Noise-induced hearing loss (NIHL) is the second most prevalent occupational disease in China. Due to its insidious onset, patients are often diagnosed at an irreversible stage, yet high-quality prospective cohorts addressing this critical issue remain limited. We established a multicenter prospective cohort-the Study of Health Effects from Noise Generated in China (SHENG)-with the primary objectives of systematically characterizing the epidemiological features, identifying environmental and genetic risk factors, elucidating molecular mechanisms, and investigating systemic health effects of NIHL, ultimately providing a scientific foundation for evidence-based prevention and control strategies. The baseline survey of SHENG was completed in 2023, covering eight enterprises across seven provinces and enrolling 4,660 young male workers (mean age 23.5 years). Based on high-frequency pure-tone average (3-8 kHz), 27.4% of participants were classified as having hearing loss, though most of them did not report subjective hearing difficulties. Compared with the normal hearing group, the hearing loss group had significantly more noise exposure events, higher exposure rates to occupational co-hazards such as dust and vibration, and poorer hearing protection practices. SHENG is planned to conduct follow-up assessments every 1-2 years. Through longitudinal follow-up and multidimensional data integration, this cohort will establish an "environmental-clinical-genetic" risk assessment model, elucidate the dynamic progression of NIHL and its associations with systemic diseases, and provide key evidence for refining occupational noise exposure standards and developing precision prevention strategies tailored to susceptible populations.

The relationship between kidney function and mortality in centenarians, particularly with respect to hormonal regulation, remains unclear. This study investigated the association between estimated glomerular filtration rate (eGFR) and all-cause mortality in female centenarians and explored the potential role of testosterone. Within the China Hainan Centenarian Cohort Study, 701 female centenarians (median age: 102 years) were enrolled. eGFR was calculated using the CKD-EPI 2009 creatinine equation. Restricted cubic splines (RCSs) and multivariable Cox proportional hazards models were employed to assess nonlinear associations. Likelihood ratio tests were used to evaluate the interaction effect of testosterone. During a median follow-up of 31 months, 643 participants (91.7

BackgroundThe complement system plays an important role in innate immunity and age-related inflammation, but its prognostic value in centenarians remains unclear. This study aimed to examine the associations between serum complement C3 and C4 levels and all-cause mortality among centenarians.MethodsWe studied centenarians in Hainan Island, China. We used multivariable-adjusted restricted cubic splines, Cox proportional hazards models, and Kaplan–Meier survival analysis to assess the relationships between serum C3 and C4 levels and all-cause mortality.ResultsA total of 906 centenarians were included in the final analysis. During a median follow-up of 30.1 months, 838 (92.5%) participants died. There was a significant inverse linear relationship between serum C3 levels and all-cause mortality (P = 0.031). Compared with the highest C3 quartile (Q4), individuals in the lowest quartile (Q1) had an increased risk of all-cause mortality (hazard ratio = 1.337; 95% confidence interval: 1.092–1.635; P = 0.005), whereas C4 levels showed no significant relationship with mortality (P > 0.05). When we used Q1 (0.86 g/L) as a cut-off, centenarians with C3 levels below this threshold also showed a higher mortality risk than those above this threshold (hazard ratio = 1.250; 95% confidence interval: 1.063–1.470; P = 0.007). A Kaplan–Meier analysis further indicated a shorter survival time in the lowest C3 quartile (Q1 vs. Q4: 26 vs. 34 months, P = 0.002). In contrast, C4 levels were not significantly associated with survival.ConclusionSerum complement C3 levels, but not C4 levels, might be associated with the risk of all-cause mortality in centenarians. However, because all centenarians were recruited from Hainan Island, external validation in other regions and ethnic populations is warranted.

Purpose To compare differences in inpatient costs between endoscopic submucosal dissection (ESD) and endoscopic mucosal resection (EMR) for the treatment of patients with colorectal neoplastic lesions (including precancerous lesions and early-stage cancer), analyze the associated influencing factors, and conduct short-term and long-term cost-effectiveness evaluations, so as to provide a basis for clinical procedure selection and optimization of healthcare resource allocation. Methods Clinical data were retrospectively collected from 144 patients treated with ESD and 95 patients treated with EMR. Univariate analyses were performed using the Mann-Whitney U test and the Kruskal-Wallis H test. Multivariate linear regression and quantile regression models were further used to explore the influencing factors across different levels of cost distribution. Results Both univariate and multivariate linear regression analyses indicated that occupation, lesion site, maximum tumor diameter, and length of hospital stay were independent factors influencing hospitalization costs for ESD procedures ( P < 0.05); pathological findings, maximum tumor diameter, number of adenomas, and length of hospital stay were independent factors influencing hospitalization costs for EMR procedures ( P < 0.05). Quantile regression results showed that in the ESD group, hospitalization costs for patients who were specialized technical personnel decreased significantly at the 50th quantile ( P = 0.044), while unemployed patients exhibited a negative effect on costs at the 25th and 90th quantiles ( P = 0.05). Compared to lesions located in the right half of the colon, costs for lesions in the left half of the colon were significantly lower at the 25th percentile, and costs for rectal lesions were significantly lower at the 50th percentile ( P < 0.05). A maximum tumor diameter ≥ 2 cm significantly increased hospitalization costs at the 50th percentile ( P = 0.007); a hospital stay of ≥ 11 days had a positive effect on costs at the 10th, 25th, 50th, and 75th percentiles ( P < 0.05). Quantile regression analysis in the EMR group showed that a pathological diagnosis of early-stage cancer significantly increased hospitalization costs at all cost percentiles ( P < 0.01); a maximum tumor diameter ≥ 2 cm significantly increased costs at the 10th to 75th percentiles ( P < 0.05); 3 or more adenomas significantly increased costs only at the 25th percentile ( P = 0.032); a length of hospital stay ≥ 11 days had a significant positive effect on hospitalization costs at the 25th, 50th, and 75th percentiles ( P < 0.05). Conclusion Hospitalization costs for ESD and EMR treatments of colorectal lesions are influenced by multiple factors, and these factors exhibit heterogeneity across different cost quantiles. Length of hospital stay is the most robust positive cost driver for both surgical procedures, with a particularly pronounced effect in the mid-cost range. This suggests that in clinical practice, developing individualized treatment plans based on tumor size, lesion location, and patient occupational background, and shortening hospital stays through Enhanced Recovery After Surgery (ERAS) strategies, are key to achieving optimal allocation of healthcare resources.

BACKGROUND:China's rapid aging has exposed gaps in understanding life-course modifiable mortality risk factors, especially in the oldest-old. METHODS:This pooled cohort study analyzed 11 modifiable risk factors across age groups (30-49, 50-59, 60-79, 80-99, ≥100 years) using data from the China Kadoorie Biobank, China Hainan Centenarian Cohort Study, and Guangzhou Biobank Cohort Study. A modifiable risk factor score summed present factors. Cox models adjusted for age, sex, and other factors estimated age-stratified associations; hazard ratios (HRs) and population attributable fractions (PAFs) were calculated for all-cause mortality. RESULTS:Among 61,045 participants followed for mean 3.79-13.20 years, mortality rates were 6.45-169.52 per 1,000 person-years. A higher modifiable risk factor score was associated with increased mortality from middle age to centenarians (HR 1.11 [1.01-1.21] to 1.31 [1.21-1.36]). Metabolic risk factors attenuated with age: HR 1.43 (1.14-1.80) in middle-aged adults to 1.07 (0.99-1.17) in centenarians; diabetes and hypertension dominated this cluster. Hypertension-attributable mortality peaked at 16.2% (8.3-22.6%) in presenium, declining to 0.6% and 0.1% in advanced longevity groups. Conversely, low educational attainment showed increasing mortality impact with age (HR 1.55 [1.13-2.14] to 1.74 [1.01-3.01]; PAF 6.4%-30.8%); physical inactivity contributed significantly in both middle-aged adults and centenarians. CONCLUSIONS:Life-course stratification reveals dynamic transitions: metabolic burdens diminish while socio-behavioral risks intensify with longevity, supporting age-specific prevention strategies to optimize healthy aging.

BACKGROUND:The possible joint association of vitamin D and obesity in regard to clinical biomarker-based biological aging process has not been well studied. We investigated the independent and combined associations of serum 25-hydroxyvitamin D [25(OH)D] concentrations and body mass index (BMI) with phenotypic age (PhenoAge) and Klemera-Doubal method Biological Age (KDM-BA) acceleration. METHODS:This study was conducted using data from participants in the UK Biobank baseline survey. Restricted cubic splines and multivariable logistic regression analyses were used to investigate the associations of serum 25(OH)D concentrations and BMI with PhenoAge and KDM-BA acceleration. Mediation analyses were conducted to assess whether biological age acceleration potentially mediated the association between 25(OH)D or BMI and all-cause mortality. RESULTS:In Analysis 1 (n = 389 217) for PhenoAge, and Analysis 2 for KDM-BA (n = 329 561), participants whose serum 25(OH)D concentration ≥50.0 nmol/L or with normal weight (BMI <25 kg/m2) had the lowest odds of biological age acceleration. Those with both 25(OH)D <25.0 nmol/L and BMI ≥30.0 kg/m2 had the highest odds of PhenoAge acceleration ([OR [95% CI], 2.387 [2.303, 2.474]) and KDM-BA acceleration [OR (95% CI), 4.096 (3.926, 4.274)]. The mediation analysis revealed that PhenoAge acceleration mediated 11.4% and 47.1% of the associations of 25(OH)D and BMI with all-cause mortality; while KDM-BA acceleration accounted for 7.41% and 55.2%. CONCLUSIONS:Serum 25(OH)D concentrations and BMI were significantly associated with the acceleration of biological aging. Combining vitamin D deficiency and obesity demonstrated enhanced synergistic association on the biological aging process, highlighting the importance of vitamin D and BMI in promoting healthy aging.

BACKGROUND:Guidelines and consensus statements lack consistent management targets and ranges for low density lipoprotein cholesterol (LDL-C) and high density lipoprotein cholesterol (HDL-C) in older adults. OBJECTIVES:The objectives of the study were to investigate the relationships of LDL-C and HDL-C with cardiovascular disease (CVD) risk in older adults and to identify optimal target ranges for their management. METHODS:This study included 217,442 U.K. Biobank participants aged ≥60 years, free of CVD and cancer at baseline. Multivariable Cox regression models and restricted cubic splines were employed to estimate HRs and 95% CIs for the associations of LDL-C and HDL-C levels with CVD outcome. RESULTS:During follow-up, 26,756 CVDs and 2,726 CVD deaths occurred. LDL-C exhibited U-shaped relationships with both incident CVD and CVD mortality (minimal risk: 3.600-4.204 mmol/L). HDL-C showed an L-shaped association with incident CVD but a U-shaped association with CVD mortality (minimal risk: 1.421-1.699 mmol/L). Compared with the reference LDL-C group, the Q1 group had a 39% higher incident CVD risk (HR: 1.39; 95% CI: 1.32-1.47) and 27% higher CVD mortality risk (HR: 1.27; 95% CI: 1.08-1.48). Conversely, compared with the reference HDL-C group, the Q6 group was associated with a lower incident CVD (HR: 0.90; 95% CI: 0.84-0.97) and higher CVD mortality risk (HR: 1.24; 95% CI: 1.01-1.51). Notably, the CVD risk rose progressively with joint LDL-C and HDL-C risk tiers. CONCLUSIONS:U/L-shaped associations of LDL-C and HDL-C with CVD risk in older adults underscore the importance of maintaining lipids within an optimal range. This distinct "Goldilocks zone" is associated with minimized risk and highlights current guideline limitations.

BACKGROUND:Obesity and handgrip strength are independently associated with mortality risk; however, research evidence regarding their effects on premature mortality risk, either individually or in combination, remains limited. Concurrently, the European Association for the Study of Obesity (EASO) has introduced a novel obesity classification framework offering more refined criteria for weight status categorisation. Research re-evaluating the relationship between obesity and mortality risk based on this new framework is urgently required. OBJECTIVE:To investigate the association between weight status (WS), handgrip strength (HGS), their combined effect, and premature mortality risk. METHOD:This study utilised data from the UK Biobank (2006-2010) to construct a dynamic cohort of older adults (aged ≥60.0 years). Multivariable Cox proportional hazards models were employed to analyse the independent associations of body weight status and HGS, as well as their combined effects, with the risk of premature mortality. Heterogeneity was explored by stratifying for age, sex, and age at death. RESULTS:The study ultimately included 200,405 older adults. During a median follow-up of 5311.0 days, 28,094 all-cause mortality and 5172 premature mortality (2.6%) occurred. Obesity prevalence was significantly higher (62.5%) when defined by the new EASO framework compared to BMI-based obesity (24.9%). After adjusting for confounding factors, both weight category and muscular function were independently associated with premature mortality under the new classification. Compared to individuals with normal weight, underweight individuals (HR = 2.40, 95% CI: 1.79-3.23) and obese individuals (HR = 1.07, 95% CI: 1.00-1.14) exhibited significantly elevated premature mortality risks. Conversely, overweight individuals demonstrated a significantly reduced risk of premature mortality (HR = 0.78, 95% CI: 0.69-0.89). Compared with normal grip strength, abnormal grip strength increased premature mortality risk (HR = 1.46, 95% CI: 1.35-1.57). In the combined analysis of weight categories and grip strength, the underweight with abnormal grip strength (UW/A-HGS) group exhibited the most pronounced increase in premature mortality risk relative to the normal weight with normal grip strength group (HR = 4.96, 95% CI: 3.07-8.01). Conversely, a significantly decreased risk was observed in the overweight with normal grip strength group (HR = 0.79, 95% CI: 0.69-0.91). Stratified analysis revealed notable gender- and age-specific differences in outcomes. CONCLUSIONS:This study demonstrates that: 1) The new obesity criteria significantly enhance obesity detection rates and improve mortality risk prediction sensitivity; 2) Both weight status and grip strength independently and synergistically influence premature mortality risk; 3) Combined assessment of WS and HGS significantly optimises premature mortality risk stratification in older adults, with effects exhibiting gender and age heterogeneity. Integrating the EASO obesity criteria with grip strength into geriatric health assessment systems enables more precise identification of high-risk populations, providing critical scientific evidence for early intervention and personalised health management.

Background:The uric acid-to-albumin ratio (UAR) has emerged as a potential composite biomarker reflecting oxidative stress and nutritional status, both of which are relevant to aging and mortality risk. However, its prognostic value in extremely long-lived individuals remains unclear. Methods:A prospective cohort study involving 1,002 centenarians from China Hainan was conducted between June 2014 and December 2016. Participants were followed for survival status through March 31, 2023. Restricted cubic spline (RCS) modeling, Cox proportional hazards regression, and Kaplan-Meier survival analyses were employed to assess the association between UAR and mortality risk. Results:After excluding 78 centenarians, the cohort included 924 centenarians (median age: 102 years; 18.29% male). During a median follow-up of 29.70 months, 854 (92.42%) died. RCS analysis indicated a statistically significant overall association between UAR and mortality (adjusted P for overall = 0.009), with evidence of non-linearity (adjusted P for non-linearity = 0.029). In multivariable Cox regression analysis, individuals in the higher UAR quartile (Q4) demonstrated a 28.7% increased risk of mortality compared with those in the lower three quartiles (Q1-Q3) (adjusted hazard ratio: 1.287, 95% CI: 1.093,1.516; P = 0.003). Kaplan-Meier analysis further revealed that participants in Q4 had a significantly shorter median survival time (26 months) compared with those in Q1-Q3 (32 months) (log-rank test, P < 0.001). Conclusion:Elevated UAR is independently associated with increased all-cause mortality in centenarians, suggesting its potential utility as a prognostic biomarker for risk stratification in exceptionally long-lived populations.

While Life's Essential 8 (LE8) provides a comprehensive measure of cardiovascular health (CVH), its association with mortality among the oldest-old, including centenarians, remains unclear. This study evaluated the relationship between LE8-defined CVH and all-cause mortality across adulthood using data from the China Kadoorie Biobank (Hainan cohort) and the China Hainan Centenarian Cohort Study, including 31,473 individuals aged 30-116. Participants were categorized by life stage and CVH score (low, moderate, high). Higher CVH scores were associated with significantly reduced mortality risk at all life stages, including among centenarians, who experienced a 54.8% lower risk with high CVH. A near-linear dose-response relationship was observed. Population-attributable fractions for mortality reached 36.8% in centenarians. Physical activity and body mass were particularly important in reducing mortality among centenarians. These findings challenge therapeutic nihilism in the oldest-old while underscoring the need for age-specific strategies tailored to distinct physiological profiles is crucial for extending healthy lifespan across the adult life course.

In this prospective cohort study of 1545 participants aged 80 years and older from the China Hainan Centenarian Cohort Study, we investigated the independent and joint associations of modifiable risk factors and genetic predisposition with life expectancy. A weighted modifiable risk factor score (MRFS) based on 11 factors and a polygenic risk score (PRS) for longevity were constructed. A favorable modifiable risk factor profile (low MRFS) was associated with a 40.7% lower death risk (HR 0.593, 95%CI 0.505-0.696) compared with high MRFS. Genetic predisposition to longer lifespan (high PRS) conferred a 13.0% lower risk (HR 0.870, 95%CI 0.768-0.986). Participants with both low MRFS and high PRS had the lowest mortality (HR 0.544, 95%CI 0.432-0.686), with a borderline significant multiplicative interaction (P = 0.040). Life expectancy gains from a low MRFS were more pronounced in those with high PRS (6.92 years at age 80) than low PRS (5.35 years). Among the oldest-old Han Chinese, favorable modifiable risk profiles and genetic predisposition independently and jointly contribute to substantially longer life expectancy. Importantly, an unfavorable modifiable profile may largely negate genetic longevity benefits, emphasizing the critical role of managing these factors even in advanced age and irrespective of genetic inheritance.

BackgroundMuscle mass (MM) has a strong correlation with all-cause mortality. However, its assessment is not easily accessible and expensive. Serum creatine kinase (CK) has been proposed as a solution, but its association with mortality remains unclear. This study aimed to investigate the association between the serum CK level and all-causes mortality among centenarians in China.MethodsThis prospective cohort study included Chinese centenarians residing in the community between June 2014 and December 2016. All-cause mortality was analyzed according to serum CK level using restricted cubic spline (RCS) analysis, Cox regression analysis, Kaplan–Meier curves, the log-rank test, and subgroup analysis.ResultsIn total, 949 centenarians were eligible for participation and were followed up for a median of 29.4 months (IQR 14.5, 51.7). During the study period, 92.9% of the study participants died. RCS analysis revealed an inverse J-shaped relationship between the serum CK level and the risk of death. Mortality was 34.3% higher when the serum CK level was in the range of 8–66 U/L (Q1–Q2) than in the range of 66–192 U/L (Q3–Q4) (HR = 1.343 in multivariable analysis; 95%CI: 1.173–1.538; P<0.001). Kaplan–Meier analysis showed a significantly shorter median survival in the low-CK group (Q1–Q2) compared to the high-CK group (Q3–Q4). (26 months vs 36 months; P<0.001, log-rank test).ConclusionsAmong community-dwelling centenarians, serum CK level was independently and inversely associated with all-cause mortality in an inverse J−shaped manner and may serve as a practical biomarker for physiological status and survival.

Neonatal pediatricians are facing relatively high risk of medical disputes since higher risk of mortality during the neonatal period caused by the increased number of premature births worldwide. However, there is little knowledge about the current status and distribution of medical disputes in Chinese neonatology. We conducted a cross-sectional survey to investigate the prevalence, potential causes, and associated risk factors of medical disputes in neonatology in the mainland of China. The statistical analysis was done by SPSS, including Chi-square test and independent samples t-test, Pearson correlation analysis and binary logistic regression analysis. Among the 12,118 participated neonatal pediatricians, 9,013 (74.4%) experienced medical disputes, and about 96% neonatal pediatricians older than 60 experienced medical disputes. A positive correlation was found between the prevalence of medical disputes and gross domestic product (GDP) per capita of the corresponding city or province. “Overestimation of treatment effects from the perspective of the patients and their families” was the primary cause of medical disputes. Gender, age, educational background, hospital level, and the number of responsible beds were independent risk factors contributing to medical disputes. Information obtained from this study may provide useful clues for reducing the occurrence of medical disputes in neonatology in the mainland of China.

The atherogenic index of plasma (AIP) is a lipid-based biomarker associated with cardiovascular and renal risks in individuals with type 2 diabetes mellitus (T2DM). However, its relationship with diabetic nephropathy (DN) remains inadequately defined. This meta-analysis aims to assess the association between AIP and DN in T2DM patients. We conducted a comprehensive search in PubMed, Embase, and Web of Science for observational studies that compared the incidence or prevalence of DN across varying AIP levels in T2DM populations. Data were synthesized using a random-effects model to account for potential heterogeneity. A total of eleven datasets from ten studies, encompassing 25,773 T2DM patients, were included in the analysis. The pooled results indicated that higher AIP levels are significantly associated with DN (risk ratio [RR] = 1.51, 95% confidence interval [CI]: 1.36-1.67; p < 0.001). Subgroup analyses revealed a stronger association in patients aged 58 years or older (RR = 1.66) compared to those younger than 58 years (RR = 1.35; p for subgroup difference = 0.02). Similar associations were observed across different study designs, sex distributions, AIP cutoff values, definitions of DN, and quality scores (p for subgroup difference all > 0.05). Meta-regression analysis further indicated that older age positively influenced the strength of the association (coefficient = 0.018, p = 0.03). In conclusion, elevated AIP levels are significantly associated with diabetic nephropathy in T2DM patients, particularly among older individuals.

Gastrointestinal cancers represent a significant public health burden in China. Current evidence regarding treatment approaches for early-stage gastrointestinal malignancies predominantly derives from case reports and small-scale studies. Furthermore, existing gastrointestinal disease cohorts primarily focus on community-based screening or high-risk populations, leaving a substantial gap in systematically collected data from hospitalized early stage cancer patients. We established the National Early Gastrointestinal Cancer Cohort (NEGCC), which constitutes, to our knowledge, one of the most comprehensive multicenter cohorts of hospitalized early gastrointestinal cancer patients in China and Asia. This initiative has been complemented by the development of a dedicated clinical platform, an integrated database, a biorepository, and a health economic evaluation framework. The study enrolled patients who underwent surgical resection for early gastrointestinal cancer at participating institutions between January 1, 2015, and June 30, 2023, with planned follow-up continuing until December 31, 2026. Standardized data collection includes comprehensive baseline characteristics, treatment parameters, and prospective outcome measures, integrated through a centralized electronic registry ( https://bjdigest.sino-med.net ). The initial dataset comprises 3,348 patients who underwent surgical management at the PLA General Hospital between January 2015 and December 2019. The cohort had a male predominance (73.7

BACKGROUND:Early control of low-density lipoprotein cholesterol (LDL-C) is crucial for reducing the progress of cardiovascular disease. However, its additional role to the risk of primary osteoporosis in men with coronary heart disease was inconclusive. Our study aims to determine the association of LDL-C and its trajectories for osteoporosis risk in the middle-aged and aged men of China. METHODS:The retrospective cohort study of 1546 men aged 69.74 ± 11.30 years conducted in Beijing, China from 2015 to 2022. And the incidence of primary osteoporosis was annually recorded. LDL-C trajectories were further identified by latent class growth model using repeated measurements of LDL-C. The association of baseline LDL-C for osteoporosis was estimated using hazard ratio (HR) with 95% CI in Cox proportional hazard model, while mean level and trajectories of LDL-C for osteoporosis were evaluated using odds ratio (OR) with 95% CI in logistic regression model. RESULTS:During the median 6.2-year follow-up period, 70 men developed primary osteoporosis. The higher level of baseline LDL-C (HR = 1.539, 95% CI: 1.012-2.342) and mean LDL-C (OR = 2.190, 95% CI: 1.443-3.324) were associated with higher risk of osteoporosis in men with coronary heart disease after adjusted for covariates. Compared with those in the LDL-C trajectory of low-stable decrease, participants with medium-fluctuant trajectory, whose longitudinal LDL-C started with a medium LDL-C level and appeared an increase and then decrease, were negatively associated with osteoporosis risk (OR = 2.451, 95% CI: 1.152-5.216). And participants with initially high LDL-C level and then a rapid decrease demonstrated a tendency towards reduced risk (OR = 0.718, 95% CI: 0.212-2.437). CONCLUSIONS:Elevated LDL-C level and its long-term fluctuation may increase the risk of primary osteoporosis in men. Early controlling a stable level of LDL-C is also essential for bone health.

Lung transplantation is the most important treatment for end-stage lung disease. However, the clinical outcomes of lung transplantation in patients with connective tissue disease(CTD) complicated with end-stage pulmonary complications are unclear. Consequently, we performed a systematic review and meta-analysis to compare the survival rates and incidences of adverse events between patients with and without CTD who underwent lung transplantation for end-stage lung disease. We searched the PubMed, Embase, Web of Science, Cochrane, Wanfang, VIP, CNKI, and CBM databases from their inception until October 18, 2023, for eligible studies. A meta-analysis of each study was performed using State14.0 with a 95