Background:Increasing suicidal thoughts and behaviors (STB) among adolescents raise social concerns and have a well-recognized association with sexual abuse (SA). However, research regarding the mechanisms explaining the association between SA and STB remains limited. Objective:This study aims to examine the chained mediating effects of negative life events (NLE) and internet addiction (IA) between SA and STB among adolescents in China. Methods:This cross-sectional study used data from the Science Database of the People Mental Health survey conducted between March 2013 and December 2022 by the National Population Health Data Center of the National Research Institute for Family Planning. Through stratified sampling, 20,893 adolescents were recruited from 16 Chinese provinces. After excluding samples with missing relevant variables, 10,664 (55.89%; aged 16-17.9 y; n=5826, 54.63% women) adolescents were included in the final analysis. STB was the outcome variable, with NLE and IA as mediators, all assessed via a questionnaire that was uniformly administered by trained investigators in school settings. The Pearson χ2 test was used to analyze the association between SA and STB. Using a combination of multiple linear regression and bootstrap testing, the study constructed a chain mediation model to explore how SA influences STB in adolescents through NLE and IA. Results:The scores for SA, NLE, IA, and STB were 1.330 (SD 1.714), 51.960 (SD 23.822), 34.88 (SD 13.852), and 0.690 (SD 1.396), respectively. Multiple linear regression analysis indicated SA was associated with NLE (β=2.382, 95% CI 2.112-2.653; P<.001), IA (β=1.094, 95% CI 0.939-1.249; P<.001), and STB (β=0.135, 95% CI 0.119-0.151; P<.001). Mediation analysis revealed a significant direct association between SA and STB (74.81%; β=0.101, 95% CI 0.085-0.117; P<.001). Indirect effects constituted 25.19% of the total association (β=0.034, 95% CI 0.029-0.040; P<.001), comprised of 3 specific pathways: via NLE (11.85%; β=0.016, 95% CI 0.012-0.020; P<.001), via IA (10.37%; β=0.014, 95% CI 0.010-0.018; P<.001), and via the sequential pathway through NLE and then IA (2.96%; β=0.004, 95% CI 0.003-0.006; P<.001). Conclusions:Unlike previous research that examined them separately, this study reveals the chain mediation mechanism of NLE and IA in the relationship between SA and STB, providing a new research perspective on the complex evolution from early adversity to extreme outcomes. This research also provided clear direction and scientific evidence for the development of comprehensive suicide prevention strategies. Future efforts should focus on the prevention of SA and trauma intervention while simultaneously strengthening adolescents' cognitive reappraisal of negative events and guiding their online behavior.

BACKGROUND:Adverse Childhood Experiences (ACEs) have long-term effects on health, but the mechanisms remain unclear. OBJECTIVE:To investigate the association between ACEs and health status, exploring the potential mediating roles of activities of daily living (ADL) and chronic diseases. PARTICIPANTS AND SETTING:9575 middle-aged and older adults from the China Health and Retirement Longitudinal Study (CHARLS). METHODS:Longitudinal analysis of 4 waves (2013-2018) data. ACEs were derived from 2014 self-report life history survey. Latent growth curve modeling assessed the mediating effect of ADL and chronic diseases on the relationship between ACEs and self-rated health (SRH). RESULTS:Among the 9575 individuals (mean [standard deviation, SD] age, 58.12 [8.73] years; 5174 [54.04 %] were females), the average ACEs score was 2.27 (SD = 1.75). Individuals with higher ACEs reported lower baseline SRH (β = -0.156, P < .001) and greater decline over time (β = -0.075, P < .001). Mediation analysis indicated that both baseline and longitudinal changes in ADL and chronic diseases (intercept and slope) partially mediated the association between ACE and the intercept of SRH, while ADL (intercept and slope) and chronic diseases (slope) fully mediated the association between ACE and the slope of SRH. CONCLUSIONS:ACEs were associated with poorer health status and accelerated decline, partially mediated by impaired ADL and increased chronic diseases. Interventions targeting ACE reduction, enhancing ADL, and managing chronic diseases could effectively improve the health of middle-aged and older adults.

OBJECTIVE:Our study explored the association between depressive symptoms and non-fatal cardiovascular disease, as well as other significant risk factors for non-fatal cardiovascular disease, in middle-aged and elderly patients with hypertension in China. DESIGN:Prospective cohort study. SETTING:Data were sourced from the China Health and Retirement Longitudinal Study (CHARLS) database over a 9-year period (2011-2020). PARTICIPANTS:Middle-aged and elderly patients with hypertension aged 45 and above in China. OUTCOME MEASURES:Non-fatal cardiovascular disease was ascertained based on self-reported, physician-diagnosed heart disease. Depressive symptoms were measured using the Center for Epidemiologic Studies Depression Scale-10. RESULTS:A total of 1755 participants were enrolled in the prospective cohort study. The incidence of non-fatal cardiovascular diseases among patients with hypertension was 5 per 1000 person-months. There was a positive linear correlation between depressive symptoms and the risk of non-fatal cardiovascular diseases (pnon-linear=0.625). Meanwhile, an inverted U-shaped relationship was identified between baseline duration of hypertension and risk of non-fatal cardiovascular diseases; those experiencing hypertension for 15 years had the highest risk, with the risk decreasing for durations above or below this value (pnon-linear <0.001). Other risk factors identified were female gender (HR 1.19, 95% CI 1.01 to 1.40), health education (HR 0.81, 95% CI 0.70 to 0.95), comorbidity of diabetes (HR 1.60, 95% CI 1.30 to 1.97) and age (HR 1.01, 95% CI 1.01 to 1.02). CONCLUSIONS:This study demonstrates graded associations between depression severity and incident non-fatal cardiovascular disease in middle-aged and elderly patients with hypertension in China. The multivariable analysis identified five modifiable risk determinants: inadequate health education, advanced age, female gender, diabetes comorbidity and hypertension exposure duration of 7-21 years. These findings necessitate precision prevention strategies combining psychocardiological interventions with risk factor modification in high-risk subgroups.

BACKGROUND:Healthy lifestyle modification is widely recommended for preventing digestive system diseases, but the effects of individual and combined behaviors, particularly potential interactions, are not fully understood. METHODS:This study investigates the association between six healthy lifestyle behaviors (moderate alcohol consumption, never smoking, adequate sleep, regular physical activity, a healthy diet, and limited sedentary behavior) and the risk of 20 digestive system diseases, participants were grouped into high, moderate, and low adherence. Cox proportional hazards models evaluated the associations between these behaviors and disease risk. RESULTS:Among 267,408 participants, 53,690 (20.08%) were classified as high adherence group, 158,023 (59.09%) as moderate adherence group, and 55,695 (20.83%) as low adherence group. Compared with the low adherence group, the high adherence group had a hazard ratio of 0.72 (95% CI: 0.70 to 0.74) and the moderate adherence group 0.82 (95% CI: 0.80 to 0.84). Each behavior independently reduced risk, indicating there were only additive effects but no synergistic or antagonistic interactions. CONCLUSIONS:Greater adherence to healthy lifestyle behaviors is associated with a reduced risk of digestive system diseases. The absence of interactions among behaviors simplifies implementation, allowing individuals to focus on adopting as many behaviors as possible to maximize benefits.

Chinese workers are confronted with severe mental health issues. This study aimed to investigate the reasons for the differences in depressive symptoms between agricultural and non-agricultural workers in China, and to measure the contribution of relevant influencing factors. The data used in this study came from the 2018 China Family Panel Studies (CFPS) data. We used the brief 8-item Centre for Epidemiological Studies Depression Scale (CES-D8) to measure participants’ depressive symptoms, and Fairlie decomposition model was used to analyze the influencing factors for the differences in depressive symptoms between agricultural and non-agricultural workers and their contribution. The percentage of employed people with depressive symptoms was 14.44

INTRODUCTION:Discrepancies exist in findings on how varying body mass index (BMI) levels impact physical training-related injuries across different studies. This systematic review and meta-analysis aimed to evaluate the relationship between BMI and physical training-related injuries both qualitatively and quantitatively. METHODS:A comprehensive search of the MEDLINE, Cochrane and EMBASE databases was performed. The study selection followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A systematic review and meta-analysis were conducted using weighted data and a random-effects model. Subgroup analyses were based on gender and military service branches. Heterogeneity among the studies was assessed through the I2 statistic, indicating the proportion of total variation in effect size estimates. Funnel plots and Egger's test were employed to assess publication bias. RESULTS:33 studies were included in the analysis, with abnormal BMI (underweight, overweight and obesity) identified as a clear risk factor for training-related injuries (overall RR=1.21, 95% CI 1.15 to 1.27; male RR=1.16, 95% CI 1.08 to 1.23; female RR=1.05, 95% CI 1.02 to 1.09). No significant heterogeneity was observed among navy, army and air force personnel (p=0.58), although abnormal BMI remained a notable risk factor in both the army and air force. Meta-regression analysis indicated that the lowest injury risk occurred at a BMI of 23 kg/m2. Obese individuals under the age of 27 and underweight individuals over the age of 27 were at high risk. Additionally, the highest injury risk was observed during the first 5 months of military training, with a gradual decline in subsequent months, stabilising by the 12th month. CONCLUSION:Findings suggest that abnormal BMI increases the risk of training injuries among military personnel and that this risk varies with age and the duration of training. Emphasis should be placed on risk prevention in the early stages of military training and on enhanced protection for high-risk populations.

Background: Accumulated evidence has highlighted the association between atrial fibrillation and the risk of developing dementia. Methods: This current cohort study utilized data from the UK Biobank to explore the association between atrial fibrillation (AF) and all -cause dementia (ACD), encompassing its main subtypes (Alzheimer's disease (AD), and vascular dementia (VD)). Cox proportional hazards models were applied to examine the association of AF and dementia with its primary subtypes after adjusting for different sets of covariates. Hazard ratios (HRs) with 95 % confidential intervals (CIs) were estimated to quantify the associated risks. Competing risk model was applied in sensitivity analysis. Results: After exclusion, 373, 415 participants entered the primary analysis. Among these, 27, 934 (7.48 %) were with a history AF at baseline, while 345, 481 (92.52 %) were without. During a mean follow-up of 13.45 years, ACD was diagnosed in 1215 individuals with AF and 3988 individuals without AF. Participants with AF had higher risks of ACD (1.79 [1.67-1.91]), AD (1.48 [1.32-1.65]), and VD (2.46 [2.17-2.80]) in the fully adjusted Cox regression models. Results of subgroup and sensitivity analyses predominantly aligned with the positive associations in primary analysis. Limitations: The applicability of our findings to diverse ethnicities might require careful consideration and the behind biological mechanisms need to be further revealed. Conclusions: It indicated that people with atrial fibrillation had an increased future risk of all -cause dementia, Alzheimer's disease, vascular dementia. Atrial fibrillation screening and prevention strategies should take into account to prevent and delay the onset of dementia.

Background: Numerous studies have suggested the health benefits of a plant -based dietary pattern. However, whether this dietary pattern is associated with health benefits for centenarians remains unexplored. Our study aimed to investigate the correlation between 16 widely consumed Chinese food items and the incidence rates of chronic diseases and all-cause mortality among centenarians. Methods: We conducted a dietary survey on 3372 centenarians with an average age of 102.33 y in China. After rigorous screening, we identified 2675 centenarians, who underwent a 10-y follow-up study with all-cause mortality as the primary outcome. We developed 6 dietary patterns on the basis of the food consumption frequency of each participant. To model the impact of missing values, we employed multiple imputation methods, verifying the robustness of models. Results: The overall plant -based diet index (PDI), healthy plant -based diet index (hPDI), unhealthy plant -based diet index (uPDI), healthy plant -based foods index (HPF), unhealthy plant -based foods index (uHPF), and animal -based foods index (AF) scores among centenarians in China were 46.95 +/- 6.29, 44.43 +/- 5.76, 51.09 +/- 6.26, 21.63 +/- 4.79, 9.91 +/- 2.41, and 14.59 +/- 3.58, respectively. High scores of PDI, hPDI, and HPF were associated with a lower risk of chronic diseases. In the 10-y follow-up study, 92.90% of centenarians have died. The high scores of the PDI (HRPDI = 0.81), hPDI (HRhPDI = 0.79), and HPF (HRHPF = 0.81) scores were significantly associated with a lower risk of death compared with the low scores. Conversely, the high AF score (HRAF = 1.17) was significantly associated with a higher risk of death compared with the low scores. Conclusion: Despite the fact that a higher score in both a predominantly plant -based dietary pattern and a healthy dietary pattern can decrease the death among centenarians, not all HPFs have this effect. A higher AF predicted a higher risk of mortality, whereas higher PDI, hPDI, and HPF were associated with a lower risk of mortality among Chinese centenarians.

The aim of this study is to investigate the factors influencing the disparity in catastrophic health expenditure (CHE) among middle-aged and elderly individuals with multiple chronic conditions in urban and rural areas of China, as well as to measure the contributions of these influencing factors. Elderly individuals with multiple chronic conditions represent a high-risk population burdened with significant healthcare expenses. This study focused on exploring this population and identifying the independent factors contributing to catastrophic health expenditure among them. This study aimed to identify the factors and contribution levels of the dual urban-rural disparities in catastrophic health expenditure among elderly individuals with multiple chronic conditions in China through decomposition analysis. This study presented strategies to reduce the risk of catastrophic health expenditure among this population and mitigate urban-rural disparities, aiming to alleviate the burden of healthcare expenses. This study aims to construct a binary logistic regression model to examine the primary factors influencing catastrophic health expenditure (CHE), and to utilize the Fairlie model to analyze the factors and contributions affecting the disparities in catastrophic health expenditure (CHE) among middle-aged and elderly individuals with multiple chronic conditions in urban and rural areas. In Chinese, the prevalence of catastrophic health expenditure (CHE) in households with middle-aged and elderly individuals with multiple chronic conditions is 54.8%. The proportion of households experiencing catastrophic health expenditure (CHE) in rural areas (57.7%) is higher than in urban areas (49.5%). The established Fairlie model has an explanatory power of 90.21%. The main factors contributing to the disparities in catastrophic health expenditure (CHE) among middle-aged and elderly individuals with multiple chronic conditions in urban and rural areas are primarily related to household economic status (-64.16%), self-rated health (-15.71%), hospitalization in the past year (-8.23%), activities of daily living (-2.98%), marital status (-2.18%), physical activity (-1.90%), outpatient visits in the past month (-1.84%), household size (-1.83%), age (-1.74%), alcohol consumption (-1.63%), number of chronic conditions (1.20%), and geographic location (0.73%). The study found that the prevalence of catastrophic health expenditure (CHE) among middle-aged and elderly individuals with multiple chronic conditions is higher in rural areas of China compared to urban areas. This difference is mainly attributed to disparities in household economic status, household size, health condition, lifestyle, and hospitalization between urban and rural residents. The Chinese government should pay close attention to households with middle-aged and elderly individuals with multiple chronic conditions in both urban and rural areas, and take measures to improve fairness in catastrophic health expenditure (CHE) for this population.

Background Hypertension is the most prevalent chronic disease among China’s older population, which comprises a growing proportion of the overall demographic. Older individuals with chronic diseases have a higher risk of developing depressive symptoms than their healthy counterparts, as evidenced in China’s older population, where patients with hypertension exhibit varying rates of depression depending on residing in urban or rural areas. Objective This study aimed to investigate factors influencing and contributing to the disparities in depressive symptoms among older urban and rural patients with hypertension in China. Methods We used a cross-sectional study design and derived data from the 8th Chinese Longitudinal Health Longevity Survey of 2018. The Fairlie model was applied to analyze the factors contributing to disparities in depressive symptoms between urban and rural older populations with hypertension. Results The sample size for this study was 5210, and 12.8% (n=669) of participants exhibited depressive symptoms. The proportions of depressive symptoms in rural and urban areas were 14.1% (n=468) and 10.7% (n=201), respectively. In rural areas, years of education (1-6 years: odds ratio [OR] 0.68, 95% CI 1.10-1.21; ≥7 years: OR 0.47, 95% CI 0.24-0.94), alcohol consumption (yes: OR 0.52, 95% CI 0.29-0.93), exercise (yes: OR 0.78, 95% CI 0.56-1.08), and sleep duration (6.0-7.9 hours: OR 0.29, 95% CI 0.17-0.52; 8.0-9.9 hours: OR 0.24, 95% CI 0.13-0.43; ≥10.0 hours: OR 0.22, 95% CI 0.11-0.41) were protective factors against depressive symptoms in older adults with hypertension, while gender (female: OR 1.94, 95% CI 1.33-2.81), self-reported income status (poor: OR 3.07, 95% CI 2.16-4.37), and activities of daily living (ADL) dysfunction (mild: OR 1.69, 95% CI 1.11-2.58; severe: OR 3.03, 95% CI 1.46-6.32) were risk factors. In urban areas, age (90-99 years: OR 0.37, 95% CI 0.16-0.81; ≥100 years: OR 0.19, 95% CI 0.06-0.66), exercise (yes: OR 0.33, 95% CI 0.22-0.51), and sleep duration (6.0-7.9 hours: OR 0.27, 95% CI 0.10-0.71; 8.0-9.9 hours: OR 0.16, 95% CI 0.06-0.44; ≥10.0 hours: OR 0.18, 95% CI 0.06-0.57) were protective factors, while years of education (1-6 years: OR 1.91, 95% CI 1.05-3.49), self-reported income status (poor: OR 2.94, 95% CI 1.43-6.08), and ADL dysfunction (mild: OR 2.38, 95% CI 1.39-4.06; severe: OR 3.26, 95% CI 1.21-8.76) were risk factors. The Fairlie model revealed that 91.61% of differences in depressive symptoms could be explained by covariates, including years of education (contribution 63.1%), self-reported income status (contribution 13.2%), exercise (contribution 45.7%), sleep duration (contribution 20.8%), ADL dysfunction (contribution −9.6%), and comorbidities (contribution −22.9%). Conclusions Older patients with hypertension in rural areas had more depressive symptoms than their counterparts residing in urban areas, which could be explained by years of education, self-reported income status, exercise, sleep duration, ADL dysfunction, and comorbidities. Factors influencing depressive symptoms had similarities regarding exercise, sleep duration, self-reported income status, and ADL dysfunction as well as differences regarding age, gender, years of education, and alcohol consumption.

Growing evidence indicates a link between diet and depression risk. We aimed to examine the association between an inflammatory diet index and depression utilising extensive data from UK biobank cohort. The energy-adjusted dietary inflammation index (E-DII) was calculated to quantify the potential of daily diet, with twenty-seven food parameters utilised. The E-DII scores were classified into two categories (low v. high) based on median value. To mitigate bias and ensure comparability of participant characteristics, propensity score matching was employed. To ascertain the robustness of these associations, sensitivity analyses were conducted. Subgroup analyses were performed to evaluate the consistency of these associations within different subpopulations. Totally, 152 853 participants entered the primary analyses with a mean age of 56·11 (sd 7·98) years. Employing both univariate and multivariate logistic regression models, adjustments were made for varying degrees of confounding factors (socio-demographics, lifestyle factors, common chronic medical conditions including type 2 diabetes and hypertension). Results consistently revealed a noteworthy positive correlation between E-DII and depression. In the context of propensity score matching, participants displaying higher E-DII scores exhibited an increased likelihood of experiencing incident depression (OR = 1·12, 95 % CI: 1·05, 1·19; P = 0·000316). Subgroup analysis results demonstrated variations in these associations across diverse subpopulations. The E-value for the point-estimate OR calculated from the propensity score matching dataset was 1·48. Excluding individuals diagnosed with type 2 diabetes or hypertension, the findings consistently aligned with the positive association in the primary analysis. These findings suggested that consumption of a diet with higher pro-inflammatory potential might associated with an increase of future depression risk.

BACKGROUND:Childhood trauma is a risk factor for self-harm/suicidal behavior, but research on the potential association linking sleep quality and anxiety symptoms to childhood trauma and self-harm attempt is limited. The aim of this study was to describe the mediating role of sleep quality and anxiety symptoms between childhood trauma and self-harm attempt, and to provide a scientific basis for the prevention of self-harm behaviors. METHODS:This study ultimately included 11,063 study participants who participated in the baseline survey of this large prospective cohort study of the UK Biobank. We used structural equation modeling (SEM) to analyze the chain mediating role of sleep quality and anxiety symptoms in childhood trauma and self-harm attempt while controlling for covariates. RESULTS:A total of 19.58 % of study participants self-reported self-harm attempt. Sleep quality was negatively correlated with childhood trauma, anxiety symptoms, and self-harm attempt (p < 0.01). Childhood trauma, anxiety symptoms, and self-harm attempt were positively correlated (p < 0.01). In addition, after adjusting for confounders, anxiety symptoms were able to partially mediate the association between childhood trauma and self-harm attempt (effect value: 0.042, p < 0.01), and sleep quality and anxiety symptoms can chain mediate the association between childhood trauma and self-harm attempt (effect value:0.002, p < 0.01), with a total mediating effect of 65.67 % of the total effect. Subgroup analyses further showed that the mediating effects of sleep quality and anxiety symptoms on childhood trauma and self-harm attempt differed across age, gender, ethnicity, and smoking and drinking subgroups. CONCLUSIONS:This study found a complex relationship between childhood trauma, sleep quality, anxiety symptoms, and self-harm attempt, with sleep quality and anxiety symptoms mediating the relationship between childhood trauma and self-harm attempt. Multiple avenues of intervention, such as the provision of professional psychological interventions and timely monitoring, should be used to improve the sleep quality and mental health of individuals with traumatic childhood experiences and to prevent the occurrence of emotionally harmful behaviors such as self-harm/suicide.

Background Edentulism impacts the physical health and quality of life of older individuals. The prevalence, influencing factors, and differences in terms of edentulism in urban and rural areas of China are unclear. Objective This study investigated the denture-wearing conditions and causes affecting older patients with edentulism in urban and rural areas of China and analyzed the differences. Methods This cross-sectional study included the data of 5139 older individuals (age>65 years) with edentulism obtained from 23 Chinese provinces in 2018. Participants were divided into urban and rural groups based on their household registration. Factors influencing denture use in both groups were explored using binary logistic regression, while factors influencing differences in denture wearing in both groups were explored using the Fairlie decomposition model. Results Of the 5139 participants, 67.05% (808/1205) from urban areas and 51.12% (2011/3934) from rural areas wore dentures. In the urban group, participants with a higher level of education (1-6 years: odds ratio [OR] 2.093, 95% CI 1.488-2.945; ≥7 years: OR 2.187, 95% CI 1.565-3.055) or who exercised (OR 2.840, 95% CI 2.016-3.999) preferred wearing dentures, but individuals with BMI<18.5 kg/m2 (OR 0.558, 95% CI 0.408-0.762) or widowed (OR 0.618, 95% CI 0.414-0.921) did not. In the rural group, a higher level of education (1-6 years: OR 1.742, 95% CI 1.429-2.123; ≥7 years: OR 1.498, 95% CI 1.246-1.802), living alone (OR 1.372, 95% CI 1.313-1.663), exercise (OR 1.612, 95% CI 1.340-1.940), high economic status (OR 1.234, 95% CI 1.035-1.472), residence in the eastern area (OR 2.045, 95% CI 1.723-2.427), presence of chronic diseases (1 disease: OR 1.534, 95% CI 1.313-1.793; ≥2 diseases: OR 1.500, 95% CI 1.195-1.882) were positively associated and age≥80 years (OR 0.318, 95% CI 0.247-0.408), BMI<18.5 kg/m2 (OR 0.692, 95% CI 0.590-0.813), and widowed (OR 0.566, 95% CI 0.464-0.690) or other marital status (OR 0.600, 95% CI 0.392-0.918) were negatively associated with denture use. The Fairlie decomposition model revealed that the number of chronic diseases (16.34%), education level (11.94%), region of residence (11.00%), annual income (10.55%), exercise (6.81%), and age (–0.92%) were the main factors responsible for differences between urban and rural edentulism and could explain the difference in the denture-wearing rate (58.48%) between both groups. Conclusions Older individuals with edentulism with a higher education level and who exercise are more willing to wear dentures, while those with BMI<18.5 kg/m2 show a decreased willingness to wear dentures in both urban and rural areas in China. Controlling the number of chronic diseases, improving the education level and annual income, cultivating good exercise habits, and bridging the gap between the economic status of the east and west can narrow the differences in denture wearing among urban and rural older individuals with edentulism.

In China, In China, depression among the oldest-old (aged 80 + years) is a major public health issue. As the gap in development between urban and rural China widens, the aim of this study was to demonstrated whether there are disparities in the incidence of depressive symptoms between the urban and rural oldest-old (aged 80+) in China and to quantify the contribution of relevant influencing factors. The study evaluated data on 5,116 oldest adults (female, 55.88

Objectives: Little is known about the relationship between the level of disability in activities of daily living (ADL) and cardiovascular disease (CVD) in the elderly population. Using data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS), this study aimed to investigate the association between ADL status and CVD in Chinese older adults, both cross-sectionally and longitudinally.Methods: The study sample included 15,909 participants aged 60 years and above, drawn from the CLHLS 2008 dataset. ADL status was evaluated using the Katz index, while CVD was determined based on a physician's diagnosis of heart disease and/or stroke. From the CLHLS 2008 dataset, 11,414 participants without CVD were identified and followed up from 2011 to 2018. Cox proportional hazard regression models were used to examine the impact of ADL on CVD.Results: Overall, the prevalence of CVD was 13.68% (2,176/15,909). The prevalence of CVD in individuals with no-ADL, mild-ADL, moderate-ADL, and severe-ADL status was 11.67% (1,475/12,635), 17.60% (304/1,727), 19.29% (142/736), and 31.44% (255/811), respectively. Mild-ADL, moderate-ADL, and severe-ADL were all significantly associated with CVD in the total study population [odds ratios (95% confidence intervals): 2.05 (1.76–2.40), 2.53 (2.04–3.13), and 4.80 (3.99–5.77), respectively]. Over the 10-year follow-up period, 2931 new cases (25.7%) of CVD occurred. In the longitudinal analysis, individuals with mild-ADL [hazard ratio (95% confidence intervals): 1.68 (1.47–1.93)], moderate-ADL [2.05 (1.65–2.54)], and severe-ADL [3.62 (2.89–4.54)] were at higher risk of developing CVD than those with no-ADL (all P < 0.001).Conclusions: This study found that mild-ADL, moderate-ADL, and severe-ADL are significantly associated with higher risk of CVD among Chinese older adults.Funding: The research was sponsored by the National Social Science Foundation of China (grant number 2022-SKJJ-C-022).Declaration of Interest: The authors have no relevant financial or non-financial interests to disclose.Ethical Approval: The study was conducted following ethical standards. All participants gave informed consent, and the biomedical ethics committee of Peking University approved the protocol (approval number: IRB00001052-13074). The institutional and/or national research committees' ethical guidelines and the 1964 Helsinki statement, along with its later amendments, were followed in all human participant procedures.

BACKGROUND:This study aimed to examine the factors influencing self-rated health (SRH) among Chinese older adults by gender differences and provide suggestions and theoretical references to help make policies for older adults' health concerns by government agencies.METHODS:Chinese Longitudinal Health Longevity Survey (CLHLS) in 2018 was adopted, the chi-squared test and the logistic regression analysis were performed to analyse self-rated health reported by Chinese female and male older adults and its influencing factors. In addition, Fairlie decomposition analysis was performed to quantify the contribution level of different influencing factors.RESULTS:Among older adults, males (48.0%) reported a significantly higher level of good self-rated health than females (42.3%). Residence, body mass index (BMI), self-reported income, smoking, drinking, exercise, and social activity were the factors that influenced SRH reported by male and female respondents, with age, marital status and education reaching the significance level only in women. The Fairlie decomposition model can explain the underlying reasons for 86.7% of the gender differences in SRH, with self-reported income (15.3%), smoking (32.7%), drinking (42.5%), exercise (17.4%), social activity (15.1%) and education (-14.6%) being the major factors affecting gender differences in SRH.CONCLUSIONS:The study results can help promote the implementation of the Healthy China Initiative, inform intervention measures, and offer new proposals on creating policies for older adults' health issues by the Chinese government to improve health equity.

目的 分析我国独居老年人的失能状况及其影响因素.方法 基于2018年中国老年人健康影响因素调查项目的 调查结果 ,纳入1 854名独居老年人的数据,采用Kata量表判断老年人的失能状况.采用χ2 检验分析独居老年人失能状况的分布特征,利用二分类logistic回归模型分析独居老年人失能的影响因素.结果 13.86％(257/1 854)的独居老年人出现失能.单因素分析显示,失能的独居老年人和未失能的独居老年人在年龄、BMI、吸烟状况、饮酒状况、规律锻炼情况、自评健康状况和年度体检情况等指标分布的差异均有统计学意义(P均＜0.05).多因素logistic回归分析显示,年龄≥80 岁(OR=2.554)、睡眠时长＜4.0 h(OR=2.460)是独居老年人失能的危险因素,规律锻炼(OR=0.637)、自评健康较好(OR=0.593)和参加年度体检(OR=0.698)是独居老年人失能的保护因素.结论 独居老年人的失能状况受多种因素的影响,其发生率低于整体老年人的水平.

PurposeTo evaluate the overall health status and health-related abilities and problems of elderly patients with diabetes and multimorbidity compared with those with diabetes only. Additionally, we aimed to identify different subgroups of elderly, multimorbid patients with diabetes. MethodsThis cross-sectional study included 538 elderly patients with diabetes. The participants completed a series of questionnaires on self-rated health (SRH), diabetes self-management, self-efficacy, health literacy, depression, and diabetes distress. Differences in health-related abilities and problems were compared between elderly patients with diabetes and multimorbidity and those with diabetes only, with adjustments for covariates using propensity score matching. A cluster analysis was also performed to identify the overall health status subgroups of elderly, multimorbid patients with diabetes. Additionally, we conducted a multinomial logistic regression analysis to examine the predictors of health-related abilities and problem-cluster group membership. ResultsElderly patients with diabetes and multimorbidity experienced more health-related abilities and problems than those with diabetes only, particularly within the domains of depression (p < 0.001), and diabetes distress. The level of health literacy (p < 0.001) and self-management (p = 0.013) in elderly, multimorbid patients with diabetes was also significantly higher than that in elderly patients with diabetes only. Cluster analysis of elderly, multimorbid patients with diabetes revealed three distinct overall health status clusters. Multinomial logistic regression analysis indicated that age (OR = 1.090, p = 0.043), sex (OR = 0.503, p = 0.024), living situation (OR = 2.769, p = 0.011), BMI (OR = 0.838, p = 0.034), regular exercise (OR = 2.912, p = 0.041 in poor vs. good; OR = 3.510, p < 0.001 in intermediate vs. good), and cerebral infarction (OR = 26.280, p < 0.001) independently and significantly predicted cluster membership. ConclusionCompared with elderly patients with diabetes only, those with diabetes and multimorbidity experienced more health-related abilities and problems within the domains of depression, and diabetes distress. Additionally, the level of health literacy and self-management in elderly, multimorbid patients with diabetes was significantly higher than that in those with diabetes only. Among the multimorbid diabetes group, old age, male sex, living without a partner, slightly lower BMIs, not exercising regularly, and experiencing cerebral infarctions were all positively correlated with worse overall health status.

The number of Chinese oldest-old (aged 80+) is growing rapidly and some studies have shown that the health status is unequal among older persons in different regions. However, to the best of our knowledge, no study to date has analyzed health inequalities among the oldest-old in urban and rural areas in China. This study therefore aimed to examine the correlation between health inequalities among the oldest-old in urban and rural areas of China. From the 8th wave of the Chinese Longitudinal Health Longevity Survey (CLHLS), we selected 8124 oldest-old participants who met the requirements of the study. Chi-square tests were used to analyze the distribution characteristics of indicators and a logistic model was performed to determine the factors associated with different self-rated health (SRH). The Fairlie model was adopted to decompose the causes and related contributions to health inequality. Our results found that of the Chinese oldest-old, 46.57% were in good health. Urban residents reported significantly better SRH than rural residents (50.17% vs. 45.13%). Variables associated with good and poor SRH had different distribution characteristics. The logistic model suggested that marital status, alcohol consumption, and annual income were important factors underlying the SRH differences. Our decomposition analysis indicated that 76.64% of the SRH differences were caused by observational factors, and validated that the difference in SRH between urban and rural areas was significantly (P<0.05) associated with exercise status (45.44%), annual income (37.64%), social activity status (3.75%), age (-5.27%), and alcohol consumption (-2.66%). Therefore, socioeconomic status and individual lifestyle status were the main factors underlying the health inequality between urban and rural Chinese oldest-old.