Background:The cancer burden in the United States of America (USA) has decreased gradually. However, China is experiencing a transition in its cancer profiles, with greater incidence of cancers that were previously more common in the USA. This study compared the latest cancer profiles, trends, and determinants between China and USA.Methods:This was a comparative study using open-source data. Cancer cases and deaths in 2022 were calculated using cancer estimates from GLOBOCAN 2020 and population estimates from the United Nations. Trends in cancer incidence and mortality rates in the USA used data from the Surveillance, Epidemiology, and End Results program and National Center for Health Statistics. Chinese data were obtained from cancer registry reports. Data from the Global Burden of Disease 2019 and a decomposition method were used to express cancer deaths as the product of four determinant factors.Results:In 2022, there will be approximately 4,820,000 and 2,370,000 new cancer cases, and 3,210,000 and 640,000 cancer deaths in China and the USA, respectively. The most common cancers are lung cancer in China and breast cancer in the USA, and lung cancer is the leading cause of cancer death in both. Age-standardized incidence and mortality rates for lung cancer and colorectal cancer in the USA have decreased significantly recently, but rates of liver cancer have increased slightly. Rates of stomach, liver, and esophageal cancer decreased gradually in China, but rates have increased for colorectal cancer in the whole population, prostate cancer in men, and other seven cancer types in women. Increases in adult population size and population aging were major determinants for incremental cancer deaths, and case-fatality rates contributed to reduced cancer deaths in both countries.Conclusions:The decreasing cancer burden in liver, stomach, and esophagus, and increasing burden in lung, colorectum, breast, and prostate, mean that cancer profiles in China and the USA are converging. Population aging is a growing determinant of incremental cancer burden. Progress in cancer prevention and care in the USA, and measures to actively respond to population aging, may help China to reduce the cancer burden.

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Highlights• Higher folate and lower vitamin B 12 levels were associated with higher glucose and a higher risk of gestational diabetes mellitus (GDM). • The association between folate and vitamin B 12 imbalance and GDM risk can be further modified by maternal risk factors. Abstract Background: This study examined whether folate and vitamin B 12 imbalance is associated with gestational diabetes mellitus (GDM) and explored interactions between B vitamin imbalance and maternal risk factors for GDM. Methods: A cross-sectional study was performed in 406 Chinese pregnant women. Serum folate, vitamin B 12 , and blood glucose concentrations were measured at 24 to 28 weeks gestation during GDM screening. A diagnosis of GDM was made based on International Association of Diabetes and Pregnancy Study Groups criteria (fasting plasma glucose [FPG] ≥5.1 mM, 1-hour plasma glucose ≥10.0 mM, or 2-hour plasma glucose ≥8.5 mM). Binary logistic regression was used to obtain odds ratios (ORs) after controlling for different confounders. Results: Higher folate levels were associated with higher glucose concentrations and a higher risk of GDM (OR 1.98; 95% confidence interval [CI] 1.00-3.90), whereas higher vitamin B 12 levels were associated with lower FPG and a lower risk of GDM (OR 0.30; 95% CI 0.15-0.60). A higher folate: vitamin B 12 ratio was associated with higher glucose and a higher risk of GDM (OR 3.08; 95% CI 1.63-5.83). The presence of both a higher folate: vitamin B 12 ratio and advanced age further increased the OR to 2.13 (95% CI 1.09-4.15) with a significant additive interaction. Furthermore, a higher folate: vitamin B 12 ratio and a higher prepregnancy body mass index (pp-BMI) were synergistically associated with an increased risk of GDM (OR 3.03; 95% CI 1.40-6.57). Conclusions: An imbalance between folate and vitamin B 12 , represented by a higher folate: vitamin B 12 ratio, was highly associated with GDM risk, and this association could be further modified by maternal age and pp-BMI. K E Y W O R D S folate, gestational diabetes mellitus, pregnancy, synergistic effect, vitamin B 12

Cancer has become the most common cause of death in China. Owing to rapid economic development, improved livelihood, and shifts in risk factors, cancer epidemiology has experienced substantial changes during the past several decades. In this review, we aim to describe the current cancer epidemiology of the main types of cancer in China, report major risk factors associated with cancer development, and summarize the contributions of the Chinese government to controlling the cancer burden. A total of 4,064,000 new cases were diagnosed in China in 2016. The most frequent types are lung cancer (828,100; 20.4%), colorectal cancer (408,000; 10.0%), and gastric cancer (396,500; 9.8%). Lung (657,000; 27.2%), liver (336,400, 13.9%), and stomach (288,500; 12.0%) cancers are the 3 most deadly cancers in the general population. The 5-year survival rate for cancer has dramatically increased in recent decades. However, liver and particularly pancreatic cancers still have the poorest prognosis. The main modifiable risk factors associated with cancer development include infectious agents, smoking, alcohol consumption, obesity, unhealthful dietary habits, and inadequate physical activity. The Chinese government has made unremitting efforts to decrease the cancer burden, including cancer education and investment in cancer screening programs.

Objective Population-level economic burden is essential for prioritizing healthcare resources and healthcare budget making in the future. However, little is known about the economic burden of lung cancer in China. Methods A prevalence-based approach was adopted to estimate the economic burden of lung cancer, including direct expenditure (medical and non-medical) and indirect cost (disability and premature death). Data on direct expenditure and work-loss days per patient in each year post-diagnosis were obtained from two primary surveys. Other parameters were obtained from literatures and official reports. Projections were conducted based on varying parameters. All expenditure data were reported in United States dollars (USD) using 2017 value (exchange rate: 1 USD= 6.760 CNY), with the discount rate of 3%. Results The total economic burden of lung cancer was estimated to be 25,069 million USD in China in 2017 (0.121% of gross domestic productivity, GDP). The estimated direct expenditure was 11,098 million USD, up to 1.43% of total healthcare expenditure for China, covering 10,303 million USD and 795 million USD for medical and non-medical expenditure, respectively. The estimated indirect cost was 13,971 million, including 1,517 million USD due to disability and 12,454 million USD due to premature death. Under current assumptions, the projected total economic burden would increase to 30.1 billion USD, 40.4 billion USD, and 53.4 billion USD in 2020, 2025, and 2030, accounting for 0.121%, 0.131%, and 0.146% of China’s GDP, respectively. However, if China meets the United Nation sustainable development goal of reducing premature death from non-communicable diseases by one-third by 2030, the total economic burden in 2030 would be 31.9 billion USD, 0.087% of China’s GDP. Conclusions The economic burden of lung cancer in China in 2017 is substantial and more likely to increase significantly in the future. Policy makers need to take urgent actions in budget making for health systems. The economic burden could be alleviated by reducing the disease burden of lung cancer via effective control and prevention actions.

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Impaired heart function is the main reason for increased mortality of diabetes mellitus. Development of drugs with cardioprotective effects against diabetic myocardiopathy would benefit patients with diabetes. In this study, we tested the cardioprotective effects of Daming capsule (DMC), a traditional Chinese formula, on heart function in streptozocin (STZ)-induced diabetic rats with high fat-diet (HFD). DMC 100 mg/kg/d markedly decreased fasting blood glucose (FBG) and total cholesterol (TC), but did not affect triglycerides (TG) in diabetic rats at 30 d. The decreased heart rate (HR) and prolonged QT and PR interval induced by diabetes mellitus were significantly reversed by DMC (pϽ0.05). The mechanism may involve that DMC attenuated L-type calcium channel a a 1c subunit increasing and Kv4.2 decreasing at both mRNA and protein level in diabetic rats. Additionally, DMC could obviously ameliorate the impaired heart function of diabetic rats by decreasing elevated left ventricular end-diastolic pressure (LVEDP) and increasing the attenuated maximum change velocity of left ventricular pressure in the isovolumic contraction or relaxation period (؎dp/dt max ). Transmission electron microscopy (TEM) results showed that myocardium injury was attenuated by DMC (100 mg/kg/d) in STZ-induced diabetic rats with HFD. In conclusion, DMC could recover the prolonged QT interval and PR interval and elevated diastolic and systolic function of diabetic heart. This protective effect may partially be mediated through affecting the mRNA and protein expression of Kv4.2 and a a 1c as well as preventing cardiomyocyte morphological remodeling.

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