Publications by authors named "Jinjun Ran"

45 Publications

Increase in Diabetes Mortality Associated With COVID-19 Pandemic in the U.S.

Diabetes Care 2021 Jun 16. Epub 2021 Jun 16.

Department of Environmental Health, Boston University School of Public Health, Boston, MA

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http://dx.doi.org/10.2337/dc21-0213DOI Listing
June 2021

Dietary potato intake and risks of type 2 diabetes and gestational diabetes mellitus.

Clin Nutr 2021 Jun 1;40(6):3754-3764. Epub 2021 May 1.

School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China; Key Laboratory of Environment and Genes Related to Diseases (Xi'an Jiaotong University), Ministry of Education of China, Xi'an, China. Electronic address:

Background & Aims: Evidence regarding associations between potato consumption and type 2 diabetes (T2D) and gestational diabetes mellitus (GDM) risks is accumulating. This study aims to synthesize the evidence by conducting a meta-analysis of available studies.

Methods: PubMed, Web of Science, EMBASE and Cochrane Library were searched (up to August 2020) to retrieve all eligible studies on the associations of interest. The risk estimates with 95% confidence intervals (CIs) were summarized using random- or fixed-effects model based on heterogeneity. Meta-analyses were performed for East and West regions separately. Dose-response relationship was assessed using data from all intake categories in each study.

Results: A total of 19 studies (13 for T2D; 6 for GDM) were identified, including 21,357 T2D cases among 323,475 participants and 1516 GDM cases among 29,288 pregnancies. Meta-analysis detected a significantly positive association with T2D risk for total potato (RR: 1.19 [1.06, 1.34]), baked/boiled/mashed potato (RR: 1.08 [1.00, 1.16]), and French fries/fried potato (RR: 1.33 [1.03, 1.70]) intakes among Western populations. Dose-response meta-analysis demonstrated a significantly increased T2D risk by 10% (95% CI: 1.07, 1.14; P for trend<0.001), 2% (95% CI: 1.00, 1.04; P for trend = 0.02) and 34% (95% CI: 1.24, 1.46; P for trend<0.001) for each 80 g/day (serving) increment in total potato, unfried potato, and fried potato intakes, respectively. As for GDM, summarized estimates also suggested a higher though non-significant GDM risk for total potato (RR: 1.19 [0.89, 1.58]), and French fries/fried potato (RR: 1.03 [0.97, 1.09]) intakes in Western countries. In the dose-response meta-analysis, a significantly increased GDM risk was revealed for each daily serving (80 g) intakes of total potato (RR: 1.22; 95% CI: 1.06, 1.42; P for trend = 0.007) and unfried potato (RR: 1.26; 95% CI: 1.07, 1.48; P for trend = 0.006).

Conclusions: This study suggests that higher potato intake is associated with higher T2D risk among Western populations. The positive relationship presents a significant dose-response manner. Wisely controlled potato consumption may confer potential glucometabolic benefits.
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http://dx.doi.org/10.1016/j.clnu.2021.04.039DOI Listing
June 2021

The joint association of physical activity and fine particulate matter exposure with incident dementia in elderly Hong Kong residents.

Environ Int 2021 May 18;156:106645. Epub 2021 May 18.

School of Public Health, The University of Hong Kong, Hong Kong, China.

Objective: The evidence for the beneficial effects of physical activity (PA) and potentially detrimental effects of long-term exposure to fine particulate matter (PM) on neurodegeneration diseases is accumulating. However, their joint effects remain unclear. We evaluated joint associations of habitual PA and PM exposure with incident dementia in a longitudinal elderly cohort in Hong Kong.

Methods: A total of 57,775 elderly participants (≥65 years) without dementia were enrolled during 1998-2001 and followed up till 2011. Their information on PA and other relevant covariates were collected at baseline (1998-2001) by a standard self-administered questionnaire, including PA volumes (high, moderate, low, and inactive) and types (aerobic exercise, traditional Chinese exercise, stretching exercise, walking slowly, and no exercise). Their annual mean PM exposures at the residential address were estimated using a satellite-based spatiotemporal model. We then adopted the Cox proportional hazards model to examine the joint associations with the incidence of all-cause dementia, Alzheimer's diseases, and vascular dementia on additive and multiplicative scales.

Results: During the follow-up period, we identified 1,157 incident cases of dementia, including 642 cases of Alzheimer's disease and 324 cases of vascular dementia. A higher PA level was associated with a lower risk of incident all-cause dementia (hazard ratio (HR) for the high-PA volume was 0.59 (95% CI, 0.47, 0.75), as compared with the inactive-PA), whereas a high level of PM was related to the higher risk with an HR of 1.15 (95%CI: 1.00, 1.33) compared with the low-level of PM. No clear evidence was observed of interaction between habitual PA (volume and type) and PM inhalation to incident dementia on either additive or multiplicative scale.

Conclusion: Habitual PA and long-term PM exposure were oppositely related to incident dementia in the Hong Kong aged population. The benefits of PA remain in people irrespective of exposure to air pollution.
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http://dx.doi.org/10.1016/j.envint.2021.106645DOI Listing
May 2021

Estimating the Instantaneous Asymptomatic Proportion With a Simple Approach: Exemplified With the Publicly Available COVID-19 Surveillance Data in Hong Kong.

Front Public Health 2021 3;9:604455. Epub 2021 May 3.

Department of Applied Mathematics, Hong Kong Polytechnic University, Hong Kong, China.

The asymptomatic proportion is a critical epidemiological characteristic that modulates the pandemic potential of emerging respiratory virus, which may vary depending on the nature of the disease source, population characteristics, source-host interaction, and environmental factors. We developed a simple likelihood-based framework to estimate the instantaneous asymptomatic proportion of infectious diseases. Taking the COVID-19 epidemics in Hong Kong as a case study, we applied the estimation framework to estimate the reported asymptomatic proportion (rAP) using the publicly available surveillance data. We divided the time series of daily cases into four stages of epidemics in Hong Kong by examining the persistency of the epidemic and compared the rAPs of imported cases and local cases at different stages. As of July 31, 2020, there were two intermittent epidemics in Hong Kong. The first one was dominated by imported cases, accounting for 63.2% of the total cases, and the second one was dominated by local cases, accounting for 86.5% of the total cases. The rAP was estimated at 23.1% (95% CI: 10.8-39.7%) from January 23 to July 31, and the rAPs were estimated at 22.6% (95% CI: 11.1-38.9%) among local cases and 38.7% (95% CI: 9.0-72.0%) among imported cases. Our results showed that the rAPs of local cases were not significantly different between the two epidemics, but increased gradually during the first epidemic period. In contrast, the rAPs of imported cases in the latter epidemic period were significantly higher than that in the previous epidemic period. Hong Kong has a high rAP of imported COVID-19 cases and should continue to strengthen the detection and isolation of imported individuals to prevent the resurgence of the disease.
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http://dx.doi.org/10.3389/fpubh.2021.604455DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8126604PMC
May 2021

Attach importance of the bootstrap test against Student's test in clinical epidemiology: a demonstrative comparison using COVID-19 as an example.

Epidemiol Infect 2021 04 30;149:e107. Epub 2021 Apr 30.

JC School of Public Health and Primary Care, Chinese University of Hong Kong, Shatin, Hong Kong.

Student's t test is valid for statistical inference under the normality assumption or asymptotically. By contrast, although the bootstrap t test was proposed in 1993, it is seldom adopted in medical research. We aim to demonstrate that the bootstrap t test outperforms Student's t test under normality in data. Using random data samples from normal distributions, we evaluated the testing performance, in terms of true-positive rate (TPR) and false-positive rate and diagnostic abilities, in terms of the area under the curve (AUC), of the bootstrap t test and Student's t test. We explore the AUC of both tests with varying sample size and coefficient of variation. We compare the testing outcomes using the COVID-19 serial interval (SI) data in Shenzhen and Hong Kong, China, for demonstration. With fixed TPR, the bootstrap t test maintained the equivalent accuracy in TPR, but significantly improved the true-negative rate from the Student's t test. With varying TPR, the diagnostic ability of bootstrap t test outperformed or equivalently performed as Student's t test in terms of the AUC. The equivalent performances are possible but rarely occur in practice. We find that the bootstrap t test outperforms by successfully detecting the difference in COVID-19 SI, which is defined as the time interval between consecutive transmission generations, due to sex and non-pharmaceutical interventions against the Student's t test. We demonstrated that the bootstrap t test outperforms Student's t test, and it is recommended to replace Student's t test in medical data analysis regardless of sample size.
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http://dx.doi.org/10.1017/S0950268821001047DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8137228PMC
April 2021

The reproductive number of Lassa fever: a systematic review.

J Travel Med 2021 04;28(3)

School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China.

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http://dx.doi.org/10.1093/jtm/taab029DOI Listing
April 2021

Limited role for meteorological factors on the variability in COVID-19 incidence: A retrospective study of 102 Chinese cities.

PLoS Negl Trop Dis 2021 02 24;15(2):e0009056. Epub 2021 Feb 24.

Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China.

While many studies have focused on identifying the association between meteorological factors and the activity of COVID-19, we argue that the contribution of meteorological factors to a reduction of the risk of COVID-19 was minimal when the effects of control measures were taken into account. In this study, we assessed how much variability in COVID-19 activity is attributable to city-level socio-demographic characteristics, meteorological factors, and the control measures imposed. We obtained the daily incidence of COVID-19, city-level characteristics, and meteorological data from a total of 102 cities situated in 27 provinces/municipalities outside Hubei province in China from 1 January 2020 to 8 March 2020, which largely covers almost the first wave of the epidemic. Generalized linear mixed effect models were employed to examine the variance in the incidence of COVID-19 explained by different combinations of variables. According to the results, including the control measure effects in a model substantially raised the explained variance to 45%, which increased by >40% compared to the null model that did not include any covariates. On top of that, including temperature and relative humidity in the model could only result in < 1% increase in the explained variance even though the meteorological factors showed a statistically significant association with the incidence rate of COVID-19. In conclusion, we showed that very limited variability of the COVID-19 incidence was attributable to meteorological factors. Instead, the control measures could explain a larger proportion of variance.
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http://dx.doi.org/10.1371/journal.pntd.0009056DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7904227PMC
February 2021

Obesity and COVID-19 in Adult Patients With Diabetes.

Diabetes 2021 05 17;70(5):1061-1069. Epub 2021 Feb 17.

School of Nursing, Hong Kong Polytechnic University, Hong Kong Special Administrative Region, China

Obesity has caused wide concerns due to its high prevalence in patients with severe coronavirus disease 2019 (COVID-19). Coexistence of diabetes and obesity could cause an even higher risk of severe outcomes due to immunity dysfunction. We conducted a retrospective study in 1,637 adult patients who were admitted into an acute hospital in Wuhan, China. Propensity score-matched logistic regression was used to estimate the risks of severe pneumonia and requiring in-hospital oxygen therapy associated with obesity. After adjustment for age, sex, and comorbidities, obesity was significantly associated with higher odds of severe pneumonia (odds ratio [OR] 1.47 [95% CI 1.15-1.88]; = 0.002) and oxygen therapy (OR 1.40 [95% CI 1.10-1.79]; = 0.007). Higher ORs of severe pneumonia due to obesity were observed in men, older adults, and those with diabetes. Among patients with diabetes, overweight increased the odds of requiring in-hospital oxygen therapy by 0.68 times ( = 0.014) and obesity increased the odds by 1.06 times ( = 0.028). A linear dose-response curve between BMI and severe outcomes was observed in all patients, whereas a U-shaped curve was observed in those with diabetes. Our findings provide important evidence to support obesity as an independent risk factor for severe outcomes of COVID-19 infection in the early phase of the ongoing pandemic.
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http://dx.doi.org/10.2337/db20-0671DOI Listing
May 2021

Inferencing superspreading potential using zero-truncated negative binomial model: exemplification with COVID-19.

BMC Med Res Methodol 2021 02 10;21(1):30. Epub 2021 Feb 10.

JC School of Public Health and Primary Care, Chinese University of Hong Kong, Hong Kong, China.

Background: In infectious disease transmission dynamics, the high heterogeneity in individual infectiousness indicates that few index cases generate large numbers of secondary cases, which is commonly known as superspreading events. The heterogeneity in transmission can be measured by describing the distribution of the number of secondary cases as a negative binomial (NB) distribution with dispersion parameter, k. However, such inference framework usually neglects the under-ascertainment of sporadic cases, which are those without known epidemiological link and considered as independent clusters of size one, and this may potentially bias the estimates.

Methods: In this study, we adopt a zero-truncated likelihood-based framework to estimate k. We evaluate the estimation performance by using stochastic simulations, and compare it with the baseline non-truncated version. We exemplify the analytical framework with three contact tracing datasets of COVID-19.

Results: We demonstrate that the estimation bias exists when the under-ascertainment of index cases with 0 secondary case occurs, and the zero-truncated inference overcomes this problem and yields a less biased estimator of k. We find that the k of COVID-19 is inferred at 0.32 (95%CI: 0.15, 0.64), which appears slightly smaller than many previous estimates. We provide the simulation codes applying the inference framework in this study.

Conclusions: The zero-truncated framework is recommended for less biased transmission heterogeneity estimates. These findings highlight the importance of individual-specific case management strategies to mitigate COVID-19 pandemic by lowering the transmission risks of potential super-spreaders with priority.
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http://dx.doi.org/10.1186/s12874-021-01225-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7874987PMC
February 2021

Effect of ambient air pollution on tuberculosis risks and mortality in Shandong, China: a multi-city modeling study of the short- and long-term effects of pollutants.

Environ Sci Pollut Res Int 2021 Jun 30;28(22):27757-27768. Epub 2021 Jan 30.

Department of Respiratory and Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324 Jingwuweiqi Road, Jinan, 250021, Shandong, China.

Few studies conducted in China have assessed the effects of ambient air pollution exposure on tuberculosis (TB) risk and mortality, especially with a multicity setting. We evaluated the effect of short- and long-term ambient sulfur dioxide (SO), nitrogen dioxide (NO), carbon monoxide (CO), ozone (O), and particulate matter≤2.5 μm in aerodynamic diameter (PM) exposures on development and mortality of active TB in 7 Chinese cities in Shandong province from January 1, 2013, to December 31, 2017. We estimated the pollution-associated risk to new infection TB, recurrent TB, and mortality in relation to 1-μg/m increases in air pollutants using the penalized multivariate Poisson regression models. A total of 83,555 new infective TB and 3060 recurrent TB including 997 deaths were recorded. Short- and long-term exposures to outdoor air pollutants (SO, NO, CO, O, and PM) were significantly associated with new infection TB, recurrent TB risk, and mortality. The dominant positive effects of SO, NO, CO, and PM for new infection and recurrent TB risk were observed at long-term (>30 days) exposure, whereas the dominant effects of SO, CO, and PM for mortality were observed at short-term (≤30 days) exposures. Of the 5 air pollutants we assessed, SO and PM exhibited more consistent and strong associations with TB-related outcomes. We estimated an increase of 1.33% (95% CI 1.29%, 1.37%) and 3.04% (95% CI 2.98%, 3.11%) in new infection TB count for each 1-μg/m increase of SO at lag 0-180 days and PM at lag 0-365 days, respectively. This epidemiologic study in China shows that air pollution exposure is associated with increased risk of active TB development and mortality. The control of ambient air pollution may benefit the control and decrease the mortality of TB disease.
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http://dx.doi.org/10.1007/s11356-021-12621-6DOI Listing
June 2021

Trends of temperature variability: Which variability and what health implications?

Sci Total Environ 2021 May 6;768:144487. Epub 2021 Jan 6.

School of Physics, Peking University, Beijing, China.

A large majority of climate change studies carried out to date are on changes in mean climate, which have comparatively downplayed variability. In terms of trend analysis or forecast, the scientific output and common knowledge for global warming are much more robust than for changes in temperature variability. Quantification of temperature variability adds another dimension of temporal scale, requiring immense labor and presenting great uncertainty. Regardless, this endeavor is necessary since changes in ambient temperature variabilities could also contribute to current and future human health burden besides changes in mean quantities. Here, we review the current literature on trends of surface air temperature variability defined at a range of timescales, aiming to tease out the welter of evidence and thus improving the scientific recognition of changes in air temperature variability in the context of climate change. The findings of reviewed studies from numerous regions differ substantially over various temporal scales. In general, the ambient temperature variability on short time scales (e.g., diurnal or inter-day) shows a downward trend, while it is increasing on longer time scales (e.g., inter-annual). We then move beyond the review and deliver an extended discussion of potential implications for future research related to ambient temperature variability. We highlight the need to consider the methodological choices, especially timescales of interest, in the trend analysis as well as health impact studies. Continued research focusing on temperature variability at multiple timescales, with concerted efforts from scientists of all relevant stripes, is meaningful in synthesizing knowledge and reducing uncertainties surrounding air temperature variability.
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http://dx.doi.org/10.1016/j.scitotenv.2020.144487DOI Listing
May 2021

Long-term exposure to fine particulate matter and dementia incidence: A cohort study in Hong Kong.

Environ Pollut 2021 Feb 25;271:116303. Epub 2020 Dec 25.

School of Public Health, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China.

Recent studies suggested that long-term exposure to fine particulate matter (PM) was related to a higher risk of dementia incidence or hospitalizations in western populations, but the evidence is limited in Asian cities. Here we explored the link between long-term PM exposure and dementia incidence in the Hong Kong population and whether it varied by population sub-group. We utilized a Hong Kong Chinese cohort of 66,820 people aged ≥65 years who were voluntarily enrolled during 1998-2001 and were followed up to 2011. Prevalent dementia cases were excluded based on the face-to-face interview at baseline. We ascertained the first occurrence of hospitalization for all-cause dementia and major subtypes during the follow-up period. We assessed PM concentrations using a satellite data-based model with a 1 × 1 km resolution on the residential address. Cox proportional hazards models were adopted to estimate associations of annual mean PM exposure with dementia incidence, adjusting for potential confounders. We identified 1183 incident cases of all-cause dementia during the follow-up period, of which 655 (55.4%) were cases of Alzheimer's disease, and 334 (28.2%) were those of vascular dementia. We found a positive association between annual mean PM exposure and all-cause dementia incidence in the fully adjusted model. The estimated hazard ratio was 1.06 (95% confidence interval (CI): 1.00, 1.13) per every 3.8 μg/m increase in annual mean PM exposure. And the estimated HRs for Alzheimer's disease and vascular dementia were 1.03 (95% CI: 0.94, 1.12) and 1.09 (95% CI: 0.98, 1.22), respectively. We did not find effect modifications by age, sex, BMI, hypertension, diabetes, or heart disease on the associations. Results suggest that long-term exposure to PM is associated with a higher risk of dementia incidence in the Asian population.
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http://dx.doi.org/10.1016/j.envpol.2020.116303DOI Listing
February 2021

The changing patterns of COVID-19 transmissibility during the social unrest in the United States: A nationwide ecological study with a before-and-after comparison.

One Health 2021 Jun 1;12:100201. Epub 2020 Dec 1.

Department of Applied Mathematics, Hong Kong Polytechnic University, Hong Kong Special Administrative Region.

Nationwide mass social unrest has emerged in the US since May 25 and raised broad concerns about its impacts on the local COVID-19 epidemics. We compared the COVID-19 transmissibility between May 19-May 25 and May 29-June 4 for each state of the US. We found that social unrest is likely associated with the rebound of the COVID-19 transmissibility, which might raise difficulties in the pandemic control.
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http://dx.doi.org/10.1016/j.onehlt.2020.100201DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7704341PMC
June 2021

Outdoor light at night and risk of coronary heart disease among older adults: a prospective cohort study.

Eur Heart J 2021 02;42(8):822-830

Department of Environmental Health, Boston University School of Public Health, 715 Albany Street, Boston, MA 02118, USA.

Aims: We estimated the association between outdoor light at night at the residence and risk of coronary heart disease (CHD) within a prospective cohort of older adults in Hong Kong.

Methods And Results: Over a median of 11 years of follow-up, we identified 3772 incident CHD hospitalizations and 1695 CHD deaths. Annual levels of outdoor light at night at participants' residential addresses were estimated using time-varying satellite data for a composite of persistent night-time illumination at ∼1 km2 scale. We used Cox proportional hazards models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) of the association between outdoor light at night at the residence and risk of CHD. The association between light at night and incident CHD hospitalization and mortality exhibited a monotonic exposure-response function. An interquartile range (IQR) (60.0 nW/cm2/sr) increase in outdoor light at night was associated with an HR of 1.11 (95% CI: 1.03, 1.18) for CHD hospitalizations and 1.10 (95% CI: 1.00, 1.22) for CHD deaths after adjusting for both individual and area-level risk factors. The association did not vary across strata of hypothesized risk factors.

Conclusion: Among older adults, outdoor light at night at the residence was associated with a higher risk of CHD hospitalizations and deaths. We caution against causal interpretation of these novel findings. Future studies with more detailed information on exposure, individual adaptive behaviours, and potential mediators are warranted to further examine the relationship between light at night and CHD risk.
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http://dx.doi.org/10.1093/eurheartj/ehaa846DOI Listing
February 2021

Association of time to diagnosis with socioeconomic position and geographical accessibility to healthcare among symptomatic COVID-19 patients: A retrospective study in Hong Kong.

Health Place 2020 11 17;66:102465. Epub 2020 Oct 17.

JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China; Centre for Health Systems and Policy Research, The Chinese University of Hong Kong, China; CUHK Institute of Health Equity, The Chinese University of Hong Kong, Hong Kong, China. Electronic address:

Early diagnosis is important to control COVID-19 outbreaks. This study aimed to assess how individual and area socioeconomic position and geographical accessibility to healthcare services were associated with the time to diagnosis among symptomatic COVID-19 patients in Hong Kong. Multivariable generalized linear regression was used to estimate the associations while adjusting for sociodemographic characteristics and case classification. This study found living in public rental housing and living in an area with low education were associated with longer time to diagnosis in the first wave of infections. Specifically, the risk of delayed diagnosis for public rental housing residents was mitigated by the higher density of public clinics/hospitals but was slightly increased by the higher density of private medical practitioners nearby. No such relations were found in the second wave of infections when the surveillance measures were enhanced. Given the grave impact of pandemics around the world, our findings call on taking inequalities into account when public health policies are being devised.
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http://dx.doi.org/10.1016/j.healthplace.2020.102465DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7568172PMC
November 2020

Initial COVID-19 Transmissibility and Three Gaseous Air Pollutants (NO, SO, and CO): A Nationwide Ecological Study in China.

Front Med (Lausanne) 2020 24;7:575839. Epub 2020 Sep 24.

Department of Applied Mathematics, Hong Kong Polytechnic University, Hong Kong, China.

In this study, we conducted an ecological study to examine their effects in the early phase of the pandemic (from December 2019 to February 2020) in China. We found that the associations between the average concentrations of NO, SO, and CO and the COVID-19 transmissibility are not statistically clear.
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http://dx.doi.org/10.3389/fmed.2020.575839DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7541936PMC
September 2020

Source-Specific Volatile Organic Compounds and Emergency Hospital Admissions for Cardiorespiratory Diseases.

Int J Environ Res Public Health 2020 08 27;17(17). Epub 2020 Aug 27.

School of Public Health, The University of Hong Kong, Hong Kong, China.

Knowledge gaps remain regarding the cardiorespiratory impacts of ambient volatile organic compounds (VOCs) for the general population. This study identified contributing sources to ambient VOCs and estimated the short-term effects of VOC apportioned sources on daily emergency hospital admissions for cardiorespiratory diseases in Hong Kong from 2011 to 2014. We estimated VOC source contributions using fourteen organic chemicals by positive matrix factorization. Then, we examined the associations between the short-term exposure to VOC apportioned sources and emergency hospital admissions for cause-specific cardiorespiratory diseases using generalized additive models with polynomial distributed lag models while controlling for meteorological and co-pollutant confounders. We identified six VOC sources: gasoline emissions, liquefied petroleum gas (LPG) usage, aged VOCs, architectural paints, household products, and biogenic emissions. We found that increased emergency hospital admissions for chronic obstructive pulmonary disease were positively linked to ambient VOCs from gasoline emissions (excess risk (ER%): 2.1%; 95% CI: 0.9% to 3.4%), architectural paints (ER%: 1.5%; 95% CI: 0.2% to 2.9%), and household products (ER%: 1.5%; 95% CI: 0.2% to 2.8%), but negatively associated with biogenic VOCs (ER%: -6.6%; 95% CI: -10.4% to -2.5%). Increased congestive heart failure admissions were positively related to VOCs from architectural paints and household products in cold seasons. This study suggested that source-specific VOCs might trigger the exacerbation of cardiorespiratory diseases.
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http://dx.doi.org/10.3390/ijerph17176210DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7503811PMC
August 2020

Blood pressure control and adverse outcomes of COVID-19 infection in patients with concomitant hypertension in Wuhan, China.

Hypertens Res 2020 11 27;43(11):1267-1276. Epub 2020 Aug 27.

School of Nursing, Hong Kong Polytechnic University, Hong Kong, China.

Hypertension is a common comorbidity in hospitalized patients with COVID-19 infection. This study aimed to estimate the risks of adverse events associated with in-hospital blood pressure (BP) control and the effects of angiotensin II receptor blocker (ARB) prescription in COVID-19 patients with concomitant hypertension. In this retrospective cohort study, the anonymized medical records of COVID-19 patients were retrieved from an acute field hospital in Wuhan, China. Clinical data, drug prescriptions, and laboratory investigations were collected for individual patients with diagnosed hypertension on admission. Cox proportional hazards models were used to estimate the risks of adverse outcomes associated with BP control during the hospital stay. Of 803 hypertensive patients, 67 (8.3%) were admitted to the ICU, 30 (3.7%) had respiratory failure, 26 (3.2%) had heart failure, and 35 (4.8%) died. After adjustment for confounders, the significant predictors of heart failure were average systolic blood pressure (SBP) (hazard ratio (HR) per 10 mmHg 1.89, 95% confidence interval (CI): 1.15, 3.13) and pulse pressure (HR per 10 mmHg 2.71, 95% CI: 1.39, 5.29). The standard deviations of SBP and diastolic BP were independently associated with mortality and ICU admission. The risk estimates of poor BP control were comparable between patients receiving ARBs and those not receiving ARBs, with the only exception of a high risk of heart failure in the non-ARB group. Poor BP control was independently associated with higher risks of adverse outcomes of COVID-19. ARB drugs did not increase the risks of adverse events in hypertensive patients.
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http://dx.doi.org/10.1038/s41440-020-00541-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7450040PMC
November 2020

The ambient ozone and COVID-19 transmissibility in China: A data-driven ecological study of 154 cities.

J Infect 2020 09 8;81(3):e9-e11. Epub 2020 Jul 8.

Department of Applied Mathematics, Hong Kong Polytechnic University, Hong Kong Special Administrative Region, China. Electronic address:

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http://dx.doi.org/10.1016/j.jinf.2020.07.011DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7342057PMC
September 2020

A re-analysis in exploring the association between temperature and COVID-19 transmissibility: an ecological study with 154 Chinese cities.

Eur Respir J 2020 08 27;56(2). Epub 2020 Aug 27.

Dept of Applied Mathematics, Hong Kong Polytechnic University, Hong Kong Special Administrative Region, China

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http://dx.doi.org/10.1183/13993003.01253-2020DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7338403PMC
August 2020

Modelling the Measles Outbreak at Hong Kong International Airport in 2019: A Data-Driven Analysis on the Effects of Timely Reporting and Public Awareness.

Infect Drug Resist 2020 17;13:1851-1861. Epub 2020 Jun 17.

Division of Biostatistics, JC School of Public Health and Primary Care, Chinese University of Hong Kong, Hong Kong, People's Republic of China.

Background: Measles, a highly contagious disease, still poses a huge burden worldwide. Lately, a trend of resurgence threatened the developed countries. A measles outbreak occurred in the Hong Kong International Airport (HKIA) between March and April 2019, which infected 29 airport staff. During the outbreak, multiple measures were taken including daily situation updates, setting up a public enquiry platform on March 23, and an emergent vaccination program targeting unprotected staff. The outbreak was put out promptly. The effectiveness of these measures was unclear.

Methods: We quantified the transmissibility of outbreak in HKIA by the effective reproduction number, (), and basic reproduction number, (). The reproduction number was modelled as a function of its determinants that were statistically examined, including lags in hospitalization, situation update, and level of public awareness. Then, we considered a hypothetical no-measure scenario when improvements in reporting and public enquiry were absent and calculated the number of infected airport staff.

Results: Our estimated average is 10.09 (95% CI: 1.73-36.50). We found that () was positively associated with lags in hospitalization and situation update, while negatively associated with the level of public awareness. The average predicted basic reproduction number, , was 14.67 (95% CI: 9.01-45.32) under the no-measure scenario, which increased the average by 77.57% (95% CI: 1.71-111.15). The total number of infected staff would be 179 (IQR: 90-339, 95% CI: 23-821), namely the measure induced 8.42-fold (95% CI: 0.21-42.21) reduction in the total number of infected staff.

Conclusion: Timely reporting on outbreak situation and public awareness measured by the number of public enquiries helped to control the outbreak.
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http://dx.doi.org/10.2147/IDR.S258035DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7308762PMC
June 2020

Quantifying the improvement in confirmation efficiency of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during the early phase of the outbreak in Hong Kong in 2020.

Int J Infect Dis 2020 Jul 8;96:284-287. Epub 2020 May 8.

JC School of Public Health and Primary Care, Chinese University of Hong Kong, Hong Kong, China; Shenzhen Research Institute of Chinese University of Hong Kong, Shenzhen, China. Electronic address:

Backgrounds: The emerging virus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), caused a large outbreak of coronavirus disease, COVID-19, in Wuhan, China, since December 2019. COVID-19 soon spread to other regions of China and overseas. In Hong Kong, local mitigation measures were implemented since the first imported case was confirmed on January 23, 2020. Here we evaluated the temporal variation of detection delay from symptoms onset to laboratory confirmation of SARS-CoV-2 in Hong Kong.

Methods: A regression model is adopted to quantify the association between the SARS-CoV-2 detection delay and calendar time. The association is tested and further validated by a Cox proportional hazard model.

Findings: The estimated median detection delay was 9.5 days (95%CI: 6.5-11.5) in the second half of January, reduced to 6.0 days (95%CI: 5.5-9.5) in the first half of February 2020. We estimate that SARS-CoV-2 detection efficiency improved at a daily rate of 5.40% (95%CI: 2.54-8.33) in Hong Kong.

Conclusions: The detection efficiency of SARS-CoV-2 was likely being improved substantially in Hong Kong since the first imported case was detected. Sustaining enforcement in timely detection and other effective control measures are recommended to prevent the SARS-CoV-2 infection.
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http://dx.doi.org/10.1016/j.ijid.2020.05.015DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7207138PMC
July 2020

Indoor Environmental Factors and Acute Respiratory Illness in a Prospective Cohort of Community-Dwelling Older Adults.

J Infect Dis 2020 08;222(6):967-978

School of Nursing, the Hong Kong Polytechnic University, Hong Kong Special Administrative Region, People's Republic of China.

Background: Ambient environmental factors have been associated with respiratory infections in ecological studies, but few studies have explored the impact of indoor environmental factors in detail. The current study aimed to investigate the impact of indoor environment on the risk of acute respiratory illness (ARI) in a subtropical city.

Method: A prospective cohort study was conducted in 285 community-dwelling older adults from December 2016 through May 2019. Individual household indoor environment data and ARI incidence were continuously collected. A time-stratified case-crossover analysis was conducted to estimate the excess risk of ARI associated with per-unit increase of daily mean indoor temperature, relative humidity, and absolute humidity (AH).

Result: In total, 168 episodes of ARI were reported with an average risk of 36.8% per year. We observed a negative association of ARI with indoor AH up to 5 lag days in cool seasons, with a 6-day cumulative excess risk estimate of -9.0% (95% confidence interval, -15.9% to -1.5%). Negative associations between household temperature or relative humidity and ARI were less consistent across warm and cool seasons.

Conclusions: Lower indoor AH in household was associated with a higher risk of ARI in the community-dwelling older adults in Hong Kong during cold seasons.
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http://dx.doi.org/10.1093/infdis/jiaa188DOI Listing
August 2020

Modelling the effective reproduction number of vector-borne diseases: the yellow fever outbreak in Luanda, Angola 2015-2016 as an example.

PeerJ 2020 27;8:e8601. Epub 2020 Feb 27.

School of Nursing, Hong Kong Polytechnic University, Hong Kong, China.

The burden of vector-borne diseases (Dengue, Zika virus, yellow fever, etc.) gradually increased in the past decade across the globe. Mathematical modelling on infectious diseases helps to study the transmission dynamics of the pathogens. Theoretically, the diseases can be controlled and eventually eradicated by maintaining the effective reproduction number, ( ), strictly less than 1. We established a vector-host compartmental model, and derived ( ) for vector-borne diseases. The analytic form of the ( ) was found to be the product of the basic reproduction number and the geometric average of the susceptibilities of the host and vector populations. The ( ) formula was demonstrated to be consistent with the estimates of the 2015-2016 yellow fever outbreak in Luanda, and distinguished the second minor epidemic wave. For those using the compartmental model to study the vector-borne infectious disease epidemics, we further remark that it is important to be aware of whether one or two generations is considered for the transition "from host to vector to host" in reproduction number calculation.
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http://dx.doi.org/10.7717/peerj.8601DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7049463PMC
February 2020

Attach importance to the procedure of deriving reproduction numbers from compartmental models: Letter to the editor in response to ''.

Epidemiol Infect 2020 03 2;148:e62. Epub 2020 Mar 2.

Clinical Research Centre, Zhujiang Hospital, Southern Medical University, Guangzhou, China.

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http://dx.doi.org/10.1017/S0950268820000588DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7118356PMC
March 2020

The basic reproduction number of novel coronavirus (2019-nCoV) estimation based on exponential growth in the early outbreak in China from 2019 to 2020: A reply to Dhungana.

Int J Infect Dis 2020 05 20;94:148-150. Epub 2020 Feb 20.

JC School of Public Health and Primary Care, Chinese University of Hong Kong, Hong Kong, China; Shenzhen Research Institute of Chinese University of Hong Kong, Shenzhen, China. Electronic address:

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http://dx.doi.org/10.1016/j.ijid.2020.02.025DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7130104PMC
May 2020