Objective:This study aimed to determine the temporal trends in sleep duration among Chinese adults. Methods:In this series of repeated nationally representative cross-sectional surveys (China Chronic Disease and Risk Factors Surveillance) conducted between 2010 and 2018, a total of 645,420 adult participants (97,741 in 2010; 175,749 in 2013; 187,777 in 2015; and 184,153 in 2018) were included in the trend analysis. Linear and logistic regression models were utilized to assess trends in sleep duration. Results:In 2018, the estimated overall mean sleep duration among the Chinese adult population was 7.58 (SD, 1.45) hours per day, with no significant trend from 2010. A significant increase in short sleep duration (≤ 6 hours) was observed in the total population, from 15.3% (95% CI: 14.1%-16.5%) in 2010 to 18.5% (95% CI: 17.7%-19.3%) in 2018 ( P < 0.001). Similarly, the trend in long sleep duration (> 9 hours) was also significant, increasing in weighted prevalence from 7.2% (95% CI: 6.3%-8.1%) in 2010 to 9.0% (95% CI: 8.2%-9.9%) in 2018 ( P < 0.001). Conclusion:The prevalence of both short and long sleep durations significantly increased among Chinese adults from 2010 to 2018, highlighting the urgency of health initiatives to promote optimal sleep duration in China.

OBJECTIVE:To assess the awareness of tobacco-related health hazards and its associated factors among adults aged ≥18 years in China. METHODS:Data were derived from the 2018 China Chronic Disease and Risk Factor Surveillance, a nationally representative survey using a multistage stratified cluster sampling design. Awareness rates and 95%CI were estimated using complex sampling weights. Factors associated with awareness of SHS hazards were analyzed using weighted multivariable logistic regression. RESULTS:In 2018, the proportions of Chinese adults aged ≥18 years who were aware that exposure to secondhand smoke could cause adult lung cancer, childhood lung diseases, and adult heart disease were 69.81%, 66.83%, and 52.88%, respectively. The awareness rate that secondhand smoke can cause at least one disease was 72.61%. Univariate analyses showed that awareness of secondhand smoke-related health hazards differed significantly across subgroups defined by age, marital status, household annual income, urban-rural residence, geographic region, educational attainment, and smoking status(P&lt;0.001). Multivariable logistic regression showed that age ≥65 years(OR =0.41, 95%CI 0.37-0.44), being unmarried(OR=0.76, 95%CI 0.70-0.83), low income(OR=0.66, 95%CI 0.62-0.71), rural residence(OR=0.68, 95%CI 0.65-0.71), residence in western regions(OR=0.64, 95%CI 0.61-0.67), low educational attainment(OR=0.09, 95%CI 0.08-0.11), and current smoking(OR=0.85, 95%CI 0.81-0.89) were independently associated with a lower awareness that secondhand smoke causes at least one disease(P&lt;0.01). Awareness levels varied substantially across provinces, with higher awareness observed in Beijing and Shanghai(≥80% for adult lung cancer and childhood respiratory diseases, and ≥70% for heart disease), whereas awareness remained low in provinces such as Guizhou and Tibet, particularly for heart disease(&lt;50%). CONCLUSION:In 2018, awareness of the health hazards of secondhand smoke among Chinese adults aged ≥18 years remained relatively low, particularly regarding adult heart disease. Awareness rates varied across population groups and provinces, with lower levels observed among individuals aged ≥65 years, single, low-income, rural, western-region residents, those with lower education, and smokers; provincially, Guizhou and Tibet showed relatively low awareness.

BACKGROUND:Recent studies suggest that intermittent explosive disorder (IED) may be more prevalent than previously recognized, but its comorbidities and functional impacts, particularly in non-Western populations, are not well understood. This study estimates the prevalence of psychiatric comorbidities in IED and explores its relationships with other mental disorders, suicidality, and functional impairment in a nationally representative sample from mainland China. METHODS:Data from the China Mental Health Survey (2013-2015) were analyzed, including 28,140 adults. IED was assessed using the Composite International Diagnostic Interview, and five behavioral subtypes were identified. Logistic regression explored the associations between these subtypes and lifetime comorbidity, suicidality, and 12-month functional impairment. RESULTS:The weighted 12-month and lifetime prevalence of IED were 1.23% and 1.54%, respectively. Comorbidity was common, with 61.87% of individuals with IED having at least one comorbid disorder, most notably mood disorders (55.1%). The highest likelihood of comorbidity was observed in the "destroy property and hurt people" subtype (OR: 17.2; 95% CI: 7.4-41.8). Of the 391 individuals, 4.77% had ever consulted a medical doctor or other professional about their anger attacks, and 7.27% accessed mental health services. Approximately 4.45% (SE: 1.49) reported suicidal ideation, 1.79% (SE: 0.91) had a suicidal plan, and 0.88% (SE: 0.51) reported suicide attempts or gestures. Among those with 12-month IED, 10.57% reported severe functional impairment. CONCLUSION:IED is common in China but has low service utilization and high comorbidity, potentially leading to underreported impairment. These findings highlight the need for increased awareness, research, and culturally sensitive management.

Background Mepolizumab is clinically beneficial for patients with severe asthma with an eosinophilic phenotype (SA-EP) but lacks randomised controlled trial efficacy data in those on medium-dose inhaled corticosteroids (ICS). This analysis assessed mepolizumab's efficacy in a subgroup of patients on medium-dose ICS from a Chinese phase 3 trial ( NCT03562195 ). Methods Eligible SA-EP patients had received daily ≥500 µg·day −1 fluticasone propionate or equivalent. In this post hoc evaluation, we included patients who were on baseline medium-dose ICS. Outcomes assessed were rate of clinically significant exacerbations (CSEs) at week 52, time to first CSE, St George's Respiratory Questionnaire (SGRQ) score, pre-bronchodilator forced expiratory volume in 1 s (FEV 1 ), asthma control questionnaire-5 (ACQ-5) score and rate of clinical remission. Results At week 52, in the medium-dose ICS subgroup, mepolizumab (n=115) versus placebo (n=104) significantly reduced the rate of CSEs (0.53 versus 1.30 events·yr −1 ; rate ratio 0.41 (95% CI 0.25–0.66); p<0.001), with a lower probability of CSE (Kaplan–Meier estimate, 27.0% versus 49.3%; HR 0.47 (95% CI 0.30–0.73); p<0.001), greater improvements, as measured by difference in least-square mean, in SGRQ score (−5.58, 95% CI −10.73 to −0.44), FEV 1 (119.06 mL, 95% CI 6.66–231.45) and ACQ-5 score (−0.25, 95% CI −0.46 to −0.04), and a higher proportion of patients achieving three- or four-component clinical remission (31.3–57.4% versus 13.5–36.5%). The rate of clinical remission was higher in patients on medium-dose ICS than those on high-dose ICS. Conclusions Mepolizumab provided greater clinical benefit across multiple outcomes including clinical remission versus placebo in Chinese SA-EP patients on medium-dose ICS. Earlier treatment could increase the chance of clinical remission.

BackgroundDepressive disorders pose a significant public health burden, particularly among older adults. However, their prevalence, associated factors, role impairment, and mental health service utilization patterns among community-dwelling older ay -30dults in China remain understudied.MethodsThe data for this study were obtained from the China Mental Health Survey (CMHS) among participants aged 60 years and older. The World Health Organization Composite International Diagnostic Interview Version 3.0 (CIDI 3.0) was administered to generate mental disorder diagnoses consistent with the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR). We calculated weighted prevalence of depressive disorders and applied multivariable logistic regression to identify associated factors, with further analyses of role impairment and mental health service utilization.ResultsThe final sample encompassed 7,454 older adults. The weighted lifetime and 12-month prevalence of depressive disorders among Chinese community-dwelling older adults were 7.9% (95% CI: 6.4%-9.5%) and 4.1% (95% CI: 3.2%-4.9%), respectively. Multivariable logistic regression analysis showed that older adults with three or more physical illnesses exhibited greater odds of past-year depressive disorders (OR = 11.4, 95% CI: 7.0-18.6). Elevated odds were also observed among those with comorbid anxiety and substance use disorders (OR = 8.4, 95% CI: 5.5-12.8; OR = 8.9, 95% CI: 3.9-20.0, respectively). Among respondents with 12-month depressive disorders, 67.9% had role impairment in household duties, 73.2% in work, 62.2% in relationships, and 60.7% in social life. Only 11.3% of those diagnosed with depressive disorders in the past 12 months utilized any form of mental health service.ConclusionsDepressive disorders are prevalent among community-dwelling Chinese older adults and are associated with various factors. Patients commonly experienced multi-domain role impairment, whereas mental health service uptake was low, calling for strengthened screening, intervention and accessible care for older adults.

Heat waves are increasingly recognized as an environmental determinant of chronic kidney disease (CKD). However, the CKD burden attributable to heat waves and associated healthcare inequalities, particularly under future climate change, remains insufficiently characterized. Based on two nationally representative cross-sectional surveys in China, we established climate region-specific exposure-response functions between heat waves and CKD. Then, we conducted 1-km grid-level health impact assessments integrating the most up-to-date nationally representative CKD prevalence data, temperature projections, population estimates, and socioeconomic indicators. The analyses focused on stages 4–5 CKD (advanced CKD), given its progressive nature and requirements for continuous medical treatment. Heat wave-attributable CKD burden was quantified as attributable cases (ACs), attributable fractions (AFs), and population attributable fractions (PAFs). Projections for 2030–2090 were generated under multiple Shared Socioeconomic Pathways (SSPs). Hospital accessibility was evaluated using AC-weighted driving times and accessibility scores, with inequality assessed via Gini indices and Lorenz curves. In 2020, an estimated 491,362 (227,772–694,191) stages 4–5 CKD cases (about 30.06

Background: Dementia is a major global mortality cause and key driver of disability in older adults, imposing multidimensional burdens. As China's population ages, accurate prevalence estimates and care need assessments are essential for equitable policy planning. This study investigates young- and late-onset dementia prevalence while comparing health service utilization and unmet care needs between affected and unaffected populations.Methods: Utilizing China Mental Health Survey data (2013-2015) with multistage probability sampling, we identified 12,663 nationally representative adults aged ≥55 years. Of these, 10,839 completed Stage I assessments and 2,261 received Stage II evaluations, supplemented by psychiatric assessments of initial non-participants (n=197). Dementia diagnosis followed DSM-IV criteria via validated cognitive/functional instruments. Health service utilization and multidimensional care needs (ADLs/IADLs/safety) were quantified through participant/informant interviews.Results: Among 2 458 participants assessed, dementia prevalence was 2.65% (55-64y) and 5.56% (≥65y). Rural residents showed consistently higher rates than urban counterparts across age groups. Significant education gradients emerged, with urban prevalence decreasing with higher education while rural patterns differed. Individual living with dementia required substantially more care for both samples (55-64 years: 37.4% vs 11..9%, +81.3 monthly hours; 65+ years: 62.6% vs 13.4%, +88.8 monthly hours) without increased health service utilization.Conclusion: This national study reveals substantial dementia burden in China, exposing systemic healthcare deficiencies through misaligned functional care needs and medical engagement. The neglect of chronic disability management in aging populations necessitates urgent integration of prevention strategies and tailored support frameworks within primary care systems.

BACKGROUND:Ensifentrine, a novel phosphodiesterase 3/4 inhibitor, was shown to significantly improve lung function and reduced COPD exacerbations in previous trials in Western populations. However, efficacy and safety data on its use in Chinese participants with COPD remain limited. RESEARCH QUESTION:Is nebulized ensifentrine effective and safe compared with placebo for the treatment of COPD in Chinese participants? STUDY DESIGN AND METHODS:A phase III, multicenter, randomized, double-anonymized, placebo-controlled trial was conducted between March 2023 and March 2025. The study enrolled participants with moderate to severe symptomatic COPD randomized to the ensifentrine group or the placebo group (5:3) over 24 weeks. Participants were stratified according to maintenance therapy and smoking status. The primary end point was lung function improvement measured by FEV1 area under the curve at 0 to 12 hours. Other end points included quality of life, symptoms, and exacerbations. RESULTS:Overall, 525 participants were included in the analysis, with 45.9% receiving concomitant maintenance therapy. Ensifentrine significantly improved average FEV1 area under the curve at 0 to 12 hours vs placebo (110 mL; 95% CI, 69-151 mL; P < .0001). Lung function improvement was consistent across clinically relevant subgroups, including participants with and without maintenance therapy, as well as participants with moderate and severe COPD. Ensifentrine significantly improved Transition Dyspnea Index score and showed improvements in Evaluating Respiratory Symptoms and St. George's Respiratory Questionnaire scores vs placebo. Ensifentrine treatment tended to reduce the rate of moderate to severe exacerbations and increased the time to first exacerbation. Adverse event rates were similar between the ensifentrine and placebo groups. INTERPRETATION:Ensifentrine was shown to significantly improve lung function and showed efficacy benefits in symptoms and quality of life improvement in Chinese individuals with COPD. CLINICAL TRIAL REGISTRATION:ClinicalTrials.gov; No.: NCT05743075; URL: www. CLINICALTRIALS:gov.

Background: China experienced a rapid increase in hospitalisation over the past decade, yet the relative associations of healthcare demand and supply remain unclear. We examined long-term trends in hospitalisation and quantified the model-based contribution of hospital bed expansion to hospitalisation growth across provinces in China. Methods: We conducted a provincial panel study of 31 mainland Chinese provinces, 2011–2024. Hospitalisation rate was the primary outcome. Demand-side and supply-side factors were analysed using two-way fixed-effects models. Regression-based decomposition quantified model-based contributions. Subgroup analyses assessed heterogeneity by region, economic development, and bed density. Findings: The hospitalisation rate increased from 11.37% in 2011 to 22.62% in 2024, with persistent regional disparities. Hospital bed density was positively associated with hospitalisation after adjustment for demand-side factors and physician density (β=0.992, p<0.01). Bed density had the largest model-based contribution to this growth (3.44 percentage points, 30.6%), exceeding economic development (22.8%) and population ageing (7.2%). This association was stronger in central (β=1.505, p<0.01) and western provinces (β=2.453, p<0.01) but was not statistically significant in eastern provinces. Measured demand-side and supply-side factors together explained 38.6% of the total increase; the remaining 61.4% was unexplained. Interpretation: Long-term hospitalisation growth in China is associated with both rising healthcare needs and supply expansion, yet a substantial proportion remains unexplained by conventional frameworks. Hospital bed expansion showed the largest model-based contribution, but this association was context-dependent. Future reforms should prioritise resource optimisation over capacity expansion. Funding : None

Ovarian cancer is a major female reproductive health issue with heterogeneous biological features on its subtypes, which may require different therapeutic strategies. Glucagon-like peptide-1 receptor (GLP-1R) agonists were reported to be beneficial for ovarian cancer, but the causal effects and mechanisms on its heterogeneous subtypes remain unclear. We used genetic variants robustly associated with gene expression, protein level, splicing event, and DNA methylation of GLP-1R in six endocrine-related tissues (N ≤ 35,431) as genetic instruments to proxy the effect of GLP-1R agonism. To increase power, we conducted a meta-analysis of genome-wide association studies of ovarian cancer (29,066 cases, 461,542 controls), and identified 12 genome-wide associated variants, including two previously unreported variants: rs77247401 (MIR1208) and rs56159231 (PLEKHM1). Here we show that gene expression of GLP-1R in pancreas is associated with a reduced risk of overall ovarian cancer risk odds ratio ([OR] = 0.94, 95

Background The associations between different definitions of prediabetes and diabetes with mortality and life expectancy remain unclear. Clarifying these associations is essential for informing hyperglycemia management policies. We aimed to compare the prevalence of prediabetes and newly diagnosed diabetes across different glycemic indicators and diagnostic criteria, and to examine their associations with mortality and life expectancy. Methods We analyzed data from 141,945 adults from a nationally representative cohort study in China. Cox proportional hazards regression models were used to estimate hazard ratios (HRs). Using fasting plasma glucose (FPG), 2-hour postload glucose (2hPG), and hemoglobin A1c (HbA1c) levels, prediabetes was defined according to the American Diabetes Association (ADA), World Health Organization (WHO), or International Expert Committee (IEC) criteria, and newly diagnosed diabetes according to the ADA criteria. Results Prediabetes prevalence varied widely across glycemic indicators, ranging from 3.0% to 26.1%, while newly diagnosed diabetes prevalence ranged from 2.6% to 4.4%. Over a median follow-up of 9.0 years, a total of 6,924 deaths were documented. Compared with people with normoglycemia, prediabetes defined by FPG (either ADA or WHO criteria) was not significantly associated with increased risks of all-cause or cardiovascular disease (CVD) mortality (all P>0.05). In contrast, prediabetes defined by 2hPG or HbA1c (either ADA or IEC criteria) was each associated with higher risks of all-cause mortality (HRs: 1.13-1.23; all P<0.001) and CVD mortality (HRs: 1.12-1.25; all P<0.001). Prediabetes defined by 2hPG or HbA1c, but not FPG, was associated with 1.1-2.3 years reduction in life expectancy, with the largest loss observed for IEC HbA1c. In addition, diabetes defined by FPG, 2hPG or HbA1c was each significantly associated with higher risk of all-cause and CVD mortality (HRs: 1.25-1.51), and reduction in life expectancy (2.0-3.7 years). Furthermore, the 2hPG-based definition of prediabetes and diabetes was associated with mortality risk, independent of FPG and HbA1c levels. Conclusions These findings suggest that reliance on FPG alone may fail to identify certain individuals at elevated mortality risk. In contrast, 2hPG and HbA1c provide additional prognostic information beyond FPG.

BACKGROUND:Role impairment due to health problems is a public health issue. China Mental Health Survey (CMHS) is a national epidemiological study in China, providing plenty of information on mental disorders and physical diseases.This study focused on the association between mental disorders and physical diseases with role impairment. METHODS:This study was based on CMHS, a cross-sectional study in a large-scale nationally representative sample across China from 2012 to 2015. Trained interviewers carried out face-to-face interviews with 28,140 respondents using the Composite International Diagnostic Interview-3.0 (CIDI-3.0). The prevalence of mental disorders and physical diseases was assessed. In addition, each respondent reported information about the number of days in the past month being totally and partially unable to work or carry out their other normal daily activities because of problems with either mental disorders or physical diseases. Associations of role impairment with physical diseases and mental disorders were analyzed by multiple regression. RESULTS:Overall, the weighted rate of role impairment was 3.68% in patients with any mental disorders and 8.75% in those with any physical diseases. Chronic pain ( β = 0.07, P <0.001) became the main physical disease associated with role impairment, while depressive disorder ( β = 0.12, P <0.001) became the main mental disorder associated with role impairment. Patients with more mental disorders or physical diseases experienced more days with role impairment. CONCLUSIONS:Common mental disorders and physical diseases account for a large proportion of the number of days out of role. It should be addressed to substantially increase the level of mental health in China.

Background: Utilisation of health services is low and delayed among individuals with mood mental disorders and anxiety disorders, despite high disease burdens and available effective treatments. This study aims to examine patterns and delays in help-seeking and associated factors among individuals with lifetime disorder of mood disorders and/or anxiety disorders. Methods: We used data from the China Mental Health Survey (CMHS), a nationally representative multistage clustered-area probability sample study across 31 provinces. We assessed lifetime mental disorders and helpseeking behaviour using the Composite International Diagnostic Interview (CIDI). Logistic regression analyses were used to examine sociodemographic and clinical correlates of delay to seek health care. Results: Among 32,552 participants, we identified 3075 patients with lifetime mood and/or anxiety disorders; 486 (15.5 % [95 % CI: 13.6-17.5 %]) have sought health care. Of these, 163 (4.8 % [95 % CI: 3.7-6.3]) ever sought specialized mental health services. The delays to initial health care were 1.0 (IQR: 0-7.1), 1.9 (0-10.0), and 10.0 (1.0-22.1) years for depressive, bipolar, and anxiety disorders. Patients with comorbidities, later age of onset, and living in urban areas showed a higher propensity for help-seeking (all p < 0.05). Older cohort was associated with longer delays in seeking health care, while a later age of onset was associated with shorter delays (all p < 0.05). Limitations: The cross-sectional retrospective design and self-assessment approach may add bias. Conclusions: Failure and delays in help-seeking are common in China. National strategies are needed to promote health care utilisation.

BACKGROUND:Understanding the patterns of unintentional injuries (UIs) among children admitted to the Pediatric Intensive Care Unit (PICU) is crucial for effective prevention and management. We aimed to explore the demographic, situational and clinical characteristics of children with UIs admitted to the PICU. METHODS:We conducted a cross-sectional, retrospective study of patients under 18 with UIs admitted to the PICU of Children's Hospital of Fudan University from October 2017 to December 2022. RESULTS:A total of 395 children were admitted, with a mean (SD) age of 5.6 (3.7) years. Road traffic injuries (RTI) (146 (37%)) and high falls (119 (30.1%)) were dominant. Patients with foreign body injuries had a lower median (Q1, Q3) age of 1.6 (1.1, 1.8) years (P＜0.001). Most UIs occurred when children were alone (318 (80.5%), P＜0.001), during recreation (61 (15.4%), P＜0.001) and indoors (212 (53.7%), P＜0.001). Injury types differed significantly in hospital stay length (P＜0.001) and prognosis (P＜0.001). Compared with RTIs, drowning and poisoning were more likely to result in poor prognosis (drowning OR=9.778 (3.515,28.537), P＜0.001; poisoning OR=3.556 (1.123,10.428), p=0.023). CONCLUSIONS:RTIs and high falls were the leading types of children with UIs admitted to the PICU. Injury patterns varied with age, situational characteristics and involved substantial medical costs. Tailored interventions based on injury patterns are essential to improve child safety and well-being.

What is already known about this topic?:Potentially inappropriate medication (PIM) use is a global challenge. The World Health Organization's 2017 Medication Without Harm initiative set a target to reduce medication-related harm by 50% within five years. However, trends and disease burden related to PIM use in China have remained unclear. What is added by this report?:This study found that from 2015 to 2023, the prevalence of PIM use and the associated cardiovascular disease mortality and morbidity nearly halved. Nonetheless, substantial disparities persist across sex, age, urban-rural status, and geographic region. Inner Mongolia and Tianjin exhibited the most pronounced reductions after 2018. What are the implications for public health practice?:Develop population-based systems to monitor medication use. Integrate rational-use training and public education into essential public health services, and strengthen implementation at the primary care level, particularly in northern and northeastern provinces.