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BMJ Open Is Committed to Open Peer Review. As Part of This Commitment We Make the Peer Review History of Every Article We Publish Publicly Available BMJ Open: first published as 10.1136/bmjopen-2020-042006 on 7 April 2021. Downloaded from BMJ Open is committed to open peer review. As part of this commitment we make the peer review history of every article we publish publicly available. When an article is published we post the peer reviewers’ comments and the authors’ responses online. We also post the versions of the paper that were used during peer review. These are the versions that the peer review comments apply to. The versions of the paper that follow are the versions that were submitted during the peer review process. They are not the versions of record or the final published versions. They should not be cited or distributed as the published version of this manuscript. BMJ Open is an open access journal and the full, final, typeset and author-corrected version of record of the manuscript is available on our site with no access controls, subscription charges or pay-per-view fees (http://bmjopen.bmj.com). If you have any questions on BMJ Open’s open peer review process please email [email protected] http://bmjopen.bmj.com/ on September 27, 2021 by guest. Protected copyright. BMJ Open BMJ Open: first published as 10.1136/bmjopen-2020-042006 on 7 April 2021. Downloaded from Clustering analysis of modifiable risk factors for upper digestive tract cancer among residents aged 40 to 69 years in Yangzhong City, China: a cross-sectional study ForJournal: peerBMJ Open review only Manuscript ID bmjopen-2020-042006 Article Type: Original research Date Submitted by the 23-Jun-2020 Author: Complete List of Authors: xiang Feng, xiang Feng; Yangzhong People's Hospital, Institute of Cancer Prevention and Treatment, Hua, Zhao-lai; Yangzhong People's Hospital, Institute of Cancer Prevention and Treatment, Zhou, Qin; Yangzhong People's Hospital, Institute of Cancer Prevention and Treatment, Shi, Ai-wu; Yangzhong People's Hospital, Institute of Cancer Prevention and Treatment, Song, Tong-qiu; Yangzhong People's Hospital, Institute of Cancer Prevention and Treatment, Qian, Dongfu; Nanjing Medical University, School of Health Policy & Management http://bmjopen.bmj.com/ Chen, Ru; National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Wang, Gui-qi; National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Wei, Wen-Qiang; National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, on September 27, 2021 by guest. Protected copyright. Zhou, Jin-Yi; Jiangsu Provincial Center for Disease Control and Prevention, Institute of Chronic Non-communicable Diseases Prevention and Control Wang, Jie-jun Shao, Gang Wang, Xi EPIDEMIOLOGY, Endoscopy < GASTROENTEROLOGY, Risk management Keywords: < HEALTH SERVICES ADMINISTRATION & MANAGEMENT For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml Page 1 of 37 BMJ Open 1 2 3 4 BMJ Open: first published as 10.1136/bmjopen-2020-042006 on 7 April 2021. 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Where the Submitting Author wishes to make the Work available on an Open Access basis (and 21 intends to pay the relevant APC), the terms of reuse of such Open Access shall be governed by a Creative 22 Commons licence – details of these licences and which Creative Commons licence will apply to this Work are set 23 out in our licence referred to above. 24 25 Other than as permitted in any relevant BMJ Author’s Self Archiving Policies, I confirm this Work has not been 26 accepted for publication elsewhere, is not being considered for publication elsewhere and does not duplicate 27 material already published. I confirm all authors consent to publication of this Work and authorise the granting 28 of this licence. 29 30 31 32 33 34 35 36 http://bmjopen.bmj.com/ 37 38 39 40 41 42 43 44 on September 27, 2021 by guest. Protected copyright. 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open Page 2 of 37 1 2 3 4 BMJ Open: first published as 10.1136/bmjopen-2020-042006 on 7 April 2021. Downloaded from 5 Clustering analysis of modifiable risk 6 7 factors for upper digestive tract cancer 8 9 10 among residents aged 40 to 69 years in 11 12 Yangzhong City, China: a cross-sectional 13 14 15 study 16 17 Xiang Feng,1,2 Zhaolai Hua,1 Qin Zhou1, Aiwu Shi,1 Tongqiu Song,1 Dongfu Qian,2 Ru Chen,3 18 For peer review only 19 GuiQi Wang,3 Wenqiang Wei,3 Jinyi Zhou,4 Jiejun Wang,5 Gang Shao,6 Xi Wang6 20 21 22 23 1Institute of tumor prevention and control, People’s Hospital of Yangzhong City, Yangzhong, 24 25 China 26 27 2School of Medicine and Politics, Nanjing Medical University, Nanjing, China 28 29 3 30 National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese 31 Academy of Medical Science and Peking Union Medical College, Beijing, China 32 33 4Depatment of Non-communicable Disease Prevention, Jiangsu Center for Disease Control and 34 35 Prevention, Nanjing, China 36 http://bmjopen.bmj.com/ 37 5Department of Oncology, Changzheng Hospital, Naval Military Medical University, Shanghai 38 39 200070, China. [email protected] 40 41 6Department of Oncology, the 903rd Hospital of PLA, Hangzhou, China. 42 43 [email protected] 44 on September 27, 2021 by guest. Protected copyright. 45 6Department of Oncology, the 903rd Hospital of PLA, Hangzhou, China. [email protected] 46 47 48 49 50 Correspondence to Zhaolai Hua; [email protected]; Dr Wenqiang Wei; 51 [email protected] 52 53 54 55 56 ABSTRACT 57 58 Objectives To describe the prevalence of modifiable risk factors for upper digestive tract cancer 59 (UDTC) and its clustering, and investigate relevant influencing factors of modifiable UDTC risk 60 1 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml Page 3 of 37 BMJ Open 1 2 3 factors clustering among residents aged 40-69 years in Yangzhong City, China. 4 BMJ Open: first published as 10.1136/bmjopen-2020-042006 on 7 April 2021. Downloaded from 5 6 Design Cross-sectional study 7 8 Participants A total of 21 175 participants aged 40-69 years enrolled in the study. 1 962 subjects 9 10 were excluded due to missing age, marital status or some other key information. Eventually, 19 11 213 participants were available for the present analysis. 12 13 Main outcomes measures Prevalence and clustering of eight modifiable UDTC risk factors 14 15 (overweight or obesity, current smoking, excessive alcohol consumption, insufficient vegetables 16 intake, insufficient fruit intake, and the consumption of pickled, fried and hot food) were analyzed. 17 18 For peer review only 19 Results The prevalence of overweight/obesity, current smoking, excessive alcohol consumption, 20 21 insufficient vegetable intake, insufficient fruit intake and the consumption of pickled, fried and hot 22 23 food in this study was 45.3%, 24.1%, 16.2%, 66.1%, 94.5%, 68.1%, 36.0% and 88.4%, 24 25 respectively. Nearly all(99.9%) participants showed one or more UDTC risk factors, 98.7% of the 26 27 participants showed at least two risk factors and 92.2% of the participants had at least three risk 28 29 factors. Multivariate logistic regression analysis revealed that men, younger age, single, higher 30 31 education, higher annual family income and smaller household size were more likely to present 32 33 modifiable UDTC risk factors clustering. 34 35 Conclusions A large proportion of the participants had modifiable UDTC risk factors with a 36 http://bmjopen.bmj.com/ 37 tendency of clustering in Yangzhong City. Extra attention is required to pay on these groups who 38 39 are susceptible to risk factors clustering during the progress of screening. Relative departments 40 41 also need to make effective public health programs that aim to decrease modifiable UDTC risk 42 43 factors clustering among residents aged 40-69 years from high-risk areas of UDTC. 44 on September 27, 2021 by guest. Protected copyright. 45 46 47 48 49 Strengths and limitations of this study 50 51 This is the first study examining the prevalence and clustering of modifiable upper digestive tract 52 53 cancer (UDTC) risk factors, and investigating relevant influencing factors in Yangzhong City, 54 with large and representative residents aged 40-69 years from the Upper Digestive Tract Cancer 55 56 Early Diagnosis and Treatment (UDTCEDAT).
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