Lili Liu

All Publications

• Gestational diabetes and subsequent risk of type 2 diabetes and metabolic dysfunction-associated steatotic liver disease in a commercially insured U.S. Pregnancy cohort. Diabetes research and clinical practice Liu, L., Velasquez, E. E., Ananth, C. V., Nadeau, K. C., Bondy, M. L., Nguyen, M. H., Williams, M. A. 2026: 113240

  Abstract

  Gestational diabetes mellitus (GDM) is a common pregnancy complication and marker of subsequent metabolic risk. Whether GDM increases metabolic dysfunction-associated steatotic liver disease (MASLD) directly or mainly through progression to type 2 diabetes (T2D) remains unclear.Using Merative© MarketScan® Commercial Claims (2007-2023), we assembled a retrospective cohort of females aged 12-55 years with ≥ 20 gestational weeks and continuous enrollment from 90 days pre-pregnancy through ≥ 1 year postpartum. GDM was identified by ICD codes during pregnancy. Claims-diagnosed T2D and MASLD were ascertained after delivery for up to 15 years. We estimated adjusted hazard ratios (HRs) using Cox models and used a semi-Markov multistate model to quantify direct and T2D-mediated associations.Among 1,363,040 women (mean follow-up 3.1 years), 8.43% had GDM. GDM was associated with incident T2D (adjusted HR 11.96; 95% CI 11.55-12.38) and MASLD (2.29, 2.15-2.43). Multistate models showed a direct GDM-to-MASLD association (2.16, 2.02-2.31) and a dominant indirect pathway through T2D. In model-based counterfactual projections, preventing post-GDM T2D reduced projected 5-year MASLD risk from 13.30% to 0.93% (0.45% without GDM).In this claims-based cohort, GDM confers increased risk of T2D and MASLD, with most excess MASLD risk acted through T2D. Postpartum strategies prioritizing diabetes prevention may markedly attenuate liver disease burden in this high-risk population.

  View details for DOI 10.1016/j.diabres.2026.113240

  View details for PubMedID 41936946

• Daily Walking and Mortality in Racially and Socioeconomically Diverse U.S. Adults. American journal of preventive medicine Liu, L., Jia, G., Shrubsole, M. J., Wen, W., Andersen, S. W., Sudenga, S. L., Zheng, W. 2025; 69 (4): 107738

  Abstract

  While the health benefits of daily walking are well-established, limited research has investigated effects of factors such as walking pace on mortality, particularly in low-income and Black/African-American populations.Data from the Southern Community Cohort Study were used, including information from nearly 85,000 predominantly low-income and Black individuals recruited during 2002-2009 across 12 southeastern U.S. states. Participants provided baseline information on daily walking pace and time, demographic information, lifestyle factors, and health status. Mortality data were collected until December 31, 2022. Analysis was conducted from September 2023 to June 2024.Over a median follow-up of 16.7 (2.0-20.8) years, 26,862 deaths occurred. Significant associations were found between all-cause mortality and daily fast walking time. Fast walking as little as 15 minutes a day was associated a nearly 20% reduction in total mortality (hazard ratios=0.81; 95% CI=0.75, 0.87), while only a 4% reduction in mortality (hazard ratios=0.96; 95% CI=0.91, 1.00) was found in association with more than 3 hours of daily slow walking. Fast walking was independently associated with reduced mortality, regardless of the leisure-time physical activity levels. The inverse association was more pronounced for mortality due to cardiovascular diseases than cancers. Participants with baseline comorbidities had larger risk reductions compared to their generally healthy counterparts, although all individuals benefited from fast walking.Regular walking, particularly fast walking, was associated with reduced mortality. These findings underscore the importance of promoting fast walking as a feasible and effective strategy to improve health outcomes and address health disparities among low socioeconomic populations.

  View details for DOI 10.1016/j.amepre.2025.107738

  View details for PubMedID 40744164

• Associations of alcohol intake with gut microbiome: a prospective study in a predominantly low-income Black/African American population. The American journal of clinical nutrition Liu, L., Nguyen, S. M., Wang, L., Shi, J., Long, J., Cai, Q., Shrubsole, M. J., Shu, X. O., Zheng, W., Yu, D. 2025; 121 (1): 134-140

  Abstract

  Alcohol intake can alter gut microbiome, which may subsequently affect human health. However, limited population-based, prospective studies have investigated associations of habitual and recent alcohol intake with the gut microbiome, particularly among Black/African American individuals.We examined the association of alcohol intake with gut microbiome in a predominantly low-income Black/African American population.We investigated the dose- and type-specific associations of habitual and recent alcohol intake with the gut microbiome among 538 Black/African American adults (150 males and 388 females). Habitual and recent alcohol intakes were assessed at cohort baseline (2002-2009) and stool collection (2018-2021), respectively. Gut microbiome was profiled using shotgun metagenomic sequencing. Generalized linear models were employed to evaluate the associations between alcohol intakes and gut microbiome composition, with adjustments for sociodemographic characteristics, other lifestyle factors, and comorbidities. False discovery rate (FDR) <0.1 was considered statistically significant.The mean age at enrollment was 53.2 ± 7.7 y, with a mean interval of 13.8 y (range: 9.0-18.1 y) between baseline and stool sample collection. Recent alcohol intake was not significantly associated with microbial taxa abundance. However, habitual alcohol intake, both total amount and types of alcoholic beverages, showed significant associations with several microbial taxa abundance, primarily in males, including species within classes Clostridia, Bacilli, and Mahellia within Firmicutes. Specifically, total alcohol, beer, and red wine intakes were all inversely associated with genus MGYG-HGUT-02719 within class Clostridia (β = -2.26 to -0.09 per 1 drink/d increase). Red wine consumption was also inversely associated with the abundance of genera CAG-110, Oscillibacter, and Gemmiger within class Clostridia (β = -3.88 to -2.69), whereas positively associated with genus Absiella (β = 1.81) within class Bacilli. Most of these associations remained significant after additionally adjusting for BMI and baseline comorbidities.We identified gut microbial taxa associated with habitual alcohol intake among Black/African American males, although the magnitudes of these associations were generally small. Further research is needed to determine if these bacteria modify alcohol-disease relationships.

  View details for DOI 10.1016/j.ajcnut.2024.11.007

  View details for PubMedID 39537028

  View details for PubMedCentralID PMC11747185

• Associations of blood lipids and LDL cholesterol lowering drug-targets with colorectal cancer risk: a Mendelian randomisation study. British journal of cancer Chan, W. C., Liu, L., Bouras, E., Zuber, V., Wen, W., Long, J., Gill, D., Murphy, N., Gunter, M. J., Assimes, T. L., Bujanda, L., Gruber, S. B., Küry, S., Lynch, B. M., Qu, C., Thomas, M., White, E., Woods, M. O., Peters, U., Li, C. I., Chan, A. T., Brenner, H., Tsilidis, K. K., Zheng, W. 2024

  Abstract

  Whether blood lipids are causally associated with colorectal cancer (CRC) risk remains unclear.Using two-sample Mendelian randomisation (MR), our study examined the associations of genetically-predicted blood concentrations of lipids and lipoproteins (primary: LDL-C, HDL-C, triglycerides, and total cholesterol), and genetically-proxied inhibition of HMGCR, NPC1L1, and PCSK9 (which mimic therapeutic effects of LDL-lowering drugs), with risks of CRC and its subsites. Genetic associations with lipids were obtained from the Global Lipids Genetics Consortium (n = 1,320,016), while genetic associations with CRC were obtained from the largest existing CRC consortium (n = 58,221 cases and 67,694 controls). Our main analysis was a multivariable MR (MVMR) with mutual adjustments for LDL-C, HDL-C, and triglycerides. Secondary analyses, including MVMR additionally-adjusting for BMI or diabetes, were also performed.Genetically-predicted LDL-C was positively associated with CRC risk in the MVMR adjusted for HDL-C and triglycerides (OR = 1.09; 95%CI 1.02-1.16 per SD increase) and additionally-adjusted for BMI (OR = 1.12; 95%CI 1.05-1.21) or diabetes (OR = 1.09; 95%CI 1.02-1.17). Associations were generally consistent across anatomical subsites. No clear evidence of association was found for other lipids, lipoproteins, or LDL-lowering drug-targets.We found evidence of a weak positive association between LDL-C and CRC that did not appear to be explained by potential pleiotropic pathways such as via HDL-C, triglycerides, BMI, or diabetes.

  View details for DOI 10.1038/s41416-024-02900-7

  View details for PubMedID 39580580

  View details for PubMedCentralID 8931669

• Impacts of Poverty and Lifestyles on Mortality: A Cohort Study in Predominantly Low-Income Americans. American journal of preventive medicine Liu, L., Wen, W., Shrubsole, M. J., Lipworth, L. E., Mumma, M. T., Ackerly, B. A., Shu, X. O., Blot, W. J., Zheng, W. 2024; 67 (1): 15-23

  Abstract

  Low socioeconomic status has been linked to increased mortality. However, the impacts of poverty, alone or combined with health behaviors, on mortality and life expectancy have not been adequately investigated.Data from the Southern Community Cohort Study was used, including nearly 86,000 participants recruited during 2002-2009 across 12 US southeastern states. Analysis was conducted from February 2022 to January 2023.During a median follow-up of 12.1 years, 19,749 deaths were identified. A strong dose-response relationship was found between household incomes and mortality, with a 3.3-fold (95%CI=3.1-3.6) increased all-cause mortality observed for individuals in the lowest income group (<$15,000/year) compared with those in the highest group (≥$50,000/year). Within each income group, mortality monotonically increased with declining healthy lifestyle score. Risk was significantly lower among those in the lowest income but healthiest lifestyle group, compared to those with the highest income but unhealthiest lifestyle (HR=0.82, 95%CI=0.69-0.97). Poor White participants appeared to experience higher all-cause mortality than poor Black participants. Life expectancy was more than 10.0 years shorter for those in the lowest income group compared with those in the highest income group.Poverty is strongly associated with increased risk of death, but the risks could be modestly abated by a healthier lifestyle. These findings call for a comprehensive strategy for enhancing a healthy lifestyle and improving income equality to reduce death risks, particularly among those experiencing health disparities due to poverty.

  View details for DOI 10.1016/j.amepre.2024.02.015

  View details for PubMedID 38417593

  View details for PubMedCentralID PMC11312224

• Sex-specific associations between lipids and cognitive decline in the middle-aged and elderly: a cohort study of Chinese adults. Alzheimer's research & therapy Liu, L., Zhang, C., Lv, X., Lai, X., Xu, L., Feng, J., Song, Y., Wang, S., Zhan, S. 2020; 12 (1): 164

  Abstract

  Studies regarding the lipid-cognition relationship have increasingly gained popularity but have generated much mixed results. To date, few studies have focused on the difference between sexes.This study included 6792 Chinese adults aged over 45 years (women, 48.56%; mean age, 57.28 years), who were free of severe conditions known to affect cognitive function at the baseline (2011). Blood concentrations of total cholesterol (TC), high-density lipoprotein cholesterol (HDL-c), low-density lipoprotein cholesterol (LDL-c), and triglycerides (TG) were assessed at baseline, and both continuous and categorical values were used in final analyses. Global cognitive functions were assessed by the word recall test and the mental status test in 2011, 2013, and 2015, respectively. We graded participants into three groups according to the cognitive change slopes: no decline (≥ 0), moderate decline (median to 0), and severe decline (< median). Sex-specific associations between blood lipids and cognitive decline were analyzed using ordinal logistic models, adjusting for sociodemographic information, lifestyle behaviors, and health status.Higher baseline TC and LDL-C concentrations exhibited no significant association with 5-year cognitive decline in men but were significantly associated with greater 5-year cognitive decline in women [odds ratio (OR) 1.026, 95% confidence interval (CI) 1.003, 1.050; OR 1.026, CI 1.002, 1.051, respectively]. For higher serum HDL-c levels, a significantly protective effect on cognition was observed in men, but a slightly adverse effect was found in women (not significant after Bonferroni correction). TG presented almost no effect on later cognition in either sex.Different associations between sexes were observed for the lipid-cognition relationship, and maintaining serum cholesterol levels at an appropriate range may have a positive effect on cognitive health.

  View details for DOI 10.1186/s13195-020-00731-1

  View details for PubMedID 33287901

  View details for PubMedCentralID PMC7722300

• Income, race and survival among low-income Black and White Americans with lung, breast, prostate or colorectal cancer. Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology Holowatyj, A. N., Liu, L., Munro, H. M., Perkins-Smith, J. J., Han, X., Kolitsopoulos, F., Shrubsole, M. J., Lipworth, L., Russo, L. J., Zheng, W. 2025

  Abstract

  Race and income are social factors that contribute to persistent inequities in cancer care delivery/outcomes. However, cancer disparities patterns within underserved populations-such as those with annual household income (AHI)<$15,000-remain incompletely understood. We evaluated survival among low-income Americans who identified as Black or White with breast, prostate, lung, or colorectal cancer.Using the Southern Community Cohort Study prospectively-collected data and linkages to state cancer registries and National Death Index, we identified adults with primary breast, prostate, lung or colorectal cancer. Cox proportional hazards models were used to compare race-specific overall survival among individuals by AHI.A total of 4,651 individuals who self-identified as Black or White were diagnosed with breast (n=1,223), prostate (n=1,158), lung (n=1,469) or colorectal (n=801) cancer. Over half (56.8%) reported AHI<$15,000. Specific to those reporting AHI<$15,000, Black individuals with lung cancer had a significantly lower hazard of death than Whites after adjustment for age, sex, surgery, clinical stage, smoking history, lung cancer subtype, BMI, COPD, persistent poverty, enrollment year and source (HR=0.78; 95%CI=0.66-0.92). In contrast, Black females with AHI<$15,000 had a slightly higher hazard of death than Whites for breast cancer (HR=1.20; 95%CI=0.85-1.70), although these differences were not statistically significant. No racial differences were observed for prostate or colorectal cancers.Among individuals with AHI<$15,000, racial disparities in survival were observed for lung, but not other, cancers.Disentangling the interplay of race and individual-level income on cancer survival guides improved access to high-quality cancer care services, which could reduce inequities and improve clinical outcomes.

  View details for DOI 10.1158/1055-9965.EPI-24-1161

  View details for PubMedID 40787997

• Integrating multi-ancestry genomic and proteomic data to identify blood risk biomarkers and target proteins for breast cancer genetic risk loci. International journal of cancer Jia, G., Ping, J., Tao, R., Long, J., Liu, L., Xu, S., Munro, H. M., Ambs, S., Barnard, M. E., Chen, Y., Choi, J. Y., Gao, Y. T., Garcia-Closas, M., Gu, J., Hu, J. J., Iwasaki, M., John, E. M., Kweon, S. S., Matsuda, K., Matsuo, K., Nathanson, K., Nemesure, B., Olopade, O. I., Pal, T., Park, S. K., Park, B., Press, M. F., Sanderson, M., Sandler, D. P., Yao, S., Zheng, Y., Adejumo, P. O., Ahearn, T., Brewster, A. M., Hennis, A. J., Ito, H., Kubo, M., Lee, E. S., Low, S. K., Makumbi, T., Ndom, P., Noh, D. Y., O'Brien, K. M., Olshan, A. F., Oluwasanu, M. M., Park, M. H., Reid, S., Yamaji, T., Zirpoli, G., Butler, E. N., Huang, M., Ntekim, A., Weinberg, C. R., Li, B., Huo, D., Kang, D., Ambrosone, C., Troester, M. A., Haiman, C. A., Shu, X. O., Palmer, J. R., Guo, X., Zheng, W. 2025

  Abstract

  Genome-wide association studies (GWAS) have identified more than 200 risk loci for breast cancer. However, target genes and their encoded proteins in these loci remain largely unknown. In this study, we utilized genetic prediction models for 1349 circulating proteins derived from individuals of African (n = 1871) and European (n = 7213) ancestry to investigate genetically predicted protein levels in association with breast cancer risk among females of African (n = 40,138), Asian (n = 137,677), and European (n = 247,173) ancestry. We identified 51 blood protein biomarkers associated with breast cancer risk, overall or by subtypes, at a false discovery rate (FDR) < 0.05, including 27 proteins encoded by genes located at least 1 Mb away from any of the known risk loci identified in GWAS. Of them, 32 proteins showed significant associations with breast cancer risk at the Bonferroni-corrected significance level (p < 2.45 × 10-4). Of the 24 proteins located at GWAS-identified risk loci, associations for 14 proteins were significantly attenuated after adjustment for the index risk variant of each respective locus, suggesting that these proteins may be target proteins for the risk loci. Encoding gene expression levels in normal breast tissue could be genetically predicted for 23 of the 51 identified proteins, and 13 encoding genes were associated with breast cancer risk in the same direction (p < .05). Our study identified potential protein targets of GWAS risk loci and biomarkers for breast cancer risk and provided additional insights into breast cancer genetics and etiology.

  View details for DOI 10.1002/ijc.70041

  View details for PubMedID 40658085

• Genetically Predicted Gene Expression Effects on Changes in Red Blood Cell and Plasma Polyunsaturated Fatty Acids. Genetic epidemiology Khankari, N. K., Su, T., Cai, Q., Liu, L., Jasper, E. A., Hellwege, J. N., Murff, H. J., Shrubsole, M. J., Long, J., Edwards, T. L., Zheng, W. 2025; 49 (1): e22613

  Abstract

  Polyunsaturated fatty acids (PUFAs) including omega-3 and omega-6 are obtained from diet and can be measured objectively in plasma or red blood cells (RBCs) membrane biomarkers, representing different dietary exposure windows. In vivo conversion of omega-3 and omega-6 PUFAs from short- to long-chain counterparts occurs via a shared metabolic pathway involving fatty acid desaturases and elongase. This analysis leveraged genome-wide association study (GWAS) summary statistics for RBC and plasma PUFAs, along with expression quantitative trait loci (eQTL) to estimate tissue-specific genetically predicted gene expression effects for delta-5 desaturase (FADS1), delta-6 desaturase (FADS2), and elongase (ELOVL2) on changes in RBC and plasma biomarkers. Using colocalization, we identified shared variants associated with both increased gene expression and changes in RBC PUFA levels in relevant PUFA metabolism tissues (i.e., adipose, liver, muscle, and whole blood). We observed differences in RBC versus plasma PUFA levels for genetically predicted increase in FADS1 and FADS2 gene expression, primarily for omega-6 PUFAs linoleic acid (LA) and arachidonic acid (AA). The colocalization analysis identified rs102275 to be significantly associated with a 0.69% increase in total RBC membrane-bound LA levels (p = 5.4 × 10-12). Future PUFA genetic studies examining long-term PUFA biomarkers are needed to confirm our results.

  View details for DOI 10.1002/gepi.22613

  View details for PubMedID 39812514

  View details for PubMedCentralID PMC11734643

• Sitting Time, Physical Activity and Mortality: A Cohort Study In Low-Income Older Americans. American journal of preventive medicine Liu, L., Wen, W., Andersen, S. W., Shrubsole, M. J., Steinwandel, M. D., Lipworth, L. E., Sudenga, S. L., Zheng, W. 2024; 67 (6): 924-931

  Abstract

  Physical inactivity and sedentary behavior are recognized as independent risk factors for many diseases. However, studies investigating their associations with total and cause-specific mortality in low-income and Black populations are limited, particularly among older adults.A prospective cohort study was conducted among 8,337 predominantly low-income and Black Americans aged ≥65 years residing in the southern United States. Participants reported their daily sitting time and leisure-time physical activity (LTPA) at baseline (2002-2009), and mortality data were collected through 2019. Analysis was conducted from September 2022 to October 2023.During a median follow-up of 12.25 years, nearly 50% (n=4,111) were deceased. A prolonged sitting time (>10 hours/day versus <4 hours/day) was associated with elevated all-cause mortality (hazard ratios [HR], 1.15; 95% confidence intervals [CI], 1.04-1.27) after adjusting for LTPA and other potential confounders. LTPA was associated with a reduced risk of all-cause mortality, with an adjusted HR of 0.75 (95% CI 0.64, 0.88) associated with 150-300 minutes per week of moderate-intensity physical activity. Individuals who were physically inactive and had a sitting time of >10 hours/day had the highest mortality risk (HR, 1.48; 95% CI, 1.23-1.78), compared with those who were physically active and had low sitting time. These associations were more pronounced for mortality due to cardiovascular diseases.High sitting time is an independent risk factor for all-cause and cardiovascular disease mortality, and LTPA could partially attenuate the adverse association of prolonged sitting time with mortality.

  View details for DOI 10.1016/j.amepre.2024.07.018

  View details for PubMedID 39089431

• [Epidemiological and etiological characteristics of hand, foot and mouth disease among children aged 5 years and younger in Ningbo (2016 to 2019)]. Beijing da xue xue bao. Yi xue ban = Journal of Peking University. Health sciences Liu, L. L., Liu, Z. K., Zhang, L., Li, N., Fang, T., Zhang, D. L., Xu, G. Z., Zhan, S. Y. 2021; 53 (3): 491-497

  Abstract

  To describe the epidemiological and etiological characteristics of hand, foot and mouth disease (HFMD) among children aged 5 years and younger in Ningbo after the access of entero-virus-A71 vaccine (2016 to 2019).A retrospective cohort study were performed in children aged 5 years and younger in Ningbo from 2016 to 2019. Data for incidence of HFMD was collected from the National Notifiable Disease Surveillance Reporting System and the Electronic Medical Records (EMRs) System, while the demographic information was derived from the Immunization Information System. Speci-mens were detected by real-time fluorescence quantitative PCR and the Wilson method was used to estimate the incidence rate and 95% confidence interval.From 2016 to 2019, a total of 1 044 800 residential children were observed in this population-based cohort. In the study, 102 471 cases of HFMD were diagnosed in 2 651 081 person-years, revealing an overall incidence density of 3 865.25/100 000 person-years. There was no significant decline in the number of the cases after the vaccine was available. The number of the patients of hand foot mouth disease during the four years was 93 421, of whom 84 875 (90.85%) had only one incident record, while 8 946 (9.15%) had 2 or more cases in this period; there were 69 771 (66.06%) patients who only needed to see a doctor once for each disease, 19.92% of the patients needed to be treated twice, and 14 801 (14.02%) patients needed to go to the hospital or clinic three times or more. The incidence of HFMD showed obvious seasonality and periodicity, which mainly concentrated in April to July each year, and the epidemic cycle was 2 years; most of the cases were 1 to 3-year old children, with more cases in male. The incidence density varied across the region, with the highest density observed in Ninghai (4 524.76/100 000 person-years), followed by Xiangshan (3 984.22/100 000 person-years). In 3 748 library-conformed cases, 2 834(75.61%) were detected positive, among which enterovirus-A71, Cox-A16 and other enteroviruses accounted for 9.03%, 31.55% and 59.42%, respectively. During the study period, the cumulative coverage of enterovirus-A71 vaccine increased year by year, with the proportion of enterovirus-A71 and severe cases both gradually decreasing.The current status of hand, foot and mouth disease in Ningbo is still serious. Children under 3-year old (especially male children aged 1 year) were the key population for prevention and control. Vaccination might lead to changes in major pathogenic virus type, of which more attention should be paid to the potential impact on disease surveillance, prevention and control.

  View details for DOI 10.19723/j.issn.1671-167X.2021.03.009

  View details for PubMedID 34145850

  View details for PubMedCentralID PMC8220059

• Incidence of and trends in hip fracture among adults in urban China: A nationwide retrospective cohort study. PLoS medicine Zhang, C., Feng, J., Wang, S., Gao, P., Xu, L., Zhu, J., Jia, J., Liu, L., Liu, G., Wang, J., Zhan, S., Song, C. 2020; 17 (8): e1003180

  Abstract

  Hip fracture is a public health concern because of its considerable morbidity, excess mortality, great risk of disability, and high societal healthcare costs. China has the largest population of older people in the world and is experiencing rapid population aging and facing great challenges from an increasing number of hip fractures. However, few studies reported the epidemiology, especially at a national level. We aimed to evaluate trends in hip fracture incidence and associated costs for hospitalization in China.We conducted a population-based study using data between 2012 and 2016 from the national databases of Urban Employee Basic Medical Insurance and Urban Resident Basic Medical Insurance in China, covering about 480 million residents. Data from around 102.56 million participants aged 55 years and older during the study period were analyzed. A total of 190,560 incident hip fracture patients (mean age 77.05 years, standard deviation 8.94; 63.99% female) were identified. Primary outcomes included the age- and sex-specific incidences of hip fracture. Associated annual costs for hospitalization were also calculated. Incidence was described as per 100,000 person-years at risk, and 95% confidence intervals were computed assuming a Poisson distribution. Hip fracture incidence overall in China did not increase during the study period despite rapid population aging. Incidence per 100,000 was 180.72 (95% CI 137.16, 224.28; P < 0.001) in 2012 and 177.13 (95% CI 139.93, 214.33; P < 0.001) in 2016 for females, and 121.86 (95% CI 97.30, 146.42; P < 0.001) in 2012 and 99.15 (95% CI 81.31, 116.99; P < 0.001) in 2016 for males. For both sexes, declines in hip fracture incidence were observed in patients aged 65 years and older, although incidence was relatively stable in younger patients. However, the total absolute number of hip fractures in those 55 years and older increased about 4-fold. The total costs for hospitalization showed a steep rise from US$60 million to US$380 million over the study period. Costs for hospitalization per patient increased about 1.59-fold, from US$4,300 in 2012 to US$6,840 in 2016. The main limitation of the study was the unavailability of data on imaging information to adjudicate cases of hip fracture.Our results show that hip fracture incidence among patients aged 55 and over in China reached a plateau between 2012 and 2016. However, the absolute number of hip fractures and associated medical costs for hospitalization increased rapidly because of population aging.

  View details for DOI 10.1371/journal.pmed.1003180

  View details for PubMedID 32760065

  View details for PubMedCentralID PMC7410202

• Global variation in prevalence and incidence of amyotrophic lateral sclerosis: a systematic review and meta-analysis. Journal of neurology Xu, L., Liu, T., Liu, L., Yao, X., Chen, L., Fan, D., Zhan, S., Wang, S. 2020; 267 (4): 944-953

  Abstract

  Amyotrophic lateral sclerosis (ALS) is a global disease, which adversely affects the life quality of patients and significantly increases the burden of families and society. We aimed to assess the changing incidence, prevalence of ALS around the world.We searched Medline, Embase, Web of Science, and Cochrane library to identify articles published until September 9, 2018. Each included study was independently reviewed for methodological quality by two reviewers. We used a random-effects model to summarize individual studies and assessed heterogeneity (I2) with the χ2 test on Cochrane's Q statistic.We identified 124 studies that were eligible for final inclusion, including 110 studies of incidence and 58 studies of prevalence. The overall crude worldwide ALS prevalence and incidence were 4.42 (95% CI 3.92-4.96) per 1,00,000 population and 1.59 (95% CI 1.39-1.81) per 1,00,000 person-years, respectively. ALS prevalence and incidence increased by age until the age of 70-79. Since 1957, incidence has been significantly rising year by year, and this upward trend was weakened after standardization. The longest survival time were in Asia (ranging from 3.74 years in South Asia to 9.23 years in West Asia).With the aggravation of population aging and the rapid growth of economy, developing regions following the development pattern of the developed regions may suffer rising ALS prevalence and incidence which may increase their disease burden as well. These data highlight the need for research into underlying mechanism and innovations in health-care systems.

  View details for DOI 10.1007/s00415-019-09652-y

  View details for PubMedID 31797084

• Prevalence and Incidence of Multiple Myeloma in Urban Area in China: A National Population-Based Analysis. Frontiers in oncology Wang, S., Xu, L., Feng, J., Liu, Y., Liu, L., Wang, J., Liu, J., Huang, X., Gao, P., Lu, J., Zhan, S. 2019; 9: 1513

  Abstract

  Multiple myeloma (MM) is the second most frequent malignancy of blood, and information on disease burden of MM is limited in developing countries. We aimed to estimate the prevalence and incidence of MM in China. We used data from the national urban employee and urban resident basic medical insurance from 2012 to 2016 in China. MM cases were based on the primary diagnosis (International Classification of Diseases (ICD) code, ICD for oncology, or text of diagnosis) of patients. The crude prevalence and incidence were 6.88 per 100,000 population (95% CI, 5.75-8.00) and 1.60 per 100,000 person-years (1.28-1.92), respectively. The standardized prevalence and incidence were 5.68 (5.64-5.72) and 1.15 (1.11-1.19), respectively. Overall, the rates were higher in males compared with females for prevalence (7.89 vs. 5.79, P < 0.05) and incidence (1.84 vs. 1.30, P < 0.05). Both rates increased with age, and the mean age (SD) of MM patients was 57.9 (14.4) years. Prevalence peaked between 55 and 74 years old for both genders. The incidence in women aged 55-59 had a significantly high incidence of 5.53 (4.98-6.11). The prevalence and incidence were significantly lower than those in North America, Australia, and Western Europe but were in the same range as those in Japan or Korea. MM should be one of the cancers in the spotlight from both medical and socioeconomic perspectives in low-resource but populous countries because of the incidence of more elderly MM patients in the next decade. Further research is warranted to examine the potential pathophysiologic mechanism.

  View details for DOI 10.3389/fonc.2019.01513

  View details for PubMedID 32039008

  View details for PubMedCentralID PMC6993203