Evidence map›Paper›PMID 33077583›Full record

ArticleProceedings of the National Academy of Sciences of the United States of America2020

Prenatal and early-life exposure to the Great Chinese Famine increased the risk of tuberculosis in adulthood across two generations.

Qu Cheng, Robert Trangucci, Kristin N Nelson, Wenjiang Fu, Philip A Collender, Jennifer R Head, Christopher M Hoover, Nicholas K Skaff, Ting Li, Xintong Li and 7 more

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Proceedings of the National Academy of Sciences of the United States of America, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 30 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
30citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

30 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
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  4. Elevated risk of infectious diseases in adulthood after prenatal or early postnatal exposure to the Great Chinese Famine.Proceedings of the National Academy of Sciences of the United States of America · 2025
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  12. Applying Multiple Analyses to Quantify Changes in the Global, Regional, and National Burden of Tuberculosis From 1990 to 2021 and the Forecast Until 2035.The Canadian journal of infectious diseases & medical microbiology = Journal canadien des maladies infectieuses et de la microbiologie medicale · 2025
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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

17 authors.

Qu ChengDivision of Environmental Health Sciences, School of Public Health, University of California, Berkeley, CA 94720.ORCID 0000-0003-3074-9218
Robert TrangucciDepartment of Statistics, University of Michigan, Ann Arbor, MI 48109.
Kristin N NelsonRollins School of Public Health, Emory University, Atlanta, GA 30322.
Wenjiang FuDepartment of Mathematics, University of Houston, Houston, TX 77204.
Philip A CollenderDivision of Environmental Health Sciences, School of Public Health, University of California, Berkeley, CA 94720.
Jennifer R HeadDivision of Epidemiology, School of Public Health, University of California, Berkeley, CA 94720.
Christopher M HooverDivision of Environmental Health Sciences, School of Public Health, University of California, Berkeley, CA 94720.ORCID 0000-0003-1976-8493
Nicholas K SkaffDivision of Environmental Health Sciences, School of Public Health, University of California, Berkeley, CA 94720.ORCID 0000-0002-5929-3966
Ting LiInstitute of Tuberculosis Control and Prevention, Sichuan Center for Disease Control and Prevention, 610041 Chengdu, China.
Xintong LiDepartment of Biostatistics, Rollins School of Public Health, Emory University, Atlanta, GA 30322.
Yue YouDivision of Biostatistics, School of Public Health, University of California, Berkeley, CA 94720.
Liqun FangDepartment of Infectious Disease Epidemiology, Institute of Microbiology and Epidemiology, 100850 Beijing, China.ORCID 0000-0002-4981-1483
Song LiangDepartment of Environmental and Global Health, College of Public Health and Health Professions, University of Florida, Gainesville, FL 32611.
Changhong YangInstitute of Health Informatics, Sichuan Center for Disease Control and Prevention, 610041 Chengdu, China.
Jin'ge HeInstitute of Tuberculosis Control and Prevention, Sichuan Center for Disease Control and Prevention, 610041 Chengdu, China.
Jonathan L ZelnerDepartment of Epidemiology, University of Michigan, Ann Arbor, MI 48109.ORCID 0000-0002-0708-2008
Justin V RemaisDivision of Environmental Health Sciences, School of Public Health, University of California, Berkeley, CA 94720; jvr@berkeley.edu.ORCID 0000-0002-0223-4615

Funding

Integrating Epidemiologic and Environmental Approaches to Understand and Predict Coccidioides Exposure and Coccidioidomycosis EmergenceR01AI148336 · NIAID · UNIVERSITY OF CALIFORNIA BERKELEY · PI REMAIS, JUSTIN V · 2020 to 2024
$4.5M
Spatio-temporal data integration methods for infectious disease surveillanceR01AI125842 · NIAID · UNIVERSITY OF CALIFORNIA BERKELEY · PI CHANG, HOWARD H, REMAIS, JUSTIN V · 2017 to 2021
$3.6M
Effects of agricultural expansion and intensification on infectionsR01TW010286 · FIC · UNIVERSITY OF SOUTH FLORIDA · PI REMAIS, JUSTIN V, ROHR, JASON ROBERT · 2015 to 2019
$2.4M
FIC NIH HHS R01 TW010286NIAID NIH HHS R01 AI125842NIAID NIH HHS R01 AI148336
6 · The paper itself

Abstract

Global food security is a major driver of population health, and food system collapse may have complex and long-lasting effects on health outcomes. We examined the effect of prenatal exposure to the Great Chinese Famine (1958-1962)-the largest famine in human history-on pulmonary tuberculosis (PTB) across consecutive generations in a major center of ongoing transmission in China. We analyzed >1 million PTB cases diagnosed between 2005 and 2018 in Sichuan Province using age-period-cohort analysis and mixed-effects metaregression to estimate the effect of the famine on PTB risk in the directly affected birth cohort (F1) and their likely offspring (F2). The analysis was repeated on certain sexually transmitted and blood-borne infections (STBBI) to explore potential mechanisms of the intergenerational effects. A substantial burden of active PTB in the exposed F1 cohort and their offspring was attributable to the Great Chinese Famine, with more than 12,000 famine-attributable active PTB cases (>1.23% of all cases reported between 2005 and 2018). An interquartile range increase in famine intensity resulted in a 6.53% (95% confidence interval [CI]: 1.19-12.14%) increase in the ratio of observed to expected incidence rate (incidence rate ratio, IRR) in the absence of famine in F1, and an 8.32% (95% CI: 0.59-16.6%) increase in F2 IRR. Increased risk of STBBI was also observed in F2. Prenatal and early-life exposure to malnutrition may increase the risk of active PTB in the exposed generation and their offspring, with the intergenerational effect potentially due to both within-household transmission and increases in host susceptibility.

Indexed as

FamineAdolescentAdultAgedAged, 80 and overChinaCohort StudiesFemaleHumansIncidenceMaleMiddle AgedMycobacterium tuberculosisPregnancyPrenatal Exposure Delayed EffectsRisk FactorsTuberculosis Vaccinesfood systemsGreat Chinese Famineinfectious diseasenutritiontuberculosis

Identifiers

PMID33077583
PMCPMC7959515

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.