National and subnational disease burden of age-related eye diseases in China

Background In the past decades, China has experienced one of the fastest ageing processes in the world. Alongside the demographic transition, there is a dramatic increase in age-related disability. Currently, vision loss is the leading cause of age-related disability in developing countries. Age-related eye diseases (AREDs), mainly including age-related macular degeneration (AMD), glaucoma, cataract and diabetic retinopathy, are primarily degenerative diseases in older people, whose burden is expected to increase with demographic ageing. This thesis aims to estimate the prevalence and burden of AREDs in China. Methods I searched three Chinese and three English bibliographic databases, namely China National Knowledge Infrastructure (CNKI), Wanfang, Chinese Biomedicine Literature Database (CBM-SinoMed), PubMed, Embase and Medline for studies of the prevalence of age-related macular degeneration (AMD), cataract, glaucoma, and diabetic retinopathy (DR) in China. For diseases where a single study could contribute multiple stratum-specific (e.g. age-specific and sex-specific) data points, a multilevel mixed-effects meta-regression was applied to generate the stratum-specific prevalence estimates of disease. For diseases where only study-level prevalence estimates were available, a random-effects meta-analysis was conducted to generate the pooled prevalence. By applying the estimated stratum-specific prevalence (or pooled prevalence) to the corresponding population data, available from the United Nations Population Division (UNPD), the national number of affected people was determined. By taking the geographic effects, the national number of cases was finally distributed into the six geographic regions (East China, North China, Northeast China, Northwest China, South Central China, Southwest China) in China. Results For estimating the prevalence and burden of AMD, 25 eligible studies were identified in the systematic review. The prevalence of any AMD ranged from 2.44% (95% CI: 1.85-3.22) in people aged 45-49 years to 18.98% (95% CI: 15.05-23.66) in people aged 85-89 years. Prevalence of early AMD ranged from 1.79% (95% CI: 1.05-3.02) to 10.05% (95% CI: 6.17-15.97), and, in the case of late AMD, from 0.38% (95% CI: 0.16-0.97) to 3.88% (95% CI: 1.68-9.13). In late AMD, the prevalence of geographic atrophy (GA) was 0.15% (95% CI: 0.05-0.47) in people aged 45-49 years and 1.09% (95% CI: 0.35-3.36) in those aged 85-89 years, and the prevalence of neovascular AMD (NVAMD) ranged between 0.24% (95% CI: 0.11-0.50) and 2.79% (95% CI: 1.33-5.77). In people aged 45-89 years, the number of people with any AMD was 12.01 million (95% CI: 9.29-15.46) in 1990 and 26.65 million (95% CI: 20.62-34.27) in 2015. Within the same period, the number of people with early AMD increased from 9.44 million (95% CI: 7.74-11.15) to 20.91 million (95% CI: 17.16-24.68), and those with late AMD rose from 2.58 million (95% CI: 1.56-4.30) to 5.74 million (95% CI: 3.46-9.59). In late AMD, the number of people living with GA ranged from 0.87 million (95% CI: 0.40-1.83) in 1990 to 1.93 million (95% CI: 0.89-4.08) in 2015, and NVAMD from 1.71 million (95% CI: 1.16-2.47) to 3.81 million (95% CI: 2.57-5.51). It is projected the number of people with any AMD in 2050 will be 55.19 million (95% CI: 43.04-70.30). Among different regions, the South Central owed the most AMD cases (5.50 million in 2000 and 7.52 million in 2010), whereas North-West China the least (0.66 million in 2000 and 0.95 million in 2010). For estimating the prevalence and burden of glaucoma, 30 studies met the inclusion criteria in the systematic review. In males, the prevalence of POAG ranged from 0.74% (95% CI: 0.48-1.14) in individuals aged 45-49 years to 3.02% (95% CI: 1.92-4.73) in those aged 85-89 years. The prevalence of POAG in females was slightly lower than that in males across the whole age spectrum from 45 to 89 years, ranging from 0.54% (95% CI: 0.35-0.84) to 2.24% (95% CI: 1.41-3.53). For PACG, the prevalence increased from 0.48% (95% CI: 0.39-0.60) in males aged 45-49 years to 3.44% (95% CI: 2.66-4.45) in males aged 85-89 years. The prevalence of PACG was consistently higher in females than in males, ranging from 0.91% (95% CI: 0.74-1.11) in females aged 45-49 years to 6.33% (95% CI: 4.98-8.02) in females aged 85-89 years. The pooled prevalence of secondary glaucoma was 0.15% (95% CI: 0.10-0.23). In people aged 45-89 years, the number of people affected by POAG increased from 2.35 million (95% CI: 1.54-3.60) in 1990 to 5.22 million (95% CI: 3.40-7.98) in 2015, PACG from 3.22 million (95% CI: 2.70-3.84) to 7.14 million (95% CI: 5.97-8.53), and secondary glaucoma from 0.34 million (95% CI: 0.23-0.53) to 0.76 million (95% CI: 0.51-1.17). In 2015, more than half (54.42%) of the glaucoma cases were PACG, followed by POAG (39.79%) and secondary glaucoma (5.79%). By 2050, the number of all glaucoma cases in China will be 25.16 million (95% CI: 18.96-33.86). %). In both 2000 and 2010, East China owed the most POAG cases (1.02 million in 2000 and 1.39 million in 2010) and PACG cases (1.24 million in 2000 and 1.68 million in 2010), whereas Northwest China the least (POAG: 0.19 million in 2000 and 0.27 million in 2010; PACG: 0.32 million in 2000 and 0.46 million in 2010). For estimating the prevalence and burden of cataract and cataract blindness, 55 studies met the eligibility criteria and were included in the systematic review and meta-analysis. In males, the prevalence of any cataract (including post-surgical cases) ranged from 6.71% (95% CI: 5.06-8.83) in people aged 45-49 years to 73.01% (95% CI: 65.78-79.2) in elderly aged 85-89 years. In females, the prevalence of any cataract increased from 8.39% (95% CI: 6.36-10.98) in individuals aged 45-49 years to 77.51% (95% CI: 71.00-82.90) in those aged 85-89 years. For age-related cataract (ARC, including post-surgical cases), in males, the prevalence rates ranged from 3.23% (95% CI: 1.51-6.80) in adults aged 45-49 years to 65.78% (95% CI: 46.72-80.82) in those aged 85-89 years. The prevalence of ARC in females was 4.72% (95% CI: 2.22-9.76) in the 45-49 years age group and 74.03% (95% CI: 56.53-86.21) in the 85–89 years age group. The pooled prevalence rate of cataract blindness (including post-surgical cases) by best corrected visual acuity (BCVA) <0.05 among middle-aged and older Chinese was 2.30% (95% CI: 1.72-3.07), and those of cataract blindness by BCVA <0.10 and cataract blindness by presenting visual acuity (PVA) <0.10 were 2.56% (95% CI: 1.94-3.38) and 4.51% (95% CI: 3.53-5.75) respectively. In people aged 45-89 years, the number of any cataract cases was 50.75 million (95% CI: 42.17-60.37) in 1990 and 111.74 million (95% CI: 92.94-132.84) in 2015, and that of ARC rose from 35.77 million (95% CI: 19.81-59.55) in 1990 to 79.04 million (95% CI: 44.14-130.85) in 2015. By 2050, it is projected that the number of people (45-89 years of age) affected by any cataract will be 240.83 million (95% CI: 206.07-277.35), and that of those with ARC will be 187.26 million (95% CI: 113.17-281.23). During 2000 and 2010, South Central China consistently owed the most cases of any cataract (23.50 million in 2000 and 31.79 million in 2010), whereas Northwest China the least (3.37 million in 2000 and 4.87 million in 2010). For estimating the prevalence and burden of DR. A total of 31 studies provided information on the prevalence of DR and 21 explored potential risk factors for DR. The pooled prevalence of any DR, nonproliferative DR (NPDR) and proliferative DR (PDR) was 1.14% (95% CI: 0.80-1.52), 0.90% (95% CI: 0.56-1.31) and 0.07% (95% CI: 0.02-0.14) in general population; In people with DM, the pooled prevalence rates were 18.45% (95% CI:14.77-22.43), 15.06% (95% CI:11.59-18.88) and 0.99% (95% CI: 0.40-1.80) for any DR, NPDR and PDR, respectively. The prevalence of any DR in DM patients peaked between 60 and 69 years of age, and increased steeply with the duration of DM. DM patients residing in rural China were at a higher risk to have DR than those in urban areas. In addition, insulin treatment, elevated FBG level and higher HbA1c concentration were confirmed to be associated with a higher prevalence of DR in people with DM, with meta-ORs of 1.99 (95% CI: 1.34-2.95), 1.33 (95% CI: 1.12-1.59) and 1.15 (95% CI: 1.09-1.20) respectively. In 2010, a total of 13.16 million (95% CI: 8.95-18.00) Chinese aged 45 years and above were living with DR, among whom the most were in South Central China (3.71 million) and the least were in Northwest China (0.87 million). Conclusions This thesis presents a comprehensive estimation of the prevalence and burden of AREDs in China. With the dramatic ageing trend in the next three decades, the prevalence and burden of AREDs will continue to increase. More elaborate epidemiological studies are still required for better estimation of the disease burden of AREDs. Primary and secondary prevention, treatment and effective government response are urgently needed to optimise public health strategies for mitigating this important health problem

Adaptation and Psychometric Evaluation of the Chinese Counseling Competencies Scale-Revised

Objectives: This study conducted a linguistic and psychometric evaluation of the Chinese Counseling Competencies Scale-Revised (CCS-R).Methods: The Chinese CCS-R was created from the original English version using a standard forward-backward translation process. The psychometric properties of the Chinese CCS-R were examined in a cohort of 208 counselors-in-training by two independent raters. Fifty-three counselors-in-training were asked to undergo another counseling performance evaluation for the test-retest. The confirmatory factor analysis (CFA) was conducted for the Chinese CCS-R, followed by internal consistency, test-retest reliability, inter-rater reliability, convergent validity, and concurrent validity.Results: The results of the CFA supported the factorial validity of the Chinese CCS-R, with adequate construct replicability. The scale had a McDonald's omega of 0.876, and intraclass correlation coefficients of 0.63 and 0.90 for test-retest reliability and inter-rater reliability, respectively. Significantly positive correlations were observed between the Chinese CCS-R score and scores of performance checklist (Pearson's γ = 0.781), indicating a large convergent validity, and knowledge on drug abuse (Pearson's γ = 0.833), indicating a moderate concurrent validity.Conclusion: The results support that the Chinese CCS-R is a valid and reliable measure of the counseling competencies.Practice implication: The CCS-R provides trainers with a reliable tool to evaluate counseling students' competencies and to facilitate discussions with trainees about their areas for growth

The Global and Regional Prevalence of Abdominal Aortic Aneurysms:A Systematic Review and Modelling Analysis

Objective: To estimate the global and regional prevalence and cases of abdominal aortic aneurysms (AAA) in 2019 and to evaluate major associated factors. Summary Background Data: Understanding the global prevalence of AAA is essential for optimizing health services and reducing mortality from reputed AAA. Methods: PubMed, MEDLINE and Embase were searched for articles published until Oct 11 2021. Population-based studies that reported AAA prevalence in the general population, defined AAA as an aortic diameter of 30mm or greater with ultrasonography or computed tomography. A multilevel mixed-effects meta-regression approach was used to establish the relation between age and AAA prevalence for high- socio-demographic index (H-SDI) and low-and middle-SDI (LM-SDI) countries. Odds ratios (ORs) of AAA associated factors were pooled using a random-effects method. Results: We retained 54 articles across 19 countries. The global prevalence of AAA among persons aged 30-79 years was 0.92% (95% confidence interval, CI: 0.65-1.30), translating to a total of 35.12 million (95% CI: 24.94-49.80) AAA cases in 2019. Smoking, male sex, family history of AAA, advanced age, hypertension, hypercholesterolemia, obesity, cardiovascular disease, cerebrovascular disease, claudication, peripheral artery disease, pulmonary disease and renal disease were associated with AAA. In 2019, the Western Pacific region (WPR) had the highest AAA prevalence at 1.31% (95% CI: 0.94-1.85), while the African region (AFR) had the lowest prevalence at 0.33% (95% CI: 0.23-0.48). Conclusions: A substantial proportion of people are affected by AAA. There is a need to optimise epidemiological studies to promptly respond to at-risk and identified cases to improve outcomes

Aspirin Use and Common Cancer Risk:A Meta-Analysis of Cohort Studies and Randomized Controlled Trials

BackgroundWhether aspirin use can decrease or increase cancer risk remains controversial. In this study, a meta-analysis of cohort studies and randomized controlled trials (RCTs) were conducted to evaluate the effect of aspirin use on common cancer risk.MethodMedline and Embase databases were searched to identify relevant studies. Meta-analyses of cohort studies and RCTs were performed to assess the effect of aspirin use on the risk of colorectal, gastric, breast, prostate and lung cancer. Cochran Q test and the I square metric were calculated to detect potential heterogeneity among studies. Subgroup meta-analyses according to exposure categories (frequency and duration) and timing of aspirin use (whether aspirin was used before and after cancer diagnosis) were also performed. A dose-response analysis was carried out to evaluate and quantify the association between aspirin dose and cancer risk.ResultsA total of 88 cohort studies and seven RCTs were included in the final analysis. Meta-analyses of cohort studies revealed that regular aspirin use reduced the risk of colorectal cancer (CRC) (RR=0.85, 95%CI: 0.78-0.92), gastric cancer (RR=0.67, 95%CI: 0.52-0.87), breast cancer (RR=0.93, 95%CI: 0.87-0.99) and prostate cancer (RR=0.92, 95%CI: 0.86-0.98), but showed no association with lung cancer risk. Additionally, meta-analyses of RCTs showed that aspirin use had a protective effect on CRC risk (OR=0.74, 95%CI: 0.56-0.97). When combining evidence from meta-analyses of cohorts and RCTs, consistent evidence was found for the protective effect of aspirin use on CRC risk. Subgroup analysis showed that high frequency aspirin use was associated with increased lung cancer risk (RR=1.05, 95%CI: 1.01-1.09). Dose-response analysis revealed that high-dose aspirin use may increase prostate cancer risk.ConclusionsThis study provides evidence for low-dose aspirin use for the prevention of CRC, but not other common cancers. High frequency or high dose use of aspirin should be prescribed with caution because of their associations with increased lung and prostate cancer risk, respectively. Further studies are warranted to validate these findings and to find the minimum effective dose required for cancer prevention

Associated factors and global adherence of cervical cancer screening in 2019:a systematic analysis and modelling study

BACKGROUND: Cervical cancer screening is vital for its prevention. Adherence is a crucial indicator that implies the individual willingness to take cervical cancer screening. We aimed to estimate the global and regional adherence rates of cervical cancer screening in 2019 and identify its associated factors among general women. METHOD: We searched studies in PubMed, Web of Science, Embase, China National Knowledge Infrastructure, Wanfang Database, ProQuest theses database and Google Web, without a lower time limit and until 23 June, 2021. Survey studies were considered eligible if they investigated cervical cancer screening adherence among general women, with data on sample size, the number of adherent subjects, and/or adherence rate. Random-effects were used to pool the odds ratios (ORs) of associated factors of adherence. Using modelling analysis, we estimated 2019 overall and age-specific adherence rates at the global and regional levels in women aged 20–69 years. RESULTS: Eight thousand two hundred ninety records were identified, and 153 articles were included. Being married (vs not married: OR, 1.34; 95% confidence interval [CI]: 1.23–1.46), higher educational attainment (higher than high school vs less than high school: OR, 1.44; 95% CI: 1.35–1.53), having healthcare (OR, 1.64; 95% CI: 1.43–1.88), former smoking (OR, 1.20; 95% CI: 1.07–1.34), physical activity (OR, 1.19; 95% CI: 1.05–1.36), parity (OR, 1.07; 95% CI: 1.01–1.12), and chronic disease (OR, 1.17; 95% CI: 1.04–1.32) were associated with better adherence, whereas obesity (vs normal: OR, 0.85; 95% CI: 0.74–0.97) and current smoking (vs former/never: OR, 0.64; 95% CI: 0.54–0.76) were associated with worse adherence. In 2019, the adherence was at 33.66% (95% CI: 23.34–39.30%) worldwide, and was higher in high-income countries (HICs) (75.66, 95% CI: 66.74–82.81%) than in low and middle-income countries (LMICs) (24.91, 95% CI: 14.30–30.24%). It varied across regions, the highest in the European region (65.36, 95% CI: 55.40–74.19%), but the lowest in the African region (5.28, 95% CI: 3.43–8.03%). CONCLUSIONS: Cervical cancer screening adherence remained low globally, exhibiting geographical discrepancy with HICs higher than LMICs. Further implementations of screening programs should comprehensively consider the local economy, social benefits, and demographic structure to adapt delivery for vulnerable or underserved women to boost screening adherence. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12992-022-00890-w