Higher intake of high-fat cheese and high-fat cream was associated with a lower risk of all-cause dementia, whereas low-fat cheese, low-fat cream, and other dairy products showed no significant association. APOE ε4 status modified the association between high-fat cheese and AD. Our study's observational design limits causal inference.

Equity is a key issue in the utilization of health services. However, existing research have focused on the developed eastern regions of China, and fails to account for the equity of the level of health service utilization (out-of-pocket payments). This study aims to assess the equity of health service utilization. By analyzing socioeconomic disparities in access to medical services, we seek to identify key barriers and provide evidence for policymakers to improve equitable healthcare delivery in resource-limited settings. Taking the data of the 7th National Health Service Survey in Gansu Province as an example, based on Anderson model, the equity of health service utilization and its influencing factors were evaluated by using the centralized index and its decomposition method. On this basis, it screened out patients who had used outpatient or inpatient services from the survey subjects, and extracted their out-of-pocket payments incurred by using the above services. Recentered influence functions regression and its decomposition method were used to analyze the equity difference of health service utilization level between urban and rural residents, and the contributing factors were discussed. The centralized index of outpatient service utilization was 0.0422 and − 0.0268, and the centralized index of inpatient service utilization was 0.1462 and − 0.1294, respectively. The utilization of both outpatient and inpatient services tends to be high income residents in cities, while in rural areas, the lower the economic level of residents, the higher the utilization rate. Further analysis of the level of health service utilization showed that the Gini coefficients of out-of-pocket payments for urban and rural patients were 0.703 and 0.748, respectively, indicating a large inequality. Recentered influence functions regression and its decomposition results show that rural patients have greater inequality than urban patients in out-of-pocket payments for out-patient and in-patient care, and there is discrimination effect. At present, there are still inequities in the utilization of health services in less developed areas of China, especially in the utilization of inpatient services, but the degree of inequity is reduced compared with previous studies. In terms of the fairness of health service utilization level, the inequality degree of rural residents is greater than that of urban residents, and there is a greater discrimination effect. This finding suggests that it needs to develop and implement health equity policies for rural residents to ensure that they are not discriminated against in their access to health services. Equity in the utilization of health services is also monitored and evaluated to ensure the effectiveness of the policies and equal treatment in their implementation.

Kawasaki disease (KD), an acute systemic vasculitis of unknown etiology, has attracted widespread attention regarding the triggering role of environmental factors in its development. We assessed the effects of air pollutants and meteorological factors on KD, providing evidence for the etiology of KD and data guidance in Northwest China. This time-stratified case-crossover study combined KD inpatient data with air pollutant and meteorological data. We completed individual exposure assessment using ArcGIS 10.8.1 according to the patient’s home address. The associations between air pollutants, meteorological factors, and KD on the previous 0–2 days before disease onset were evaluated through conditional logistic regression. We found that each 10 μg m−3 increment of air PM10 at 1-day delay causes a 1.6

Background: Comprehensive data on the economic burden of cervical cancer treatment remain scarce in China’s less developed regions, necessitating this study on hospitalization costs and expenditure trends in these areas. Methods: Employing a multi-stage stratified cluster sampling approach, this study enrolled 10,070 cervical cancer inpatients from 72 healthcare facilities in Gansu Province. Clinical and expenditure data were extracted from hospital information systems. Rank sum tests and Spearman correlation analyses were performed for univariate assessment, while quantile regression and random forest models were applied to identify determinant factors. Results: From 2019 to 2023, the average hospitalization duration for cervical cancer patients in Gansu Province was 16.12 days, with an average hospitalization cost of USD 3862.08 (2023 constant prices, converted from CNY at 1:7.0467). During these five years, the average inpatient costs per hospitalization increased from USD 3473.45 to USD 4202.57, and the average daily hospitalization cost rose from USD 230.53 to USD 241.77. The average drug cost decreased from USD 769.06 to USD 640.16. The main factors influencing hospitalization costs included the length of hospital stay, whether cervical cancer surgery was performed, hospital type, hospital level, and the proportion of medications. Conclusions: Our findings indicate that cervical cancer is a considerable economic burden on both families and society. This highlights the need to control the length of hospital stay and optimize the allocation of medical resources, in addition to strengthening cervical cancer screening and HPV vaccination in underdeveloped areas, in order to enhance the efficiency of prevention and treatment and ensure medical equity.

We evaluated the effects of environmental factors on the occurrence and regression of coronary artery lesions (CAL) in patients with Kawasaki disease (KD), intending to provide a scientific basis for the prevention, treatment, and long-term management of KD. We enrolled pediatric patients with KD hospitalized in the Pediatric Cardiovascular Department of a tertiary comprehensive hospital between June 2015 and December 2020 as research subjects. The medical record information of the children during hospitalization and follow-up was obtained by reviewing the hospital’s electronic medical record system. The air pollutants including CO, NO2, PM10, PM2.5, SO2 and O3 were collected from the National Urban Air Quality Real-time Release Platform of the China National Environmental Monitoring Centre. The meteorological data were sourced from the China Meteorological Data Network, including the daily average temperature and the daily average relative humidity. We assessed the individual and combined effects of air pollutants and meteorological factors on CAL by Unconditional logistic regression and Bayesian kernel regression, respectively, and to explore their dose-response relationships. We estimated the overall time to regression of CAL by Kaplan-Meier, assessed the effects of air pollutants and meteorological factors on the regression of CAL by Cox proportional risk regression model, and evaluated the dose-response relationship by restricted cubic spline. The OR for CAL formation in children with KD was 1.267 (95

The aging population poses challenges in various areas, particularly regarding the health of older adults, which is becoming a worldwide issue due to decreasing physical abilities. Social participation improves both mental and physical well-being, making it an important approach for promoting active aging. This research examined the patterns of social participation among the older adults and how these patterns relate to their Activity of Daily Living and their Self-rated Health. Utilizing data from the 7th National Health Service Survey in Gansu, a potential category analysis was performed to examine the social participation patterns of older adults. To investigate how these patterns influence Self-rated Health and the Activity of Daily Living, mediation effect analysis was carried out, incorporating classical triple regression, structural equation modeling, and Bayesian structural equation modeling. In Gansu Province, the social participation patterns among older adults are categorized as Diverse Participation(9.85

BackgroundEconomic data on congenital heart disease are scarce in economically underdeveloped areas of China. Therefore, this study aimed to shed light on the level and changing trend of congenital heart disease inpatients' economic burden in underdeveloped areas.MethodThis study used a multi-stage stratified cluster sampling method to select 11,055 inpatients with congenital heart disease from 197 medical and health institutions in Gansu Province. Their medical records and expenses were obtained from the Hospital Information System. Univariate analysis was conducted using the rank sum test and Spearman rank correlation. Quantile regression and random forest were used to analyze the influencing factors.ResultsFrom 2015 to 2020, the average length of stay for congenital heart disease patients in Gansu Province was 10.09 days, with an average inpatient cost of USD 3,274.57. During this period, the average inpatient costs per time increased from USD 3,214.85 to USD 3,403.41, while the average daily inpatient costs increased from USD 330.05 to USD 376.56. The average out-of-pocket costs per time decreased from USD 2,305.96 to USD 754.77. The main factors that affected the inpatient costs included length of stay, cardiac procedure, proportion of medications, age, and hospital level.ConclusionCongenital heart disease causes a significant economic burden on both families and society. Therefore, to further reduce the patient's financial burden, the length of stay should be reasonably reduced, and the rational distribution of medical resources should be continuously promoted to ensure equitable access to healthcare services.

Background Since the twenty-first century, the prevalence of diabetes has risen globally year by year. In Gansu Province, an economically underdeveloped province in northwest China, the cost of drugs for diabetes patients accounted for one-third of their total drug costs. To fundamentally reduce national drug expenditures and the burden of medication on the population, the relevant departments of government have continued to reform and improve drug policies. This study aimed to analyse long-term trends in antidiabetic drug use and expenditure in Gansu Province from 2012 to 2021 and to explore the role of pharmaceutical policy.Methods Data were obtained from the provincial centralised bidding and purchasing (CBP) platform. Drug use was quantified using the anatomical therapeutic chemistry/defined daily dose (ATC/DDD) method and standardised by DDD per 1000 inhabitants per day (DID), and drug expenditure was expressed in terms of the total amount and defined daily cost (DDC). Linear regression was used to analyse the trends and magnitude of drug use and expenditure.Results The overall trend in the use and expenditure of antidiabetic drugs was on the rise, with the use increasing from 1.04 in 2012 to 16.02 DID in 2021 and the expenditure increasing from 48.36 in 2012 to 496.42 million yuan in 2021 (from 7.66 to 76.95 million USD). Some new and expensive drugs changed in the use pattern, and their use and expenditure shares (as the percentage of all antidiabetic drugs) increased from 0 to 11.17% and 11.37%, but insulins and analogues and biguanides remained the most used drug class. The DDC of oral drugs all showed a decreasing trend, but essential medicines (EMs) and medical insurance drugs DDC gradually decreased with increasing use. The price reduction of the bid-winning drugs was over 40%, and the top three drugs were glimepiride 2mg/30, acarbose 50mg/30 and acarbose 100mg/30.Conclusions The implementation of pharmaceutical policies has significantly increased drug use and expenditure while reducing drug prices, and the introduction of novel drugs and updated treatment guidelines has led to changes in use patterns.

BACKGROUND:In China, enhancing the pooling levels of basic health insurance has consistently been regarded as a pivotal measure to promote the refinement of the healthcare insurance system. From 2020 to 2022, the widespread outbreak of COVID-19 posed new challenges to China's basic health insurance.METHODS:The research utilizes Data Envelopment Analysis (DEA), Malmquist index assessment, and fixed-effects panel Tobit models to analyze panel data from 2020 to 2022, assessing the efficiency of basic health insurance in Gansu Province.RESULTS:From 2020 to 2022, the average overall efficiency of the municipal pooling of Basic Medical Insurance for Urban and Rural Residents was 0.941, demonstrating a stable trend with a modest increase. The efficiency frontier regions have expanded from 5 (35.71%) to 7 (50%). Operational efficiency exhibited a negative correlation with per capita hospitalization expenses and per capita fund balance but a positive correlation with per capita accumulated fund balance and reimbursement rates for hospitalized patients. In 2021, compared to 2020, the county-pooling Basic Medical Insurance for Urban Employees saw a decline of 0.126 in overall efficiency, reducing the efficiency frontier regions from 8 to 3. However, from 2021 to 2022, the municipal-coordinated Basic Medical Insurance for Urban Employees experienced a 0.069 increase in overall efficiency, with the efficiency frontier regions expanding from 3 to 5. Throughout 2020 to 2022, the operational efficiency of the Urban Employee Basic Medical Insurance showed a consistent negative correlation with per capita fund balance.CONCLUSION:From 2020 to 2022, the overall operational performance of basic health insurance in Gansu Province was satisfactory, and enhancing the pooling level is beneficial in addressing the impact of unforeseen events on the health insurance system.

Perfluoroalkyl and polyfluoroalkyl substances (PFAS) are associated with adverse health effects. This study examined the trend of perfluorooctanoic acid (PFOA) and perfluorooctane sulfonic acid (PFOS) levels in individuals with and without pre-existing comorbidities. We analyzed the characteristics of 13,887 participants across nine U.S. NHANES cycles (1999-2000 to 2017-2018) and calculated the geometric mean (GM) of PFOA and PFOS levels, standardized by sex and age. A joinpoint regression model was used to analyze the temporal trends of serum PFOA and PFOS levels. We observed declining PFOA and PFOS serum levels among adults in NHANES from 1999-2000 to 2017-2018. Serum PFOA and PFOS concentrations were higher in men, smokers, and individuals with pre-existing CKD, hyperlipidemia, CVD, and cancer. We observed faster decline rates in PFOA levels among individuals with diabetes and CKD and faster decline rates in PFOS levels among individuals with diabetes and those without CKD. This study provided evidence of varying levels and changing trends of PFOA and PFOS between groups with and without established chronic disease, highlighting the role of environmental chemicals in the onset and development of chronic diseases.

Metals have been proved to be one of risk factors for chronic kidney disease (CKD) and diabetes, but the effect of mixed metal co-exposure and potential interaction between metals are still unclear. We assessed the urine and whole blood levels of cadmium (Cd), manganese (Mn), lead (Pb), mercury (Hg), and renal function in 3080 adults from National Health and Nutrition Survey (NHANES) (2011-2018) to explore the effect of mixed metal exposure on CKD especially in people with type 2 diabetes mellitus (T2DM). Weighted quantile sum regression model and Bayesian Kernel Machine Regression model were used to evaluate the overall exposure impact of metal mixture and potential interaction between metals. The results showed that the exposure to mixed metals was significantly associated with an increased risk of CKD in blood glucose stratification, with the risk of CKD being 1.58 (1.26,1.99) times in urine and 1.67 (1.19,2.34) times in whole blood higher in individuals exposed to high concentrations of the metal mixture compared to those exposed to low concentrations. The effect of urine metal mixture was elevated magnitude in stratified analysis. There were interactions between urine Pb and Cd, Pb and Mn, Pb and Hg, Cd and Mn, Cd and Hg, and blood Pb and Hg, Mn and Cd, Mn and Pb, Mn and Hg on the risk of CKD in patients with T2DM and no significant interaction between metals was observed in non-diabetics. In summary, mixed metal exposure increased the risk of CKD in patients with T2DM, and there were complex interactions between metals. More in-depth studies are needed to explore the mechanism and demonstrate the causal relationship.

Background Equity is a key issue in the utilization of health services. All countries in the world are constantly exploring the reform of health system to promote the equality of residents' utilization of health services. Methods Using the data of the 7th National Health Service Survey of Gansu Province in 2023 as an example, based on the Anderson model, the equity of health services utilization and its influencing factors were evaluated by using the concentration index(CI) and its decomposition method. On this basis, we screened patients who had used outpatient or inpatient services from the survey subjects and extracted their out-of-pocket(oop) expenditures incurred by using the above services. RIF regression and its decomposition method based on counterfactual analysis were used to analyze the differences in the equity of health service utilization level between urban and rural residents, and the contributing factors were discussed. Results The concentration index of outpatient service utilization (two-week visit rate) of urban and rural residents were 0.0422 and -0.0268, and the concentration index of inpatient service utilization (hospitalization rate) were 0.1462 and -0.1294, respectively. Both outpatient and inpatient services tend to be utilized by high-income residents in cities, while in rural areas, the lower the economic level of residents, the higher the utilization rate. Further analysis of the level of health service utilization showed that the Gini coefficients of out-of-pocket expenditures for urban and rural patients were 0.703 and 0.748, respectively, indicating high inequality. RIF regression and its decomposition results show that rural patients have greater inequality than urban patients in outpatient and inpatient out-of-pocket expenditures, and there is discrimination effect. Conclusion At present, there are still inequities in the utilization of health services in less developed areas of China, especially in the utilization of hospitalization services, but the degree of inequity is lower than that in previous studies. In terms of the fairness of health service utilization level, the inequality of degree of rural residents is greater than that of urban residents, and there is a greater discrimination effect.

Abstract Background Previous studies have reported associations between obstructive sleep apnea (OSA) and several mental disorders. However, further research is required to determine whether these associations are causal. Therefore, we evaluated the bidirectional causality between the genetic liability for OSA and nine mental disorders by using Mendelian randomization (MR). Method We performed two-sample bidirectional MR of genetic variants for OSA and nine mental disorders. Summary statistics on OSA and the nine mental disorders were extracted from the FinnGen study and the Psychiatric Genomics Consortium. The primary analytical approach for estimating causal effects was the inverse-variance weighted (IVW), with the weighted median and MR Egger as complementary methods. The MR Egger intercept test, Cochran’s Q test, Rucker’s Q test, and the MR pleiotropy residual sum and outlier (MR-PRESSO) test were used for sensitivity analyses. Result MR analyses showed that genetic liability for major depressive disorder (MDD) was associated with an increased risk of OSA (odds ratio [OR] per unit increase in the risk of MDD, 1.29; 95% CI, 1.11–1.49; P < 0.001). In addition, genetic liability for OSA may be associated with an increased risk of attention-deficit/hyperactivity disorder (ADHD) (OR = 1.26; 95% CI, 1.02–1.56; p = 0.032). There was no evidence that OSA is associated with other mental disorders. Conclusion Our study indicated that genetic liability for MDD is associated with an increased risk of OSA without a bidirectional relationship. Additionally, there was suggestive evidence that genetic liability for OSA may have a causal effect on ADHD. These findings have implications for prevention and intervention strategies targeting OSA and ADHD. Further research is needed to investigate the biological mechanisms underlying our findings and the relationship between OSA and other mental disorders.

There is evidence to support the links between lead and cadmium exposure with hypertension and also with leukocyte telomere length (LTL). The objective of this study is to investigate the role that LTL may play in the relationship between lead and cadmium exposure and hypertension. This study consisted of 3718 participants from the National Health and Nutrition Examination Survey (NHANES) 1999–2002. Logistic regression was used to analyze the relationship between blood metals with hypertension, and the mediating model was used to evaluate the mediating effect of LTL. In the fully adjusted model, both blood lead and cadmium ln-transformed concentrations were significantly positively associated with hypertension risk, as were all quartiles of blood lead. Additionally, we observed positive linear dose–response relationships with hypertension by restricted cubic spline analysis (both p overall < 0.001, p non-linear = 0.3008 for lead and p non-linear = 0.7611 for cadmium). The ln-transformed blood lead and cadmium concentrations were associated with shorter LTL. LTL was inversely related to hypertension and the OR was 0.65 (95% CI: 0.47 to 0.89). Furthermore, LTL had mediating effects on the associations of blood lead and cadmium with hypertension risk, and the mediation proportions were 2.25% and 4.20%, respectively. Our findings suggested that exposure to lead and cadmium raised the risk of hypertension, while LTL played as a mediating factor.

Background: Excessive out-of-pocket payments (OOP) as a share of total health expenditure (THE) may lead to financial catastrophe and health inequity. Spatiotemporal studies on OOP share are scarce. We aim to explore the spatial distribution pattern, identify the dynamic determinants of the OOP as a share of THE in different regions.Methods: The Global Moran’s I index was applied to assess the spatial autocorrelation of OOP as a proportion of THE. Ordinary least squares (OLS) regression was used to explain the relationship between the OOP as a share of THE and influencing factors, and to diagnose multicollinearity. The GTWR model was established to compare with the OLS and geographically weighted regression (GWR) models. Meanwhile, the relationship between the OOP as a share of THE and related influencing factors in mainland China from 2015 to 2020 was explored based on the GTWR model.Findings: The OOP as a share of THE exhibited an obvious spatial correlation feature, and the high financial burden of personal health tend to occur in eastern and middle regions. Urbanization rate (UR), population ageing rate (PAR), GDP per capita (GDPPC), participation rate of urban workers' basic medical insurance (PRUWBMI) and average length of stay for hospital discharges (ALSHD) represented significant effects on OOP as a share of THE, with GDPPC and UR representing the greatest impact. The GTWR model outperformed OLS and GWR for determining the relations between the OOP as a share of THE and the relevant influencing factors.Interpretation: The heterogeneity of the influence patterns of OOP as a share of THE exists from economically underdeveloped to developed regions. GDPPC and UR are the most significant drivers of the OOP as a share of THE, especially in the underdeveloped regions. These results of this study demonstrate the importance of different measures for different regions to reduce the OOP as a share of THE, and to reduce the national or global personal burden of health economy ultimately.\Funding: Centre for Health Development Research of China Health and Wellness Commission, Gansu Provincial Health Commission of China, and Gansu Medical Protection Bureau of China.Declaration of Interest: The authors declare no competing interests.\

Epidemiological evidence for the relationship between cadmium exposure and mortality in specific chronic kidney disease (CKD) populations remains scarce. We aimed to explore the relationships between cadmium concentrations in urine and blood and all-cause mortality among CKD patients in the USA. This cohort study was composed of 1825 CKD participants from the National Health and Nutrition Examination Survey (NHANES) (1999–2014) who were followed up to December 31, 2015. All-cause mortality was ascertained by matching the National Death Index (NDI) records. We estimated hazard ratios (HRs) and 95

目的 探讨基于尿液镉、钴、铅、钨、砷五种微量元素水平与乳腺癌的关系,为乳腺癌的诊治拓展新的思路.方法 基于2013—2020年3月美国健康与营养检查的调查数据,以110例乳腺癌患者作为乳腺癌组,2849例无癌症研究对象作为非乳腺癌组;研究资料包括研究对象的人口学信息、生殖健康状况、五种尿液微量元素含量等.基本情况的比较采用 χ2检验,采用Wilcoxon秩和检验比较两组尿中微量元素浓度差异,采用多因素Logistic回归模型分析尿液五种微量元素水平与乳腺癌的关系,采用限制性立方样条方法探讨尿液微量元素暴露与乳腺癌的剂量—反应关系.结果 乳腺癌组尿液镉、钴、铅、钨、砷五种微量元素浓度M(P25,P75)分别为0.35(0.24,0.61)、0.49(0.32,0.74)、0.51(0.34,0.74)、0.08(0.05,0.14)、7.90(4.28,18.58)μg/g肌酐,非乳腺癌组尿液镉、钴、铅、钨、砷五种微量元素浓度M(P25,P75)分别为0.27(0.15,0.48)、0.45(0.29,0.71)、0.34(0.21,0.54)、0.06(0.04,0.11)、7.01(3.92,15.15)μg/g肌酐;乳腺癌组尿液镉、铅、钨浓度均高于非乳腺癌组(P<0.05).多因素校正后尿镉、尿铅、尿钨浓度与乳腺癌存在关联,与镉的Q1组相比,Q2、Q3、Q4组患乳腺癌的风险增加,OR(95％CI)值分别为2.63(1.17～5.92)、3.49(1.57～7.79)、2.87(1.24～6.66),P趋势>0.05;与铅的Q1组相比,Q4组患乳腺癌的风险增加,OR(95％CI)值为2.45(1.22～4.93),P趋势<0.05;与钨的Q1组相比,Q3、Q4组患乳腺癌的风险增加,OR(95％CI)值分别为1.90(1.04～3.47)、2.03(1.10～3.75),P趋势<0.05;尿液镉、铅、钨水平与乳腺癌患病风险之间存在非线性剂量—反应关系,乳腺癌的患病风险会随着尿镉、尿铅、尿钨浓度的升高而增大.结论 暴露于镉、铅、钨可能与女性人群乳腺癌风险增加有关.

Background: To construct a predictive model for intravenous immunoglobulin (IVIG) resistant Kawasaki disease (KD) based on the gradient boosting decision tree (GBDT), so as to early identify children with IVIG resistance and actively take additional treatment to prevent adverse events. Methods: The case data of KD children hospitalized in the Pediatric Department of Lanzhou University Second Hospital from October 2015 to July 2020 were collected. All KD patients were divided into IVIG responsive group and IVIG resistant group. GBDT was used to explore the influencing factors of IVIG-resistant KD and to construct a prediction model. Then compared with previous models, the optimal model was selected. Results: In the process of GBDT model construction, 80% of the data were used as the test set, and 20% of the data were used as the validation set. Among them, the verification set was used to adjust the hyperparameters in GDBT learning. The model performed best with a hyperparameter tree depth of 5. The area under the curve of the GBDT model constructed based on the best parameters was 0.87 (95% CI: 0.85–0.90), the sensitivity was 72.62%, the specificity was 89.04%, and the accuracy was 61.65%. The contribution degree of each feature value to the model was total bilirubin, albumin, C-reactive protein, fever time, and Na in order. Conclusion: The GBDT model is more suitable for the prediction of IVIG-resistant KD in this study area.

Background. Although several studies have examined the association between chronic kidney disease (CKD) and hyperuricemia (HUA), the direction of the association remains unclear. We aimed to investigate whether there was a bidirectional association between them. Methods. The present study was conducted in three analyses. Analysis I included 25,433 participants free of HUA at baseline to evaluate the associations between CKD and estimated glomerular filtration rate (eGFR) with incident HUA. Analysis II had 28,422 participants free of CKD at baseline to analyze the relationships between HUA and serum uric acid (sUA) with new-onset CKD. Cox proportional hazards regression models were applied to evaluate the association involved in Analysis I and II. Analysis III included 31,028 participants with complete data and further dissected the bidirectional association between sUA and eGFR using cross-lag models. Results. New-onset HUA and CKD were observed in the first round of the follow-up study among 1597 and 1212 participants, respectively. A significantly higher risk of HUA was observed in individuals with CKD compared to individuals without CKD (HR = 1.58, 95% CI: 1.28–1.95). The adjusted HRs (95% CIs) of HUA were 3.56 (2.50–5.05) for the participants in the group of eGFR less than 60 mL·min−1·1.73 m−2, 1.61 (1.42–1.83) for those in the group of eGFR between 60 and 90 mL·min−1·1.73 m−2, and 1.74 (1.42–2.14) for those in the group of eGFR more than 120 mL·min−1·1.73 m−2, compared with the group of eGFR between 90 and 120 mL·min−1·1.73 m−2. A higher risk of CKD was also observed in individuals with HUA compared to individuals without HUA (HR = 1.28, 95% CI: 1.12–1.47). Compared with the first quintile of sUA, the adjusted HR (95% CI) of CKD was 1.24 (1.01–1.51) for the participants in the fourth quantile. There was a bidirectional relationship between sUA and eGFR, with the path coefficients (ρ1 = −0.024, p < 0.001) from baseline eGFR to follow-up sUA and the path coefficients (ρ2 = −0.015, p = 0.002) from baseline sUA to follow-up eGFR. Conclusions. The present study indicated that CKD and HUA were closely associated, and there was a bidirectional relationship between sUA and eGFR.

Psychological violence is a widespread but neglected dimension in interpersonal violence.It not only causes psychological damage to victim and affects long-term health of the individual,but can also lead to risky behaviors and negative impact on society.However,existing studies have not systematically sorted out issues related to psychological violence.To understand the current status and progress of research on the problem,this paper reviewed the research on psychological violence and provided a comprehensive description of the concepts,hazards,types,influencing factors and research methods of psychological violence,with the aim of exploring current research gaps and future research directions in this field.Our review is expected to draw increased attention and consideration to psychological violence,and to provide a reference for its research in the field of injury prevention.