This study examines the impact of extreme heat on stroke-related hospitalization outcomes, specifically total expenditures and length of hospital stay, in a developing country context. Using patient-level hospitalization data collected from a major Chinese city, we report that heatwave exposure is positively correlated with both hospitalization expenditures and duration. Specifically, each additional day within the preceding week in which the average temperature exceeds 30 °C, relative to a moderate-temperature day (18-22 °C), is associated with a 1.92% (95% CI 1.390-2.453, 340.98 yuan) increase in total hospitalization expenditures. The effects are especially pronounced among male patients and those experiencing hemorrhagic stroke, with reimbursement-related costs accounting for the majority of the observed increase. We further explored potential mechanisms through both physiological and psychological pathways. Our findings suggest that stroke patients with preexisting cardiovascular conditions and mental disorders may be particularly vulnerable to extreme heat exposure.

What is already known about this topic?:Chronic diseases and multimorbidity impose substantial burdens on healthcare systems globally, particularly in aging populations, resulting in elevated healthcare utilization rates and increased expenditures. What is added by this report?:This study validates previous research findings using an extensive administrative database from a major city in South China. Additionally, it provides comprehensive estimates of annual hospitalization expenditures per patient associated with chronic diseases and multimorbidity patterns among older adults, elucidating the economic burden and cost variations across specific diseases and multimorbidity combinations. Cancer, cerebrovascular disease (CVD), and heart disease - whether occurring individually or in conjunction with other chronic conditions, particularly within complex multimorbidity patterns - were associated with substantial annual hospitalization expenditures and significant healthcare resource utilization. What are the implications for public health practice?:Disease burden studies provide critical evidence for prioritizing public health policies and targeted interventions. Policymakers should implement comprehensive prevention strategies, evidence-based interventions, appropriate reimbursement policies, and integrated management approaches to control disease progression and reduce healthcare expenditures.

Using individuals' life history information from a large-scale national survey (N = 13,044), we causally evaluate how exposure to SARS-Cov-1, the first global pandemic in the 21st century, affects long-term psychological well-being. We find that exposure to local pandemic risk, that is, local deaths due to the pandemic, significantly reduced people's mental health 12 years later. Consistent with the belief-based account of depression, exposure to pandemic risk resulted in more pessimistic beliefs about the future and survival probability. People reduced savings and increased hedonic consumption, suggesting a "carpe diem" effect of the pandemic exposure.

Complicated associations between multiplexed environmental factors and aging are poorly understood. We manipulated aging using multidimensional metrics such as phenotypic age, brain age, and brain volumes in the UK Biobank. Weighted quantile sum regression was used to examine the relative individual contributions of multiplexed environmental factors to aging, and self-organizing maps (SOMs) were used to examine joint effects. Air pollution presented a relatively large contribution in most cases. We also found fair heterogeneities in which the same environmental factor contributed inconsistently to different aging metrics. Particulate matter contributed the most to variance in aging, while noise and green space showed considerable contribution to brain volumes. SOM identified five subpopulations with distinct environmental exposure patterns and the air pollution subpopulation had the worst aging status. This study reveals the heterogeneous associations of multiplexed environmental factors with multidimensional aging metrics and serves as a proof of concept when analyzing multifactors and multiple outcomes.

Pronoun usage’s psychological underpinning and behavioral consequence have fascinated researchers, with much research attention paid to second-person pronouns like “you,” “your,” and “yours.” While these pronouns’ effects are understood in many contexts, their role in bilateral, dynamic conversations (especially those outside of close relationships) remains less explored. This research attempts to bridge this gap by examining 25,679 instances of peer review correspondence with Nature Communications using the difference-in-differences method. Here we show that authors addressing reviewers using second-person pronouns receive fewer questions, shorter responses, and more positive feedback. Further analyses suggest that this shift in the review process occurs because “you” (vs. non-“you”) usage creates a more personal and engaging conversation. Employing the peer review process of scientific papers as a backdrop, this research reveals the behavioral and psychological effects that second-person pronouns have in interactive written communications.

退休制度在老年人的福利中扮演着重要角色,然而鲜有文献专门考察配偶退休如何改变中老年人的健康行为.本文利用中国强制性退休制度对夫妻双方造成的外生性冲击,采用断点回归设计分析了配偶退休对中老年人健康行为的影响及作用机制.基于中国健康与养老追踪调查数据(CHARLS)的研究表明,配偶退休显著减少了中老年人的每日吸烟量并降低了其酗酒概率,增加了其门诊医疗服务利用率.然而,配偶退休也降低了中老年人的住院医疗服务利用率,但对他们的健康水平没有显著影响.本文认为,配偶退休带来的正向"关爱效应"和负向"收入效应"的叠加,可以解释上述实证发现.在此基础上,本文将Becker利他主义思想与Grossman健康人力资本理论相结合,通过建立理论模型对上述结果进行了阐释.

Scientific collaboration plays a significant role in scientists' research performance. When scientists move from one institution to another and leave the team they belong to or lead, they may continue collaborating with the former team because engaging in or building a new team takes time. In this study, we collected data from the Open Researcher and Contributor ID (ORCID) website on 2,922 scientists who published first-tier journal papers defined by the Chinese Academy of Science (CAS) before they moved to a new institution. By applying a Poisson regression model to the dataset, we explored the correlation between continued collaboration and the transition period after scientists moved, which is defined as the time span between the year of the move and the year when they published their first top-tier journal paper after moving. Our findings indicated that: (1) continued collaboration significantly shortens the transition period by 27.2%; (2) continued collaboration significantly shortens the transition period of senior scientists to a larger extent than that of junior scientists; (3) continued collaboration significantly shortens the transition period of social scientists to a larger extent than that of natural scientists; (4) the transition period is shorter after moves for scientists with higher inherent potential; and (5) there is no evidence that the transition period is associated with culture-related differences between the origin country and the destination country after the move, or whether they had lived in the destination country before.

OBJECTIVES:Childhood adversity and lifestyle have been associated with frailty in later life, but not much is known about factors that may explain these associations. Therefore, this study aims to investigate the association of childhood adversity with frailty, and the mediating role of unhealthy lifestyle in the association. METHODS:This lifespan analysis included 152,914 adults aged 40-69 years old from the UK Biobank. We measured childhood adversity with five items: physical neglect, emotional neglect, sexual abuse, physical abuse, and emotional abuse through online mental health survey. Frailty was measured by the frailty index; an unhealthy lifestyle score (range: 0-5) was calculated based on unhealthy body mass index, smoking, alcohol consumption, physical inactivity, and unhealthy diet at the baseline survey. Multiple logistic regression and mediation analysis were performed. RESULTS:A total of 10,078 participants (6.6%) were defined as having frailty. Participants with any childhood adversity had higher odds of frailty. For example, in the fully adjusted model, with a one-point increase in cumulative score of childhood adversity, the odds of frailty increased by 38% (odds ratio: 1.38; 95% Confidence Interval: 1.36, 1.40). Unhealthy lifestyle partially mediated the associations of childhood adversity with frailty (mediation proportion: 4.4%-7.0%). The mediation proportions were largest for physical (8.2%) and sexual (8.1%) abuse. CONCLUSIONS:Childhood adversity was positively associated with frailty, and unhealthy lifestyle partially mediated the association. This newly identified pathway highlights the potential of lifestyle intervention strategies among those who experienced childhood adversity (in particular, physical, and sexual abuse) to promote healthy aging.

The COVID-19 pandemic and its resultant lockdowns have interrupted the way scientists live and work. This nevertheless caused an unforeseen impact of COVID-19: the pandemic substantially increased editorial speed. Here, we causally identify the impact of the pandemic on the editorial decision time, based on a quasi-experimental regression discontinuity (RD) design that compares (N = 339,199) papers submitted in the lead-up to and aftermath of the COVID-19 pandemic. We find that editors make acceptance decisions significantly quicker after the pandemic, reducing the editorial decision time of revised papers by 8.9 days on average. The pandemic, however, has unequal impacts on editors. The results reveal a larger reduction in editorial decision time for editors of high-tier journals, in the field of social science, or with busy work schedules. Finally, our findings also allude to the potential for the increase of editorial speed, and will stimulate policy changes in scientific enterprises that strive for accelerated publishing.

We document an affiliation bias in top Chinese journals and the gender gap in the current affiliation effect. We find that papers written by researchers who are affiliated with the journals' host institutions on average receive fewer citation counts than those written by non-affiliated researchers. Moreover, we show that this affiliation bias is greater for men than for women. We propose that the current effect can be accounted for by a social capital mechanism, and we provide evidence consistent with our proposition. In addition, the results of our analyses demonstrate heterogeneity of the affiliation bias and the gender gap with regard to researcher status. We discuss alternative mechanisms of the current effect and implications of our research.

Peer review plays an essential role in scientific research, but the influence of reviewers' academic status is often overlooked during this process. By accessing peer review reports, in this study we empirically investigate this effect. Specifically, we analyzed 2,580 peer review histories from eLife submissions between 2016 and 2021 to examine the relationship between reviewers' academic status and their language usage in the first round of peer review. We focused on two types of language features: emotional features (e.g., positivity and subjectivity) and linguistic features (e. g., number of long words and complex words). Our findings revealed no significant reviewer bias of academic status, such that the reviewers' comments with emotional features were not signif-icantly associated with reviewers' awareness of being more prestigious than the last corre-sponding author of the manuscripts. More accomplished reviewers, however, were more likely to use longer and more complex words. Additionally, the results of linguistic features remained robust in the group where the last author served as the last corresponding author. Overall, our findings suggest that the quality of peer review remains the primary consideration for reviewers when evaluating submissions. These results have significant implications for open peer review practices and the fair assessment of the peer review process.

BACKGROUND:This study investigated multimorbidity patterns among middle-aged and older Chinese people and whether healthcare costs varied among different multimorbidity patterns.METHODS:Data were from the 2011-2018 waves of the China Health and Retirement Longitudinal Study (CHARLS). We included 20,855 unique observations with information coming from their last wave of interviews and aged at least 45 years or older. Latent class analysis (LCA) was performed to classify individuals with common multimorbidity clusters based on 14 self-reported chronic diseases. Healthcare costs were from participants' self-reports and categorized into outpatient, inpatient, and self-treatment. Two-part regression was performed to analyze the association of multimorbidity patterns with healthcare costs.RESULTS:Five multimorbidity clusters were identified: minimal disease, arthritis, cardiovascular disease (CVD), lung/asthma, and multisystem morbidity. The multisystem morbidity group had the highest use in all three types of healthcare and the highest self-treatment cost. Compared with the minimal disease group, the other four groups did not show significant differences in outpatient costs. Relative to the minimal disease group, the lung/asthma group reported lower inpatient costs.CONCLUSION:Healthcare use and costs varied across multimorbidity patterns among middle-aged and older Chinese people. Implementing an integrated care plan for multimorbidity is suggested to improve the cost-effectiveness of healthcare provision and reduce the financial burden of the healthcare system. Reimbursement policy design should also take multimorbidity patterns into account.

Background Childhood adversity and lifestyle have been associated with frailty in later life, but not much is known about factors that may explain these associations. An unhealthy lifestyle may play an important role in the pathway from childhood adversity to frailty. Therefore, this study aims to investigate the association of childhood adversity with frailty, and the mediating role of unhealthy lifestyle in the association. Methods This lifespan analysis included 152914 adults aged 40-69 years old from the UK Biobank. We measured childhood adversity with five items: physical neglect, emotional neglect, sexual abuse, physical abuse, and emotional abuse through online mental health survey. Frailty was measured by the frailty index; an unhealthy lifestyle score (range: 0-5) was calculated based on unhealthy body mass index, smoking, drinking, physical inactivity, and unhealthy diet at the baseline survey. Multiple logistic regression and mediation analysis were performed. Results A total of 10078 participants (6.6%) were defined as having frailty. Participants with any childhood adversity had higher odds of frailty. For example, in the fully adjusted model, with a one-point increase in cumulative score of childhood adversity, the odds of frailty increased by 41% (Odds Ratio: 1.41; 95% Confidence Interval: 1.39, 1.44). Unhealthy lifestyle partially mediated the associations of childhood adversity with frailty (mediation proportion: 4.4%-7.0%). The mediation proportions were largest for physical (8.2%) and sexual (8.1%) abuse. Conclusions Among this large sample, childhood adversity was positively associated with frailty, and unhealthy lifestyle partially mediated the association. This newly identified pathway highlights the potential of lifestyle intervention strategies among those who experienced childhood adversity (in particular, physical and sexual abuse) to promote healthy aging.

The complex relationship between life course traumas and cardiovascular disease (CVD) and the underpinning pathways are poorly understood. We aimed to (1) examine the associations of three separate assessments including childhood, adulthood (after 16 years of age), and lifetime traumas (childhood or adulthood) with CVD; (2) examine the associations between diverse life course traumatic profiles and CVD; and (3) examine the extent to which PhenoAge, a well-developed phenotypic aging measure, mediated these associations. Using data from 104,939 participants from the UK Biobank, we demonstrate that subgroups of childhood, adulthood, and lifetime traumas were associated with CVD. Furthermore, life course traumatic profiles were significantly associated with CVD. For instance, compared with the subgroup experiencing nonsevere traumas across life course, those who experienced nonsevere childhood and severe adulthood traumas , severe childhood and nonsevere adulthood traumas , or severe traumas across life course had significantly higher odds of CVD (odds ratios: 1.07–1.33). Formal mediation analyses suggested that phenotypic aging partially mediated the above associations. These findings suggest a potential pathway from life course traumas to CVD through phenotypic aging, and underscore the importance of policy programs targeting traumas over the life course in ameliorating inequalities in cardiovascular health.

"健康移民效应"是指相比于本地居民,移民的健康状况更好.本文使用RUMiC 2008和2009数据,发现外出农民工心理健康状况比城市居民更差.为剖析我国现实与"健康移民效应"这一典型事实相矛盾的原因,本文将"机会平等"哲学理念与"健康移民效应"相结合,在新构建的框架下进行了分解研究,结果显示:按照合理的"努力特征效应"来看,外出农民工本该比城市居民更健康(GHQ值小0.145),即我国农民工的"健康移民效应"本该存在,但严重的机会不平等拉低了他们的心理健康水平(GHQ值大了0.257),最终导致外出农民工的心理健康水平反倒比城市居民更差(GHQ值大了0.112).此外,外出农民工的心理健康状况好于从未外出的农村居民,也好于回流的农民工,这表明农民工的外出和回流存在"自选择"机制.但这些自选择机制主要是合理因素在起作用,而不是机会的不平等.

The complex relationship between life course traumas and cardiovascular disease (CVD) and the underpinning pathways are poorly understood. We aimed to (1) examine the associations of three separate assessments including childhood, adulthood (after 16 years of age), and lifetime traumas (childhood or adulthood) with CVD; (2) examine the associations between diverse life course traumatic profiles and CVD; and (3) examine the extent to which PhenoAge, a well‐developed phenotypic aging measure, mediated these associations. Using data from 104,939 participants from the UK Biobank, we demonstrate that subgroups of childhood, adulthood, and lifetime traumas were associated with CVD. Furthermore, life course traumatic profiles were significantly associated with CVD. For instance, compared with the subgroup experiencing nonsevere traumas across life course, those who experienced nonsevere childhood and severe adulthood traumas , severe childhood and nonsevere adulthood traumas , or severe traumas across life course had significantly higher odds of CVD (odds ratios: 1.07–1.33). Formal mediation analyses suggested that phenotypic aging partially mediated the above associations. These findings suggest a potential pathway from life course traumas to CVD through phenotypic aging, and underscore the importance of policy programs targeting traumas over the life course in ameliorating inequalities in cardiovascular health.

(1) Background: To explore the relationship between health status, social security status, and the occurrence of depression in older adults and provide a basis for mental health care services for the elderly population; (2) Methods: This study used the 2018 China Health and Senior Care Tracking Survey (CHARLS) data to select 8383 older people aged over 60 years old as the research subjects. The two-category Logistic model was used to analyze the research problem; (3) Results: Older adults with depressive tendencies accounted for 34.1% of the total older adults. The incidence of depression among female older adults reached 41.51%. The risk of depression in the elderly population was 40.3% lower in males than in females (OR = 0.597, 95% CI: 0.539–0.662). Self-rated health status, physical disability, and receipt of pensions affected the incidence of depression in older adults (all p < 0.05); (4) Conclusions: Focus on and intervene in the mental status of elderly females and disabled elderly people. Provide mental and economic support and mental health care services to the elderly at the family and social levels. Promote the healthy development of the mental health of the elderly and promote active aging.

目的 分析江苏省流动农民工参保城镇职工医保现状,探究参保影响因素及参与城镇职工医保对就医行为的影响,为提高我国流动农民工医疗保障水平提供理论依据.方法 基于2019年4-8月在江苏省13个地市开展的江苏省农民工市民化发展状况重点调查数据,运用stata 15.0进行统计分析.结果 与江苏省城镇劳动者相比,流动农民工参保城镇职工医保的比率较低(P<0.001).Mlogit回归分析结果显示,年龄为21～50岁、文化程度较高、中等收入、雇员、流入打工地3年以上,以及城镇户籍样本更有可能参与城镇职工医保.logit回归分析结果显示,参与城镇职工医保的流动农民工在打工地门诊就诊的可能性更大(OR=3.635).结论 要减小城乡医疗保障差距,提高农民工收入水平.重视农民工健康教育,增强流动农民工健康保障意识,提高流动农民工参保城镇职工基本医疗保险的比率,提升农民工医疗保障水平.

由于中国居民医疗费用快速增长,仅依靠医疗保险并不足以缓解过重的居民医疗负担.本文发现,作为一项保障中国农村老年居民收入的社会保障制度,新农保可以显著缓解医疗负担.本文采用中国健康与养老追踪调查2015年数据,利用老年人超过60岁可以领取养老金这一自然实验,使用断点回归方法考察了领取养老金对医疗负担的因果效应.结果 显示,获得新农保可以显著降低自负医疗费用在收入中的比例,并显著降低灾难性医疗支出发生的概率.在此基础上,本文通过建立理论模型讨论了为什么在缓解医疗负担上,新农保做到了新农合没做到的事.因为医疗保险待遇的提高会因道德风险而不能有效降低自负医疗费用,而养老保险可以通过收入效应缓解医疗负担.这一解释也得到了样本数据和数值模拟的验证.最后,从更一般的社会总福利视角看,医疗保险虽然在缓解医疗负担上效果不明显,但其强大的共济性可以在很大程度上提升社会总福利.

(1) Background: We aim to measure the urban-rural inequality of opportunity in healthcare in China based on the theory of Equality of Opportunity (EOp). (2) Methods: Following the compensation principle, we establish a decomposition strategy for the fairness gap, which we use for the measurement of the inequality of opportunity in urban-rural healthcare utilization. We then use China Health and Nutrition Survey (CHNS) data from 1997 to 2006 to calculate the fairness gap. (3) Results: Empirical analysis using CHNS data shows that the ratio of the fairness gap to the directly observed average urban-rural difference in healthcare was 1.167 for 1997–2000 and 1.744 for 2004–2006. The average urban-rural difference observed directly from original statistical data may have underestimated the degree of this essential inequity. (4) Conclusions: Our findings suggest that upgrading urban-rural reimbursement ratios may not be sufficient in eliminating the inequality of opportunity in healthcare utilization between urban and rural residents. Within the context of an urban-rural dualistic social structure and widening of the urban-rural income gap, a shift to a pro-disadvantaged policy will be a more effective approach in promoting equality of opportunity in healthcare.