Objective: To investigate the trend in incidence and change in age at onset of malignant tumor in cancer registration areas of Jiangsu Province from 2009 to 2021, so as to provide the evidence for formulating cancer prevention and control strategies and optimizing the allocation of healthcare resources. Methods: Incidence data of malignant tumor cases from 2009 to 2021 were collected from the aggregated database of 16 qualified cancer registries of Jiangsu Province. The crude incidence, age-specific incidence, average age at onset, proportion of age-specific incidence, and proportion of incidence in cases aged ≥60 years were calculated by genders and urban/rural areas, and age-standardized using the Segi's world standard population. The trend in incidence of malignant tumor from 2009 to 2021 was evaluated using average annual percent change (AAPC). The trend in average age at onset of malignant tumor from 2009 to 2021 was evaluated using the linear regression model. Results: From 2009 to 2021, a total of 703 185 cases of malignant tumor were reported in Jiangsu Province, comprising 400 970 males and 302 215 females. The crude incidence of malignant tumor increased from 268.26/100 000 in 2009 to 380.97/100 000 in 2021 (AAPC=2.880%, P<0.05). From 2009 to 2021, the world population-standardized incidence of malignant tumor showed upward trends in the total population, females, and urban and rural areas (AAPC=0.635%, 2.332%, 0.795%, and 0.385%, all P<0.05), while a downward trend was observed in males (AAPC=-0.608%, P<0.05). From 2009 to 2021, the crude incidence of malignant tumor in the groups aged 0-<30 years, 30-<40 years, 40-<50 years, 60-<70 years, and ≥80 years showed upward trends (AAPC=3.160%, 4.462%, 1.295%, 0.569%, and 1.496%, all P<0.05), a downward trend was found in the group aged 50-<60 years (AAPC=-0.860%, P<0.05), while no statistically significant trend was observed in the group aged 70-<80 years (P>0.05). The world population-standardized average age at onset showed downward trends in the total population, females, and urban areas, with average annual decreases of 0.085, 0.223, and 0.136 years, respectively (all P<0.05). Conversely, an upward trend was observed in males, with an average annual increase of 0.081 years (P<0.05). No statistically significant trend was found in rural areas (P>0.05). Compared with 2009, the proportion of malignant tumor incidence cases increased in all age groups between 20-<50 years in 2021. Additionally, the proportion of malignant tumor cases aged over 60 years showed a downward trend from 2009 to 2021 (AAPC=-0.322%, P<0.05). Conclusions From 2009 to 2021, the overall incidence of malignant tumor in registration areas of Jiangsu Province showed an upward trend, with the age at onset tending to become younger. There were differences in the incidence trends across genders and urban/rural areas.

Objective To construct 5 machine-learning models and compare their performance in predicting the associations between pre-pregnancy socio-psycho-behavioral exposures of both spouses and preconception outcomes.Methods Based on Chongqing Preconception Reproductive Health and Birth Outcome Cohort of volunteers recruited from Chongqing Health Center for Women and Children during January 2019 and March 2022,5 447 couples were recruited and surveyed through interviewer-interview for the demographic and social-psychological-behavioral data of both spouses(221 variables).According to the inclusion and exclusion criteria,4 097 couples were finally included,and randomly assigned into a training set(n=2 867 spouses)and a validation set(n=1 230 spouses)at a ratio of 7∶3.Feature analysis and collinear screening were applied to select the potential exposure factors.In consideration of difficulty to carry out semen parameters analysis in primary healthcare institutions,feature Set 1 including sperm parameters and feature Set 2 excluding semen parameters were constructed by including or excluding sperm quality simultaneously in the training set and the validation set.Five algorithms,that is,Logistic Regression,Naive Bayes,Random Forest,Gradient Boosting Machine,and Support Vector Machine,were used to construct preconception outcome prediction models,and the parameters of each model were optimized using random search combined with grid search.The predictive performance of each model was compared using precision,recall,F1 score,area under the receiver operating characteristic curve(AUC),and calibration curve.The optimal model was then selected by comparing the changes in the predictive ability of the questionnaire data for fertility outcomes with or without semen parameters.Results There were 24 variables screened out in feature Set 1,and 16 variables in feature Set 2.In feature Set 1,the gradient boosting machine performed better,with a relatively higher AUC value(0.651)and better F1 score(0.61).The logistic regression model performed stably(AUC value=0.647)and was suitable as the reference model.The random forest(AUC value=0.641),Naive Bayes(AUC value=0.641),and support vector machine(AUC value=0.634)performed second-best.By utilizing the gradient boosting machine,comparable results were found between the predictions from feature sets with or without semen parameters,as in feature Set 1,the AUC value of its validation set was 0.651(95%CI:0.629～0.681),the prediction accuracy was 0.63,the recall rate was 0.65,and the average precision value F1 was 0.61;and in feature Set 2,the AUC value of its validation set was 0.649(95%CI:0.624～0.663),and both the calibration curves were close to the ideal curve.The prediction results indicated that in feature Set 1,the features highly negatively correlated with preconception outcomes were female age,male age,and no pregnancy within 1 year without contraception,while the features highly positively correlated with preconception outcomes were female pregnancy history,total sperm vitality,and use of contraceptive measures before enrollment.Conclusion Among the 5 machine-learning algorithms performed in this cohort data,the gradient boosting machine shows slightly better performance.There are 24 factors being associated with preconception outcomes in both spouses,and the performance of the simplified model excluding semen parameters is not significantly declined.It is feasible to use machine-learning methods to predict human preconception outcomes through social-psychological-behavioral questionnaires.

Objective To analyze the changing trends of the incidence and onset age of cervical cancer in Jiangsu Province by using cancer registration data from 2009 to 2019. Methods The information of national cancer registries with continuous data from 2009 to 2019 was selected, and the quality control indices of cancer registration must be up to standards. A total of 16 registries were included in this study. Statistical analysis indicators include the crude incidence rate of cervical cancer, age-standardized incidence rate, actual average onset age, age-standardized average onset age, and average annual percentage change (AAPC). A birth cohort model was constructed to analyze the incidence of cervical cancer among women born from 2009 to 2019 and its incidence trend. Results From 2009 to 2019, the crude and age-standardized incidence rates of cervical cancer among women in Jiangsu Province showed upward trends, with AAPCs of 5.62% (95%CI: 3.47−7.82) and 4.14% (95%CI: 2.06−6.27), respectively. The incidence rate of cervical cancer in rural areas (AAPC=4.46, 95%CI: 1.13−7.91) increased more than that in urban areas (AAPC=3.83, 95%CI: 2.81−4.86). The actual average onset age of cervical cancer increased from 51.53 years in 2009 to 55.07 years in 2019 (β=0.36, P<0.05). The age-standardized average onset age increased from 48.89 years in 2009 to 50.43 years in 2019 (β=0.21, P<0.05). The age composition ratios of cervical cancer in the age group of 60 years and older were 31.90% in 2019 and 22.40% in 2009 (β=3.66, P<0.05). The incidence of cervical cancer in the same age group of people with different birth years showed an upward trend with the increase in birth year. Conclusion From 2009 to 2019, the incidence rate of cervical cancer in Jiangsu Province showed an upward trend, and this trend was more obvious in rural areas than in urban areas. In addition, the average onset age of cervical cancer showed an upward trend.

Objective:To investigate the common viral pathogen spectrum of acute respiratory infection (ARI) cases in Changshu city.Methods:Nasopharyngeal swab samples from outpatients and inpatients in five sentinel hospitals in Changshu city from January 2022 to October 2023 were collected. Real-time fluorescent quantitative polymerase chain reaction was used to detect the nucleic acids of influenza virus (Flu) and respiratory syncytial virus (RSV), adenovirus (AdV), human rhinovirus (HRV), human parainfluenza virus (HPIV), enterovirus (EV), human coronavirus (HCoV), human metapneumovirus (HMPV), and human bocavirus (HBoV).Results:Of the 1 936 ARI cases, 18.1% (350/1 936) were tested positive for viral nucleic acid. Flu had the highest detection rate (7.1%), followed by HBoV (3.7%), AdV (1.9%) and RSV (1.6%). The virus detection rate was significantly different among different age groups and seasons. In March 2023, the total virus detection rate was the highest (47.6%), mainly Flu. Flu showed unimodal prevalence in spring and winter. The prevalence trend of HBoV and HCoV was consistent, and the detection rate of HBoV (5.43%) was higher than that of HCoV (2.45%), both of which peaked in summer. RSV prevalence peaks in autumn (4.5%). The detection rate of children aged 0-5 years was the highest, reaching 33.3%.Conclusions:The main ARI pathogens in Changshu city from 2022 to 2023 were Flu, HBoV, AdV and RSV.

[Purpose]To analyze the trend of gastric cancer incidence and age characteristics in Jiangsu cancer registration areas from 2009 to 2019.[Methods]Cancer registration data from 2009 to 2019 meeting quality control requirements were collected from 16 cancer registries in Jiangsu Province.The crude incidence rate and age-standardized incidence rate by Chinese standard population in 2000(ASIRC)were calculated by gender,urban/rural areas and age groups.The inci-dence trends were analyzed by Joinpoint.A birth cohort model was constructed to calculate the in-cidence rate of gastric cancer for men and women born between 1929 and 2019.The age composi-tion of gastric cancer incidence in Jiangsu Province between 2009 and 2019 was calculated and compared.[Results]The crude incidence rate and ASIRC of gastric cancer in Jiangsu cancer regi-stration areas from 2009 to 2019 showed a significant decreasing trend in both male and female or urban and rural areas,in which the decrease in male(AAPC=-1.28％,P＜0.001)was higher than that of female(AAPC=-1.17％,P=0.030),and the decrease in urban(AAPC=-1.66％,P＜0.001)was higher than that of rural(AAPC=-0.72％,P＜0.001).The incidence rates of gastric cancer in age groups of 40～79 years old showed a significant decreasing trend from 2009 to 2019 with the AAPC ranging from-6.75％to-3.54％(all P＜0.05).In age groups of 40～79 years old,the inci-dence rates of gastric cancer among people with different years of birth showed a decreasing trend with the increase of the birth year.For ASIRC,the composition of patients aged 60 years old above increased by 0.63％(95％CI:0.46％～0.81％)per year from 2009 to 2019.[Conclusion]The inci-dence rate of gastric cancer in cancer registration areas of Jiangsu Province from 2009 to 2019 showed a decreasing trend,the average age of incidence showed a trend of backward moving,and for age-standardized incidence the proportion of patients over 60 years old was increased.

[Purpose]To investigate the trends of incidence and age at onset of female breast can-cer in Jiangsu cancer registration areas from 2009 to 2019.[Methods]The continuous monitoring data of female breast cancer from 2009 to 2019 were collected from 16 cancer registries in Jiangsu Province.All datasets were checked and evaluated based on data quality control criteria and were included in the analysis.Crude rate(CR),age-standardized incidence rate by Chinese standard population(ASIRC),the average annual percentage change(AAPC),crude and adjusted mean age at onset were calculated.Incidence rates stratified by regions and age groups were calculated.Age-period-cohort model was used to analyze the changes of cancer incidence and age-adjusted mean ages.[Results]The incidence CR of female breast cancer was significantly increased from 24.39/105 in 2009 to 46.72/105 in 2019 with an AAPC in CR of 6.97％(95％CI:5.26％～8.70％)and AAPC in ASIRC of 4.67％(95％CI:3.00％～6.37％).The crude mean age and adjusted mean age at onset increased from 54.10 and 52.89 years old in 2009 to 56.23 and 53.36 years old in 2019,respectively.Crude mean age at onset increased significantly over time in all registry areas(β=0.21,P＜0.001),urban(β=0.1 8,P＜0.001)and rural(β=0.25,P＜0.001)areas,while adjusted mean age at onset remained stable in all registry areas(β=0.05,P=0.024)and rural areas(β=0.09,P=0.008).From 2009 to 2019,the incidence rate of female breast cancer of all age groups showed upward trends,with an average annual growth rate of 3.26％to 7.79％(all P＜0.05),and the incidence rate in rural areas increased faster than that in urban areas.The age composition of breast cancer onset and standardized age composition of onset in women over 60 years old showed an upward trend(all P＜0.05).[Conclusion]The incidence rate of female breast cancer in Jiangsu Province in-creased from 2009 to 2019,and the mean age of onset showed a backward trend.

[Purpose]To investigate the trends of incidence and age at onset of uterine corpus can-cer in Jiangsu cancer registration areas from 2009 to 2019.[Methods]The continuous monitoring data of uterine corpus cancer from 2009 to 2019 were collected from 16 cancer registries in Jiang-su Province.The crude incidence rate,the age-standardized incidence rate by Chinese standard population(ASIRC),crude and adjusted mean age,and standardized age-specific incidence composition were calculated.The average annual percentage change(AAPC)were analyzed by the Joinpoint regression model.The linear regression model was used to analyze the relationship be-tween mean age at onset and year.The standardized age-specific incidence composition in 2009 and 2019 were compared.[Results]The ASIRC of uterine corpus cancer in all registration areas and in rural areas of Jiangsu Province showed upward trends with AAPC of 1.78％and 2.38％,re-spectively(P＜0.05),but not showed in the urban areas(AAPC=1.30％,P＞0.05).The crude mean age at onset increased from 56.48 years old in 2009 to 58.26 years old in 2019 with an average annual growth of 0.173 years old(P=0.001).After the population structure standardized,the trends disappeared in all registration areas.[Conclusion]From 2009 to 2019,the standardized incidence rates of uterine corpus cancer were on rise in Jiangsu cancer registration areas,especially in the age group of 50 to 59 years old.

[Purpose]To analyze the trend of bladder cancer incidence and age at diagnosis in can-cer registration areas of Jiangsu Province from 2009 to 2019.[Methods]The data of bladder can-cer incidence from 2009 to 2019 were collected from 16 cancer registries in Jiangsu Province,and quality control indicators of the data were evaluated.The crude rate(CR)of incidence,age-standar-dized incidence rate by Segi world standard population(ASIRW),age-specific incidence rate,mean age at diagnosis,mean standardized age at diagnosis,and age-specific incidence composi-tion ratio were calculated.Incidence trends were analyzed using Joinpoint software and the average annual percentage change(AAPC)was calculated.Birth cohort models were constructed and can-cer incidence rates were calculated for people born from 1929 to 2019 and the incidence trends were analyzed.The linear regression models were used to analyze the relationship of average age at onset,standardized average age of onset with year of onset.[Results]The CR of bladder cancer in Jiangsu Province increased from 4.27/105 in 2009 to 7.04/105 in 2019.The CR and ASIRW showed upward trends(CR:AAPC=4.62％,ASIRW:AAPC=1.92％,both P＜0.001).Sex-specific analysis showed that the incidence rate was higher in male(AAPC=5.32％)than that in female(AAPC=1.98％).Birth cohort results indicated a significant upward trend in incidence rates among age groups of 60 years old above,and the fastest increase was in those aged 80 years old and above(AAPC=3.27％,P=0.007).From 2009 to 2019,the average age of bladder cancer onset in Jiangsu Province showed a significant rising trend,increasing by an average of 0.17 years old annually,but the standardized average age of onset showed no significant change after adjusting for age structure.[Conclusion]The incidence rate of bladder cancer showed an increasing trend from 2009 to 2019 in Jiangsu Province,with a significantly higher incidence rate in male than that in female.

[Purpose]To analyze the incidence trend and age at diagnosis of thyroid cancer in can-cer registration areas of Jiangsu Province from 2009 to 2019.[Methods]The continuous and com-plete cancer data from 2009 to 2019 meeting quality control requirements were collected from 16 registries in Jiangsu Province.Thyroid cancer was coded as C73 according to ICD-10.The crude incidence rate,age-standardized incidence rate by Chinese standard population(ASIRC),the mean diagnostic age and adjusted mean diagnostic age of thyroid cancer were calculated by sex,age groups and regions.The trends of above indicators were analyzed and the average annual per-centage change(AAPC)was calculated.[Results]The crude incidence rate and ASIRC of thyroid cancer for men in Jiangsu cancer registration areas in 2009 and 2019 were 1.25/105,1.00/105 and 7.32/105,6.48/105,respectively.For women those were 3.64/105,3.06/105 and 24.91/105,20.94/105,respectively.The AAPC of crude incidence rate and ASIRC of thyroid cancer from 2009 to 2019 were 22.05％(95％CI:19.70％～24.45％)and 22.55％(95％CI:20.06％～25.08％),respectively.The adjusted mean diagnostic age of thyroid cancer declined from 46.27 years old in 2009 to 43.03 years old in 2019(β=-0.243,P＜0.001).[Conclusion]The incidence rate of thyroid cancer showed an increasing trend in cancer registration areas of Jiangsu Province from 2009 to 2019,while the diagnostic age showed a downward trend during the same period.

[Purpose]To analyze the trend of incidence and mean age at diagnosis of lymphoma in cancer registration areas of Jiangsu Province from 2009 to 2019.[Methods]Continuous and com-pleted data of cancer incidence from 2009 to 2019 were collected from 16 cancer registries in Jiangsu Province,and all indicators meeting the requirements.Joinpoint 4.7.0.0 software was used to analyze the trend of lymphoma incidence,the average annual percentage change(AAPC)and 95％confidence interval(CI)were calculated.A birth cohort was built from 1929 to 2019,to ana-lyze the change trend of lymphoma incidence rate among people born in different periods.[Re-sults]From 2009 to 2019,the AAPC of lymphoma incidence rate in cancer registration areas of Jiangsu Province was 5.74％,5.55％for men and 5.02％for women.The AAPC in urban areas was higher than that in rural areas(6.26％vs 4.90％).The age-standardized incidence rate(ASIR)of lymphoma increased by 3.40％annually on average.The rising amplitude of ASIR of women(3.16％)was higher than that of men(3.05％),and the rising amplitude of ASIR of lymphoma in urban areas(3.39％)was higher than that in rural areas(2.43％).The birth cohort analysis showed that the incidence rate of lymphoma fluctuated greatly before the age of 40,and there was no sig-nificant trend of change,while the incidence rate in age groups of 40 years old and above showed an overall upward trend.The average age at onset of lymphoma showed an upward trend from 2009 to 2019,with an average annual increase of 0.35 years old(P＜0.001).The standardized average age at onset for lymphoma still showed a significant upward trend,with an average annual increase of 0.15 years old(P=0.016).Compared with 2009,the standardized age specific incidence of lym-phoma in 2019 showed an overall backward trend,while the standardized incidence in all age groups after 60 years old(except for the age group of 70～74 years old)increased.The proportion of lymphoma in people above 60 years old was 56.16％in 2019,which was higher than that in 2009(52.57％).[Conclusion]The incidence rate of lymphoma in Jiangsu Province was increasing year by year from 2009 to 2019.The age at onset tended to shift back,and the trend was more pronounced in male than female.