This study examined gender differences in sleep outcomes among spousal caregivers of disabled partners in China and the relationship between the breadth of a care recipient's functional disability and a caregiver's sleep. This study used the 2020 data from the fifth wave of the China Health and Retirement Longitudinal Study (CHARLS), including 13 243 participants, of whom 1600 were caregivers for disabled spouses. The degree of disability was assessed using the Basic/Instrumental Activities of Daily Living (BADL/IADL) scale. Sleep quality and duration were measured by self-report. Statistical analyses included chi-square tests and binary logistic regression, adjusting for potential confounders such as sociodemographic characteristics, health status, and lifestyle factors. Women spousal caregivers had shorter sleep duration (OR = 1.309, 95% CI: 1.098-1.561) and poorer sleep quality (OR = 1.200, 95% CI: 1.011-1.424) versus non-caregivers, whereas no significant differences were observed among men caregivers. Analysis of the parametric relationship revealed that when the number of types of disabilities in care recipients reached 5 to 8, caregivers' sleep duration was significantly reduced (OR = 1.238, 95% CI: 1.007-1.522); when the number reached 9 to 12, both sleep duration (OR = 1.616, 95% CI: 1.096-2.382) and sleep quality (OR = 1.774, 95% CI: 1.220-2.579) of caregivers deteriorated significantly. Caregiving for a disabled spouse impairs sleep among women. A clear graded relationship exists between care recipients' functional disability types and caregivers' sleep problems. Support policies should consider gender differences and target women undertaking high-intensity care.

The full text of this preprint has been withdrawn, as it was submitted in error. Therefore, the authors do not wish this work to be cited as a reference. Questions should be directed to the corresponding author.

Glycemic control in women with gestational diabetes mellitus(GDM) is largely dependent on effective self-management. The adequacy of health information provided plays a critical role in determining self-management success. While existing studies recognise the importance of addressing health information needs, the specific needs of women with GDM in China remain unclear. Sixteen women diagnosed with GDM were recruited using purposive sampling from a tertiary general hospital in Hefei, Anhui Province, China. Face-to-face semi-structured interviews were conducted individually. The verbatim transcripts were analyzed by employing hybrid deductive-inductive qualitative content analysis. Health information needs were extracted for 3 domains and 10 topics. These include health information needs related to existence (disease, treatment, examination, childbirth); relationships (social support); and growth (dietary management, exercise management, blood glucose management, emotional management, and postnatal management). Based on ERG theory, this study identified patient-centered health information needs among women with GDM. The findings call for structured, staged, and accessible information services, with healthcare providers playing a key role in individualized assessment and trust-building. Future research should explore information prioritization and evaluate targeted strategies to improve self-management, clinical outcomes, and long-term health literacy in diverse GDM populations.

PurposeDespite the growing role of Traditional Chinese Medicine (TCM) in China, little is known about the spatial accessibility and equity of TCM hospital resources at high geographic resolution. This study quantifies the spatial accessibility (SA) of TCM hospitals and assess the equity in resource distribution across Zhejiang Province to identify distributional disparities and inform policy responses.MethodsWe applied a Two-Step Floating Catchment Area (2SFCA) framework augmented with navigation-derived travel times from a real-time route API to estimate SA for 99 public TCM hospitals and 25,601 residential demand points; equity was evaluated using Gini coefficients for four core resources (TCM physicians, TCM pharmacists, inpatient beds, and high-value TCM equipment), and spatial clustering was examined via Moran's I.ResultsAmong the 25,601 residential points analyzed, 93.47% were within a 60 min driving distance of a TCM hospital, covering 97.21% of the provincial population. However, accessibility varied considerably by municipality: Hangzhou exhibited the highest SA scores, while Lishui demonstrated consistently poor equity across all resource indicators. Gini coefficients ranged from 0.365 for TCM pharmacists (indicating proper equity) to 0.505 for medical equipment (indicating high inequity). Spatial autocorrelation analysis revealed distinct clustering patterns, with accessibility shaped by both topographical constraints and disparities in resource allocation.ConclusionWhile Zhejiang achieves high overall SA to TCM hospitals, substantial inequities in resource allocation remain. Policy implications include targeted redistribution of high-value assets (for example, regional equipment-sharing consortia), deployment of mobile diagnostic and treatment units for remote and insular areas, incentives to attract TCM practitioners to underserved localities, and strengthening county-level service capacity to reduce intra-municipal disparities. These measures would help translate broad coverage into more equitable access to TCM services.

Background As artificial intelligence (AI) tools rapidly permeate medical education, understanding individual differences in their adoption becomes increasingly important. Personality traits, particularly those defined by the Five-Factor Model, may influence how students engage with AI for learning and how they perceive its value.Objective This study aimed to examine the associations between personality traits and both AI tool use behaviors and attitudes among fourth-year clinical medical students in China.Methods A cross-sectional survey was conducted among 661 fourth-year clinical students at a medical university in Anhui Province. Personality traits were assessed using the Ten-Item Personality Inventory (TIPI). AI use frequency, specific AI-assisted learning behaviors, and attitudes toward AI in medical education were measured via structured questionnaires. Ordinal and binary logistic regressions were used to analyze behavioral outcomes, while multiple linear regression examined attitudinal associations.Results Neuroticism was negatively associated with overall AI use frequency (OR = 0.90, 95% CI: 0.83-0.98). Openness was positively linked to using AI for literature translation (OR = 1.14, 95% CI: 1.04-1.245), and conscientiousness predicted use for Auxiliary examination learning (OR = 1.15, 95% CI: 1.045-1.26). Conscientiousness, agreeableness, and openness were significantly associated with more positive attitudes toward AI's educational and clinical utility. Neuroticism was associated with greater concern over data privacy.Conclusions Personality traits meaningfully shape how students interact with AI tools and perceive their role in medical training. Tailored AI literacy programs and supportive learning environments may improve equitable adoption and optimize educational outcomes.

Purpose:Women in late pregnancy experience multiple co-occurring physical and psychological symptoms that may affect daily functioning and well-being. However, conventional approaches are limited in identifying priority intervention targets within complex symptom patterns. This study aimed to identify core symptoms and potential targets for symptom management using a network-based approach. Patients and Methods:A cross-sectional study was conducted among 444 women in late pregnancy recruited by convenience sampling from a maternal and child health hospital and a tertiary general hospital. Data were collected using a general information questionnaire and a Symptom Assessment Scale for Women in Late Pregnancy, which demonstrated good content validity and internal consistency. Symptom clusters were identified using exploratory factor analysis with principal component extraction, and a covariate-adjusted symptom network was constructed to explore inter-symptom relationships. Computer-simulated interventions were performed to examine the potential impact of symptom alleviation and aggravation within the network. Results:Six symptom clusters were identified: sleep and physical discomfort, cardiopulmonary load-related, emotional, gastrointestinal, uterine activity-related, and limb/skin clusters. After controlling for covariates, the cluster-specific core symptoms were fatigue (strength = 0.93), chest tightness (strength = 1.18), anxiety (strength = 1.15), nausea (strength = 0.70), abdominal tightness (strength = 1.26), and numbness or tingling in the hands, feet, or legs (strength = -0.11). Simulation analyses suggested that, in the alleviation simulations, shortness of breath/dyspnoea, fatigue, and chest tightness were associated with the largest simulated reductions in overall symptom burden. In the aggravation simulations, loss of appetite, nausea, and anxiety showed the largest simulated increases in overall symptom burden. Conclusion:This study identified key symptoms and candidate symptom targets within interconnected symptom networks in late pregnancy. The findings may provide exploratory insights for multidisciplinary healthcare professionals, including midwives and obstetricians, to better prioritise and individualise symptom assessment and management in antenatal care.

Background Late pregnancy is characterised by a high prevalence of co-occurring physical and psychological symptoms, which often cluster and interact. Traditional factor analysis can identify symptom clusters but fails to reveal inter-symptom associations or pinpoint core symptoms, limiting precise symptom management. This study aimed to identify symptom clusters and core symptoms among women in late pregnancy using network analysis. Methods A cross-sectional survey was conducted among 444 women in late pregnancy recruited from two hospitals in *Province, China. Symptom clusters were identified using principal component analysis. Factors associated with overall symptom burden were examined via multiple regression analysis. A contemporaneous symptom network of 21 frequent symptoms was then constructed after adjusting for significant covariates. Results Six symptom clusters were identified: sleep and physical discomfort, cardiopulmonary load-related, emotional, gastrointestinal, uterine activity-related, and limb/skin clusters. After controlling for age, gestational age, physical activity, and pregnancy complications, the core symptoms within these clusters were fatigue (strength = 0.93), chest tightness (1.18), anxiety (1.15), nausea (0.70), abdominal tightness (1.26), and numbness or tingling in the hands/feet/legs (− 0.11). Conclusions Symptoms in late pregnancy demonstrated complex clustering and interconnections. Targeting core symptoms may disrupt these networks and reduce the overall symptom burden. These findings provide an evidence base for individualised, precision symptom assessment and management in antenatal care, supporting evidence-based nursing interventions to improve maternal well-being.

INTRODUCTION:Spousal caregiving for disabled adults poses health risks, yet few studies address chronic diseases among caregivers of middle-aged and older spouses. This study explores the impact of caregiving on caregivers' chronic disease. METHODS:Using data from the China Health and Retirement Longitudinal Study, the authors included 10,090 spousal caregivers of disabled individuals aged ≥45 years, categorized into current, previous and no caregiving groups across 2015-2020 waves, and recorded caregiving duration. Chronic diseases (e.g., hypertension, dyslipidemia, diabetes), their counts, and covariates (including sex, age, education level, location, number of children, internet use, drinking and smoking status, physical activity and social activities) were obtained from the 2020 wave. Binary logistic regression assessed the relationship between caregiving status and chronic diseases, while zero-inflated negative binomial regression analyzed caregiving status and duration on disease counts. Analyses were conducted in October 2024. RESULTS:About 54.55% of the participants were men, and the mean age was 59.35±8.60 years. The current and previous caregiving groups were more likely to have chronic diseases, particularly arthritis and heart disease, compared to the no-caregiving group. Chronic disease counts were also higher in these groups. Longer caregiving duration also was associated with increased disease counts in both the current and previous caregiving groups. CONCLUSIONS:Caregiving for disabled middle-aged and older adults is associated with a higher prevalence and greater number of chronic diseases among caregivers. Caregiving duration is also positively associated with chronic disease counts. Tailored health policies and support systems are crucial for improving caregivers' health and care quality for disabled individuals in China.

OBJECTIVE:To investigate the association between depressive symptoms in spousal caregivers and both fall risk and the frequency of falls requiring medical treatment in care recipients with disabilities. DESIGN:A retrospective cohort study. SETTING:Data from the China Health and Retirement Longitudinal Study. PARTICIPANTS:1357 patient-caregiver dyads. INTERVENTIONS:Not applicable. MAIN OUTCOME MEASURES:The incidence of falls and the frequency of falls requiring medical treatment among care recipients. RESULTS:The mean (standard deviation) age of care recipients was 61.6 (9.1) years, and 62.1% of them were women. After adjusting for covariates, it was found that caregiver depressive symptoms were associated with a 32% higher risk of falls (relative risk [RR], 1.32; 95% confidence interval [CI], 1.08-1.61). Moreover, caregivers who exhibited depressive symptoms only at follow-up had a RR of falls requiring medical treatment of 2.74 (95% CI, 1.28-5.88), whereas those who had depressive symptoms at both the baseline and follow-up had a RR of 2.13 (95% CI, 1.19-3.80). The likelihood ratio test showed that grouping depressive symptoms significantly improved the model fit for both fall risk (likelihood ratio [LR] χ²(3)=8.89, P=.031) and falls requiring medical treatment (LR χ²(3)=14.50, P=.002). CONCLUSION:Caregiver depressive symptoms are significantly associated with an increased risk of falls and a higher frequency of falls requiring medical treatment among care recipients with disabilities. Addressing the mental health of caregivers may help reduce fall-related risks in this population.

It is widely recognized that individuals with disabilities are at a significantly higher risk of mental health issues. However, the mental health status of their spousal caregivers often tends to be overlooked. To investigate the association between caring for a disabled spouse and depressive symptoms among middle-aged and older adults, and to assess whether this association differs by caregiver gender. Cross-sectional data were drawn from the 2020 China Health and Retirement Longitudinal Study (CHARLS). Depressive symptoms in respondents were measured by the CESD-10. Associations were estimated using generalized estimating equations (GEE) with a logit link to account for intra-household correlation. Models adjusted for sociodemographic and health-related confounders. We conducted gender-stratified analyses, tested the interaction between gender and caregiving, performed an analysis restricted to caregivers (n = 1,357), and examined the relation between the number/types of recipient disabilities and caregiver depressive symptoms. In multivariable GEE models, spousal caregiving was associated with higher odds of depressive symptoms (OR = 1.278, 95

Enhancing the accessibility and equity of primary healthcare (PHC) is a crucial objective of China’s healthcare reform. However, spatial barriers remain a significant factor contributing to the inequitable access to PHC services among residents. This study aims to quantify the spatial accessibility (SA) and evaluate the equity of PHC resources in a pilot province for healthcare reform, and its municipalities, thereby providing insights that can be generalized to the broader context of China. The study used the navigation function provided by Gaode Map to estimate the time it takes for residents to visit PHC institutions. The two-step floating catchment area (2SFCA) method, weighted by a Gaussian function, was employed to measure the SA of PHC institutions, general practitioners (GPs), and beds across various residential areas. The Gini coefficient was utilized to assess disparities in SA among different regions. Additionally, Getis-Ord Gi* analysis was conducted to visualize these spatial disparities. The study analyzed 25,601 residential and 1,451 healthcare points in Zhejiang Province, revealing significant disparities in SA of PHC. Urban residents reached PHC institutions faster than rural ones (7.05 ± 4.7 min vs. 9.17 ± 7.78 min, P < 0.001). Within 30 min, 98.4

BackgroundPhlegm-dampness constitution is a traditional Chinese medicine constitution typically associated with essential hypertension. Previous studies have demonstrated that auricular acupuncture effectively decreases blood pressure and adjusts the constitution. However, the mechanism underlying auricular acupuncture's effect is poorly understood.MethodsA non-blinded, randomized controlled trial will be undertaken between September 2022 and May 2023. Eighty essential hypertensive patients with a phlegm-dampness constitution will be randomly allocated to one of two groups. The intervention group will receive eight weeks of auricular acupuncture and regular use of antihypertensive drugs, while the control group will only receive antihypertensive drugs. The primary outcome will be any mean differences in office systolic blood pressure. The secondary outcomes investigations will include proteins of the renin-angiotensin system, office blood pressure of different genotypes, and phlegm-dampness constitution scores.DiscussionBy demonstrating how auricular acupuncture affects the renin-angiotensin system, this research will offer significant new information on the mechanism underlying the action of auricular acupuncture in hypertension. Moreover, the results will provide crucial clinical information on the associations between renin-angiotensin system gene polymorphisms and the antihypertensive effects of auricular acupuncture.Trial registrationRegistered at the chictr.org.

Abstract Background Despite the growing recognition of the importance of social support and physical literacy in managing hypertension among young and middle-aged patients, there is a lack of research exploring the mediating effects of sense of coherence and self-efficacy in this relationship. This study aims to bridge this gap by investigating the interplay between social support, physical literacy, sense of coherence, and self-efficacy, thus contributing to a deeper understanding of effective interventions for hypertension management. Methods A cross-sectional study was conducted using convenience sampling to survey 280 young and middle-aged patients diagnosed with hypertension from five community settings in Zhejiang and Anhui provinces between January and February 2024. Measurement instruments included the General Information Questionnaire, Physical Literacy Scale for Young and Middle-aged Patients with Hypertension, Sense of Coherence Scale 13, General self-efficacy Scale, and Perception Social Support Scale. Data analysis was performed using SPSS 27.0 and AMOS 28.0, with reporting following the STROBE checklist. Results A total of 270 valid questionnaires were collected. The total score of physical literacy for young and middle-aged patients with hypertension ranged from 18 to 90, with a mean score of 62.30 ± 13.92, indicating a moderate level. There was a positive correlation between the physical literacy score and the scores of social support (r = 0.557, P<0.01), sense of coherence (r = 0.392, P<0.01), and self-efficacy (r = 0.466, P<0.01) among young and middle-aged patients with hypertension. Furthermore, social support was found to have multiple mediating effects through sense of coherence and self-efficacy on physical literacy. Conclusion This study sheds light on the interconnectedness of social support, physical literacy, sense of coherence, and self-efficacy among young and middle-aged patients with hypertension. The findings underscore the importance of considering these factors holistically in hypertension management strategies.

目的 探讨血管紧张素Ⅱ1型受体(AT1R)A1166C基因多态性与中国人原发性高血压的相关性.方法 系统检索PubMed、Web of science、Embase、Cochrane Library、中国知网(CNKI)、万方数据库、中国生物医学文献数据库(SinoMed)中关于AT1R A1166C基因多态性与中国人原发性高血压相关性的文献.两名研究者按照纳入与排除标准独立筛选文献、提取资料并进行文献质量评价后,采用RevMan 5.3软件进行Meta分析.结果 最终纳入39篇文献,其中病例组12,638例,对照组8,494例.Meta分析结果显示AT1R A1166C的C等位基因(OR:1.80,95％CI:1.51～2.15,P<0.0001)和AC/CC基因型(OR:1.81,95％CI:1.49～2.20,P<0.0001)可增加患高血压的风险.通过亚组分析发现,在汉族、彝族人群和东部、中部人群中,C等位基因、AC/CC基因型增加原发性高血压的易感性,在西部人群中只有AC/CC基因型展现这种相关性,而年龄可能不是影响A1166C与高血压相关性的因素.结论 AT1R A1166C基因的C等位基因和AC/CC基因型与中国人高血压易感性相关.

Objectives: Correlations between obstructive sleep apnea (OSA) and gastroesophageal reflux disease (GERD) have been detected in previous observational studies. However, this association remains uncertain due to the potential presence of selection and confounding biases. Therefore, this bidirectional two-sample Mendelian randomization (MR) study was conducted to evaluate the causal relationship between OSA and GERD. Methods: In this study, instrumental variables (IVs) for OSA were selected from publicly available genetic summary data (27,207 cases and 280,720 controls). Summary statistics for GERD were obtained from a genome-wide association study of 602,604 individuals. The inverse variance weighted (IVW) method was used as the main MR method. The MR-Egger intercept test, MR pleiotropy residual sum and outlier, and leave-one-out analysis were used to detect pleiotropy. Heterogeneity was detected by Cochran's Q test. Results: The IVW results revealed that OSA [odds ratio (OR): 1.19, 95% confidence interval (CI): 1.11-1.28, p = 8.88E-07] was causally associated with the incidence of GERD. Moreover, there was evidence of GERD leading to OSA in the IVW analysis (OR: 1.44, 95%CI: 1.33-1.57, p = 7.74E-19). No directional pleiotropy was detected by the MR-Egger intercept test (all p > 0.05). Conclusion: This study found that OSA is linked to a higher incidence of GERD, and vice versa. This finding might be helpful for the screening and prevention of these two diseases.

ObjectiveWe determined the distribution of constitutional types of high-normal blood pressure in Traditional Chinese Medicine (TCM) and provided evidence for the prevention of high-normal blood pressure and hypertension.MethodsEight digital databases were searched from January 2011 to November 2022, including PubMed, EMBASE, Web of Science, EBSCOhost, CNKI, CBM, Wangfang, and CQVIP. We performed a meta-analysis with the random-effects model or fixed-effects model to describe the distribution of constitutional types of high-normal blood pressure in TCM. The studies were assessed based on heterogeneity testing and the potential for publication bias. The meta-analysis was performed on Stata software 15.0.ResultsA total of 17 studies with 8118 participants were included in this meta-analysis. The proportion of the biased constitution (82.3%; 95% CI: 75.6%–89.1%, p < 0.001) was higher than the balanced constitution (17.3%; 95% CI: 10.7–23.8%, p < 0.001). Phlegm-dampness constitution, Yin-deficiency constitution, and damp-heat constitution accounted for 16.0% (95%CI: 10.5–21.5%, p < 0.001), 14.8% (95% CI: 11.0–18.6%, p < 0.001), 11.3% (95% CI: 8.0–14.5%, p < 0.001) of the total high-normal blood pressure cases, respectively. The subgroup analyses performed that region, age and gender were positively associated with the distribution of constitution types of high-normal blood pressure in TCM. Compared with the general population, the risk of high-normal blood pressure in people with the phlegm-dampness constitution, Yin-deficiency constitution, and blood-stasis constitution was 2.665 (95%CI: 2.286–3.106, p < 0.001), 2.378 (95%CI: 1.197–4.724, p = 0.013), 1.965 (95%CI: 1.634–2.363, p < 0.001) times of the general population, respectively. Meanwhile, the risk of high-normal blood pressure was lower in people with a balanced constitution (0.248, 95%CI: 0.165–0.372, p < 0.001).ConclusionsPhlegm-dampness constitution, Yin-deficiency constitution, and damp-heat constitution were the common constitution types of high-normal blood pressure. There might also be differences in the distribution characteristics of TCM constitution among people with high-normal blood pressure in different regions, ages, and genders. Finally, a balanced constitution might be a protective factor for hypertensive people.

目的 总结国内外正常高值血压人群运动干预相关证据,为制定针对正常高值血压人群的运动方案提供依据.方法 系统检索BMJ Best Practice、UpToDate、Cochrane Library、JBI Library、国际指南协作网、英国国家卫生与临床优化研究所、苏格兰校际指南网络、PubMed、Web of Science、EBCOS、Embase、中国知网、万方数据知识服务平台等数据库,并补充检索国家心血管病中心、中国高血压联盟、国际高血压学会等数据库中正常高值血压人群运动干预相关文献,包括证据总结、临床决策、推荐实践、临床实践指南、专家共识、系统评价或M eta分析、随机对照试验,检索时限为2017年1月1日至2021年11月30日.由研究者独立进行文献质量评价,并对纳入的文献进行证据提取.结果 共纳入18篇文献,包括9篇指南、2篇临床决策、3篇系统评价、1篇专家共识和3篇随机对照试验,从适宜人群、运动前评估、运动强度、运动类型、减轻压力的运动类型、注意事项6个方面总结出24条证据.结论 正常高值血压人群运动方案的最佳证据可为社区卫生服务机构及健康管理中心的医护人员提供循证依据,但医护人员在应用证据时应考虑具体情境,对不同特点的个体进行准确评估,以便采取个体化、精细化干预措施.

Allostatic load (AL) is a biological tool for objectively assessing chronic stress and has been discussed inconsistently for its correlation with socioeconomic factors and unhealthy lifestyles. Therefore, this meta-analysis was performed to explore the impact of socioeconomic factors and unhealthy lifestyles on AL. Different databases, including Web of Science, PubMed, EBSCOhost, Embase, CNKI, VIP, SinoMed, and Wanfang, were searched from inception to June 6, 2023. A total of 25 studies, reporting the correlations of seven socioeconomic factors and three unhealthy lifestyles with AL, were finally included. The pooled odds ratios (OR) and 95

Background The outbreak of COVID-19 in early 2020 presented a major challenge to the healthcare system in China. This study aimed to quantitatively evaluate the impact of COVID-19 on health services utilization in China in 2020. Methods Health service-related data for this study were extracted from the China Health Statistical Yearbook. The Auto-Regressive Integrated Moving Average model (ARIMA) was used to forecast the data for the year 2020 based on trends observed between 2010 and 2019. The differences between the actual 2020 values reported in the statistical yearbook and the forecast values from the ARIMA model were used to assess the impact of COVID-19 on health services utilization. Results In 2020, the number of admissions and outpatient visits in China declined by 17.74 and 14.37%, respectively, compared to the ARIMA model’s forecast values. Notably, public hospitals experienced the largest decrease in outpatient visits and admissions, of 18.55 and 19.64%, respectively. Among all departments, the pediatrics department had the greatest decrease in outpatient visits (35.15%). Regarding geographical distribution, Beijing and Heilongjiang were the regions most affected by the decline in outpatient visits (29.96%) and admissions (43.20%) respectively. Conclusion The study’s findings suggest that during the first year of the COVID-19 pandemic, one in seven outpatient services and one in six admissions were affected in China. Therefore, there is an urgent need to establish a green channel for seeking medical treatment without spatial and institutional barriers during epidemic prevention and control periods.

Background: Clinical decision support tools (CDSs) have been demonstrated to enhance the accuracy of antibiotic prescribing among physicians. However, their effectiveness in reducing inappropriate antibiotic use for respiratory tract infections (RTI) is controversial. Methods: A literature search in 3 international databases (Medline, Web of science and Embase) was conducted before 31 May 2023. Relative risk (RR) and corresponding 95% confidence intervals (CI) were pooled to evaluate the effectiveness of intervention. Summary effect sizes were calculated using a random-effects model due to the expected heterogeneity ( I 2 over 50%). Results: A total of 11 cluster randomized clinical trials (RCTs) and 5 before-after studies were included in this meta-analysis, involving 900,804 patients met full inclusion criteria. Among these studies, 11 reported positive effects, 1 reported negative results, and 4 reported non-significant findings. Overall, the pooled effect size revealed that CDSs significantly reduced antibiotic use for RTIs (RR = 0.90, 95% CI = 0.85 to 0.95, I 2 = 96.10%). Subgroup analysis indicated that the intervention duration may serve as a potential source of heterogeneity. Studies with interventions duration more than 2 years were found to have non-significant effects (RR = 1.00, 95% CI = 0.96 to 1.04, I 2 = 0.00%). Egger’s test results indicated no evidence of potential publication bias ( p = 0.287). Conclusion: This study suggests that CDSs effectively reduce inappropriate antibiotic use for RTIs among physicians. However, subgroup analysis revealed that interventions lasting more than 2 years did not yield significant effects. These findings highlight the importance of considering intervention duration when implementing CDSs. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023432584 , Identifier: PROSPERO (CRD42023432584).