中华流行病学杂志最新文献

Objective: To investigate the correlation between the cholesterol, high-density lipoprotein and glucose index (CHG) and carotid atherosclerosis (CAS). Methods: This cross-sectional study enrolled participants who underwent comprehensive health evaluations in the Health Management Center of Sichuan Provincial People's Hospital between January 2020 and December 2024. Data were collected through a standardized questionnaire survey, physical examinations, and biochemical assessments. A multivariable logistic regression model was employed to assess the correlation between the CHG and CAS. Restricted cubic spline (RCS) analysis was used to explore the dose-response relationship between the CHG and the risk of CAS. Subgroup analyses were performed to investigate the association between the CHG and CAS in different populations. Results: A total of 99 855 participants with an age of (52.50±12.82) years were included in this study, including 57 297 CAS cases and 42 558 controls. Multivariate logistic regression analysis showed that, when the CHG was treated as a continuous variable, it was associated with CAS (OR=1.44, 95%CI: 1.36-1.52), carotid intima-media thickness (CIMT) thickening (OR=1.24, 95%CI: 1.16-1.33), and carotid plaque (CP) (OR=1.80, 95%CI: 1.67-1.94). Elevated quartiles of the CHG were positively correlated with the risk of CAS, and the risk increased progressively with increasing quartiles. RCS analysis revealed a nonlinear relationship between the CHG and the risk of developing CAS, CIMT thickening, and CP (P for nonlinearity <0.001). Subgroup analysis revealed that compared with the Q₁ group, the Q₂-Q₄ groups exhibited a significantly increased risk of CAS across different demographics including gender, BMI, smoking, and alcohol consumption. Conclusion: The level of CHG is significantly associated with an increased risk of CAS, and this association exhibits a nonlinear increasing trend.

Chronic and non-communicable disease is the leading cause of death and disease burden globally. Traditional prevention and control strategies mainly focuses on dietary composition and total energy intake, with less emphasis on the temporal patterns of eating behavior. Chrono-nutrition, as an emerging interdisciplinary field, focuses on the interaction between meal timing, frequency, regularity, and the body's endogenous circadian rhythms, and its impact on health. This paper systematically summarizes the influence and potential mechanisms of chrono-nutrition in four major chronic and non-communicable diseases: cardiovascular disease, cancer, diabetes, and chronic respiratory disease. Current evidence indicates that irregular meal time (e.g., skipping breakfast, postponed evening meal, or eating at nighttime), prolonged eating windows, and disordered eating frequency might be associated with an increased risk or poor prognosis of cardiovascular disease, cancer, and type Ⅱ diabetes. The underlying mechanisms involve lipid metabolism, insulin sensitivity, inflammatory responses, and the circadian rhythm regulation. Interventions like time-restricted eating have shown potential in improving cardiometabolic parameters and in cancer models. However, research on the association between chrono-nutrition and chronic respiratory disease is limited, and existing evidence across different populations and conditions exhibits heterogeneity. This paper aims to provide a new perspective for understanding the role of chrono-nutrition in the prevention and control of four major chronic non-communicable diseases, suggest the focus for future research, and provide a theoretical basis for developing more personalized strategies for the prevention and management of chronic and non-communicable diseases.

The prevalence of dementia is increasing globally, and currently there is no effective treatment that can cure it. Therefore, it is particularly crucial to identify and prevent the occurrence of cognitive decline and dementia at an early stage. Insulin resistance (IR) is closely associated with cognitive decline, and the triglyceride-glucose (TyG) index is a simple, sensitive indicator of IR, with great significance for predicting the occurrence, progression, and prognosis of dementia-related diseases. The TyG index combined with obesity indicators such as BMI, waist circumference, waist-to-hip ratio, and waist-to-height ratio may provide a stronger predictive effect than a single indicator alone. This article will introduce the TyG index and its combined obesity indicators, and summarize research progress on the association between these indicators and dementia and its subtypes, to provide scientific evidence for the identification and prevention of dementia risk.

Emerging and re-emerging infectious diseases continue to pose a persistent threat to global public health, underscoring the need for rigorous assessment of transmission risk and intervention effectiveness. Agent-based models (ABMs), which represent individuals as the fundamental modeling units and simulate their interactions and behaviors to generate population-level dynamics, have gained increasing prominence in recent years for simulation, surveillance, early warning, and evaluation of interventions for infectious diseases. This review outlines an overview of the core components and methodological framework of ABMs, synthesizes their applications in infectious-disease simulation, surveillance, early warning, management of high-risk settings, and estimation of healthcare resource needs, and discusses key challenges such as data availability, privacy concerns, model uncertainty, and computational demands. Overall, ABMs are evolving from purely computational tools into decision-support instruments, with the potential to provide quantitative evidence for more fine-grained and targeted infectious disease control strategies.

Objective: To analyze the correlation of the vaccination prescription program with knowledge, vaccination willingness, and vaccination rates of influenza, pneumococcal, and herpes zoster vaccines among middle-aged and older adults from community-based patient populations. Methods: A before-and-after cross-sectional survey design was adopted, targeting community-based patient populations. From March to April 2024, a baseline survey was conducted among 10 500 outpatients and individuals undergoing health check-ups recruited from 175 survey sites (community health service centers/township health centers) across 35 counties (districts, cities) in Zhejiang Province using multistage sampling. Following a 16-month pilot implementation of the Vaccination Prescription Program, a terminal survey was conducted from September to October 2025 using the same methodology. Differences in indicators between the two surveys were compared using t-test or χ² test, and multivariate analysis was performed using generalized linear mixed models. Results: Compared with 2024, the knowledge scores of influenza, pneumococcal, and herpes zoster vaccines among participants significantly improved in 2025 (all P<0.001). Vaccination rates for influenza, pneumococcal, and herpes zoster vaccines increased from 45.16%, 16.42%, and 1.93% to 65.72%, 22.74%, and 5.74%, respectively (all P<0.001). Among participants who received a vaccination prescription, the vaccination rates for influenza, pneumococcal, and herpes zoster vaccines were 79.69%, 33.31%, and 11.13%, respectively, significantly higher than those in the non-prescription group (58.51%, 17.29%, and 2.96%). The composition of vaccination willingness changed, with an increase in the proportion of the "hesitant" group for all three vaccines (all P<0.001). Multivariate analysis showed that after adjusting for demographic characteristics and clustering effects of survey sites, the implementation of the vaccination prescription program intervention was positively associated with vaccination rates for all three vaccines (influenza vaccine aOR=3.16, 95%CI: 2.68-3.72; pneumococcal vaccine aOR=1.56, 95%CI: 1.30-1.87; herpes zoster vaccine aOR=3.05, 95%CI: 2.18-4.26). The proportion of "doctor's recommendation" as a reason for vaccination increased for all three vaccines. Among the reasons for non-vaccination, the proportion of "never heard of the vaccine" decreased, while the proportions of "too expensive", and "concerned about vaccine side effects" increased. Conclusion: Following the implementation of the Vaccination Prescription Program, knowledge and vaccination rates for influenza, pneumococcal, and herpes zoster vaccines significantly improved among middle-aged and older adults from community-based patient populations, with doctors' recommendation as a key facilitator.

Objective: To evaluate the associations of maternal dietary intake, folic acid supplementation, offspring BHMT and BHMT2 gene polymorphisms and their interactions with the risk for congenital heart disease (CHD) and its main subtypes. Methods: A hospital-based case control study was conducted. From January 2018 to May 2019, a total of 620 children with simple CHD and their mothers were consecutively recruited as the case group from Hunan Children's Hospital. During the same period, 620 children without any congenital anomalies and their mothers, who were diagnosed at the same hospital, were enrolled as the control group. The information about their demographic characteristics and periconceptional exposure information were collected by using structured questionnaire. In addition, peripheral venous blood samples were obtained from the children for genotyping of BHMT and BHMT2 polymorphisms. Multivariable logistic regression analysis and crossover analyses were conducted to evaluate the associations of maternal dietary intake, folic acid supplementation, offspring BHMT and BHMT2 gene polymorphisms and their interactions with the risk for CHD and its subtypes. Results: After correction for multiple testing, multivariable logistic regression analyses showed that maternal excessive intakes of smoked food, barbecued food, fried food, pickled vegetable during early pregnancy was associated with increased risk for overall CHD in offspring [aOR>1.00, false discovery rate (FDR)-adjusted P<0.05], while maternal regular intakes of fish and shrimp, fresh egg, bean, milk product as well as periconceptional folic acid supplementation were associated with reduced risk for offspring overall CHD (aOR<1.00, FDR-adjusted P<0.05). Significant associations were observed between BHMT polymorphisms and overall CHD risk, including rs3733890 (AA vs. GG, aOR=2.61, 95%CI: 1.52-4.50), rs1316753 (recessive model, aOR= 1.63, 95%CI: 1.17-2.29), and rs1915706 (CC vs. TT, aOR=2.72, 95%CI: 1.42-5.21), similar results were also found in atrial septal defect and ventricular septal defect population. Moreover, BHMT gene polymorphisms showed antagonistic interactions with the intake of fish and shrimp, as well as bean (aOR<1.00, relative excess risk of interaction <0). Conclusions: Maternal dietary patterns, folic acid supplementation, and BHMT gene polymorphisms (rs3733890, rs1316753, and rs1915706) are associated with the risk for CHD and its subtypes. In addition, interactions between BHMT polymorphisms and maternal dietary intake might contribute to the development of CHD in offspring.

HIV infection incidence reflects the level of epidemic activity and temporal trends of the HIV/AIDS epidemic, which can be used as a key indicator for the evaluation of prevention and control effectiveness to inform intervention strategies. However, because the exact time of HIV infection is difficult to determine for most individuals living with HIV, the incidence cannot be directly measured, and its estimation is a central topic in HIV epidemiological research. At present, the major approaches for estimating HIV infection incidence are as follows. The first is prospective cohort study, which follows HIV-negative individuals over time and directly observes seroconversion events to calculate incidence, and is widely regarded as the gold standard. The second approach is laboratory-based recent infection testing, which identifies recent infections based on dynamic immunological and virological changes following infection and is subsequently used to estimate incidence at population level. The third is continuous testing data analysis, which uses routine clinical testing records and repeated cross-sectional surveillance data to identify repeated tests and indirectly estimate incidence. The fourth is mathematical modelling which integrates surveillance data, demographic information, and epidemiological parameters to reconstruct incidence level and epidemic trajectory. Each of the four approaches is suitable to different research settings. They vary in data requirements, implementation costs, and estimation accuracy, with distinct strengths and limitations. This paper summarizes the principles, applications, and limitations of four major approaches, i.e. prospective cohort study, laboratory-based recent infection testing, continuous testing data analysis, and mathematical modelling, to provide methodological reference to understand HIV infection dynamics and estimate the incidence.

Objective: To characterize the dynamic changes in CD4⁺T lymphocyte (CD4) counts among HIV-infected individuals in Tianjin, China, under untreated and antiretroviral treatment (ART) conditions, and to provide evidence for optimizing HIV case management and prevention strategies. Methods: The data were derived from the follow-up records of HIV-infected individuals aged 15 and above in Tianjin from 2005 to 2024, obtained from the Chinese Disease Control and Prevention Information System. Records were split into non-ART and ART phases as time-dependent cohorts, with the same HIV-infected individuals contributing to both phases before and after treatment initiation. A continuous-time Markov model was applied to both cohorts to estimate annual transition rates of CD4 counts across immunological categories. In addition, a linear mixed-effects model with natural splines was fitted to the ART cohort to characterize individual recovery trajectories stratified by baseline CD4 count levels. Results: The non-ART cohort and the ART cohort enrolled 709 and 2 865 HIV-infected individuals, respectively. In untreated individuals, CD4 counts declined progressively: annual transition rates from ≥500 to 350-499, 350-499 to 200-349, and 200-349 to <200 cells/μl were 34.8% (95%CI: 30.3%-39.9%), 19.0% (95%CI: 16.1%-22.5%), and 9.3% (95%CI: 6.8%-12.7%), with mean sojourn times of 2.87, 5.25, and 10.73 years, respectively. After ART initiation, CD4 counts recovery followed a nonlinear pattern: transition rates from <200 to 200-349, 200-349 to 350-499, and 350-499 to ≥500 cells/μl were 91.8% (95%CI: 86.6%-97.4%), 63.7% (95%CI: 60.9%-66.6%), and 42.6% (95%CI: 40.9%-44.4%), with corresponding mean sojourn times of 1.09, 1.57, and 2.35 years. Conclusions: CD4 count transition rates in non-ART HIV-infected individuals decreased as immunodeficiency progressed, while post-ART recovery rates varied substantially across CD4 count strata.

The trend-in-trend (TIT) design is an emerging hybrid ecological- epidemiological research method. Based on cumulative exposure probability stratification and cross-stratum temporal trend differentiation, TIT compares differences in outcome temporal slopes across populations with distinct exposure rates. When its core assumptions are met, TIT effectively controls unmeasured confounding by indication and time-varying confounding, thereby inferring causal associations between exposure and outcomes and yielding more robust effect estimates than traditional cohort studies. This article systematically elaborates the statistical principles and core assumptions of the TIT design, compares its methodological characteristics with quasi-experimental methods including difference-in-differences and interrupted time series, and illustrates its implementation procedures through a case study evaluating the cardiovascular risk of rofecoxib. As a reliable methodological tool for real-world study, TIT is particularly applicable to post-marketing drug re-evaluation and scenarios with strong temporal trends and unmeasured confounding.

Objective: To analyze the epidemiological characteristics and response measures of Chikungunya fever in Foshan City in 2025, providing reference for optimizing the prevention and control strategies of vector-borne diseases in China. Methods: Data on locally acquired Chikungunya fever cases reported in Foshan City from July to October 2025 were collected. Descriptive epidemiology and spatial autocorrelation analysis were used to analyze case characteristics at each stage. Results: A total of 10 804 locally acquired Chikungunya fever cases were reported in Foshan City from July to October 2025. The interval from the onset of the earliest traceable case to the identification of the index case was 22 days. The epidemic was divided into the initial response stage (July 8 to July 16), the intensive control stage (July 17 to August 19), and the consolidation stage (August 20 to October 31). A statistically significant difference in the age distribution of cases was observed across the three stages (χ²=49.26, P<0.001). During the initial response stage, cases were reported in 11 towns/subdistricts across 3 districts, while both the intensive control and consolidation stages involved 29 towns/subdistricts across 5 districts. Global spatial autocorrelation analysis indicated Moran's I >0 (range: 0.17-0.65, P<0.05) for all three stages. High-high clustering areas shifted from 3 towns/subdistricts in Shunde District northward to 4 towns/subdistricts in Nanhai District, 3 towns/subdistricts in Chancheng District, and 1 town/subdistrict in Shunde District. Key control measures during the intensive control stage included activating a municipal level Ⅲ public health emergency response, launching citywide campaigns to eliminate mosquito breeding sites, implementing intensive adult mosquito eradication actions, and conducting a nail-removal operation in key villages/communities. During the consolidation stage, the qualified rates for the breteau index and the adult mosquito density index in affected villages/communities reached 99.18% and 98.79%, respectively; the interval from onset to reporting was shortened to 1.38 (0.97, 2.19) days, and the proportion of villages/communities that had ended the outbreak reached 55.88%. Conclusions: The Chikungunya fever epidemic in Foshan City from July to October 2025 was large in scale, widespread, and spatially clustered. Epidemiological characteristics varied across different stages. Implementing staged and differentiated control strategies was important to effectively containing the outbreak within a relatively short period.