The Lancet Regional Health: Western Pacific最新文献

{"title":"The dynamic change of tuberculosis infection prevalence in rural residents: 10-year follow-up of a population-based, multicentre cohort study from China","authors":"Xuefang Cao ,&nbsp;Lei Gao ,&nbsp;Henan Xin ,&nbsp;Limei Zhu ,&nbsp;Weitao Duan ,&nbsp;Boxuan Feng ,&nbsp;Wei Lu ,&nbsp;Zisen Liu ,&nbsp;Yijun He ,&nbsp;Lingyu Shen ,&nbsp;Juanjuan Huang ,&nbsp;Bin Zhang ,&nbsp;Dakuan Wang ,&nbsp;Jiaoxia Yan ,&nbsp;Cheng Chen ,&nbsp;Lihui Wang ,&nbsp;Wenhua Yin ,&nbsp;Guochen Wang ,&nbsp;Tonglei Guo ,&nbsp;Yuanzhi Di ,&nbsp;Qi Jin","doi":"10.1016/j.lanwpc.2025.101509","DOIUrl":"10.1016/j.lanwpc.2025.101509","url":null,"abstract":"<div><h3>Background</h3><div>The incidence of tuberculosis (TB) decreased significantly in recent years in China. However, the declining in the burden of tuberculosis infection (TBI) have not been systematically evaluated. The aim of this study was to elucidate the changes of TBI prevalence during the past decade.</div></div><div><h3>Methods</h3><div>Based on a population-based, multicenter cohort study (LATENTTB-NSTM), a 10-year follow-up survey was conducted among registered residents (≥18 years old) at two study sites (Zhongmu and Danyang) using open-cohort design. After excluding active TB, tuberculin skin test (TST) and interferon-γ release assay (IGRA) were used to determine TBI status of each participant.</div></div><div><h3>Findings</h3><div>Overall, 5924 eligible participants who completed the follow-up survey were included in the analysis. Compared to the age- and gender-standardized TBI prevalence determined by IGRA in 2013, the prevalence of TBI was observed to be decreased by 22·24% (from 15·11% to 11·75%) in Danyang site and by 40·86% (from 16·57% to 9·80%) in Zhongmu site in 2023. A consistently declining trend was observed as well for TBI prevalence determined by TST test. The acquisition of TBI in 10 years was assessed by the conversion rate of IGRA result in 4648 participants who participated in both the 2013 and 2023 surveys. The IGRA conversion rate in Danyang site was significantly higher than that in Zhongmu site (4% vs. 2%, p &lt; 0·0001). The reversion rate of IGRA result was assessed as well, and no statistically significant difference was observed between the two study sites (29% in Danyang site vs. 31% in Zhongmu site, p = 0·577). Male gender was found to be associated with an increased risk of IGRA conversion as compared to female, with adjusted odds ratio (OR) of 1·46 (95% confidence interval [CI]: 1·00–2·13). In addition, never smokers were observed to be associated with significantly higher IGRA reversion rates (OR = 2·91, 95% CI: 1·52–5·57) (p = 0.001) as compared to current smokers. We also found the influence of BCG vaccination at birth on TST positivity was non-significant among individuals aged 15 and above.</div></div><div><h3>Interpretation</h3><div>Our findings suggest that the prevalence of TBI in rural residents from China has significantly decreased along with the declining of TB incidence in the last decade. The downward trend shows regional differences, which might be partly explained by the difference in new infection rates across regions.</div></div><div><h3>Funding</h3><div>The <span>CAMS Innovation Fund</span> for Medical Sciences and the <span>National Natural Science Foundation of China</span>.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"56 ","pages":"Article 101509"},"PeriodicalIF":7.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143550473","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A 30-year case study of local implementation of global guidelines for data-driven diabetes management starting with the Hong Kong Diabetes Register","authors":"Juliana C.N. Chan ,&nbsp;Michael Cheung ,&nbsp;Andrea O.Y. Luk ,&nbsp;Harriet Chung ,&nbsp;Kit Man Loo ,&nbsp;Maria Kwan Wa Leung ,&nbsp;Kai-Ming Chow ,&nbsp;Juliana N.M. Lui ,&nbsp;Martin C.S. Wong ,&nbsp;Kin Lai Chung ,&nbsp;Maggie Lee ,&nbsp;Cheuk Chun Szeto ,&nbsp;Man Wo Tsang ,&nbsp;Sunny Wong ,&nbsp;Jack Kit Chung Ng ,&nbsp;Sydney C.W. Tang ,&nbsp;Kenny Kung ,&nbsp;Sing Leung Lui ,&nbsp;David V.K. Chao ,&nbsp;Coral Cyzewski ,&nbsp;Philip Kam-Tao Li","doi":"10.1016/j.lanwpc.2025.101505","DOIUrl":"10.1016/j.lanwpc.2025.101505","url":null,"abstract":"","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"56 ","pages":"Article 101505"},"PeriodicalIF":7.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143636279","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of family caregiving in the management of individuals with mental illnesses and the outcome of family-based interventions for mental illnesses in China: a scoping review","authors":"Mi Hu ,&nbsp;Xuping Li ,&nbsp;Yu Zhu ,&nbsp;Zhiyan Chen ,&nbsp;Chong Lai ,&nbsp;Ruijie Liu ,&nbsp;Shuiyuan Xiao ,&nbsp;Michael R. Phillips","doi":"10.1016/j.lanwpc.2024.101184","DOIUrl":"10.1016/j.lanwpc.2024.101184","url":null,"abstract":"<div><div>The effects of China's rapid economic development and urbanisation on family caregivers' responsibilities for providing essential practical, social, and psychological support to family members with mental illnesses are unclear. This scoping review identified 176 relevant studies published from 1 January 2000 to 31 December 2023 in six English-language and three Chinese-language databases. Most studies focus on family caregiving for individuals with schizophrenia (63 studies), autism (40 studies), or dementia (39 studies). Family caregiving—subclassified as informational, concrete, or psychological—was beneficial both for patients and their family members, but providing support often necessitated substantial sacrifices by family caregivers, many of whom experience psychological distress and financial difficulties. The type and intensity of the support provided are influenced by the severity of the patient's symptoms, financial and other resources of the patient's family, community members' beliefs about mental illnesses, and the local availability of mental health and social welfare services. Results from intervention studies indicate that different methods of enhancing family caregiving improved outcomes for individuals with mental illnesses. However, the methodological quality of the intervention studies was poor, and most of the studies were conducted in inpatient settings, so the benefits of these family-based strategies remain uncertain. Rapid economic development and urbanisation in China are resulting in fundamental changes in the relative responsibilities of different stakeholders for providing social welfare services—individuals, families, communities, and governmental agencies. Understanding and enhancing the role that families play in the support of community members with mental illnesses will require improving the quality of research about this issue, expanding the range of mental health conditions considered, and, most importantly, developing a dynamic overarching theoretical framework that integrates the many factors influencing ongoing changes in the structure and functioning of Chinese families.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"56 ","pages":"Article 101184"},"PeriodicalIF":7.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143724368","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health and incarceration research in Australia: a scoping review","authors":"Sarah A. Pellicano ,&nbsp;Lindsay A. Pearce ,&nbsp;Alexander C. Campbell ,&nbsp;Rebecca Shuttleworth ,&nbsp;Stuart A. Kinner","doi":"10.1016/j.lanwpc.2025.101500","DOIUrl":"10.1016/j.lanwpc.2025.101500","url":null,"abstract":"<div><h3>Background</h3><div>People who experience incarceration often have complex healthcare needs and poorer health than the general population. Australia has the eighth-largest custodial population in the Western Pacific. Understanding the breadth and quality of research on this population's health is crucial for advancing health equity both in Australia and across the region. This scoping review synthesised health research involving people in contact with the criminal justice system in Australia.</div></div><div><h3>Methods</h3><div>We searched eight databases for primary, peer-reviewed research reporting on the health of people incarcerated or previously incarcerated in Australian prisons or youth detention settings.</div></div><div><h3>Findings</h3><div>Our search identified 11,731 unique records, and 508 met the inclusion criteria. Over half (51%) were published between 2015 and 2024. Relatively few studies provided evidence on cognitive disabilities (16%), non-communicable diseases (14%), or sexual and reproductive health (6%). Few focused on youth detention (15%) or post-release health (24%). Only 27 studies (5%) focused exclusively on the health of First Nations Australians. Most studies (86%) came from Australia's most populous states—New South Wales, Queensland, and Victoria—which account for 68% of people incarcerated each year, and 58% of incarcerated First Nations peoples.</div></div><div><h3>Interpretation</h3><div>Despite considerable growth in the number of peer-reviewed studies on the health of people who experience incarceration, critical health issues, key populations, and Australian jurisdictions with the highest incarceration rates require urgent attention. Further high-quality research is needed to fill these evidence gaps and translate research into evidence-based strategies that address the complex and diverse health needs of justice-involved people.</div></div><div><h3>Funding</h3><div>SP was supported by a <span>Australian Government Research Training Program Scholarship.</span></div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"56 ","pages":"Article 101500"},"PeriodicalIF":7.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143642441","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost-effectiveness analysis of switching from a bivalent to a nonavalent HPV vaccination programme in China: a modelling study","authors":"Meng Gao ,&nbsp;Shangying Hu ,&nbsp;Xuelian Zhao ,&nbsp;Tingting You ,&nbsp;Yuting Hong ,&nbsp;Yang Liu ,&nbsp;Youlin Qiao ,&nbsp;Mark Jit ,&nbsp;Fanghui Zhao ,&nbsp;Chen Wang","doi":"10.1016/j.lanwpc.2025.101499","DOIUrl":"10.1016/j.lanwpc.2025.101499","url":null,"abstract":"<div><h3>Background</h3><div>Several domestically-manufactured nonavalent HPV vaccine candidates are in phase III clinical trials and their future availability may address the current dilemma of insufficient supply and high price of the overseas-manufactured nonavalent HPV vaccine in China. We compare the population-level effectiveness and cost-effectiveness of switching to nonavalent HPV vaccination in China.</div></div><div><h3>Methods</h3><div>We used a previously validated transmission model to project the lifetime costs and effectiveness of five same-vaccine and two mixed-vaccine strategies. Nonavalent HPV vaccines were assumed to be available and meet the production requirements for national vaccination between 2030 and 2050. All women living or projected to be born in China during 2023–2100 were considered. We adopted a societal perspective and determined optimal strategies using cost-effectiveness efficiency frontiers.</div></div><div><h3>Findings</h3><div>Under our pricing assumptions, switching to nonavalent vaccination was always cost-saving compared with maintaining the current bivalent vaccination programme, irrespective of the screening scenarios and the year when nonavalent vaccine was assumed to become available (status quo screening: net cost saving $2589–5211 million; improved screening: net cost saving $1852–3789 million). In the same-vaccine strategies, the optimal strategy changed from “routine nonavalent HPV vaccination with catch-up to age 18” to “switching from bivalent to nonavalent HPV vaccination” if nonavalent vaccination is available after 2035. Compared with the optimal same-vaccine strategy, adopting mixed schedules with bivalent and nonavalent vaccines would further save $1336–4280 million net costs and gain 87,000–833,000 QALYs, depending on the screening scenario and the year when nonavalent vaccine becomes available.</div></div><div><h3>Interpretation</h3><div>Switching from bivalent to nonavalent HPV vaccination is likely to be cost-saving and have a significant impact on reducing the cervical cancer burden in China.</div></div><div><h3>Funding</h3><div><span>Bill &amp; Melinda Gates Foundation</span> (INV-031449 and INV-003174) and <span>CAMS Innovation Fund for Medical Sciences</span> (CIFMS) (2021-I2M-1-004).</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"56 ","pages":"Article 101499"},"PeriodicalIF":7.6,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143454182","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Strategies for the prevention of ischemic stroke in atrial fibrillation in East Asia: clinical features, changes and challenges","authors":"Tze-Fan Chao ,&nbsp;Eue-Keun Choi ,&nbsp;Yutao Guo ,&nbsp;Wataru Shimizu ,&nbsp;Hung-Fat Tse ,&nbsp;Gregory Y.H. Lip","doi":"10.1016/j.lanwpc.2025.101495","DOIUrl":"10.1016/j.lanwpc.2025.101495","url":null,"abstract":"<div><div>East Asian populations exhibit a high burden of atrial fibrillation (AF) and AF-related ischemic strokes. The countries/regions in East Asia have diversities regarding patient characteristics and varying patient care represented by different adherence rates to the ABC (Atrial Fibrillation Better Care) pathway. Two changes, “from non-anticoagulation to direct oral anticoagulants (DOACs)” and “from lower dosing to appropriate dosing DOACs”, have been identified in East Asia and have been temporally linked to improved clinical outcomes in AF patients. Additional efforts are necessary to further reduce the stroke risk among AF patients, including increased communication with other specialists/societies, the initiation of prospective studies or clinical trials in Asia, and the implementation of evidence-based holistic or integrated care management based on the ABC pathway.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"56 ","pages":"Article 101495"},"PeriodicalIF":7.6,"publicationDate":"2025-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143421367","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence and temporal trends in myopia and high myopia children in China: a systematic review and meta-analysis with projections from 2020 to 2050","authors":"Wei Pan ,&nbsp;Seang-Mei Saw ,&nbsp;Tien Yin Wong ,&nbsp;Ian Morgan ,&nbsp;Zhikuan Yang ,&nbsp;Weizhong Lan","doi":"10.1016/j.lanwpc.2025.101484","DOIUrl":"10.1016/j.lanwpc.2025.101484","url":null,"abstract":"<div><h3>Background</h3><div>Myopia rates have risen in the past decades in China. New strategies for the prevention and control of myopia are now available, and understanding the prevalence and future trends in myopia and high myopia in children and adolescents in China may provide insights into the impact of implementing these measures. The study aims to provide updated data on the prevalence of myopia and high myopia in children and to project temporal trends in prevalence from 2020 to 2050 in China.</div></div><div><h3>Methods</h3><div>A systematic review and meta-analysis searching several databases in both English and Chinese: PubMed, Web of Science, Science Direct, China National Knowledge Infrastructure (CNKI), Wanfang, China Science and Technology Journal Database (CSTJ) with date limits from 01/01/2010 to 11/23/2024 was conducted. We included population-based or school-based studies in China that determined the myopia prevalence, based on the cycloplegic refraction, in children under 20. Studies with a response rate &lt;70% or sample size &lt;200 were excluded. A fixed-effect meta-analysis was used, and projections were made based on three scenarios: experience-based, maximum growth (maximum near-work, minimal outdoor time), and minimum growth (2 h outdoor time daily).</div></div><div><h3>Findings</h3><div>From 6555 reports, 82 studies with 218,794 participants were included. The overall myopia prevalence was 36.6% (95% CI: 36.4%, 36.8%), with rates of 2.6% in ages 0–4, 22.0% in ages 5–9, 45.4% in ages 10–14, and 67.2% in ages 15–19. High myopia prevalence was 5.3% overall, with rates of 0.1% in ages 0–4, 1.1% in ages 5–9, 3.0% in ages 10–14, and 9.5% in ages 15–19. Projections for 2030 under minimum growth, experience-based, and maximum growth scenarios were 26.8%, 46.2%, 56.0%; 2040 were 19.6%, 54.4%, 65.6%; and 2050 were 14.4%, 61.3%, 71.9%, respectively.</div></div><div><h3>Interpretation</h3><div>China is facing a substantial and potentially worsening epidemic of childhood myopia. This information will provide data for guiding implementation and evaluating the effectiveness of existing and new nationwide myopia prevention and control programs.</div></div><div><h3>Funding</h3><div>The <span>Science and Technology Innovation Program</span> of Hunan Province, China (2023RC1079, 2024RC5002).</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"55 ","pages":"Article 101484"},"PeriodicalIF":7.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143178053","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends in mortality for gastric cancer from 2011 to 2020 with prediction to 2030: a Bayesian age-period-cohort analysis","authors":"Zhe Liu,&nbsp;Peng Yin","doi":"10.1016/j.lanwpc.2024.101298","DOIUrl":"10.1016/j.lanwpc.2024.101298","url":null,"abstract":"<div><h3>Background</h3><div>Gastric cancer was the 3rd most common cause of cancer deaths, accounting for 11.3% of all cancer deaths in China in 2018. The study aims to analyze trends in gastric cancer mortality in China from 2011 to 2020, and predict the future burden of gastric cancer from 2021 to 2030.</div></div><div><h3>Methods</h3><div>Relevant data on gastric cancer were obtained from the National Mortality Surveillance System, which is available from the Chinese Center for Disease Control and Prevention. All deaths with underlying cause of death as gastric cancer (International Classification of Diseases-10 code: C16) were included. We analyzed the numbers and age-standardized mortality rates (ASMR) for gastric cancer by sex and urbanicity in China during 2011-2020. A Bayesian age-period-cohort (BAPC) prediction model was used to predict gastric cancer mortality by sex and urbanicity in China from 2021 to 2030. The gastric cancer death data from 2011 to 2020 were categorized into five-year age groups, from 0-4 to 80+. Population data for 2011-2020 were obtained from the National Bureau of Statistics. Projected population data for 2021-2030 were based on estimates derived from 2011-2020 population. The standard population for calculating ASMR was derived from the China Census in 2020.</div></div><div><h3>Findings</h3><div>In 2020, the ASMR for gastric cancer was 22.24/100,000, accounting for 291.20 thousand deaths in China, including 199.66 thousand males and 91.53 thousand females. The ASMR in males (32.57/100,000) was higher than that in females (13.09/100,000). From 2011 to 2020, the number of gastric cancer deaths in China showed a gradual downward trend, with a notable decline in the ASMR. From 2021 to 2030, the ASMR for gastric cancer in China is expected to continue declining. In 2030, It is anticipated that the ASMR of gastric cancer in China will be 11.68/100,000, resulting in an estimated 218.93 thousand deaths. The ASMR for males is projected to decrease to 17.78/100,000, representing a 45.4% reduction from 2020. For females, the ASMR will decrease to 6.81/100,000 corresponding to a significant reduction of 48.0% from the 2020. In 2030, the projected ASMR for gastric cancer is 11.67/100,000 in urban areas and 12.04/100,000 in rural areas, accounting for 111.90 thousand and 125.92 thousand deaths, respectively. Compared to 2020, the ASMR for gastric cancer in 2030 shows a 38.7% and 50.9% reduction in urban and rural areas, respectively.</div></div><div><h3>Interpretation</h3><div>From 2011 to 2020, both the number of deaths and the ASMR of gastric cancer in China gradually declined. The number of gastric cancer deaths in China is projected to continue declining through 2030. The findings indicate that the preventive and control measures for gastric cancer are effective and may provide useful reference for development of preventive and control strategies for other major cancers in China.</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"55 ","pages":"Article 101298"},"PeriodicalIF":7.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143427887","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Using machine learning algorithms to predict colorectal polyps","authors":"Xingjian Xiao ,&nbsp;Shiyou Liu ,&nbsp;Kubra Maqsood ,&nbsp;Xiaohan Yi ,&nbsp;Guoqun Xie ,&nbsp;Hailei Zhao ,&nbsp;Bo Sun ,&nbsp;Jianying Mao ,&nbsp;Xianglong Xu","doi":"10.1016/j.lanwpc.2024.101356","DOIUrl":"10.1016/j.lanwpc.2024.101356","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Colorectal cancer (CRC) is the third most common cancer worldwide, and colorectal polyps (CRP) represent a necessary pathway to the development of CRC. Surveys indicate that the prevalence of colorectal polyps is 20% at age 45, increasing to over 50% to 60% by age 85 globally. In China, the prevalence of colorectal polyps among residents is approximately 18.1%, and there is a certain correlation with age: the older the age, the higher the prevalence. Until now, no studies have been conducted on utilizing non-invasive factors to predict colorectal polyps.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;Our study was based on a population-based cross-sectional survey. We included data from 5,461 cases with colonoscopy results among 49,701 initial positive consultations in the colorectal cancer screening project conducted in Baoshan District, Shanghai, from 2013 to 2021. Multiple machine learning models including adaptive boosting classifier and gradient boosting machine were established to predict colorectal polyps. In the setting of outcome indicators, patients diagnosed with colorectal polyps through clinical colonoscopy results, pathological findings, and imaging techniques are considered to have colorectal polyps. An area under the curve (AUC) of each established model exceeding 0.7 was considered acceptable for predicting colorectal polyps. The optimal model was used to identify predictors of colorectal polyps.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Findings&lt;/h3&gt;&lt;div&gt;Non-invasive predictors such as sociodemographic information, behavioural history, and medical history were used to predict the current occurrence of colorectal. In our study, the AUC of Random Forest and eXtreme Gradient Boosting reached 0.71, Adaptive Boosting Machine, Gradient Boosting Machine and Light Gradient Boosting Machine reached 0.7 in predicting the occurrence of colorectal cancer. Among the various variables predicting colorectal polyps, age, smoking, gender, cancer history, FOBT (Fecal Occult Blood Test), occupation, and education level are important predictors of colorectal polyps.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Interpretation&lt;/h3&gt;&lt;div&gt;Using non-invasive factors and machine learning algorithms can accurately predict the occurrence of colorectal polyps in individuals with positive initial screening results. In the context of low colonoscopy examination rates, our machine learning predictive models may help prompt patients to undergo further examinations and interventions, thereby improve the earlier diagnosis and treatment. The rate of colonoscopy examinations is very low, even among individuals with positive initial screening results. We propose a machine learning approach that can identify individuals with colorectal polyps in this group, thereby increasing the screening rate for colorectal cancer and helping to prevent the disease.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Funding&lt;/h3&gt;&lt;div&gt;This study was supported by Health Promotion and Education of the Key medical Specialty of Baoshan District, ","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"55 ","pages":"Article 101356"},"PeriodicalIF":7.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143427545","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improvement of early gastric cancer detection via a serum-based sequential screening strategy (4S): a prospective large-scale nationwide study in China","authors":"Xianzhu Zhou,&nbsp;Yiqi Du","doi":"10.1016/j.lanwpc.2024.101286","DOIUrl":"10.1016/j.lanwpc.2024.101286","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Gastric cancer (GC) is one of the most important cancers that warrant screening. A sequential strategy incorporating risk stratification may identify the minority for further endoscopic examination, and biomarkers of gastric atrophy could serve as effective prescreening tools at a low cost. However, its feasibility and acceptability has yet to be fully validated in real-world settings, and in which scenarios a higher early cancer detection rate can be achieved remains unclear.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;This multicenter population-based prospective study was conducted in 266 participating institutions throughout China, spanning sites of communities, hospital (outpatient clinics), and physical exam centers, from 2022 to 2024. Adults aged 40–80 years, with or without mild symptoms, meeting the criteria for being at risk of GC, were invited for serological risk evaluation by pepsinogen and gastrin-17 risk panel. Those identified as intermediate or high risk were subsequently recommended for gastroscopy, establishing the serum-based sequential screening strategy (4S) group. Meanwhile, consecutive endoscopic diagnoses were collected in a real-world clinical setting, set as the control group. The rate of gross screening positivity, endoscopic positivity, early cancer detection, and endoscopic compliance, were compared between the two groups, and among the three screening sites within the ‘4S’ group.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Findings&lt;/h3&gt;&lt;div&gt;In the ‘4S' group, 106,088 participants underwent serological risk assessments and 33.0% (34,979/106,068) fell into the medium to high-risk cohort, of which 33.3% (11,660/34,979) invitees underwent gastroscopy as recommended. Meanwhile, 27,764 subjects were included in the control group. The gross screening positive rate in the ‘4S’ group achieved 3.0‰, and gastroscopy uptake increase with risk prescreening scores (OR = 3.96, P &lt; 0.001). When compared to the control group, the implementation of '4S' screening significantly increased the endoscopic positivity rate (2.2% vs. 0.8%, P &lt; 0.001), and doubled the rate of early cancer detection (62.3% vs. 26.9%, P &lt; 0.001). Compared with screening in hospital setting, community-based screening and physical examinations demonstrated superior capacity to detect tumors at an early stage (77.8% and 77.1% vs. 55.0%, P = 0.008 and 0.002), even though more cases of GC were found in the hospital setting (2.6% vs. 0.9% in community and 1.6% in physical exam). Also, the physical exam showed a poor adherence to gastroscopy (20.5% vs. 41.0% in hospital and 32.2% in community). Community or hospital-based screening showed acceptable cost-effective results by health economic analysis.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Interpretation&lt;/h3&gt;&lt;div&gt;‘4S’ strategy stands out as a practical and economical option in China, as well as in countries encountering similar high-risk GC population. Community screening is highly recommended to improve early GC detection. More ","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":"55 ","pages":"Article 101286"},"PeriodicalIF":7.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143427726","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}