Mortality trends of liver diseases in mainland China over three decades: an age-period-cohort analysis

Sun, Ying; Chang, Jie; Liu, Xin; Liu, George

doi:10.1136/bmjopen-2019-029793

Cited by 11 publications

(6 citation statements)

References 31 publications

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“…All of these can compound the prevalence of MCI. The true cohort effect can only be revealed through future studies using a method that can separate the effects of age, cohort, study period, and other confounding factors [ 138 ]. At this stage, the interpretation and application of the pooled results of this systematic review should be cautious.…”

Section: Discussionmentioning

confidence: 99%

Prevalence of mild cognitive impairment in community-dwelling Chinese populations aged over 55 years: a meta-analysis and systematic review

Lü

Liu

et al. 2021

BMC Geriatr

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Background Mild cognitive impairment (MCI) is an intermediate phase between normal cognitive ageing and overt dementia, with amnesic MCI (aMCI) being the dominant subtype. This study aims to synthesise the prevalence results of MCI and aMCI in community-dwelling populations in China through a meta-analysis and systematic review. Methods The study followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) protocol. English and Chinese studies published before 1 March 2020 were searched from ten electronic bibliographic databases. Two reviewers screened for relevance of the studies against the pre-defined inclusion and exclusion criteria and assessed the quality of the included studies using the Risk of Bias Tool independently. A random-effect model was adopted to estimate the prevalence of MCI and aMCI, followed by sub-group analyses and meta-regression. Sensitivity and publication bias tests were performed to verify the robustness of the meta-analyses. Results A total of 41 studies with 112,632 participants were included in the meta-analyses. The Chinese community-dwelling populations over 55 years old had a pooled prevalence of 12.2% [95% confidence interval (CI): 10.6, 14.2%] for MCI and 10.9% [95% CI, 7.7, 15.4%] for aMCI, respectively. The prevalence of MCI increased with age. The American Psychiatric Association’s Diagnostic tool (DSM-IV) generated the highest MCI prevalence (13.5%), followed by the Petersen criteria (12.9%), and the National Institute on Aging Alzheimer’s Association (NIA-AA) criteria (10.3%). Women, rural residents, and those who lived alone and had low levels of education had higher MCI prevalence than others. Conclusion Higher MCI prevalence was identified in community-dwelling older adult populations in China compared with some other countries, possibly due to more broadened criteria being adopted for confirming the diagnosis. The study shows that aMCI accounts for 66.5% of MCI, which is consistent with findings of studies undertaken elsewhere. Systematic review registration number PROSPERO CRD42019134686.

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Section: Discussionmentioning

confidence: 99%

Prevalence of mild cognitive impairment in community-dwelling Chinese populations aged over 55 years: a meta-analysis and systematic review

Lü

Liu

et al. 2021

BMC Geriatr

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“…In fact, older age was identified as an independent risk factor for advanced disease in the GZ phase of CHB 9 . Given the absence of hepatic inflammation and HBV‐specific T‐cell response before 30 years old 27 and that the mortality risks of HCC, chronic liver disease, and cirrhosis significantly increase with age over 30 years old, 28 age > 30 years was used in our subgroup analyses, and the results also support that age > 30 years with ALT exceeding the new thresholds (ALT >27 U/L for males and ALT >24 U/L for females) is a risk factor of SLHC in GZ CHB patients. Previous studies have shown liver damage in CHB patients with normal ALT levels and HBV DNA ≥2000 IU/mL 20,29 .…”

Section: Discussionmentioning

confidence: 99%

Determining optimal ALT cut‐off values for predicting significant hepatic histological changes in patients with normal ALT in the grey zone of chronic hepatitis B virus infection

Kang,

Wu,

Zheng

et al. 2024

Aliment Pharmacol Ther

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SummaryBackground and AimsWe aimed to define gender‐specific, optimal alanine aminotransferase (ALT) cut‐off values for the prediction of significant liver histological changes (SLHC) in Chinese patients with grey zone (GZ) chronic hepatitis B (CHB) and normal ALT.MethodsIn a retrospective study, we included 1101 consecutive patients with GZ CHB and normal ALT assigned to training or internal validation cohorts. We included an independent cohort of 842 patients for external validation. We performed receiver operating characteristic (ROC) curve, smoothed curve fitting, and threshold effect analyses to determine optimal ALT cut‐off values. Area under the curve (AUC) values were calculated to assess their predictive performance.ResultsA proportion of 79.3% of patients with GZ CHB and normal ALT (≤40 U/L) had SLHC. ROC curve analysis initially identified optimal ALT cut‐off values of 29 U/L (male) and 22 U/L (female). After smoothed curve fitting and threshold effect analyses, new optimal cut‐off values were 27 U/L for males and 24 U/L for females. AUCs for these values were 0.836 (male) and 0.833 (female) in the internal validation cohort, and 0.849 (male) and 0.844 (female) in the external validation cohort. The accuracy and discriminative ability of the newly defined ALT cut‐off values were greater than those of the current recommendations.ConclusionThis study established novel optimal ALT cut‐off values for more precise prediction of SLHC among Chinese patients with GZ CHB and normal ALT levels. This may help identify individuals who will benefit from timely antiviral therapy.

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“…In a large US cohort study of 8,539 patients with chronic HBV infection followed up for 12 years, 317 developed HCC, age and family history were independent risk factors for HCC in patients without cirrhosis, and the OR was 32.9 ( 21 ). A study based on the Chinese Health Statistics Yearbook on the relative risk of HBV-related death suggested that the risk of HCC was significantly higher in patients >30 years old ( 22 ).…”

Section: Discussionmentioning

confidence: 99%

Effect of the change in antiviral therapy indication on identifying significant liver injury among chronic hepatitis B virus infections in the grey zone

Ren

Wang

et al. 2022

Front. Immunol.

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ObjectiveIn clinical practice, a substantial proportion of chronic hepatitis B virus (HBV) infections that do not fit into any of the usual immune states are considered to be in the “grey zone (GZ)”. This study aimed to investigate the effect of the change in antiviral therapy indication on identifying significant hepatic injury among GZ patients.MethodsPatients with chronic HBV infections and a persistent normal alanine aminotransferase (ALT) level (PNALT) who underwent ultrasonography-guided percutaneous liver biopsy were examined retrospectively. Evidenced hepatic injury (EHI) was defined as an inflammation grade ≥2 (≥G2) and/or fibrosis stage ≥2 (≥F2). Complete clinical data, liver inflammation, and fibrosis grades were collected, and the levels of cytokines were detected by the Luminex technique, all of which were analysed to investigate the immune and histopathology states of the liver.ResultsA total of 347 patients with chronic HBV infections and PNALT were categorized into immune tolerant (IT, n = 108), inactive HBV surface antigen (HBsAg) carrier (IHC, n = 61), GZ-1 (HBeAg positive in GZ, n = 92), and GZ-2 (HBeAg negative in GZ, n = 68) phases. Among them, 51.3% were in the GZ phase, and 50.1% presented with EHI. The IL-6 levels were higher in the EHI group than in the non-EHI group (2.77 vs. 1.53 pg/ml, Z = −13.32, p = 0.028). The monocyte chemoattractant protein 1 (MCP-1) level was positively correlated with HBV DNA (R = 0.64, p < 0.001) and HBeAg (R = 0.5, p < 0.001) but negatively correlated with fibrosis grade (R = −0.26, p = 0.048). The ratio of EHI in the GZ phase was 60.55%, which was significantly higher than that in patients in the IT (39.8%) and IHC phases (37.7%) (χ2 = 10.4, p = 0.006). A total of 46.69% of all patients exceeded the new ALT antiviral treatment threshold (30 U/L for men and 19 U/L for women). The EHI values in the IT and IHC phases below the new ALT threshold were 32.6% and 37.8%, respectively, whereas higher EHI values of 67.4% and 68.4% were seen in GZ-1 and GZ-2 patients, respectively, exceeding the new ALT threshold, and the difference was statistically significant (χ2 = 11.13, p < 0.001; χ2 = 14.22, p = 0.002). The median age in our cohort was 38.91 years, and only 21.03% were less than 30 years old. The EHI values in the IT and IHC patients <30 years old were 32.4% and 35.8%, respectively, while the ratio of EHI increased to 43.2% once patients were older than 30 years but still in the IT and IHC stages.ConclusionSetting 30 years old as a cut-off and lowering the ALT threshold could facilitate screening for the presence of significant liver injury, especially for GZ patients. IL-6 was a good indicator of EHI, and MCP-1 was significantly positively correlated with HBV DNA but negatively correlated with liver fibrosis.

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Mortality trends of liver diseases in mainland China over three decades: an age-period-cohort analysis

Cited by 11 publications

References 31 publications

Prevalence of mild cognitive impairment in community-dwelling Chinese populations aged over 55 years: a meta-analysis and systematic review

Prevalence of mild cognitive impairment in community-dwelling Chinese populations aged over 55 years: a meta-analysis and systematic review

Determining optimal ALT cut‐off values for predicting significant hepatic histological changes in patients with normal ALT in the grey zone of chronic hepatitis B virus infection

Effect of the change in antiviral therapy indication on identifying significant liver injury among chronic hepatitis B virus infections in the grey zone

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