1.Analysis of the disease burden of falls and influencing factors among the elderly from 1990 to 2023
Xufeng LONG ; Liyu QIN ; Hongya CAO ; Keyuan LIANG ; Mingmei HUANG ; Xiandan LUO ; Quanyuan HUANG ; Hongliang ZHANG
China Pharmacy 2026;37(12):1631-1637
OBJECTIVE To analyze trends in the burden of disease associated with falls from 1990 to 2023, identify risk factors for falls, and provide a reference for the development of measures to reduce the burden of disease associated with falls and the formulation of public health policies. METHODS Based on the data of 2023 from the Global Burden of Disease (GBD) database, the changes in fall-related prevalence, mortality, disability-adjusted life years (DALYs) and incidence in China and globally from 1990 to 2023 were analyzed, and the stratified analyses by gender, age and socio-demographic index (SDI) were conducted. The risk factors related to falls in 2023 were systematically analyzed, and the impact of multimorbidity and polypharmacy on the occurrence of falls by combining relevant literature evidence was explored. RESULTS & CONCLUSIONS Globally, the percentage changes in age-standardized rates of fall-related prevalence, mortality, DALYs and incidence from 1990 to 2023 were -2.4% (95%UI: -4.8% to -0.3%), -7.8% (95%UI: -20.5% to 10.9%), -10.6% (95%UI: -16.5% to -4.3%), and -4.6% (95%UI: -8.1% to -0.8%), respectively. However, in some regions, the percentage changes in age-standardized rates for these indicators were greater than 0 (e.g., prevalence, mortality and DALYs in Australasia, and incidence in Andean Latin America). In China, the percentage changes in age-standardized rates of fall-related mortality and DALYs from 1990 to 2023 were -18.3% (95%UI: -56.7% to 32.3%) and 1.9% (95%UI: -10.1% to 12.4%), while the percentage changes in age-standardized rates of prevalence and incidence were 25.9% (95%UI: 20.2% to 32.0%) and 35.7% (95%UI: 28.5% to 44.1%), respectively. Globally, in regions with high and medium-to-high SDI levels, the percentage changes in age-standardized rates of fall-related prevalence and incidence showed an upward trend, while DALYs showed a downward trend; however, the trend in mortality was unclear. In regions with a middle SDI level, the percentage changes in age-standardized rates of fall-related prevalence and incidence both showed an upward trend, while the trends in mortality and DALYs were unclear. In regions with low-to-medium SDI level, the percentage changes in age-standardized rate of fall-related prevalence, DALYs and incidence all showed a downward trend, while the trend in mortality was unclear; in regions with low SDI level, the trends for all above indicators were unclear. Correlation analyses of the burden of fall-related diseases in China and globally indicated that the risk of fall-related diseases was higher among younger and middle-to-older adult male populations, while women were concentrated in older age groups. Meanwhile, as the SDI levels increase, the percentage change in age-standardized rate of DALYs for fall-related diseases showed a clear upward trend, and this trend was more pronounced in high-SDI regions. Tobacco use, alcohol consumption, low bone density, and occupational risks were risk factors for falls, with low bone density and occupational risks contributing significantly (exceeding 20% in some regions); multimorbidity and polypharmacy could also significantly increase the risk of falls. It is recommended that clinical settings establish a list of fall-risk increasing drugs and a warning system, improve medication reviews, strengthen medication education and adherence management, foster multidisciplinary collaboration, and develop medication strategies for specific patient populations to reduce the incidence of falls and alleviate the burden of disease.
2.Evidence-based study on postoperative chemotherapy guidelines/consensuses for ovarian epithelial tumor
Xiandan LUO ; Yanli LU ; Yihang WU ; Yanxiang GUO ; Xiaoyi YAN ; Yongchao HUO ; Hui YAN ; Zhenjiang YANG ; Hongliang ZHANG
China Pharmacy 2025;36(18):2328-2333
OBJECTIVE To systematically evaluate the methodological quality of the postoperative chemotherapy guidelines/ consensuses for ovarian epithelial tumor. METHODS A search was conducted across databases including PubMed, Embase, Web of Science, CBM, VIP, Chinese Medical Journal Data, Wanfang Data, and CNKI, as well as the official websites of GIN, NICE, Medlive, AHRQ, CSCO, ASCO, and NCCN. The search period was from the establishment of the databases/websites to March 10, 2025. The quality of the included guidelines/consensus was evaluated by using the AGREE-Ⅱ tool. RESULTS A total of 16 guidelines/consensuses were included. The domain scores of AGREE-Ⅱ evaluation were as follows: scope and purpose of 85.07%, participants of 47.92%, rigor of development of 57.49%, clarity of presentation of 88.02%, applicability of 8.20%, and independence of 53.39%. Among them, 14 were recommended at grade B and 2 were recommended at grade C. The subgroup analysis by different countries/regions and different types of studies showed that the scores for participants, rigor of development, and independence of the guidelines/consensuses in China were significantly lower than foreign countries (P<0.05); the scores for participants and rigor of development of the guidelines were significantly higher than consensuses (P<0.05). The guideline/ consensus recommendation results indicated that grade B guidelines/consensus recommend platinum-based combination chemotherapy as the preferred adjuvant chemotherapy regimen for stage Ⅰ high-grade serous carcinoma patients;platinum-based combination chemotherapy±bevacizumab was recommended as the preferred adjuvant chemotherapy regimen for stage Ⅱ-Ⅳ high- grade serous carcinoma patients and for platinum-sensitive recurrent high-grade serous carcinoma patients; non-platinum single- agent chemotherapy±bevacizumab was recommended as the preferred chemotherapy regimen for platinum-resistant recurrent high- grade serous carcinoma patients. CONCLUSIONS The overall quality of postoperative chemotherapy guidelines/consensuses for ovarian epithelial tumor is not high. The methodological quality of guidelines/consensuses in China is still lagging behind that of foreign countries. The recommendations differ from those in foreign countries. It is recommended to improve the aspects of participants, rigor of development, and independence, to recommend treatment plans based on the different stages of ovarian cancer, and develop guidelines/consensuses that align with China’s national conditions.
3.Efficacy,safety and cost-effectiveness evaluation of voriconazole original and generic drugs
Ganling TANG ; Xiangwei XIE ; Xiandan LUO ; Yanli LU ; Huixian JIANG ; Jingyi LI ; Xiaoman HUANG ; Hongliang ZHANG
China Pharmacy 2024;35(7):831-836
OBJECTIVE To evaluate the efficacy, safety and cost-effectiveness of generic drugs and original drugs of voriconazole. METHODS The information of patients who used voriconazole generic drugs selected in National Centralized Drug Procurement (generic drug group) or non-selected original drugs (original drug group) in the treatment of fungal infection was collected from the our hospital. The propensity score matching was carried out to eliminate bias. The comprehensive efficacy was evaluated according to clinical efficacy, image findings and microbiological test, and stratified analysis of different populations was conducted based on fungal species, underlying diseases, etc., the efficacy of different stratifications was evaluated. Evaluation of safety was performed by using the incidence of adverse reactions. The total cost, defined daily doses (DDDs) and defined daily dose cost (DDDc) were used to evaluate the cost-effectiveness. RESULTS A total of 436 patients were included, and there were 190 patients in each group after matching. In terms of efficacy, the effective rates of voriconazole generic drugs and original drugs were 62.63% and 59.47% (P=0.528); in terms of safety, the incidence of adverse reactions caused by generic drugs and original drugs of voriconazole was 13.68% and 7.89%, respectively(P=0.069). In terms of cost-effectiveness, the average total cost of generic drugs was 4 636.26 yuan, and that of original drugs was 8 613.20 yuan (P<0.001). After the implementation of National Centralized Drug Procurement, replacement rate of generic drugs increased to 87.30%, and DDDc decreased by 59.08%. CONCLUSIONS The efficacy and safety of voriconazole generic drugs are similar to those of original drugs in the treatment of fungal infection, and it is more cost-effective in terms of treatment cost.
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