PURPOSE:Given the differences between Chinese T2DM patients and those of other ethnicities, understanding the metabolic contributions in this population is essential. This study aimed to identify T2DM-associated metabolic biomarkers through clinical untargeted metabolomics and mendelian randomization (MR). METHODS:This study included 120 Chinese participants, including 60 patients with T2DM and 60 control subjects. We employed ultra-high performance liquid chromatography-tandem mass spectrometry (UHPLC-MS/MS) for non-targeted metabolomics analysis of plasma metabolites. Orthogonal partial least squares discriminant analysis (OPLS-DA) was used to identify T2DM-related metabolites. Integration of metabolomics and MR data identified novel key biomarkers for T2DM. RESULTS:LC-MS/MS-based untargeted metabolomics identified 71 up-regulated and 37 down-regulated metabolites in the Chinese T2DM patients. In MR analysis, 52 metabolites exhibited causal associations with the risk of T2DM. Integrating metabolomic analysis with genetic evidence-based causal inference collectively confirmed that higher adrenic acid (AdA) was associated with an increased risk of T2DM and positively correlated with fasting blood glucose (FBG). The main impacted metabolic pathways were unsaturated fatty acids biosynthesis and linoleic acid metabolism. CONCLUSIONS:Increased plasma AdA level was associated with higher FBG and an elevated risk of T2DM, suggesting that AdA represents a probable biomarker for T2DM.

This study aims to investigate the mediating role of nocturnal sleep duration in the association between depressive symptoms trajectories and subsequent pain outcomes. Using data from the English Longitudinal Study of Ageing (ELSA) and the China Health and Retirement Longitudinal Study (CHARLS), 6,874 participants were included. Latent class mixture models (LCMM) were employed to identify depressive symptoms trajectories. Logistic regression analysis was conducted to examine the association between these trajectories and pain. Three depressive symptoms trajectories were identified in both cohorts: low-stable (class 1), increase-then-decrease (class 2), and decrease-then-increase (class 3). In ELSA, classes 2 and 3 exhibited 93

Type 2 diabetes mellitus (T2DM) is characterized by β-cell dysfunction and insulin resistance, yet the early molecular drivers remain elusive. This study set out with the aim of identifying blood-pancreas shared long non-coding RNAs (lncRNAs) as potential systemic biomarkers in treatment-naïve patients with new-onset T2DM. We integrated transcriptome sequencing of peripheral blood from 8 T2DM patients and 8 controls with single-cell RNA sequencing (scRNA-seq) of pancreatic islets from an independent cohort. Differential expression analysis revealed 1,709 dysregulated lncRNAs in peripheral blood, of which 257 were identified as high-priority candidate through weighted gene co-expression network analysis (WGCNA). Further intersection with scRNA-seq data from 17 T2DM donors identified 157 β-cell-specific mRNAs co-expressed with 135 blood-derived lncRNAs. Functional enrichment analysis implicated these genes in chromatin remodeling, focal adhesion, and neurodegenerative pathways. Validation in an expanded cohort (85 T2DM vs. 85 controls) confirmed significant downregulation of ENST00000473095, MSTRG.90147.1 and ENST00000531992 in T2DM. The combined ROC-AUC value of these three lncRNAs was 0.73, which exceeds the AUCs of each individual lncRNA (0.61-0.64). Our findings tentatively suggest that blood-derived lncRNAs as early biomarkers reflecting β-cell stress and systemic dysregulation. These lncRNAs may potentially bridge peripheral blood biomarkers with tissue-specific pathophysiology in T2DM.

Depression is one of the risk factors for chronic digestive system diseases. As a chronic mental disorder, its occurrence and development process is usually slow and gradual, while there are significant individual differences. Depression varies among different individuals in terms of the speed of onset, the stages of the disease course and its manifestations. Therefore, we speculate that this disease will exhibit different disease development trajectories in the population. This study aims to understand the characteristics of the development trajectory of depression among middle-aged and elderly people in China, explore its association with chronic digestive system diseases, and further propose individualized measures to prevent the occurrence of chronic digestive system diseases in people with different development trajectories of depression. This research can provide scientific value for the precise prevention and management of chronic diseases among middle-aged and elderly people. Data for this analysis were sourced from the China Health and Retirement Longitudinal Study (CHARLS), which included 4565 participants aged 45 years and older. Group-based trajectory modelling was used to identify trajectories of depressive symptoms, and multivariable logistic regression was used to assess the association between these trajectories and chronic digestive diseases. Five distinct depressive symptom trajectories were identified: low-stable, moderate-stable, moderate-increase, high-decrease, and high-stable. Compared to the low-stable group, the risks of chronic digestive diseases in the moderate-stable, moderate-increase, high-decrease, and high-stable groups were 1.62(Odds Ratio[OR] = 1.62, 95

Pancreatic beta-cell dysfunction is a central pathological feature of type 2 diabetes (T2D). However the cell type-specific causal genes underlying β-cell dysfunction remain incompletely defined. We analyzed scRNA-seq data from 17 patients with T2D and 17 healthy controls. Four machine learning models (Random Forest, XGBoost, SVM, L2 regularized logistic regression) were applied to identify key pathogenic cell types. Differentially expressed genes(DEGs) in beta cells were identified using Seurat, and cis-eQTLs (GTEx v8) were intergrated with T2D summary statistics(FinnGen R12) through Mendelian randomizaition(MR) to identify pancreatic genes causally linked to T2D. Beta-cell-specific causal genes were defined by the intersection of beta-cell DEGs and MR-identified genes. Robustness was assessed by Steiger filtering, Bayesian colocalization (PPH4 > 0.8), and phenome-wide association studies (PheWAS). As additional support, we examined POLK expression in a high-glucose-treated beta-cell line and KCNK17 expression in an independent RNA-seq dataset of palmitate-exposed human islets. Functional enrichment (GO/KEGG) analysis were performed to explore fuctional mechanisms. Beta-cells were consistently prioritized as the top contributor to T2D pathogenesis. Integration of scRNA-seq and MR identified eight beta-cell-specificc causal genes. Higher expression of POLK, HLA-C, LINC01099, AGA, and LSAMP increased T2D risk, whereas higher KCNK17 expression was protective, with MR and colocalization results remaining robust across sensitivity analyses. In line with the genetic and single-cell findings, POLK expression was increased in high-glucose-treated beta cells, while KCNK17 expression was reduced in palmitate-exposed human islets. In scRNA-seq defined beta-cell subpopulations, KCNK17+ beta-cells were enriched in ion transport and T2D pathways, with POLK+ beta-cells showed activation of stress response and pancreatic dysfunction pathways. This study identifies KCNK17 and POLK as β -cell-specific genes with potential relevance to T2D pathogenesis and highlights distinct cellular programs associated with ion transport and stress responses. Our findings provide a cell Type-resolved, multi-omics framework for elucidating causal mechanisms underlying β-cell dysfunction in T2D.

Background: Previous studies have demonstrated that short-term exposure to ambient particulate matter elevates the risk of ischemic stroke in major urban areas of various countries. However, there is a notable gap in research focusing on remote areas inhabited by ethnic minorities and the cumulative effects of air pollutants. Our study conducted in the area aims to explore the potential association between ischemic stroke and air pollutants and contribute to improving health outcomes among the community. Methods: This retrospective observational study was conducted at the Xing’an League People’s Hospital in Inner Mongolia. The medical records of 4,288 patients admitted for IS between November 1, 2019, and October 31, 2020, were reviewed. Data on demographics (age and sex), air pollutants (PM10, PM2.5, NO2, NO, CO, and O3), and meteorological factors (daily average temperature, daily average wind speed, and daily average atmosphere pressure) were collected and analyzed. The statistical analysis included descriptive statistics, Poisson distribution analysis to evaluate the adverse effects of atmospheric pollutants on daily hospitalizations, and subgroup analysis to determine whether gender and age could modify the impact on hospitalizations. Results: A substantial correlation was revealed in single-day lags model. The peak delayed effects of PM10, PM2.5, SO2, and NO2 were observed at lag8 (PM10 (OR = 1.016, 95%CI 1.002, 1.030), PM2.5 (OR = 1.027, 95%CI 1.007, 1.048), SO2 (OR = 1.153, 95%CI 1.040, 279) and NO2 (OR = 1.054, 95%CI 1.005, 1.105)) while males exhibited a consistent trend from lag0 to lag8 (PM10 (OR = 1.035, 95%CI 1.018, 1.053), PM2.5 (OR = 1.056, 95%CI 1.030, 1.082), SO2 (OR = 1.220, 95%CI 1.072, 1.389), NO2 (OR = 1.126, 95%CI 1.061, 1.120), CO (OR = 10.059, 95%CI 1.697, 59.638) and O3 (OR = 0.972, 95%CI 0.946, 0.999)). When gender and age were considered, a positive impact was also observed after three days cumulative effect in males. Conclusions: There is a significant cumulative effect of exposure to air pollution on IS hospital admissions, especially the males and patients under the age of 65. Our results also suggested that a notable association between CO and NO2 in two-pollutant models.

Limited research have been conducted on the interrelationship and role of oxidative stress and Metabolic Associated Fatty Liver Disease (MAFLD) within the population. The Oxidative Balance Score (OBS) serves as a metric for evaluating an individual's overall oxidative stress status. This study seeks to investigate the impact of OBS on the population and elucidate its potential mechanisms. 9881 participants from the 2003-2018 NHANES were involved in our study. Covariate-adjusted regression models showed a statistically significant inverse association between elevated OBS and MAFLD risk. Specifically, participants in the upper threshold quartile (Q4) had 40% lower risk of MAFLD odds (OR = 0.60, 95% CI 0.50-0.72; P < 0.001) compared to those in the lowest reference quartile (Q1). The population attributable fraction analysis (PAF) suggested that MAFLD reduction could be attributed to approximately 12.67% Q4 OBS and 8.00% Q3 OBS. Restricted cubic spline (RCS) analysis revealed a non-linear association between oxidative balance score OBS and MAFLD. In the mediation analysis, inflammatory markers, insulin resistance markers, and body mass index (BMI) were found to partially mediate the association between OBS and MAFLD. The continuous OBS (HR: 0.97, 95% CI (0.94, 1.00); P = 0.049) demonstrated a reduced risk of total mortality among MAFLD patients. In the U.S. population, significant negative associations were observed between OBS and MAFLD. The results indicated that an antioxidant lifestyle may hold greater significance than an antioxidant diet in the prevention of MAFLD. Additionally, our findings implied that insulin resistance, inflammation, and BMI may contribute to the relationship between OBS and MAFLD.

OBJECTIVE:Eating disorders (ED) pose a significant global health challenge for women of childbearing age (WCBA). This study aims to systematically evaluate the global disease burden and temporal trends of eating disorders in this vulnerable population. METHODS:This study utilized Global Burden of Diseases (GBD) data to assess the burden and trends in prevalence, incidence, and Disability-Adjusted Life Years (DALYs) rates of eating disorders, estimating percentage changes and annual percentage changes (EAPC). The age-period-cohort (APC) model was applied to analyze the trends of different age groups, periods, and birth cohorts. RESULTS:The prevalence of cases of ED among WCBA increased from 6.180 million in 1990 to 9.656 million in 2021, the incidence of cases increased from 2.241 million in 1990 to 3.233 million in 2021, and DALYs increased from 1.308 million to 2.036 million. From 1990 to 2021, the incidence rates of ED remained relatively stable (EAPC = 0.04), but the prevalence and DALY rates increased significantly (EAPC = 0.30 and 0.29, respectively). The absolute burden of ED was highest in high Socio-demographic Index (SDI) regions, but the increasing trend was relatively flat. In low SDI regions, the percentage changes in the prevalence cases, incidence cases and DALYs increased by 168 % to 179 % between 1990 and 2021. CONCLUSIONS:Globally and across different SDI regions, the prevalence, incidence, and DALY rates of ED have increased in WCBA. Society must strengthen education and awareness campaigns on ED, and promote a healthy approach to weight management.

Background Sleep disorders and Non-alcoholic Fatty Liver Disease (NAFLD) bare both highly prevalent globally. But the relationships between them remain unclear. So we aimed to explore the impact of sleep disorders on NAFLD risk. Methods Using a combination of meta-analysis and Mendelian Randomization (MR), we investigated the associations between three common sleep disorders and NAFLD, including insomnia, obstructive sleep apnea (OSA) and narcolepsy. For meta-analysis, we systematically searched PubMed, Web of Science and Embase up to July 3, 2024. Ultimately, 13 studies were included, encompassing a total of 537,497 participants. Subsequently, MR analyses were performed to explore the causal relationships between each of the three sleep disorders and NAFLD. Results The meta-analysis revealed that insomnia (OR = 1.40, 95

Background The oxidative stress theory of aging is one of the prominent theories in the field of aging research. The Oxidative Balance Score (OBS) serves as a comprehensive tool for evaluating the effects of different diets and lifestyles on the oxidative/antioxidant system, however, its correlation with biological aging remains ambiguous. We thus conducted this study to explore the relationship between OBS and biological aging in American adults using quantitative measures. Methods We conducted a cross-sectional study using the NHANES 1999–2018 database. We examined several biological aging indicators, including biological age, phenotypic age, telomere length, and serum klotho levels. A weighted multiple linear regression model and smoothed fitted curves were employed to analyze the linear and nonlinear relationship between OBS and biological aging markers. Additionally, quantile regression was utilized to further explore their associations. Results A significant negative correlation was found between OBS and both biological and phenotypic ages, whereas a significant positive correlation was observed between telomere length and serum klotho levels. Upon comparing the highest tertile of OBS with the lowest tertile, the fully adjusted β values for OBS in the highest tertile were − 0.663 (-0.867, -0.458), -1.792 (-2.190, -1.393), and 32.332 (8.193, 56.471) for biological age, phenotypic age, and serum klotho, respectively. Notably, the positive correlation between telomere length [0.031 (0.007, 0.056)] and OBS was significant only in the partially adjusted model. The negative correlation between OBS and biological aging was consistent in individuals aged over 60 years. In quantile regression, the negative correlation between OBS, DOBS, and LOBS was most significant at the 0.93 percentile of biological age and 0.95 percentile of phenotypic age. Moreover, the serum klotho concentration exhibited a positive correlation with LOBS across all quantiles, with the strongest correlation observed at the 0.95 percentile. Conclusions Our study suggests a dose-response relationship between OBS and biological aging, indicating adopting an antioxidant-rich diet and lifestyle may yield beneficial effects on aging. These findings offer theoretical insights into strategies for aging prevention.

Adverse Childhood Experiences (ACEs) may have an impact on cognitive disability through multiple pathways. Frequent Mental Distress (FMD) could result in cognitive disability through different aspects, but the potential mediating role of FMD in the associations remained unclear. So we aimed to investigate not only the association between self-reported ACEs and cognitive disability, but also the mediating effect of FMD between ACEs and cognitive disability. A cross-sectional analysis of respondents aged 18-25 years old in the 2020 and 2021 Behavioral Risk Factor Surveillance System (BRFSS) was performed. Weighted multivariate logistic regression models were used to assess the association of ACEs with FMD and cognitive disability. Mediation effects were used to investigate FMD as mediation between ACEs and cognitive disability in emerging adults. Among the 10,309 respondents, the prevalence of cognitive disability was 15.8%, and 71.6% of them experienced ACEs. We found experienced ACEs, self-reported FMD were significantly associated with 4.05 and 5.61 times increased risk of cognitive disability, respectively. The more types of ACEs respondents experienced, the higher risks of cognitive disability. And mediating effect analysis found FMD mediated the associations between ACEs and cognitive disability. Our study indicated a strong association between ACEs and cognitive disability in emerging adults. Furthermore, FMD plays a mediating role in the associations.

The impact of body mass index (BMI) on in vitro fertilization (IVF) has been well acknowledged; however, the reported conclusions are still incongruent. This study aimed to investigate the effect of BMI on IVF embryos and fresh transfer clinical outcomes. This retrospective cohort analysis included patients who underwent IVF/ICSI treatment and fresh embryo transfer from 2014 to March 2022. Patients were divided into the underweight group: BMI < 18.5 kg/m2; normal group: 18.5 ≤ BMI < 24 kg/m2; overweight group: 24 ≤ BMI < 28 kg/m2; and obesity group: BMI ≥ 28 kg/m2. A generalized linear model was used to analyze the impact of BMI on each IVF outcome used as a continuous variable. A total of 3465 IVF/ICSI cycles in the embryo part; and 1698 fresh embryo transplanted cycles from the clinical part were included. Available embryos rate (61.59

Norovirus is one of the leading causes of acute gastroenteritis outbreaks worldwide. This study aimed to identify the epidemiological characteristics of norovirus outbreaks and to provide evidence for public health entities. Specimens and epidemiological survey data were collected to determine if there were differences in the attack rate of norovirus in terms of the year, season, transmission route, exposure setting, and region and to determine whether there were relationships between the reporting interval, the number of illnesses in a single outbreak and the duration of the outbreak. Norovirus outbreaks were reported throughout the year, with seasonal characteristics (i.e., high rates in spring and winter). Among all regions in Shenyang with the exception of Huanggu and Liaozhong, norovirus outbreaks had been reported, and the primary genotype was GII.2[P16]. Vomiting was the most common symptom. The main places of occurrence were childcare institutions and schools. The person-to-person route was the main transmission route. The median duration of norovirus was 3 days (IQR [interquartile range]: 2–6 days), the median reporting interval was 2 days (IQR: 1–4 days), the median number of illnesses in a single outbreak was 16 (IQR: 10–25); there was a positive correlation between these parameters. Norovirus surveillance and genotyping studies still need to be further strengthened to increase knowledge regarding the pathogens and their variant characteristics, to better characterize the patterns of norovirus outbreaks and to provide information for outbreak prevention. Norovirus outbreaks should be detected, reported and handled early. Public health entities and the government should develop corresponding measures for different seasons, transmission routes, exposure settings, and regions.

Abstract Purpose To evaluate the associations between calcium, magnesium, zinc, and copper intakes and the risk of diabetic retinopathy (DR) in US diabetes adults. Methods Using data from the National Health and Nutrition Examination Survey (NHANES) 2007–2018. Multivariable logistic regression models and restricted cubic spline models were applied to examine the associations between total calcium, magnesium, zinc, and copper intakes and diabetic retinopathy. Results A total of 3794 adults aged 40 years or older were included. Higher quartile intake of calcium, magnesium, zinc, and copper was associated with a lower occurrence of DR, the multivariate adjusted ORs (95% CI) were 0.57 (0.38–0.86), 0.48 (0.32–0.73), 0.58 (0.39–0.88), and 0.48 (0.30–0.77), respectively. U-shaped dose-response relationships were found between calcium, magnesium, zinc, copper intake, and the risk of DR. Conclusion Higher total calcium, magnesium, zinc, and copper intake were inversely associated with the risk of DR in US diabetes adults.

Background: Adverse childhood experiences (ACEs) are a risk factor for many chronic diseases and health behaviors. This study explores the relationship between ACEs and sleep duration in elderly populations in 22 U.S. states in 2020.Methods: This study is a cross-sectional analysis of aged 65 years or older in the 2020 Behavioral Risk Factor Database (BRFSS). The weighted multivariate logistic regression was used to assess the association of ACEs status, ACEs type, and ACE scores with sleep duration. Subgroup analysis was used to estimate differences based on covariates.Results: Among the 42,786 participants (55.8 % female) included in this analysis, 50.5 % reported at least one ACE, and 7.3 % reported 4 or more ACEs. Adjusting for confounding factors, experiencing ACEs was associated with short and long sleep duration (Odds Ratio (OR): 2.03, 95 % Confidence Interval (CI): 1.51,2.73; OR:1.78, 95%CI:1.34,2.36). Older adults who experienced sexual abuse in children were 146 % more likely to short sleep (OR:2.46,95%CI:1.84,3.31) and 99 % more likely to long sleep (OR:1.99, 95%CI:1.35,2.92). There was a doseresponse gradient between ACEs scores and sleep duration, reporting >= 4 ACEs had 3.10 (OR:3.10,95% CI:2.12,4.53) and 2.13 (OR:2.13, 95%CI:1.33,3.40) times the risk for short-sleep and long-sleep duration compared to respondents reporting no ACEs.Conclusions: This study showed the association between ACEs and a high risk of sleep duration, which increased with increasing ACEs scores.

Adverse childhood experiences (ACEs) have been associated with poor HIV testing in adulthood yet, they have not been extensively described in those at increased risk for HIV. Cross-sectional analysis data (n = 204,231) on ACEs and HIV testing were obtained from the 2019-2020 Behavioural Risk Factor Surveillance Survey. Weighted logistic regression models were used to access the association of ACEs exposure, ACEs score, and ACEs type with HIV testing among adults with HIV risk behaviours, and stratified analysis was also performed to examine gender differences. The results indicated the overall rate of HIV testing was 38.8% and was higher among those with HIV risk behaviours (64.6%) than those without (37.2%). In populations with HIV risk behaviours, the negative association of HIV testing with ACEs exposure, ACEs score, and ACEs type was identified. Relative to those without ACEs, adults who were exposed to ACEs might decrease the rate of HIV testing, participants with ≥4 ACEs scores were less likely to have HIV testing, and childhood exposure to sexual abuse had the greatest impact on HIV testing. For both males and females, childhood exposure to ACEs was associated with lower odds of HIV testing and ACEs score ≥4 had the most robust associations with HIV testing. For males, those who experienced witnessed domestic violence had the lowest odds of HIV testing but the odds of engaging in HIV testing for females were the lowest among those who experienced childhood sexual abuse.

Background and Aims Chronic Kidney Disease (CKD) is characterized by a high inflammation status with ever-increasing prevalence, and defined as low estimated glomerular filtration rate (eGFR) or albuminuria. Both low eGFR and albuminuria can have independent effects on the body. The dietary inflammatory index (DII) is a validated tool used to assess the inflammatory potential of the diet. We aim to explore not only the association between DII and CKD, but also the associations of DII with low eGFR and albuminuria, respectively. In addition, their associations in different subgroups remain to be explored. Methods and Results 18,070 participants from the 2011-2018 NHANES with complete data of dietary intake and laboratory data were involved in our study. The data of 24-hour dietary recall interview was used to calculate DII, CKD could be reflected by laboratory data of creatinine and albumin. Then weighted multivariate logistic regression models and subgroup analyses were performed. The prevalence of low eGFR, albuminuria and CKD were 6.8%, 9.8% and 14.5%, respectively. A positive association between DII and low eGFR was observed (OR=1.12, 95%CI: 1.05-1.21), Q2, Q3 and Q4 are positively associated with a significant 39%, 65% and 71% increased risk of low eGFR compared with Q1 (P for trend<0.05). DII was also associated with CKD (OR=1.06, 95%CI: 1.01-1.11). Conclusion Significant positive associations of DII with CKD and low eGFR were observed. But we didn't find such association between DII and albuminuria.

Abstract Background Emerging evidence supported that dietary zinc is beneficial for diabetes. However, few studies were available concerning the association between dietary zinc and diabetic retinopathy (DR). The present study aimed to describe the association between dietary zinc intake and the risk of DR in US adults. Methods A total of 3749 diabetic patients with self-reported eye affliction/retinopathy from the National Health and Nutrition Examination Survey (NHANES) 2007–2018 were involved. Stratified analysis by gender was performed, and logistic regression and restricted cubic spline (RCS) models were applied to assess the association between dietary zinc and DR. Receiver operating characteristic (ROC) curve was used to determine the optimal cut-off value of zinc intake for predicting DR. Results Dietary zinc was inversely associated with diabetic retinoapthy in men (OR: 0.981, 95%CI:0.965–0.997), while this trend was not significant in women. Higher quartile of dietary zinc was associated with lower occurrence of diabetic retinopathy (OR: 0.531, 95%CI: 0.334–0.846). Furthermore, increased amounts of dietary zinc was significantly associated with reduced occurrence of diabetic retinopathy (OR: 0.622, 95%CI: 0.411–0.941). ROC analysis identified a daily dietary zinc intake of 7.53 mg as the optimal cut-off value for predicting DR. Conclusion Higher levels of dietary zinc are suggested to reduce the risk of diabetic retinopathy and have been observed to have a dose-response effect in men. Assessment of dietary zinc levels may be part of the treatment of patients with diabetic complications.

BACKGROUND:Many countries and organizations recommended people living with HIV/AIDS (PLWHA) receive the COVID-19 vaccine. However, vaccine hesitancy still exists and becomes a barrier for promoting COVID-19 vaccination among PLWHA.OBJECTIVE:This study aims to investigate factors that contributed to COVID-19 vaccine hesitancy among PLWHA.METHODS:The study used a multicenter cross-sectional design and an online survey mode. We recruited PLWHA aged 18-65 years from 5 metropolitan cities in China between January 2021 and February 2021. Participants completed an online survey through Golden Data, a widely used encrypted web-based survey platform. Multiple linear regression models were used to assess the background characteristics in relation to COVID-19 vaccine hesitancy, and structural equation modeling was performed to assess the relationships among perceived benefits, perceived risks, self-efficacy, subjective norms, and COVID-19 vaccine hesitancy.RESULTS:Among 1735 participants, 41.61% (722/1735) reported COVID-19 vaccine hesitancy. Older age, no other vaccinations in the past 3 years, and having chronic disease history were positively associated with COVID-19 vaccine hesitancy. Structural equation modeling revealed a direct relationship of perceived benefits, perceived risks, and subjective norms with self-efficacy and vaccine hesitancy and an indirect relationship of perceived benefits, perceived risks, and subjective norms with vaccine hesitancy. Moreover, self-efficacy toward COVID-19 vaccination was low. PLWHA had concerns of HIV disclosure during COVID-19 vaccination. Family member support could have an impact on COVID-19 vaccination decision-making.CONCLUSIONS:COVID-19 vaccine hesitancy was high among PLWHA in China. To reduce COVID-19 vaccine hesitancy, programs and strategies should be adopted to eliminate the concerns for COVID-19 vaccination, disseminate accurate information on the safety and efficacy of the COVID-19 vaccine, encourage family member support for COVID-19 vaccination, and improve PLWHA's trust of medical professionals.