effects of Carbon Monoxide on Morbidity of Chronic Obstructive Pulmonary Disease With Comorbidities in Beijing

Abstract The association between CO and chronic obstructive pulmonary disease (COPD) has been widely reported; however, the association among patients with type 2 diabetes mellitus (T2DM) or hypertension has remained largely unknown in China. Over‐dispersed generalized additive model was adopted to quantity the associations between CO and COPD with T2DM or hypertension. Based on principal diagnosis, COPD cases were identified according to the International Classification of Diseases (J44), and a history of T2DM and hypertension was coded as E12 and I10‐15, O10‐15, P29, respectively. A total of 459,258 COPD cases were recorded from 2014 to 2019. Each interquartile range uptick in CO at lag 03 corresponded to 0.21% (95%CI: 0.08%–0.34%), 0.39% (95%CI: 0.13%–0.65%), 0.29% (95%CI: 0.13%–0.45%) and 0.27% (95%CI: 0.12%–0.43%) increment in admissions for COPD, COPD with T2DM, COPD with hypertension and COPD with both T2DM and hypertension, respectively. The effects of CO on COPD with T2DM (Z = 0.77, P = 0.444), COPD with hypertension (Z = 0.19, P = 0.234) and COPD with T2DM and hypertension (Z = 0.61, P = 0.543) were insignificantly higher than that on COPD. Stratification analysis showed that females were more vulnerable than males except for T2DM group (COPD: Z = 3.49, P < 0.001; COPD with T2DM: Z = 0.176, P = 0.079; COPD with hypertension: Z = 2.48, P = 0.013; COPD with both T2DM and hypertension: Z = 2.44, P = 0.014); No statistically significant difference could be found between age groups (COPD: Z = 1.63, P = 0.104; COPD with T2DM: Z = 0.23, P = 0.821; COPD with hypertension: Z = 0.53, P = 0.595; COPD with both T2DM and hypertension: Z = 0.71, P = 0.476); Higher effects appeared in cold seasons than warm seasons on COPD (Z = 0.320, P < 0.001). This study demonstrated an increased risk of COPD with comorbidities related to CO exposure in Beijing. We further provided important information on lag patterns, susceptible subgroups, and sensitive seasons, as well as the characteristics of the exposure‐response curves

Exploring Cancer Incidence Trends by Age and Sex Among 14.14 Million Individuals in China From 2007 to 2021: Population-Based Study

BackgroundSex is a crucial factor in the development, progression, and treatment of cancer, making it vital to examine cancer incidence trends by sex for effective prevention strategies. ObjectiveThis study aimed to assess the incidence of cancer in China between 2007 and 2021, with a focus on sex-based trends. MethodsA population-based cancer registry comprising 14.14 million individuals was maintained between 2007 and 2021 by the Beijing Municipal Health Big Data and Policy Research Center. The age-standardized rates (ASRs) of cancers were calculated using the Segi population. The average annual percentage of change (AAPC) was evaluated using the joinpoint regression model, while the Bayesian age-period-cohort model was used to predict cancer incidence in the next 10 years. ResultsFrom 2007 to 2021, the study included 651,342 incident patients with cancer, of whom 51.2% (n=333,577) were women. The incidence indicated by the ASR for all cancers combined was 200.8 per 100,000 for women and 184.4 per 100,000 for men. The increase in incidence indicated by AAPC for all malignancies combined significantly increased in women between 2007 and 2021 (AAPC=3.1%; P<.001), whereas it remained constant in men (AAPC=0.3%; P=.30). Although the overall incidence of all cancers indicated by AAPC increased in young men (AAPC=3.2%; P=.01), the greatest increase was observed among young women (AAPC=6.1%; P<.001). The incidence rate ratio for cancer in women increased among subsequent younger generations compared with patients born in the 1962-1966 cohort. The ASR in women will increase 1.6-fold over the next 10 years, with women having twice the incidence rate of men by 2031. ConclusionsThe rising incidence of cancer among women in China has become a growing concern, emphasizing the need for increased efforts in cancer prevention and early screening, especially among young women

Geographic Variation in Mortality of Acute Myocardial Infarction and Association With Health Care Accessibility in Beijing, 2007 to 2018

Background Little is known about geographic variation in acute myocardial infarction (AMI) mortality within fast‐developing megacities and whether changes in health care accessibility correspond to changes in AMI mortality at the small‐area level. Methods and Results We included data of 94 106 AMI deaths during 2007 to 2018 from the Beijing Cardiovascular Disease Surveillance System in this ecological study. We estimated AMI mortality for 307 townships during consecutive 3‐year periods with a Bayesian spatial model. Township‐level health care accessibility was measured using an enhanced 2‐step floating catchment area method. Linear regression models were used to examine the association between health care accessibility and AMI mortality. During 2007 to 2018, median AMI mortality in townships declined from 86.3 (95% CI, 34.2–173.8) to 49.4 (95% CI, 30.5–73.7) per 100 000 population. The decrease in AMI mortality was larger in townships where health care accessibility increased more rapidly. Geographic inequality, defined as the ratio of the 90th to 10th percentile of mortality in townships, increased from 3.4 to 3.8. In total, 86.3% (265/307) of townships had an increase in health care accessibility. Each 10% increase in health care accessibility was associated with a −0.71% (95% CI, −1.08% to −0.33%) change in AMI mortality. Conclusions Geographic disparities in AMI mortality among Beijing townships are large and increasing. A relative increase in township‐level health care accessibility is associated with a relative decrease in AMI mortality. Targeted improvement of health care accessibility in areas with high AMI mortality may help reduce AMI burden and improve its geographic inequality in megacities

Driving Time to the Nearest Percutaneous Coronary Intervention-Capable Hospital and the Risk of Case Fatality in Patients with Acute Myocardial Infarction in Beijing

Timely arrival at a hospital capable of percutaneous coronary intervention (PCI) is critical in treating acute myocardial infarction (AMI). We examined the association between driving time to the nearest PCI-capable hospital and case fatality among AMI patients. A total of 142,474 AMI events during 2013–2019 from the Beijing Cardiovascular Disease Surveillance System were included in this cross-sectional study. The driving time from the residential address to the nearest PCI-capable hospital was calculated. Logistic regression was used to estimate the risk of AMI death associated with driving time. In 2019, 54.5% of patients lived within a 15-min drive to a PCI-capable hospital, with a higher proportion in urban than peri-urban areas (71.2% vs. 31.8%, p p value) for AMI fatality risk associated with driving times 16–30, 31–45, and >45 min were 1.068 (95% CI 1.033–1.104, p p p < 0.001), respectively. Despite the high accessibility to PCI-capable hospitals for AMI patients in Beijing, inequality between urban and peri-urban areas exists. A longer driving time is associated with an elevated AMI fatality risk. These findings may help guide the allocation of health resources

Causal Associations of Air Pollution With Cardiovascular Disease and Respiratory Diseases Among Elder Diabetic Patients

Abstract Extensive researches have linked air pollutants with cardiovascular disease (CVD) and respiratory diseases (RD), however, there is limited evidence on causal effects of air pollutants on morbidity of CVD or RD with comorbidities, particularly diabetes mellitus in elder patients. We included hospital admissions for CVD or RD among elder (≥65 years) diabetic patients between 2014 and 2019 in Beijing. A time‐stratified case‐crossover design based on negative‐control exposure was used to assess causal associations of short‐term exposure to air pollutants with CVD and RD among diabetic patients with the maximum lag of 7 days. A random forest regression model was used to calculate the contribution magnitude of air pollutants. A total of 493,046 hospital admissions were recorded. Per 10 μg/m3 uptick in PM1, PM2.5, PM10, SO2, NO2, O3, and 1 mg/m3 in CO was associated with 0.29 (0.05, 0.53), 0.14 (0.02, 0.26), 0.06 (0.00, 0.12), 0.36 (0.01, 0.70), 0.21 (0.02, 0.40), −0.08 (−0.25, 0.09), and 4.59 (0.56, 8.61) causal effect estimator for admission of CVD among diabetic patients, corresponding to 0.12 (0.05, 0.18), 0.09 (0.05, 0.13), 0.05, 0.23 (0.06, 0.41), 0.10 (0.02, 0.19), −0.04 (−0.06, −0.01), and 3.91(1.81, 6.01) causal effect estimator for RD among diabetic patients. The effect of gaseous pollutants was higher than particulate pollutants in random forest model. Short‐term exposure to air pollution was causally associated with increased admission of CVD and RD among elder diabetic patients. Gaseous pollutants had a greater contribution to CVD and RD among elder diabetic patients

Trends and Inequalities in the Incidence of Acute Myocardial Infarction among Beijing Townships, 2007&ndash;2018

Acute myocardial infarction (AMI) poses a serious disease burden in China, but studies on small-area characteristics of AMI incidence are lacking. We therefore examined temporal trends and geographic variations in AMI incidence at the township level in Beijing. In this cross-sectional analysis, 259,830 AMI events during 2007&ndash;2018 from the Beijing Cardiovascular Disease Surveillance System were included. We estimated AMI incidence for 307 consistent townships during consecutive 3-year periods with a Bayesian spatial model. From 2007 to 2018, the median AMI incidence in townships increased from 216.3 to 231.6 per 100,000, with a greater relative increase in young and middle-aged males (35&ndash;49 years: 54.2%; 50&ndash;64 years: 33.2%). The most pronounced increases in the relative inequalities was observed among young residents (2.1 to 2.8 for males and 2.8 to 3.4 for females). Townships with high rates and larger relative increases were primarily located in Beijing&rsquo;s northeastern and southwestern peri-urban areas. However, large increases among young and middle-aged males were observed throughout peri-urban areas. AMI incidence and their changes over time varied substantially at the township level in Beijing, especially among young adults. Targeted mitigation strategies are required for high-risk populations and areas to reduce health disparities across Beijing

A Single-Cell Atlas of an Early Mongolian Sheep Embryo

Cell types have been established during organogenesis based on early mouse embryos. However, our understanding of cell types and molecular mechanisms in the early embryo development of Mongolian sheep has been hampered. This study presents the first comprehensive single-cell transcriptomic characterization at E16 in Ujumqin sheep and Hulunbuir short-tailed sheep. Thirteen major cell types were identified at E16 in Ujumqin sheep, and eight major cell types were identified at E16 in Hulunbuir short-tailed sheep. Function enrichment analysis showed that several pathways were significantly enriched in the TGF-beta signaling pathway, the Hippo signaling pathway, the platelet activation pathway, the riboflavin metabolism pathway, the Wnt signaling pathway, regulation of the actin cytoskeleton, and the insulin signaling pathway in the notochord cluster. Glutathione metabolism, glyoxylate, and dicarboxylate metabolism, the citrate cycle, thyroid hormone synthesis, pyruvate metabolism, cysteine and methionine metabolism, thermogenesis, and the VEGF signaling pathway were significantly enriched in the spinal cord cluster. Steroid biosynthesis, riboflavin metabolism, the cell cycle, the Hippo signaling pathway, the Hedgehog signaling pathway, the FoxO signaling pathway, the JAK-STAT signaling pathway, and the Wnt signaling pathway were significantly enriched in the paraxial mesoderm cluster. The notochord cluster, spinal cord cluster, and paraxial mesoderm cluster were found to be highly associated with tail development. Pseudo-time analysis demonstrated that the mesenchyme can translate to the notochord in Ujumqin sheep. Molecular assays revealed that the Hippo signaling pathway was enriched in Ujumqin sheep. This comprehensive single-cell map revealed previously unrecognized signaling pathways that will further our understanding of the mechanism of short-tailed sheep formation