上海市区女性肺癌的家族聚集性研究

我们利用在上海市区所开展的一项关于女性肺癌的较大规模人群基础上的病例对照研究资料,分析和评价了一级亲属患肺癌史者其在肺癌发生中的作用。文中重点分析了女性非吸烟者肺癌的材料。结果表明,先证者家系一级亲属患肺癌的风险性是对照组家系一级亲属的近3倍(OR=2.80,95% CI1.68-4.67)。对非吸烟先证者家系而言,比数比为2.62(95%CI1.52-4.5 2)。其中,腺癌、鳞癌、其他类和不明分类的肺癌的OR分别为2.79(95%CI 1.53-5.10)、3.88 (95%CI1.42-10.63)、1.26(95%CI0.27-6.01)、2.52 (95%CI1.16-5.49)。按年龄组分层分析的结果显示,35-59岁组与60-69岁组的比数比分别为4.01 (95%CI1.71-8.97)、 1.89(95%CI0.89-3.98)。非吸烟女性研究对象经多因素非条件logistic回归模型的分析后,比数比OR为2.71(95%CI1.54-4.76),有高度统计学意义。在该多变量回归模型的基础上估计的调整人群归因风险度为5.31%。 Abstract:The data set of a large population-based case-control study of female lung cancer conducted in Shanghai urban was used to investigate the contribution of lung cancer in first-degree relatives to lung cancer risk.The analysis in the paper is emphasized on non-smoking women.The results indicates that the risk of first-degree relatives with lung cancer is increased about 30fold(OR=2.80,95% CI:1.68-4.67),and for non-smoking probands the OR is 2.62(95% CI:1.52-4.52).The odds ratios of adeno-carcinoma,squamous cell carcinoma,others unknown of lung cancer are 2.79(95% CI:1.53-5.10),3.88(95% CI:1.42-10.63),1.26(95% CI:0.27-6.01),2.52(95% CI:1.16-5.49),respectively.For cases of age groups of 35 to 59 and 60 to 69 years of probands,with ORs of 4.01(95% CI:1.79-8.97)and 1.89(95% CI:0.89-3.98)respectively.The odds ratio from multivariable unconditional logistic regression is 2.71(95% CI:1.54-4.76).The estimation of adjusted population attributable risk is 5.31% based on the multivariable logistic regression model analysis.     

Rising Diabetes Prevalence among Urban-Dwelling Black South Africans

Objective

To examine the prevalence of and the association of psychosocial risk factors with diabetes in 25–74-year-old black Africans in Cape Town in 2008/09 and to compare the prevalence with a 1990 study.

Research Design and Methods

A randomly selected cross-sectional sample had oral glucose tolerance tests. The prevalence of diabetes (1998 WHO criteria), other cardiovascular risk factors and psychosocial measures, including sense of coherence (SOC), locus of control and adverse life events, were determined. The comparison of diabetes prevalence between this and a 1990 study used the 1985 WHO diabetes criteria.

Results

There were 1099 participants, 392 men and 707 women (response rate 86%). The age-standardised (SEGI) prevalence of diabetes was 13.1% (95% confidence interval (CI) 11.0–15.1), impaired glucose tolerance (IGT) 11.2% (9.2–13.1) and impaired fasting glycaemia 1.2% (0.6–1.9). Diabetes prevalence peaked in 65–74-year-olds (38.6%). Among diabetic participants, 57.9% were known and 38.6% treated. Using 1985 WHO criteria, age-standardised diabetes prevalence was higher by 53% in 2008/09 (12.2% (10.2–14.2)) compared to 1990 (8.0% (5.8–10.3)) and IGT by 67% (2008/09: 11.7% (9.8–13.7); 1990: 7.0% (4.9–9.1)). In women, older age (OR: 1.05, 95%CI: 1.03–1.08, p<0.001), diabetes family history (OR: 3.13, 95%CI: 1.92–5.12, p<0.001), higher BMI (OR: 1.44, 95%CI: 1.20–1.82, p = 0.001), better quality housing (OR: 2.08, 95%CI: 1.01–3.04, p = 0.047) and a lower SOC score (≤40) was positively associated with diabetes (OR: 2.57, 95%CI: 1.37–4.80, p = 0.003). Diabetes was not associated with the other psychosocial measures in women or with any psychosocial measure in men. Only older age (OR: 1.05, 95%CI: 1.02–1.08, p = 0.002) and higher BMI (OR: 1.10, 95%CI: 1.04–1.18, p = 0.003) were significantly associated with diabetes in men.

Conclusions

The current high prevalence of diabetes in urban-dwelling South Africans, and the likelihood of further rises given the high rates of IGT and obesity, is concerning. Multi-facetted diabetes prevention strategies are essential to address this burden.     

A longitudinal study of rheumatoid arthritis in South Africans

Little is known about the functional outcome of rheumatoid arthritis (RA) in Africans treated with disease-modifying antirheumatic drugs (DMARDs). We describe our experience with 182 RA patients seen at a tertiary hospital in South Africa. During the median follow-up period of 3.3 years, the proportion of patients with severe functional disability (American College of Rheumatology [ACR] functional classes [FCs] 3 and 4) declined significantly from 48.9% at presentation to 30.8% at last visit (P =.0006). There was a significant fall in the median Westergren erythrocyte sedimentation rate (ESR) (46-28 mm/hour, P <.00001) and C-reactive protein (CRP) (19-15.5 mg/L, P =.006) over this period. Logistic regression analysis showed that the factors that negatively affected functional outcome at last visit were severe functional disability at presentation (odds ratio [OR] = 4.1, P =.0004), delay in referral for specialist care > 2 years (OR = 3.1, P =.02), and ESR at last visit > 28 mm/hour (OR = 3.2, P =.002). DMARDs and oral corticosteroids were prescribed in 93.1% of patients at presentation and 60.4% of patients at last visit. Life-table analysis showed that the survival time with methotrexate (MTX) use was significantly longer compared with the other DMARDs (P =.0002). A total of only 37 surgical procedures were performed on 21 patients. This retrospective study shows that despite the late presentation and severe disease, patients do improve on DMARD therapy in the medium term. The study highlights the need for prospective studies to assess the efficacy and safety of DMARDs, particularly in early disease, in the developing countries where biologics are unlikely to be affordable in the foreseeable future.