This study develops a machine learning model to predict osteoporosis in Chinese postmenopausal women. The model was trained using the largest nationwide cohort and externally validated. It showed AUCs of 0.744–0.798 and demonstrated prognostic value for 5-year fracture risk, supporting population-level screening where DXA resources are limited. Osteoporosis is highly prevalent among Chinese postmenopausal women, yet underdiagnosis remains due to limited DXA availability. We aimed to develop and validate a machine learning–based model for osteoporosis prediction using easily obtainable variables. The model was trained using data from the largest nationwide cohort (China Osteoporosis Prevalence Study, n = 6,574) and externally validated in two independent cohorts: the China Vertebral and Osteoporosis Study (n = 1,758) and the Peking Vertebral Fracture Study baseline (n = 1,439). Five predictors selected via LASSO regression were used to train the prediction model. Model performance was evaluated by area under the curve (AUC) and calibration plot. To evaluate its ability to predict future fractures, the model was evaluated in a 5-year follow-up cohort (n = 795). A web-based calculator was developed for public use. The model showed strong discrimination (AUC: 0.798 in the training cohort; 0.775 in the internal validation cohort; 0.750 and 0.744 in the external validation cohorts) and good calibration across all cohorts. A rule-out threshold (≥ 0.098) demonstrated high sensitivity (94.7

Background: Traumatic brain injury (TBI) causes substantial disability in China, but national estimates obscure provincial variation and whether rising case numbers reflect population growth, ageing, or changing age-specific incidence. We assessed non-fatal TBI burden in China and 33 provincial-level units from 1990 to 2021 and quantified these demographic contributions. Methods: Using Global Burden of Disease Study 2021 estimates, this modelling study assessed incidence, prevalence, and years lived with disability (YLDs) by sex, age, severity, and external cause in China and 33 provincial-level units, excluding Taiwan. Shapley decomposition apportioned changes in incident cases among population growth, population ageing, and changes in age-specific incidence rates. A descriptive framework classified provincial burden, temporal direction, and the larger demographic component. Findings: Between 1990 and 2021, annual incident cases increased from 2·96 million (95% uncertainty interval [UI] 2·56–3·42 million) to 4·21 million (3·57–4·88 million), prevalent cases from 4·98 million (4·78–5·23 million) to 9·28 million (8·84–9·79 million), and YLDs from 0·75 million (0·52–1·02 million) to 1·37 million (0·96–1·87 million). The corresponding increases were 42·4%, 86·5%, and 82·9%. By contrast, the age-standardised incidence, prevalence, and YLD rates changed by only 2·7% (−2·8 to 7·8), 1·7% (−0·02 to 3·56), and 1·0% (−1·01 to 3·25), respectively. In 2021, provincial age-standardised YLD rates ranged from 48·3 per 100 000 in Tibet to 100·1 per 100 000 in Zhejiang; changes since 1990 ranged from −20·0% in Macao to 21·1% in Sichuan. The age-standardised YLD rate was 96·1 per 100 000 in males and 46·4 per 100 000 in females. Age-specific YLD rates were highest in older age groups, and moderate/severe TBI accounted for most prevalent cases and YLDs. Falls were the largest grouped external cause among older people, with fall-related incidence rising steeply after age 75 years, whereas road injuries predominated at ages 25–44 years. Of the 1·25 million additional incident cases, population growth accounted for 57·7%, population ageing for 35·5%, and changes in age-specific incidence rates for 6·8%. Ageing accounted for 47·9% of moderate/severe TBI growth and was the larger component in Sichuan and Hubei among the nine high-burden/increasing units. Interpretation: China’s non-fatal TBI burden rose substantially in absolute terms despite little change in age-standardised rates, with population growth and ageing accounting for most incident-case growth. Differences by sex, age, and province support locally tailored prevention, trauma care, and rehabilitation, particularly for road and occupational injuries at working ages and falls in later life.

Background: As a new impetus for advancing universal health coverage and women’s health, the WHO’s 2020 cervical cancer elimination strategy sets a 70% screening target, yet how this global benchmark translates into local health system realities remains unclear. This qualitative study investigates the implementation of the WHO elimination strategy in China, analyzing the multi-level mechanisms that shape health service delivery, equity, and women’s health. Methods: This study conducted 19 semi-structured interviews with national, provincial, and local program administrators, service providers, and eligible urban and rural women, recruited primarily from northern China via theoretical and snowball sampling between January to March 2023. Interviews were thematically coded, guided by an integrated conceptual framework combining global governance, policy implementation, health service use, and gender analysis. Findings: Four interacting mechanisms shaped service delivery: global agenda-setting boosted political commitment; administrative adaptation drove campaign-style implementation; frontline discretion produced outreach innovation; and local gender environments mediated participation through caregiving roles, increasing health autonomy, and urban-rural differences in collective action preferences. While screening coverage increased, unintended consequences included workforce disengagement, insufficient outreach to disadvantaged groups, and focus on process metrics. Interpretation: The global health benchmark of 70% screening target led to increased population screening coverage as well as unintended consequences on the health system and women’s health. The WHO and member states can complement biomedical guidelines with equity-oriented and contextually adaptive monitoring tools and communication toolkits that support frontline discretion and account for local gender-based barriers and social behavioral preferences.

Respiratory human adenovirus (HAdV) infections pose a significant threat to children’s health. This study investigated the prevalence and molecular epidemiology of respiratory HAdV in children from both hospital and community settings in Shenzhen between 2022 and 2024. Children under 14 years of age with suspected acute respiratory infections were enrolled from eight hospitals between November 2022 and June 2024, as well as from communities between October 2023 and April 2024 in Shenzhen. Respiratory specimens were collected and tested for HAdV. The positive rates of HAdV across different groups were compared using Pearson’s chi-square test with the Bonferroni correction, and phylogenetic analysis was performed on the detected HAdV strains. The positivity proportion of HAdV among children in hospital was 16.7% (83/498) between September 2023 and June 2024, predominantly involving HAdV-B3 (95.2%, 20/21). This rate was significantly higher than that observed from October 2022 to June 2023 (3.4%, 11/321) (χ² = 33.676, P < 0.001), during which HAdV-C1 was the predominant subtype (77.8%, 7/9). The positive proportion of HAdV in hospitalized children was higher than that in outpatient children (χ2 = 0.275, P < 0.001), and the positive proportion of HAdV in boys was lower than that in girls in community (χ2 = 4.843, P = 0.028). No significant difference in the mean age was observed between children infected with HAdV-B and those with HAdV-C (t = 0.670, P = 0.509). The Shenzhen-2023-2-ILI-P600 strain exhibited a deletion in the 362–365 aa region of its Penton base gene. Analysis of global HAdV-C1 strains revealed that aa differences at positions 339 and 472 of the Fiber gene were closely linked to specific evolutionary branches. Global HAdV-B3 strains, while highly conserved, showed branch-associated aa differences at positions 168, 403, and 541 of the Hexon gene. The rise in HAdV positivity among pediatric patients in Shenzhen hospitals from late 2022 to late 2023 coincided with a shift in the dominant type from HAdV-C1 to HAdV-B3. Branch-specific aa differences were identified in the Fiber gene of HAdV-C1 and the Hexon gene of HAdV-B3.

This study estimated FRAX®-based intervention thresholds for initiating osteoporosis treatment in Chinese postmenopausal women, using real-world data from the largest nationally representative osteoporosis survey in China and a validated Markov microsimulation model. Denosumab became cost-effective at a 10-year major osteoporotic fracture probability of 7

What is already known about this topic?:The Sustainable Development Goals target a 50% reduction in anemia among women of reproductive age by 2025 and the elimination of all forms of malnutrition by 2030. However, robust evidence documenting temporal changes in anemia prevalence remains scarce. What is added by this report?:Drawing on large-scale national health examination data, this report demonstrates overall progress in reducing anemia among urban women in China between 2019 and 2024. However, it also reveals increasing prevalence in several provinces and a growing burden of moderate-to-severe anemia specifically among women aged 40-49 years. What are the implications for public health practice?:Risk-stratified and targeted anemia prevention and control strategies are urgently needed. Priority should be given to women aged 40-49 years, women of reproductive age residing in high-burden provinces, and geographic areas where anemia prevalence either exceeds 20% or demonstrates an upward trend.

Purpose:To investigate the links between abdominal obesity and skeletal outcomes in a population-based cohort in China. Methods:8,251 participants from the COPS cohort were enrolled in this study and categorized by quartiles of abdominal obesity indices. Abdominal obesity was determined using sex-specific waist circumference (WC) cutoffs (≥ 90 cm for males, ≥ 85 cm for females), or a waist-to-height ratio (WHtR) ≥0.5. Physical performance and balance were assessed using the Five-Repetition Sit-to-Stand Test (5R-STS) and the Sharpened Romberg test. Vertebral fractures were identified by spine X-ray examination, while information on clinical fractures in recent 5y were collected by a self-report questionnaire. Multivariate regression models were employed with covariate adjustments. Predictive capacity of adiposity metrics for fractures was assessed through ROC analysis. Results:Abdominal obesity was linked to lower bone turnover rate and higher BMD. However, it was also significantly associated with impaired balance, evidenced by prolonged 5R-STS times and higher rates of positive Sharpened Romberg tests. The prevalence of vertebral fractures and clinical fractures in recent 5y increased across quartiles of WC, WHtR, and Chinese visceral adiposity index (CVAI) (all p< 0.001). An increment of one standard deviation (SD) in these indices was linked to a 19%-30% greater prevalence of fractures. These findings remained robust after limiting analysis to Genant grade ≥2 vertebral fractures. BMI-stratified analysis revealed that abdominal obesity independently increased the prevalence of vertebral fractures regardless of BMI. Notably, normal-weight individuals with abdominal obesity had a 1.75-fold higher prevalence of vertebral fractures (p = 0.022), while BMI alone showed no significant effect. Moreover, WHtR demonstrated superior predictive capacity for vertebral fractures and Genant grade ≥2 vertebral fractures vs BMI (AUC 0.62 vs 0.52), with optimal performance when combined with age, sex, fracture history, and BMD (AUC = 0.80). Conclusion:Abdominal obesity was independently associated with impaired balance and elevated prevalence of vertebral fractures and clinical fractures, even in normal-weight individuals. WHtR demonstrated superior discriminative power for vertebral fractures.

The association between metabolic risk factors and human papillomavirus (HPV) infection is under debate. This study aimed to investigate the associations between metabolic risk factors and HPV infection, while also providing updated data on the prevalence of HPV infection in the post-vaccine era in China. This cross-sectional study involved 684,632 adult women who had undergone a standard health screening in 2019. HPV infection prevalence was estimated. Linear and nonlinear associations between HPV infection and metabolic risk factors were assessed, such as body mass index (BMI), systolic blood pressure (SBP), fasting plasma glucose (FPG), and low-density lipoprotein (LDL). The standardized prevalence of overall and high-risk HPV infection was 16.2

What is already known about this topic?:Breast cancer has emerged as the most prevalent cancer among women globally and is increasingly affecting younger populations. However, the relationship between individual socioeconomic status (SES) and breast cancer risk remains incompletely understood. What is added by this report?:This population-based cohort study revealed a breast cancer incidence rate of 48.9 per 100,000 person-years. Women with high SES demonstrated a significantly elevated risk of breast cancer compared to those with low SES [hazard ratio (HR)=1.42, 95% confidence interval (CI): 1.05, 1.92]. Self-perceived SES appeared to moderate this association, with an increased breast cancer risk particularly evident among women who had both low objectively assessed and self-perceived SES. What are the implications for public health practice?:These findings underscore the need for tailored breast cancer screening programs and targeted health education initiatives that account for differences across SES groups.

Cervical cancer is one of the most common cancers in women globally and remains the leading cause of cancer-related death among women in low- and middle-income countries. It is more prevalent in populations that are unscreened or underscreened. Improving screening coverage presents a global challenge. Self-collected cervical cancer screening allows women to collect samples for high-risk human papillomavirus (HR-HPV) testing on PCR-based tests, effectively increasing screening rates for cervical cancer. In light of the push for HR-HPV testing as a primary cervical cancer screening strategy and considering the current status of cervical cancer screening in China, experts from five academic societies developed a consensus that including the definition, value, advantages, applicable people, screening proposal, tools and methods, process, sampler distribution form, organisational screening model, HPV DNA testing, abnormal results management of vaginal self-sampling, information system construction, management quality control and so on, aims to guide the standardised application of vaginal self-sampling screening, enhance cervical cancer screening coverage in China and advance the efforts to eliminate cervical cancer in the country.

What is already known about this topic?:The Chinese government has established targets for cervical cancer screening coverage among women of appropriate age: 50% by 2025 and 70% by 2030. Previous data from 2018-2019 indicated that 36.8% of women aged 35-64 years had been screened in China. What is added by this report?:In 2023-2024, screening rates reached 51.5% among women aged 35-64 years, 57.9% among women aged 35-44 years, and 36.8% among women aged 20 years and above. Rural screening coverage (48.2%) approached but remained slightly below the 50% target. Several regions, particularly in the Eastern, Central, and Southern regions have achieved the 2025 target. Significant determinants of low cervical cancer screening coverage among Chinese women encompassed lower educational attainment, unemployment status, limited household income, lack of health insurance coverage, and absence of health check-ups. What are the implications for public health practice?:Intensified implementation of the Action Plan to Accelerate Elimination of Cervical Cancer is needed, particularly in rural areas with suboptimal screening rates. Enhanced health education and service delivery should target women of lower socioeconomic status to facilitate their active participation in screening programs.

Cervical cancer is one of the main malig-nant tumours threatening women's health.In 2022,there were 661000 new cases and 348 000 deaths from cervical cancer world-wide.1 In China,there were about 150 700 new cases and 55 700 deaths from cervical cancer in 2022.

What is already known about this topic?:Female breast nodules represent the most frequently detected lesions during breast ultrasound screening. Notably, nodules classified as Breast Imaging Reporting and Data System (BI-RADS) 4 or 5 indicate an elevated risk of breast cancer. Nevertheless, the detection rate and BI-RADS classification of female breast nodules in China remain largely undocumented. What is added by this report?:In 2021, breast nodules were detected in 27.9% of urban women in China. Among women with breast nodules marked with BI-RADS classification information, 95.9% were categorized as BI-RADS 2-3, while 4.0% were classified as BI-RADS 4-5. Age, geographic location, per capita gross domestic product (GDP), body mass index (BMI), high triglyceride (TG), high low-density lipoprotein cholesterol (LDL-C), and diabetes were identified as risk factors for BI-RADS 4-5. What are the implications for public health practice?:This study highlights the importance of managing high-risk women with breast nodules through BI-RADS classification. Women with older age, high TG, high LDL-C, or diabetes demonstrate higher detection rates of BI-RADS 4-5, underscoring the need for targeted health interventions for high-risk populations while accounting for regional and socioeconomic disparities.

BACKGROUND AND AIMS:Vitamin D deficiency is a global public health concern, yet data on its prevalence across China's diverse demographics remain limited. This study aimed to evaluate vitamin D status and deficiency prevalence across various demographic and geographic groups in China. METHODS AND RESULTS:This cross-sectional analysis included 19,845 participants from the China Osteoporosis Prevalence Study, conducted between December 2017 and August 2018. Serum 25-hydroxyvitamin D (25OHD) was measured by electrochemiluminescence. Vitamin D levels and deficiency prevalence were assessed across demographic groups and provinces using weighted analysis. The mean 25OHD level in the general population was 26.00 ng/mL, with an average of 29.1 ng/mL in males and 22.84 ng/mL in females. Vitamin D deficiency (defined as 25OHD <20 ng/mL) was notably prevalent in China, affecting 29.89 % of the population. Deficiency rates were particularly high in northern China (44.02 %), females (39.95 %), individuals under 40 years old (33.46 %), individuals with obesity (32.54 %), and urban residents (39.44 %). Geographic disparities were also apparent at the provincial level, with southern provinces generally exhibiting lower prevalence and northwestern regions the highest. CONCLUSIONS:This study provides important evidence for public health policies to prevent and manage vitamin D deficiency, highlighting the need for targeted interventions among high-risk populations such as women, urban residents, individuals with high BMI, and those with conditions like diabetes.

Although obesity is generally associated with increased bone mass, recent data have challenged its potential protective effect. Our study found that increased BMI showed beneficial effects on BMD in a non-linear way. However, individuals with obesity, especially women, were more likely to have vertebral fractures. There was a U-shaped relationship between BMI and the prevalent fractures. To estimate the association of obesity with the prevalence of fractures in the Mainland Chinese population. A total of 8251 individuals from the COPS cohort were enrolled in this cross-sectional study and grouped by BMI level. The Five-Repetition Sit-to-Stand Test (5R-STS) and the Sharpened Romberg test were used to evaluate the balance ability. Vertebral fractures (VFs) were confirmed by spine X-ray examination. Prevalent fractures were defined by a self-report questionnaire which happened in the recent 5 years. The restricted cubic spline (RCS) was used to explore the non-linear relationship. Multiple linear regression and multivariable logistic regression were conducted to adjust the covariates. Obesity was correlated with a reduced bone turnover rate and increased BMD. Nevertheless, there were significant non-linear correlations between BMI and BMD, with a rapid increase and plateau at extremely high BMI levels (p for non-linear < 0.001 for all). Individuals with obesity were associated with a longer time of the 5R-STS and more likely to have a positive Sharpened Romberg test, especially in women. Compared with the normal weight group, the likelihood of prevalence of VFs and the prevalent fractures were significantly increased in the obesity group, independent of the Sharpened Romberg test and lumbar spine BMD (VFs: OR = 1.88 [95

What is already known about this topic?:Previous studies have documented the prevalence and distribution of human papillomaviruses (HPV) infection. However, there is limited current nationwide data on HPV distribution across different cytological conditions in recent years. What is added by this report?:This nationwide, cross-sectional study reveals that detection rates of HR-HPV infection and abnormal cytology among women undergoing health check-ups remain relatively high in China. Among women with abnormal cervical cytology, HPV-16 was the most prevalent HR-HPV genotype, followed by HPV-58 and HPV-52. What are the implications for public health practice?:These findings, based on a large population sample across China, provide critical insights into current cervical cancer screening outcomes and can inform the development of HPV genotype-specific vaccination and screening strategies to reduce cervical cancer burden.

To investigate the epidemiological characteristics of anemia of varying severity among women of reproductive age, we conducted a nationwide, cross-sectional study between January 1, 2019 and December 31, 2019, including 4 184 547 nonpregnant women aged 18-49 years from all 31 provinces in the mainland of China. Anemia was defined as having hemoglobin concentration < 120.0 g/L and categorized as mild, moderate, and severe. Multivariate logistic models with cluster effect were used to explore the association of anemia and metabolic risk factors. The standardized prevalence of anemia and moderate and worse anemia among women of reproductive age in China was 15.8% (95% CI 15.1%-16.6%) and 6.6% (6.3%-7.0%), respectively. The prevalence of anemia and the proportion of moderate and worse anemia significantly increased with age. We also observed great geographic variations in the prevalence of anemia, with a high likelihood in south, central, and northwest China. Moderate and/or severe anemia was positively associated with overweight and obesity, diabetes, and impaired kidney function. In conclusion, anemia remains a significant challenge for women of reproductive age in China. Geographic variations and metabolic risk factors should be considered in the comprehensive and targeting strategy for anemia reduction.

What is already known about this topic?:Previous studies have indicated a possible association between reproductive tract infections (RTIs) and high-risk human papillomavirus (HPV) infection, but the evidence is still inconclusive.What is added by this report?:This multicenter study found significantly higher positive rates of HPV, including general HPV, high-risk HPV, and HPV 16/18 infections, among women who tested positive for single or multiple RTIs compared to women who tested negative for RTIs in gynecological outpatient clinics.What are the implications for public health practice?:Infection with HPV, especially high-risk types, is linked to RTIs and imbalances in the vaginal microbiota. Implementing standardized protocols for identifying and treating RTIs could support the establishment of a healthy vaginal microenvironment. This, in turn, may offer a novel approach to preventing cervical cancer.