Background:Workplace environmental exposures (WEEs) and shift work are common occupational hazards, but their joint associations with working-age health and healthy working years are not well characterised. Methods:Data were from the UK Biobank. Lifetime WEEs (toxic substances, passive smoking, extreme temperatures, noise) and shift work (day, mixed or night shifts) were derived from complete job histories and classified as cumulative years (never, <10, >=10 years). 20 prevalent multisystem long-term work-limiting health conditions before age 70 were ascertained via linked health records. Survival analyses including Cox proportional hazards and accelerated failure time models were conducted. Results:Among 34 413 workers aged 38-54 years, half experienced WEEs or shift work. Over 13.9±1.0 years, WEEs and shift work were associated with all 20 conditions, and some associations were more pronounced or only significant in women. Specifically, workers exposed to both exposures for >=10 years (vs both never) had 154% higher risks of new-onset carpal tunnel syndrome, followed by chronic obstructive pulmonary disease, spondylopathy, diabetes and depression (increased risks: 124%-100%). They also lost 8.88 healthy working years due to incident carpal tunnel syndrome, followed by depression, spondylopathy, intervertebral disc diseases and psoriasis (years lost: 7.33-6.44). The joint impacts of multifaceted WEEs and shift work varied, but few multiplicative/additive interactions were observed. Conclusions:Co-occurrence of WEEs and shift work is associated with substantial excess risks of long-term work-limiting health conditions and loss of healthy working years. Strengthening control of WEEs and health surveillance for shift workers may be needed to protect working-age health and sustain productive employment.

BackgroundGiven the rising prevalence of chronic diseases and multimorbidity among middle-aged and older individuals in China, it is crucial to explore the patterns of chronic disease multimorbidity and uncover the underlying mechanisms driving the co-existence of multiple chronic conditions.MethodsThis study analyzed data from 19,206 participants in the China Health and Retirement Longitudinal Study (CHARLS 2018). The IsingFit model was used to build the chronic disease co-morbidity network, where nodes represented diseases and edges reflected conditionally independent partial correlations. Community detection identified groups of closely related diseases using the Louvain algorithm. Multivariable linear regression with forward stepwise selection explored factors influencing chronic disease co-morbidity. A random forest model ranked these factors by importance, providing insights into relationships and key contributors.ResultsThis study identified the most frequent multimorbidity pairs in the middle-aged and older adult population as hypertension with arthritis, and digestive diseases with arthritis. Multimorbidities were classified into four subgroups: respiratory diseases, metabolic syndrome, neurological diseases, and digestive diseases. Heart disease showed centrality in the multimorbidity network, while memory-related diseases played a bridging role. Key factors associated with multimorbidity included age, gender, pain, sleep, physical activity, depression, and education. Random forest analysis revealed that age and pain had the greatest impact on multimorbidity development, offering insights for targeted prevention and management strategies.ConclusionThis study systematically analyzed multimorbidity patterns and their influencing factors in the Chinese middle-aged and older adult population. The data were examined at three levels: overall network, key influencing factors, and individual characteristics. Cardio-metabolic diseases were identified as a core component of the multimorbidity network. Advanced age, pain, and depression were found to be independent risk factors affecting the number of multimorbidities, while healthy behaviors acted as significant protective factors. The study enhances understanding of multimorbidity mechanisms and provides a scientific basis for public health interventions, emphasizing the importance of behavioral modification, health education, and social support for high-risk groups.

Objectives Although low handgrip strength (HGS) is a well-established biomarker of aging and mortality, the prognostic significance of HGS asymmetry remains underexplored. This study sought to determine the associations of HGS asymmetry patterns with frailty, comorbidities, mortality risk, and life expectancy in a large population-based cohort. Design Prospective cohort study. Setting and Participants This study used data from the UK Biobank, including 308,810 participants aged 37 to 73 years. Methods HGS asymmetry was defined as a difference exceeding 10% in the HGS ratio. Multivariable-adjusted logistic regression was conducted to assess the associations with adverse health conditions, including frailty and comorbidities. Cox models were used to evaluate mortality risk, whereas flexible parametric survival models were used to estimate life expectancy. All analyses were adjusted for sociodemographic, lifestyle, and clinical confounders. Results HGS asymmetry, especially dominant asymmetry, was found to be significantly associated with adverse health conditions and increased mortality. In contrast with the HGS symmetry and nondominant HGS asymmetry groups, dominant HGS asymmetry conferred a higher risk of frailty (adjusted odds ratio, 1.42) and comorbidities (adjusted odds ratio, 1.15). During a median 13.6-year follow-up, dominant HGS asymmetry was linked to a 13% elevated risk of mortality (adjusted hazard ratio, 1.13), surpassing the risk associated with nondominant HGS asymmetry (adjusted hazard ratio, 1.08). Symmetrical HGS demonstrated a distinct longevity advantage, whereas dominant HGS asymmetry was associated with the shortest life expectancy. Conclusions and Implications HGS asymmetry was associated with an increased risk of frailty, comorbidities, and mortality in subsequent years. More attention should be paid to dominant HGS asymmetry when predicting adverse health conditions and mortality.

BACKGROUND:The mental health impacts of long-term ambient benzene exposure remain incompletely understood. We aim to investigate the association between long-term exposure to low-concentration ambient benzene and mental disorders in the general population. METHOD:Estimated annual benzene concentrations from UK-wide air pollution maps were linked to health data from 410,605 eligible UK Biobank participants. A nested case-control analysis was performed to assess the risk of all-cause and ten specific mental disorders, using 1:4 risk-set matching with replacement (matching each case to up to four controls). Conditional logistic regression estimated odds ratios (ORs) and 95 % confidence intervals (CIs), and restricted cubic spline models evaluated exposure-response relationships. Subgroup analyses identified potential vulnerable populations. RESULTS:In fully adjusted models, per interquartile range (IQR) increase in benzene exposure was associated with higher risks of all-cause mental disorders (OR: 1.19, 95 % CI: 1.16-1.23), mood disorders (OR: 1.12, 95 % CI: 1.06-1.19), anxiety disorders (OR: 1.31, 95 % CI: 1.25-1.38), substance use disorders (OR: 1.23, 95 % CI: 1.16-1.31), and sleep disorders (OR: 1.13, 95 % CI: 1.05-1.23). Significant associations were also observed within six subtypes: depressive episodes, panic disorder, phobic anxiety disorder, post-traumatic stress disorder, alcohol use disorder, and tobacco use disorder. Exposure-response curves were predominantly nonlinear, with risks elevated even at low concentrations, suggesting no clear safe threshold. The associations were generally consistent across subgroups, with stronger risks among individuals without hypertension or diabetes. LIMITATIONS:We cannot establish causality. CONCLUSION:Long-term exposure to low-level ambient benzene concentrations is associated with increased risks of all-cause and specific mental disorders. These findings provide evidence to inform air pollutant management policy.

China faces the dual challenge of population aging and rising disability rates, creating an "aging-disability overlap" that places unprecedented pressure on the nation's healthcare system. This paper analyzes the complex mechanisms underlying the intersection of aging and disability, revealing that chronic and degenerative diseases are primary contributors to disability among older adults, with disability rates significantly increasing with age and comorbidities. Despite China's implementation of long-term care insurance pilot programs and community-based elderly care services, multiple challenges persist: insufficient financing sustainability, inconsistent assessment standards, regional development imbalances, professional talent shortages, and social-cultural prejudices. In response, this paper proposes a comprehensive strategy framework aligned with "Healthy China 2030"'s goals of strengthening disability prevention and early intervention mechanisms; enhancing long-term care services with diversified security systems; fostering professional talent development in geriatric and rehabilitation medicine; promoting research and application of intelligent assistive technologies; and creating barrier-free communities within an inclusive social environment. Through these coordinated approaches, we aim to improve the quality of life for older adults with disabilities and facilitate dignified and high-quality healthy aging.

As the global population ages, multimorbidity has become a critical public health issue. We analyzed 332,012 adults from the UK Biobank (2006-2022) to investigate the association between biological age-measured by the Klemera-Doubal method (KDM-BA) and phenotypic age (PhenoAge)-and a new comorbidity model encompassing physical, psychological, and cognitive disorders, with overall mortality outcomes over a median follow-up of 13.6 years. Logistic regression models examined the association between baseline health status and accelerated aging, while Cox proportional hazards models assessed mortality risk and disorder development. Cross-sectional analysis showed that accelerated aging was linked to higher comorbidity prevalence. Longitudinal follow-up revealed that individuals in the highest quartile (Q4) of aging speed (residual difference between estimated biological age and chronological age) had a 16%-17% higher risk of developing a single disorder, a 41%-44% higher risk of multimorbidity, and a 54% higher overall mortality risk compared with the lowest quartile (Q1). Among those with baseline single disorder, dual comorbidity, and triple morbidity, Q4 mortality risk increased by 89%-116%, 118%-166%, and 119%-156%, respectively. Multistate Markov models confirmed that accelerated aging (residual > 0) increased the risk of transitioning to disorder, comorbidity, and death by 12%-37%. Individuals aged 45 with triple comorbidity lost an average of 5.3 years in life expectancy (LE), further reduced by 5.8 to 7.0 years due to accelerated aging. This study highlights that KDM-BA and PhenoAge robustly predict multimorbidity trajectories, mortality, and shortened LE, supporting their integration into risk stratification frameworks to optimize interventions for high-risk populations.

In this paper, a two-sector general equilibrium model with Putty-Clay technology is constructed, and the characteristics of capital heterogeneity are depicted in the model in the form of capital goods productivity variance. Through the capital selection mechanism, the impact of capital heterogeneity on labor income share is explored. It is found that the inverted U-trend of relative capital heterogeneity in capital-intensive industries is the cause. Second, the mechanism of capital heterogeneity affecting labor income share lies in the capital goods selection mechanism. With the increase of capital heterogeneity, the investment uncertainty faced by enterprises is strengthened. When choosing capital goods, enterprises will diversify investment and reduce capital intensity. After capital goods are put into production, firms will use high-productivity capital goods and shut down low-productivity capital goods, leading to a decline in capital utilization, the increase in total factor productivity, and the increase in output. Third, in the capital-intensive sector, the increase of capital heterogeneity will reduce, while in the labor-intensive sector, the opposite effect is presented. The new characteristics of Chinese capital and the change of labor income share, and has important policy reference significance for promoting.

PURPOSE:The aim of this study is to explore the prevalence, associated risk factors, and the influence of urbanization on the epidemiology of diabetic retinopathy (DR) and diabetic macular edema (DME). METHODS:This study utilized a cross-sectional design to survey residents aged 50 and older in the Beichen community, Tianjin. Participants underwent thorough examinations, including questionnaire surveys, laboratory blood tests, eye assessments, fundus photography, and optical coherence tomography (OCT) scans. DR was diagnosed using the retinopathy severity scale from fundus photographs based on the Early Treatment Diabetic Retinopathy Study (ETDRS) classification system. DME was identified through medical history records and OCT evaluations. In this study, we analyzed and assessed the prevalence and risk factors associated with DR and DME. RESULTS:The study included 5,648 participants, and 1,182 of these were diagnosed with diabetes. Among the diabetic individuals, the prevalence of DR was 28.8%. Among the eyes of those diagnosed with DR, 37.12% had mild non-proliferative DR (NPDR), 54.81% had moderate NPDR, 6.35% (33 eyes) showed severe NPDR, and 1.73% had proliferative DR (PDR). The prevalence of DME among diabetic patients was 14.13%. Age was negatively correlated with DR (OR, 0.924), while blood glucose levels (OR, 1.123) and the duration of diabetes (OR, 1.090) were positively correlated. Additionally, blood glucose levels (OR, 1.121) and the duration of diabetes (OR, 1.070) were positively associated with DME. CONCLUSION:In this study, the prevalence of DR and DME was high in the Beichen District of Tianjin than in other parts of China. Maintaining effective glycemic control is the most important modifiable factor in reducing the risk of DR and DME progression and minimizing the risk of vision loss.

Abstract Background China has a high disease burden of respiratory Tuberculosis (TB) and understanding the long-term trends in respiratory TB deaths and their epidemiological characteristics will assist China in achieving the WHO 2035 goal of ending the worldwide TB pandemic. To guide future respiratory TB preventive and intervention initiatives in China, this study thoroughly analyzed the secular trends of respiratory TB death statistics at a national level. Methods The annual estimate of respiratory TB mortality was derived from the National Health Commission (NHC). The trend pattern was detected using Joinpoint regression analysis, and the age-period-cohort model was used to estimate cohort and period effects. Results Between 1987 and 2021, China's respiratory TB mortality showed a consistent downward trend. respiratory TB mortality in urban areas decreased by 87% with an AAPC of -5.5% during the whole study period, while rural areas fell by 92% with an AAPC of -6.6%. There was a huge urban-rural disparity in respiratory TB mortality in China, with respiratory TB mortality in rural 2.05 times higher than that of the urban population in 1987, while by 2021 this figure had fallen to 1.32 times. respiratory TB mortality is higher in men than in women, and the relative risk gap has widened over time. Age effects in urban and rural areas presented inconsistent variation characteristics. The peak respiratory TB mortality rate occurs at 70–80 years of age in urban populations, whereas in rural with a peak occurs between 20 and 30 years. Overall, women had a higher mortality rate than men until the age of 25, but after 30 years, men's rates exceeded those of women. The period relative risk of respiratory TB mortality for urban and rural males and females showed a monotonic decreasing trend. And with the posterior shift of birth years, the cohort effect showed a decreasing trend. Conclusion There was a significant reduction in respiratory TB deaths between 1987–2021, particularly in rural areas. The risk of TB death is higher among men and rural populations. And the gap between urban and rural areas is widening, while the gender gap is closing. Certain groups such as children and older men need priority for prevention and control policies. The Chinese government should develop timely, effective, and targeted intervention strategies to further reduce respiratory TB mortality and help to achieve global respiratory TB control targets. Trial registration Not applicable.

ObjectivesChina has implemented an equalization of public health Services policy for migrants in 40 pilot cities since 2013. The main objective of this study is to explore the effect of this migrant-based reform policy on the health status of the migrant population in China.MethodsUsing the China Migrants Dynamic Survey (CMDS), we included 152,000 migrants aged 15 years or over in 2018. Standardized questionnaires were used to collect socio-economic information and self-reported health status. The Associations between the equalization of public health services and health status were estimated using Multiple regression estimation models and Propensity Score Matching (PSM) methods.ResultsPublic health equalization reform in China has a significant and positive effect on the health status of the migrant population (β = 0.033, p < 0.001). Compared to males, higher income, under 60 years of age, inter-provincial mobility, and migrants those already living in urban areas, the equalization of public health Services had shown more significant positive effects on the groups who were inter-provincial migration (β = 0.055, p < 0.001), females (β = 0.055, p < 0.001), having low-income (β = 0.077, p < 0.001), aged over 60 years old (β = 0.191, p < 0.001), and living in rural areas (β = 0.038, p < 0.001). And multiple robustness tests prove that the above results are reliable.Conclusions and implicationsOur findings confirmed the positive health effect of the equalization of public health services reform on china's migrant population, especially among vulnerable groups such as those in low income groups, in rural areas and females. And we recommend that it is necessary to further promote the practices and experiences of the pilot cities. First, strengthen health education for the mobile population and improve their health literacy. Second, further increase the financial investment to improve the coverage of public health services and the equity in resource allocation among regions. Last, strengthen the information-based management of the migrant population and prevent and control infectious diseases.

Abstract Diabetes mellitus (DM) is a public health challenge in China. Quantifying changes in DM mortality is of great significance, but related evidence of Chinese older adults is scarce. This study conducted a comprehensive analysis of China’s DM mortality changing trajectory. The data from 1987 to 2020 was derived from the National Health Commission of China. Joinpoint analysis and age-period-cohort (APC) model were used to calculate the annual change and the effects of age, period and cohort on DM mortality. The changing trajectory from 1987 to 2020 showed an upward trend, especially among rural groups, and the gap between rural-urban narrowed. Joinpoint analysis showed a consistent upward trend in rural areas (4.9%, 95%CI: 4.0%-5.7%). However, the urban showed an upward trend from 1987–1998 (5.7%) and a slow downward trend from 1998 to 2020 (-1.0%). The APC model showed that the reporting rate increased with age in urban and rural areas. For the effect of time period and cohort, as they proceeded, the rural showed a consistent and significant upward trend, but the trends in urban remained relatively stable. The DM mortality in China has shown an overall upward trend over the past three decades, especially in rural areas. Although the gap between urban-rural has been further reduced, the burden of the oldest-older has risen significantly regardless of areas. It is time to give priority attention to the high mortality of DM among females, the elderly and rural areas, and the government should take measures to curb this trend.

IntroductionSince the 18th National Congress of the Communist Party of China (CPC), remarkable achievements have been made in poverty alleviation. Over the past five years, the population of people living in poverty had decreased by 68.53million, fallen from 98.99 million in 2012 to 30.46 million at the end of 2017. As an impoverished province, Hebei province has been implementing the CPC Central Committee's guidance in the battle against poverty. In 2016, the government released the Implementation Scheme Plan for Improving the Level of Medical Security and Assistance. The plan introduces multi-layer medical security and assistance mechanisms which covers basic medical insurance, major disease insurance and medical assistance. In 2017, the government formulated the Implementation Plan for the Three-Batch Action Plan on the Health Care Program for Poverty Alleviation in Hebei Province, for people with major disease. Hebei Province has carried out many explorations on the health care program for poverty alleviation, and its effectiveness is a problem worthy of attention.MethodsBased on data including basic medical insurance, major illness insurance, medical assistance, and other related information, we used descriptive statistics and quantitative methods to evaluate the overall expenditure of the poverty alleviation for Hebei province and the areas under its jurisdiction. Additionally, the expenditure of different levels of medical security system, the medical burden for people facing poverty and the distribution of disease in the population with assistance were evaluated.ResultsThe out-of-pocket payment per capita has decreased year by year, and it has dropped to 3% of catastrophic medical expenditure and 20% below the poverty line by June 2018. An imbalanced situation occurred with the implementation, with the more impoverished areas having greater the pressure on medical care and poverty alleviation. For people with medical assistance, diseases with higher population and overall expenditure are cerebrovascular disease, malignant tumor, diabetes and some other chronic diseases.ConclusionsThe health policies for poverty alleviation in Hebei province has achieved a remarkable success, and the medical burden of the poor has been significantly reduced. However, the implementation of the policies in various cities has shown an imbalanced situation, and the poverty alleviation policies need to be further improved.