Hsiu-Hsi Chen

Introduction

Building up community-based cohort plays an important role in evidence-based population heath beyond randomization. There are numerous design and methods for doing so. In Taiwan, as we have created several novel community-based multiple screening programs from different counties, including northern (Keelung), central (Changhwa), southern, eastern, and remote regions, it is expedient to make use of this as a platform to conduct etiological (basic and epidemiological), interventional, surveillance-based, and therapeutic types of researches embaracing multi-disciplinary of environment/occupation/ and food safety, health care policy/management/behavior, and epidemiology/preventive medicine and biostatistics.

Aims

Matsu community-based (MACOM) cohort is one of them and their applications to different disciplines of population health are presented in this meeting to achieve the following objectives in order

(1) to build up the MACOM cohort evolving with three-phase transition from community-based gastric cancer screening to community-based intervention program;

(2) to elucidate epidemiological profiles on non-communicable disease (NCD) of Matsunese and their emigrants to Taiwan using data from (1);

(3) to evaluate the influence of life style factors with emphasis on alcohol, coffee, and tea, and biomarkers on life expectancy and the risk for the main category of NCD (including diabetes mellitus, hypertension, metabolic syndrome, and colorectal neoplasm) using data from (1)

(4) to demonstrate how to build up system epidemiology of biobank to collect integrated omics data by using periodical golbolomics design and how to investigate the association between genotype and NCD such as hypertension ;

(5) to assess medical manpower, evaluate the impact of awareness and compliance with treatment on LE, the usefulness of telemedicine on opthomology, and early detection of dementia in long-term care, each of which is in conjunction with cost-effectiveness analysis;

(6) to assess PM 2.5 and PM 10, water, and food on life expectancy and the selected NCD based on data from (1);

(7) to estimate the impacts of smoking, alcohol, coffee, and tea on life expectancy with and without adjusting for educational level, physical activity, intake of vegetable and meat, and relevant biomarkers in relation to metabolic factors using the newly developed Gompertz regression mortality model;

(8) to develop personalized prevention programs using gastric cancer and hypertension as two illustrations with system biology computational methodology under the context of synthesis science (including meta-analysis, decision science, and cost-effectiveness) with parameters based on the result of multi-disciplinary from (2)-(7);

(9) to demonstrate how to make use of big data to translate personalized preventive strategy into precision population heath in order to achieve the target of SDG on heath.

The details of results and elaboration corresponding to the aims of (1) to (9) refer to another supplementary booklet “First Volume of Proceeding of Precision Population Health, PHRC - Matsu Community-based (MACOM) Cohort Researches”.

Main Results

Section I Basic Epidemiological Profiles of Mastunese and Emigrants

The migration epidemiological study comparing Matsunese and Mastu Emigrants suggest that Matsunese Emigrants were younger but had higher risk of death and having cancer and chronic disease than Matsunese but the difference in survival was small. The longer life expectancy (Median: 88.0) in Matsunese compared with those who migrated to Taiwan (Median: 84.1) was noted. This is contradictory to the commonly seen healthy migration phenomenon and requires further researches to elucidate such a health disparity of migration.

Section II Matsu Community-based (MACOM) Cohort and Intervention Programs

The unique characteristics of Matsu Community-based (MACOM) cohort has been on the grounds of a series of intervention programs. Phase I (between 1996 and 1998), a community-based gastric cancer screening program was proposed. In Phase II (between 2002 and 2009), Matsu community-based integrated prevention program (including multi-disease screening) was built. The extended intervention programs including primary and secondary prevention with particular emphasis on gastric cancer prevention program was founded in Phase III (between 2009 and 2017). Given population-based family pedigree information system, the percentages of HP were higher in proband with positive HP among family numbers in household. The similar phenomenon was noted in pre-cancer lesion.

Section III Life Style Pattern in Matsu

The prevalence and incidence of hypertension in Matsu were higher than those in Taiwan, especially for the young adult, but the corresponding figures of DM were reverse, especially for the incidence in female, being 0.4-fold of that in Taiwan. Alcohol showed the harmful effect on hypertension based on both cohorts, and coffee had protective effect on DM, hypertension, MetS, and CKD based on Taiwan cohort. The younger generation had higher prevalence of soft drink intake. High intake of soft drink led to an increased 16% of risk of hypertension compared with none/seldom intake. A trend of protective effect of coffee on the risk colorectal cancer by weekly frequency was revealed.

Section IV System Epidemiology of the MACOM Cohort

The Matsu biospecimen resources have been preserved and become an important resource for surveillance of the health status and medical researches. An organized and regular screening program provides support for longitudinal studies which enable to capture the information in the entire disease progression from pre-disease onset, to disease diagnosis, and clinical outcomes under periodical globolomics design to collect integrative omics data. More importantly, the development of biobank facilitates personalized prevention and medicine in the future in the Matsu islands.

Section V Health Care Delivery in Matsu

Insufficient medical manpower of health care delivery was seen in Matsu compared with Taiwan and revealed two solutions, assistance from Taiwan and telomedicine. The tele-ophthalmology for screening of eye disease was applied to Tungyin, in Matsu for early detection of retinopathy. Economic evaluation also found two-stage tele-ophthalmology with time-dependent predictive model almost as cost-effective as the application of tele-ophthalmology to the whole population. From the viewpoint of integrated screening for Matsunese and Matsu emigrants, the findings also indicated the cost-effectiveness analysis of colorectal cancer screening as well as gastric cancer prevention existed heterogeneity between Matsunese and Matsu emigrations. Besides, dementia test in Matsu demonstrates the usefulness of the finding derived from dementia test in predicting the long-term survival among Matsunese aged 50 years or older.

Section VI Environmental Risk to Health in Matsu

The significant findings in the association between exposure to well water and risk of contracting H. pylori have suggested the imperative need for the household control of H. pylori through surveillance on water sources. Dietary factors play an essential role in preventing the occurrence or progression of carcinogenesis in stomach. Harmful health effects of PM2.5 was illustrated in terms of elevated risk in DM and shorter life expectancy by 13.3 years.

Section VII Alcohol, Coffee, and Tea Associated with Life Expectancy in Matsu and Four Communities in Taiwan

1. With adjustment for sex, educational level, physical activity, and smoking, detrimental effects of the habit of alcohol drinking and smoking in term of decreasing the life expectancy by around 3.5 and 7.5 years, respectively, was revealed and the protective effect of coffee by prolonging the life expectancy by 1.9 years was demonstrated.

2. The joint effects of alcohol drinking, coffee drinking, smoking, and tea drinking revealed the span of 12 years of LE between the longest group and the shortest group. Information provided in this way open the door to have a better understanding of precision science in life style habits.

Section VIII Personalized MACOM Cohort and Prevention Programs

The application of a personalized risk assessment model shows varying efficacy of mortality from gastric cancer (no benefit to 30% reduction) with H. pylori eradication combined with two-stage endoscopy screening. Personalized prevention for hypertension was cost-saving which was superior to population-wide approach and high risk-approach. A novel multi-level and multifactorious semi-Markov illness-and-death model was developed to estimate personalized life expectancy taking into account disease-duration. Using the proposed model, the prevention strategy combining life style modification, enhanced program for awareness, and improvement of environment was estimated to extend the life-expectancy and disability-adjusted life-expectancy by 10.5 and 9.4 years, respectively, in the MACOM cohort.

Section IX Big Data and Health

Through big data technique and analysis, all the analytical strategies from visualization to decision-making based on the finding from Section I to Section VIII with synthesis science will be used to develop the application software of artificial intelligence in order to realize the goal of precision population health.

Conclusions

We demonstrate here how to build up and make use of long-term MACOM cohort with intervention programs to develop precision population health under the concept of system epidemiology incorporating multidisciplinary science of environmental influence, health care delivery, behavior determinants, and epidemiological risk factors on life styles.