Search

BackgroundThe incidence of dyslipidemia as a risk factor for many serious diseases is increasing year by year. This study aimed to construct and visualize a risk prediction model for dyslipidemia in middle-aged and older adults.MethodThe subjects of our study are derived from CHARLS. Participants were allocated to training and validation groups in a 7:3 ratio at random. To identify potential predictors of dyslipidemia, we employed univariate analysis, lasso regression, and multivariate binary logistic regression analyses. A nomogram was constructed based on logistic regression results, and a ROC curve was used to evaluate its predictive performance. The accuracy and discriminatory capability were assessed using calibration curve analysis, while the net clinical benefit rate was evaluated through decision curve analysis (DCA).ResultsOur study included a total of 12,589 participants, of which 1,514 were detected with dyslipidemia syndrome. Model construction: Based on the results of the logistic regression analysis of the training set, six variables were selected to construct the model, which were ranked in order of importance as comorbid hypertension, comorbid diabetes, waistline, comorbid digestive disease, place of abode, and comorbid liver disease. The ROC curve results indicated that the prediction model exhibited moderate discriminatory ability (AUC > 0.7). Additionally, the calibration curve confirmed the model's strong predictive accuracy. The decision curve analysis (DCA) illustrated a positive net benefit associated with the prediction model.ConclusionsThe prediction model of dyslipidemia risk in middle-aged and older adults constructed in this study has good efficacy and helps to screen high-risk groups.

ObjectiveThis study aims to explore the relationship between internet use and self-rated health among middle-aged and older adults and further investigates the mediating role of health service utilization between internet use and self-rated health, providing a reference for more effectively utilizing the internet to improve the health status of middle-aged and older adults.MethodWe analyzed data from the 2018 and 2020 waves of the China Health and Retirement Longitudinal Study (CHARLS), this includes 10,011 in 2018 and 7,080 in 2020 over the age of 45. To explore the relationship between internet use and self-rated health, we employed propensity score matching (PSM) and instrumental variable regression analysis, accounting for a wide range of potential covariates. Additionally, the Sobel test was used to examine the mediating effect of health service utilization on this relationship.ResultsAccording to the fully adjusted propensity score matching and instrumental variable regression model, internet use significantly enhanced self-rated health among middle-aged and older adults (β = 0.348, P < 0.01; β = 0.293, P < 0.1). However, subgroup analyses revealed that this positive effect was not significant among middle-aged and older adults who were divorced (β = 0.190, P > 0.05), lived in special zone (β = −1.379, P > 0.05), and lacked medical insurance (β = 0.314, P > 0.05). Furthermore, mediation analysis revealed that inpatient services (β = 0.0215, P < 0.01) acted as a mediator in the relationship between internet use and self-rated health.ConclusionInternet use positively correlates with self-rated health among middle-aged and older adults. Additionally, the utilization of health services can significantly influence this relationship. These findings underscore the importance of developing targeted government strategies to promote internet access and create a supportive online environment, thereby enhancing the health outcomes of this demographic group.

BackgroundTo address the growing burden of older adult care, the Chinese government has introduced a policy that integrates medical care with elder care, launching two batches of national pilot projects. A majority of the older adult population suffers from one or more chronic diseases, with many experiencing multiple chronic conditions, necessitating support from both elder care and medical services.MethodsUsing panel data from the China Health and Retirement Longitudinal Study (CHARLS) spanning 2011 to 2020, this study employs the difference-in-difference (DID) model to analyze the impact of the integrated medical-nursing policy on the physical health of older patients with chronic diseases.ResultsThe study found that the average annual number of hospitalizations for older individuals with one or more chronic diseases was 0.276. The integrated medical-nursing policy reduced hospitalizations by 0.0405. Additionally, the average annual hospitalization rate for older individuals with two or more chronic diseases was 0.339, higher than the former group. The integrated medical-nursing policy reduced hospitalizations by 0.0738 in this group.ConclusionThe pilot study demonstrates that the implementation of the integrated medical-nursing policy has significantly improved the physical health of older patients with chronic diseases. The government should promote these policies on a larger scale, explore various forms of integrated medical care, and provide more comprehensive medical and elder care services for older patients with chronic diseases.

BackgroundWith the continuous development of society and the economy, population aging has become an inevitable global development trend, triggering a series of social problems and having a more serious impact on the physical and mental health of middle-aged and older adults. Physical exercise is one of the key factors for improving the overall health and quality of life of individuals, but the role of square dance exercise and the quality of life of middle-aged and older adults have not yet been clarified.PurposeThis study aimed to investigate the associations between square dance exercise and the quality of life of middle-aged and older adults and its mechanism of action, including its effects on physical health and mental health, with negative emotions and attitudes towards aging as mediating variables.MethodThis study adopted a cross-sectional research method, using the Physical Activity Rating Scale (PARS-3), Depression-Anxiety-Stress Scale in Simplified Chinese (DASS-21), Attitudes toward Aging Questionnaire (AAQ), and 12-item Short Form of the Health Survey (SF-12), and launched an online survey on the QuestionStar platform from August–September 2023 for 4,636 middle and older adults aged 45–74 years. The survey results were analyzed via Pearson correlation analysis via SPSS 27.0 and structural equation modeling analysis via Mplus 8.3 to test the model fit and mediation effects.ResultsSquare dance exercise was significantly correlated with negative emotions, attitudes towards aging, and quality of life (r = −0.042–0.878, p

ObjectiveTo explore the trajectories of cognitive function development and predictive factors in disabled middle-aged and older adults.MethodsUtilizing data from 983 disabled middle-aged and older adults in the China Health and Retirement Longitudinal Study (CHARLS) from 2013 to 2020, latent growth mixture models were constructed to analyze the categories of cognitive function development trajectories and their predictive factors.ResultsThe cognitive function trajectories of the disabled middle-aged and older adults were classified into three categories: rapid decline (32.6%), Slow decline (36.1%), and Stable (31.2%). Multinomial logistic regression analysis identified age, gender, residence, education, marital status, household income, sleep duration, depression, hearing ability, and social participation as predictors of these trajectories.ConclusionThere is heterogeneity in the cognitive function development trajectories among disabled middle-aged and older adults. Healthcare professionals can implement targeted health management based on the characteristics of different groups to prevent the deterioration of cognitive function in this population.

BackgroundMultimorbidity has become a major public health problem among Chinese middle-aged and older adults, and the most costly to the health care system. However, most previous population-based studies of multimorbidity have focused on a limited number of chronic diseases, and diagnosis was based on participants’ self-report, which may oversimplify the problem. At the same time, there were few reports on the relationship between multimorbidity patterns and health care costs. This study analyzed the multimorbidity patterns and changes among middle-aged and older people in China over the past decade, and their association with medical costs, based on representative hospital electronic medical record data.MethodsTwo cross-sectional surveys based on representative hospital data were used to obtain adults aged 45 years and older in Xiangyang in 2013 (n = 20,218) and 2023 (n = 63,517). Latent Class Analysis was used to analyze changes in the patterns of multimorbidity, gray correlation analysis and ordered logistics model were used to assess the association of multimorbidity patterns with medical expenses. The diagnosis and classification of chronic diseases were based on the International Classification of Diseases, Tenth Revision codes (ICD-10).ResultsThe detection rate of chronic disease multimorbidity has increased (70.74 vs. 76.63%, p

BackgroundIt has been shown that diabetes is associated with insufficient physical activity among middle-aged and older adults, but the association between different physical activity levels (PAL) and diabetes incidence needs to be further explored.ObjectiveThis study aims to explore the correlation and dose–response relationship between different PAL and the diabetes incidence in middle-aged and older adults.MethodsUtilizing data from the 2018 China Health and Retirement Longitudinal Study (CHARLS), this cross-sectional analysis included 17,226 middle-aged and older adults aged 45 and above. Binary logistic regression models and restricted cubic spline (RCS) were used to explore the correlation and dose–response relationship between different PAL and the incidence of diabetes in the total middle-aged and older adults population as well as in subgroups. Sensitivity analyses were also performed to verify the robustness of the findings.ResultsIn the entire study population, compared with the lowest PAL, participants in the third and fourth quartiles PAL saw diabetes incidence significantly reduced by 16% (p = 0.005) and 33% (p

BackgroundPrevious studies indicated that exposure to ambient fine particulate matter (PM2.5) could increase the risk of metabolic syndrome (MetS). However, the specific impact of PM2.5 chemical components remains uncertain.MethodsA national cross-sectional study of 12,846 Chinese middle-aged and older adults was conducted. Satellite-based spatiotemporal models were employed to determine the 3-year average PM2.5 components exposure, including sulfates (SO42−), nitrates (NO3−), ammonia (NH4+), black carbon (BC), and organic matter (OM). Generalized linear models were used to investigate the associations of PM2.5 components with MetS and the components of MetS, and restricted cubic splines curves were used to establish the exposure-response relationships between PM2.5 components with MetS, as well as the components of MetS.ResultsMetS risk increased by 35.1, 33.5, 33.6, 31.2, 32.4, and 31.4% for every inter-quartile range rise in PM2.5, SO42−, NO3−, NH4+, OM and BC, respectively. For MetS components, PM2.5 chemical components were associated with evaluated risks of central obesity, high blood pressure (high-BP), high fasting glucose (high-FBG), and low high-density lipoprotein cholesterol (low-HDL).ConclusionThis study indicated that exposure to PM2.5 components is related to increased risk of MetS and its components, including central obesity, high-BP, high-FBG, and low-HDL. Moreover, we found that the adverse effect of PM2.5 chemical components on MetS was more sensitive to people who were single, divorced, or widowed than married people.

ObjectiveFrailty and activities of daily living (ADL) disability are common conditions among older population. Studies on the bidirectional relationship between frailty and ADL are limited. The current study examined the cross-sectional and longitudinal associations between frailty and ADL in middle-aged and older Chinese individuals.MethodsThe data was collected through the China Health and Retirement Longitudinal Study (CHARLS), conducted in 2011, 2013, and 2015, encompassing 17,284 individuals aged ≥45 years. We excluded individuals without follow-up data. 2,631 participants finished the baseline survey. The definition of ADL disability encompasses difficulty in engaging in either basic activities of daily living (BADL) or instrumental activities of daily living (IADL). Frailty was assessed according to the Fried criteria. Logistic regression was utilized to examine odds ratios (ORs) and 95% confidence intervals (CIs) for assessing the cross-sectional relationships between ADL with frailty at baseline. The prediction effects were explored using Cox proportional hazards analysis, testing hazard ratios (HRs) and 95%CIs.ResultsIn cross-sectional analysis, BADL [OR = 6.660 (4.519–9.815)], IADL [OR = 5.950 (4.490–7.866)], and ADL [OR = 5.658 (4.278–7.483)] exhibited significant associations with frailty; frailty demonstrated significant associations with BADL [OR = 6.741 (4.574–9.933)], IADL [OR = 6.042 (4.555–8.016)] and ADL [OR = 5.735 (4.333–7.591)]. In longitudinal analysis, IADL and ADL were significantly associated with frailty in participants without baseline frailty in the short-term period [IADL: HR = 1.971 (1.150–3.379), ADL: HR = 1.920 (1.146–3.215)], IADL exhibited a significant association with frailty in the long-term period [HR = 2.056 (1.085–3.895)]. There was no significant link observed between frailty and an elevated risk of disability onset in BADL, IADL and ADL during the short-term period. When considering the long-term perspective, frailty exhibited a significant association with an elevated risk of disability onset in BADL [HR= 1.820 (1.126–2.939)] and IADL [HR = 1.724 (1.103–2.694)].ConclusionIn middle-aged and older adults, ADL and IADL disability predicted frailty after 2-year follow-up, IADL disability predicted frailty after 4-year follow-up. Moreover, frailty did not predict BADL, IADL and ADL disability after 2-year follow-up. However, frailty predicted BADL and IADL disability after 4-year follow-up.

ObjectiveChina’s middle-aged and older population is a rich source of human capital. Therefore, considering the health of this group is important when creating and using human resources.MethodsUsing data from the nationwide China Health and Retirement Longitudinal Study (CHARLS) 2018 baseline survey of 19,000 adults ages 45 years and older, this study was an objective investigation of the effects of work on the physical and mental health of middle-aged and older adults. We conducted several types of analyses using details of participants’ lifestyles and demographic characteristics (living environment, education, financial level, and access to medical services) with work (i.e., employment or volunteer work) as a primary input component of health production to examine their effects on the health status of middle-aged and older individuals.ResultsSix primary outcomes were identified: (1) Employment positively affects both the physical and mental health of middle-aged and older people; (2) Employment can influence the physical and mental health of middle-aged and older people through income, cognitive level, and social support networks; (3) Compared to non-self-employment, self-employment dramatically worsens physical health but has no apparent detrimental effects on mental health. Compared to non-agricultural employment, agricultural labor affects both physical and mental health. (4) Employment has more positive physical and mental health effects in Individuals with higher rather than lower levels of education. (5) Employment opportunities in the eastern region are more likely to promote better physical health than those in the central and western regions of China, although the effects on mental health are negative. (6) When considering groups at different ages of the lifespan, the 60–65-year-old group, who are just entering retirement probably benefit more from continuing work.ConclusionWe provide some recommendations to encourage middle-aged and older people to work and utilize their experience, which will enhance their physical and mental well-being and help them in realize their own value and social integration.

BackgroundChina has by far one of the fastest-aging populations in the world. Increasing age is often accompanied by an increasing prevalence of chronic diseases and impaired Activities of Daily Living (ADL). The aim of this study was to analyze the effects of chronic diseases on ADL in Chinese middle-aged and older adults and to provide a scientific basis for delaying the impairment of ADL and prolonging the self-care life expectancy of middle-aged and older adults.MethodsThis investigation utilized the survey information of 10,096 middle-aged and older adults from the China Health and Aging Tracking Survey (CHARLS) of 2011 as baseline data, then followed up this cohort until 2018, and performed multifactorial analyses using Cox proportional risk models to explore the strength of the associations between chronic diseases and the risk of impaired ADL in middle-aged and older adults.ResultsAmong the middle-aged and older adult population, the presence of hypertension was associated with a 38% higher risk of impaired ADL compared to those without the condition (HR = 1.38,95% CI:1.24–1.54); the involvement of heart disease was associated with a 27% higher risk of impaired ADL compared to those without the condition (HR = 1.27,95% CI:1.10- 1.46); the existence of arthritis was associated with a 38% higher risk of impaired ADL in middle-aged and older adults compared to those without arthritis (HR = 1.38,95% CI:1.25–2.08); additionally, the risk of impaired ADL with one or ≥ 2 chronic diseases was increased by 34% (HR = 1.34, 95% CI:1.18–1.52) and 84% (HR = 1.84, 95% CI:1.63–2.08) in middle-aged and older adult individuals, respectively.ConclusionHypertension is a risk factor for impaired ADL at any age in the subjects of this study. Examining the association between the number of chronic diseases and impairment in activities of daily living, it was revealed that the risk of ADL impairment increased with the number of chronic diseases in both the middle-aged (45–59 years) and older adult (60–74 years) groups.

ObjectiveThis study aims to develop and validate a prediction model for evaluating the social participation in the community middle-aged and older adult stroke survivors.MethodsThe predictive model is based on data from the China Health and Retirement Longitudinal Study (CHARLS), which focused on individuals aged 45 years or older. The study utilized subjects from the CHARLS 2015 and 2018 wave, eighteen factors including socio-demographic variables, behavioral and health status, mental health parameters, were analyzed in this study. To ensure the reliability of the model, the study cohort was randomly split into a training set (70%) and a validation set (30%). The Least Absolute Shrinkage and Selection Operator (LASSO) regression analysis was used to identify the most effective predictors of the model through a 10-fold cross-validation. The logistic regression model was employed to investigate the factors associated with social participation in stroke patients. A nomogram was constructed to develop a prediction model. Calibration curves were used to assess the accuracy of the nomogram model. The model’s performance was evaluated using the area under the curve (AUC) and decision curve analysis (DCA).ResultA total of 1,239 subjects with stroke from the CHARLS database collected in 2013 and 2015 wave were eligible in the final analysis. Out of these, 539 (43.5%) subjects had social participation. The model considered nineteen factors, the LASSO regression selected eleven factors, including age, gender, residence type, education level, pension, insurance, financial dependence, physical function (PF), self-reported healthy,cognition and satisfaction in the prediction model. These factors were used to construct the nomogram model, which showed a certain extent good concordance and accuracy. The AUC values of training and internal validation sets were 0.669 (95%CI 0.631–0.707) and 0.635 (95% CI 0.573–0.698), respectively. Hosmer–Lemeshow test values were p = 0.588 and p = 0.563. Calibration curves showed agreement between the nomogram model and actual observations. ROC and DCA indicated that the nomogram had predictive performance.ConclusionThe nomogram constructed in this study can be used to evaluate the probability of social participation in middle-aged individuals and identify those who may have low social participation after experiencing a stroke.

IntroductionUrban green space is one of the most closely related ecosystem services to residents’ lives, and it can be regarded as a preventive public health measure. Residents living in parks and other green environments can help improve their physical and mental health, reduce stress and even prevent crime and violence. Therefore, based on the actual situation in China, this paper analyzes the relationship between urban green space and the health of middle-aged and older adults and its mechanisms.MethodsThis study used multiple linear regression, based the data from the China Health and Retirement Longitudinal Study (CHARLS) in 2013, 2015, and 2018, to explore the relationship between urban green space and the health of middle-aged and older adults. At the same time, group regression was conducted to identify the heterogeneity of health effects of urban green space.ResultsThe research shows that the increase of urban green space areas can significantly improve the health status of middle-aged and older adults. After a series of robustness tests, the results are still valid. In addition, the health effects of urban green space are different because of gender, age, education level, marital status residence, geographical location of the respondents and park quantity distribution. Further research found that reducing hot weather and optimizing air quality are the potential mechanisms of urban green space affecting the health of middle-aged and older adults, providing new evidence for the causal mechanism between urban green space and the health of middle-aged and older adults.DiscussionThis study expanded the research scope of the impact of urban green space on the health of middle-aged and older adults, covering a representative sample in China. The results show that urban green space has an important impact on the health of middle-aged and older adults. Policy suggestions are made to help cities optimize the landscape and residents to enjoy ecology.

ObjectiveThis study mainly used network meta-analysis to explore the effect of different types of exercise on hypertension in middle-aged and older adults.MethodsSeveral databases (e.g., PubMed, Embase, and the Cochrane Library) were used to search for randomized controlled trials on the effects of different types of exercise on hypertension in middle-aged and older adults.ResultsA total of 19 articles and 2,385 participants were included in the analysis. Aerobic exercise interventions [MD = −9.254, P < 0.05, 95% CI (−14.810, −3.698)] and static exercise interventions [MD = −10.465, P < 0.05, 95% CI (−18.135, −2.794)] had a significant effect on the improvement in systolic blood pressure (SBP). For diastolic blood pressure (DBP), aerobic exercise interventions [MD = −1.4096; P > 0.05, 95% CI (−8.2395, 5.4201)] and static exercise interventions [MD = −4.5206, P > 0.05, 95% CI (−14.0436, 5.0023)] were not statistically significant. The results of the surface under the cumulative ranking curve (SUCRA) showed that static exercise improved hypertension better than aerobic exercise.ConclusionAerobic exercise and static exercise have been shown to have a good effect on the improvement of hypertension, but the effect on DBP is not significant.

ObjectiveThe aging trend of China's population is severe and successful aging (SA) is imminent. Aging can lead to various chronic diseases, with hypertension being the most common. Due to this lifelong disease, patients suffer from many anxieties, as death anxiety (DA) can be the most prevalent. Studies have exhibited that middle-aged adults approaching the transition to an older state show more pronounced DA than the more senior. It has been suggested that psychological resilience (PR) can reduce DA. Therefore, this study aimed to analyze the mediating effect of SA between PR and DA in middle-aged and older adults with hypertension.MethodsA cross-sectional survey was designed. From August to December 2021, 298 middle-aged and older adults with hypertension were selected by multistage cluster random sampling in three districts (Ling he District, Gu ta District, and Tai He District) of Jinzhou City, Liaoning Province. They were surveyed using the demographic questionnaires, the Conner-Davidson Resilience Scale, the Successful Aging Inventory, and the Chinese version of a Likert-type Templer-Death Anxiety Scale. Descriptive analyses, independent sample T-test, and one-way analysis of variance (ANOVA) were used to describe demographic characteristics among hypertensive patients with different characteristics, respectively. Statistics were considered significant when P < 0.05. Pearson correlation coefficients describe the relationship between PR, SA, and DA. The research model was shaped through Structural Equation Modeling (SEM). SPSS PROCESS macro was used to verify the mediation model. A binary logistic regression model was used with DA as the dependent variable.ResultsThe scores for PR, SA, and DA in hypertensive patients are (49.52 ± 14.38) points, (51.22 ± 7.63) points, and (46.67 ± 9.03) points. PR was negatively correlated with DA (r = −0.307, P < 0.01). Moreover, incorporating SA as a mediating variable in PR and DA, SA was positively correlated with PR (r = 0.335, P < 0.01) and DA (r = 0.085, P > 0.05). The direct effect is opposite to the sign of the indirect effect. There is a suppression between PR and DA with a percentage of 20.7%. Good self-assessed health status [0.057 (0.018, 0.183)] may be a protective factor for DA.ConclusionHealthcare providers should improve the PR of middle-aged and older adults with hypertension through interventions that reduce DA and increase the likelihood of SA.

IntroductionThe impact of intergenerational caregiving on the mental health of providers remains a controversial topic, especially in countries like China where it is prevalent. Given the country’s aging population and recent liberalization of the two-child policy, understanding the effects of intergenerational caregiving on the mental health of middle-aged and older adult(s) individuals is crucial. This study aimed to explore the impact of intergenerational caregiving on mental health among middle-aged and older adult(s) individuals.MethodsWe analyzed data from the China Health and Aging Tracking Survey (CHARLS) 2013, consisting of 6602 participants finally. Personal information, family structure, financial support, health status, and physical measurements were selected for analysis. Correlation and regression analyses were used for relationships among variables controlling for potential confounding variables. Mental health status was evaluated using the depression self-rating scale.ResultsThere is a significant positive effect of intergenerational care on the mental health of middle-aged and older adult(s) people. Additionally, we re-profiled intergenerational care variables by considering the number and length of intergenerational caregivers, and found that the effects remained significant. Furthermore, the effects of intergenerational care vary across subgroups based on gender, age, nature of usual residence, marital status, and physical health status. Finally, we identified two mechanisms through which intergenerational caregiving positively affects mental health: intergenerational financial support and intergenerational spiritual support.DiscussionThese findings have important implications for policymakers, healthcare professionals, and family members in promoting the mental health of middle-aged and older adult(s) individuals in China.

ObjectiveThe popularization of the internet provides the possibility to improve the depressive symptoms (DS) and social isolation of middle-aged and older adults with functional disability. There was a significant correlation between internet use and DS in middle-aged and older adults with functional disability, but the relationship between internet use, social isolation, and DS remains to be confirmed.MethodsData were obtained from 7,955 middle-aged and older adults aged 45 years and older from the 2018 China Health and Retirement Longitudinal Study (CHARLS). Multiple linear regression models were used to analyze the association between internet use and DS, and the Sobel test was used to explore mediating models.ResultsResults showed that internet use was negatively associated with DS among Chinese middle-aged and older adults. Among them, social needs (B = −0.770, p = 0.041), and information reception (B = −1.067, p = 0.007) were significantly related to DS in middle-aged and older adults. Only information reception (B = −3.161, p = 0.031) was significantly related to DS among middle-aged and older adults with functional disability. Social isolation partially mediated the association between internet use and DS in middle-aged and older adults without functional disability, whereas it was fully mediated in middle-aged and older adults with functional disability.ConclusionThis study indicates that when formulating health policies to promote the mental health of Chinese middle-aged and older adults, the use of the internet should not be overlooked.

BackgroundChronic comorbidity has become a major challenge in chronic disease prevention and control. This issue is particularly pronounced in rural areas of developing countries, where the prevalence of chronic disease comorbidity is high, especially among middle-aged and older adults populations. However, the health status of middle-aged and older adults individuals in rural areas of China has received inadequate attention. Therefore, it is crucial to investigate the correlation among chronic diseases to establish a reference basis for adjusting health policies aimed at promoting the prevention and management of chronic diseases among middle-aged and older adults individuals.MethodsThis study selected 2,262 middle-aged and older adults residents aged 50 years or older in Shangang Village, Jiangsu Province, China, as the study population. To analyze the chronic comorbidity of middle-aged and older adults residents with different characteristics, we used the χ2 test with SPSS statistical software. Data analysis was conducted using the Apriori algorithm of Python software, set to mine the strong association rules of positive correlation between chronic disease comorbidities of middle-aged and older adults residents.ResultsThe prevalence of chronic comorbidity was 56.6%. The chronic disease comorbidity group with the highest prevalence rate was the lumbar osteopenia + hypertension group. There were significant differences in the prevalence of chronic disease comorbidity among middle-aged and older adults residents in terms of gender, BMI, and chronic disease management. The Apriori algorithm was used to screen 15 association rules for the whole population, 11 for genders, and 15 for age groups. According to the order of support, the most common association rules of comorbidity of three chronic diseases were: {lumbar osteopenia} → {hypertension} (support: 29.22%, confidence: 58.44%), {dyslipidemia} → {hypertension} (support: 19.14%, confidence: 65.91%) and {fatty liver} → {hypertension} (support: 17.82%, confidence: 64.17%).ConclusionThe prevalence of chronic comorbidity among middle-aged and older adults rural residents in China is relatively high. We identified many association rules among chronic diseases, dyslipidemia is mostly the antecedent, and hypertension is primarily the result. In particular, the majority of comorbidity aggregation patterns consisted of hypertension and dyslipidemia. By implementing scientifically-proven prevention and control strategies, the development of healthy aging can be promoted.

BackgroundLong-term exposure to air pollution and physical activity (PA) are linked to blood pressure and hypertension. However, the joint effect of air pollution and PA on blood pressure and hypertension are still unknown in Chinese middle-aged and older adults.MethodsA total of 14,622 middle-aged and older adults from the China Health and Retirement Longitudinal Study wave 3 were included in this study. Ambient air pollution [particulate matter with diameter ≤ 2.5 μm (PM2.5), or ≤10 μm (PM10), sulfur dioxide (SO2), nitrogen dioxide (NO2), carbonic oxide (CO)] were estimated using satellite-based spatiotemporal models. PA was investigated using International Physical Activity Questionnaire. Generalized linear models were used to examine the associations of air pollution, PA score with blood pressure [systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP)], and the prevalence of hypertension. Subgroup analysis was conducted to investigate the effects of air pollution on blood pressure and the prevalence of hypertension in different PA groups.ResultsThe results showed that for each inter-quartile range (IQR) increase in PM2.5 (25.45 μg/m3), PM10 (40.56 μg/m3), SO2 (18.61 μg/m3), NO2 (11.16 μg/m3), CO (0.42 mg/m3) and PA score (161.3 MET/h-week), the adjusted odd ratio (OR) of hypertension was 1.207 (95% confidence interval (CI): 1.137, 1.281), 1.189 (95%CI: 1.122, 1.260), 1.186 (95%CI: 1.112, 1.266), 1.186 (95%CI: 1.116, 1.260), 1.288 (95%CI: 1.223, 1.357), 0.948 (95%CI: 0.899, 0.999), respectively. Long-term exposure to PM2.5, PM10, SO2, NO2, and CO was associated with increased SBP, DBP, and MAP levels. For example, each IQR increase in PM2.5 was associated with 1.20 mmHg (95%CI: 0.69, 1.72) change in SBP, 0.66 mmHg (95%CI: 0.36, 0.97) change in DBP, and 0.84 mmHg (95%CI: 0.49, 1.19) change in MAP levels, respectively. Each IQR increase in PA score was associated with −0.56 mmHg (95%CI: −1.03, −0.09) change in SBP, −0.32 mmHg (95%CI: −0.59, −0.05) change in DBP, and −0.33 mmHg (95%CI: −0.64, −0.02) change in MAP levels, respectively. Subgroup analysis found that the estimated effects in the sufficient PA group were lower than that in the insufficient PA group.ConclusionLong-term exposure to air pollutants is associated with increased blood pressure and hypertension risk, while high-level PA is associated with decreased blood pressure and hypertension risk. Strengthening PA might attenuate the adverse effects of air pollution on blood pressure and hypertension risk.

BackgroundWith China's rapidly aging population, chronic pain has become a major public health issue. This article aims at determining associations between chronic pain and multiple factors, including demographic characteristics, health status, and health service utilization of middle-aged and older adults in China.MethodsWe selected all the 19,829 respondents who were over 45 years old from the China Health and Aging Tracking Survey 2018 (CHARLS) as our study population. The key information in terms of the body pain, demographic characteristics, health status, behaviors and health services use was extracted and analyzed. Logistic regression model was used to determine the influencing factors of chronic pain.ResultsAnalysis revealed that 60.02% (9,257) of the data from this survey reported physical pain, with pain sites concentrated at the head (40.9%), lower back (62.2%) and knees (47.2%). Pain was positively associated with influencing factors for pain: being a female (OR = 2.10, 95% CI 1.90–2.33, p < 0.001), living in a western region (OR = 1.28, 95% CI 1.16–1.41, p < 0.001), living in a rural area (OR = 1.14, 95% CI 1.06–1.23, p < 0.001), smoked (OR = 1.26, 95% CI 1.14–1.38, p < 0.001), drank alcohol (OR = 1.16, 95% CI 1.06–1.26, p = 0.001), and had poor self-rated health (OR = 6.84, 95% CI 5.41–8.65, p < 0.001), had hearing problems (OR = 1.23, 95% CI 1.11–3.37, p < 0.001), were depressed (OR = 1.56, 95% CI 1.03–1.29, p < 0.001), had arthritis (OR = 2.21, 95% CI 2.02–2.41, p < 0.001), stomach disorders (OR = 1.69, 95% CI 1.55–1.85, p < 0.001), visited a Western medicine hospital (OR = 1.28, 95% CI 1.10–1.50, p = 0.002), and visits to other medical institutions (OR = 1.42, 95%CI 1.22–1.64, p < 0.001). On the other side, as a protective factor for pain, having nighttime sleep ≥7 h (OR = 0.74, 95%CI 0.68–0.80, p < 0.001) was negatively associated with pain.ConclusionPhysical pain affects many older adults. Women, regional, rural residents, smokers, alcohol drinkers, people with poor self-rated health, those having

Background: The incidence of dyslipidemia as a risk factor for many serious diseases is increasing year by year. This study aimed to construct and visualize a risk prediction model for dyslipidemia in middle-aged and older adults., Method: The subjects of our study are derived from CHARLS. Participants were allocated to training and validation groups in a 7:3 ratio at random. To identify potential predictors of dyslipidemia, we employed univariate analysis, lasso regression, and multivariate binary logistic regression analyses. A nomogram was constructed based on logistic regression results, and a ROC curve was used to evaluate its predictive performance. The accuracy and discriminatory capability were assessed using calibration curve analysis, while the net clinical benefit rate was evaluated through decision curve analysis (DCA)., Results: Our study included a total of 12,589 participants, of which 1,514 were detected with dyslipidemia syndrome. Model construction: Based on the results of the logistic regression analysis of the training set, six variables were selected to construct the model, which were ranked in order of importance as comorbid hypertension, comorbid diabetes, waistline, comorbid digestive disease, place of abode, and comorbid liver disease. The ROC curve results indicated that the prediction model exhibited moderate discriminatory ability (AUC > 0.7). Additionally, the calibration curve confirmed the model's strong predictive accuracy. The decision curve analysis (DCA) illustrated a positive net benefit associated with the prediction model., Conclusions: The prediction model of dyslipidemia risk in middle-aged and older adults constructed in this study has good efficacy and helps to screen high-risk groups., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Jiang, Geng, Shi, Zhang, Li, Gai, Mei and Li.)

BackgroundLifestyle factors may could help maintain cognitive function and reduce the risk of dementia. The application of the Health Belief Model (HBM) has been verified by incorporating lifestyle changes for dementia risk reduction; however, the influence of health beliefs on cognitive aging through lifestyle remains unknown. To facilitate research-based interventions to promote successful cognitive aging, we explored the relationship between health beliefs, lifestyle, and cognitive aging based on the HBM using path analysis.MethodsThis cross-sectional study recruited middle-aged and older community residents from a community health service center in Chongqing, China, through convenience sampling. Motivation to Change Lifestyle and Health Behaviors for Dementia Risk Reduction (MCLHB-DRR), Lifestyle for Dementia Risk Reduction (LDRR), and the Montreal Cognitive Assessment (MoCA) were employed to measure participants' beliefs, lifestyle, and cognitive function, respectively. The associations between the beliefs, lifestyle, and cognitive function were analyzed, and a structural equation model was constructed.ResultsA total of 202 participants completed the questionnaires, of whom only 17 (8.4%) were classified as having successful cognitive aging. The model demonstrated the data to have an acceptable fit and elucidated 39.3 and 18.2% of the variance in lifestyle and the grade of cognitive aging, respectively. Positive and negative beliefs had opposite effects on the grade of cognitive aging through lifestyle. Cues to action had opposite effects on the grades of cognitive aging through positive and negative beliefs; however, the total effects canceled each other out.ConclusionsPositive beliefs have a positive effect on lifestyle, thereby promoting successful cognitive aging, whereas negative beliefs have a negative effect on lifestyle, thereby hindering successful cognitive aging. Health education and media publicity, as specific aspects of cues to action, can have a meaningful impact on healthy behavior and successful cognitive aging by promoting positive beliefs and controlling negative beliefs. The model suggests the strengthening and weakening of the positive and negative beliefs, respectively, of middle-aged and older community residents in the formulation of relevant public health strategies in the future, thereby enabling them to adapt to a healthy lifestyle promoting successful cognitive aging.

AimsUrbanization plays an important role in individuals' health. However, it is difficult to isolate healthy migrant effect between urbanization and health. This study examined the effects of urbanization on depressive symptoms and its possible pathways among Chinese middle-aged and older adults independent of the influence of health-selective migration.MethodsUsing the baseline survey of the China Health and Retirement Longitudinal Study, this study compared the depressive symptoms among three groups (urbanized rural residents, rural non-migrants and urban non-migrants). The 10-item Center for Epidemiologic Studies Depression Scale (CESD-10) short form was used to measure depressive symptoms. Logistic regression models and Structural Equation Model (SEM) were applied to examine the association between urbanization and depressive symptoms and the corresponding potential mechanisms.ResultsOur final sample contained 11,156 respondents with an average age of 58.91 (SD = 9.48), with 5,142 males (46.09%) and 6,014 females (53.91%). Compared with urbanized rural residents, rural residents were more likely to have depressive symptoms (OR = 1.19, 95% CI = 1.07, 1.32), and urban residents were associated with a decreased risk of depressive symptoms (OR = 0.81, 95% CI: 0.70, 0.94). A large proportion of the association between urbanization and depressive symptoms were mainly mediated by social participation, income and living conditions.ConclusionsPlanned urbanization had an independent impact on decreased depressive symptoms. Improvements in social participation, income and living conditions are the main drivers behind this relationship. Additionally, urbanization compensates for the negative impact of depressive symptoms from disadvantaged early life conditions, but it cannot eliminate the gap between urbanized rural people and urban non-migrants.

ObjectivesThis study examined the mutual effects of social participation and depressive symptoms in middle-aged and older Chinese adults from offline and online perspectives. Reciprocal relationships between depressive symptoms and the four subtypes of offline participation were also examined.MethodsBased on China Health and Retirement Longitudinal Study data (CHARLS), this study conducted ID matching for three waves of data from 2013, 2015, and 2018. One thousand nine hundred ninety-nine samples for individuals over 50 were obtained. A series of cross-lagged analyses were conducted to examine the mutual influence of social participation and depressive symptoms. Depressive symptoms were assessed using the short version of the Center for Epidemiologic Studies Depression Scale (CESD-10). The social participation questionnaire included nine items referring to offline participation (eight items) and online participation (one item). Several demographic variables were adjusted when conducting the cross-lagged analyses.ResultsSocial and offline participation had significant two-way associations with depressive symptoms. Depressive symptoms had greater impacts on social and offline participation than in the opposite direction. Online participation has a significant one-way impact on depressive symptoms. The relationship between specific types of offline participation and depressive symptoms varied in existence and direction.DiscussionOverall, there was significant bidirectional causality between social participation and depressive symptoms. Social participation, both offline and online, played a positive role in alleviating depressive symptoms. Depressive symptoms also affected the level of social participation to some extent among middle-aged and older Chinese adults over time.

Prior research has shown that environmental hazards, such as limited green space, air pollution, and harmful weather, have the strong adverse impact on older adults' cognitive function; however, most of the studies were conducted in developed countries and limited to cross-sectional analyses. China has the largest aging population in the world so the research evidence from it can offer an insight to the study in other developing countries facing similar issues and inform future public health policy and disease control. This study examined the long-term impact of environmental factors, namely, green space coverage, air pollution, and weather conditions on cognitive function using a nationally representative sample consisting of adults aged 45 years and older selected from the China Health and Retirement Longitudinal Study (CHARLS 2011–2018), the China City Statistical Yearbook, and other sources. Multilevel growth curve models were utilized for analysis and the mediator effects of physical activity and social engagement on the relationship between environmental factors and cognitive function were examined. Findings of this study showed that after controlling for sociodemographic characteristics, annual precipitation of 80 cm or more, living in areas with July temperature of 28°C or higher, urban community, and green space coverage were positively associated with cognition score at the baseline and lower precipitation, urban community, and greater green space coverage were associated with slower cognitive decline over a 7-year period. The impact of gross domestic product (GDP) seemed to take into effect more and more over time. These effects did not substantially change after weekly total hours of physical activities and levels of social engagement were added. More research on the mechanisms of the effect of environmental factors on cognition is needed such as the subgroup analyses and/or with more aspects of environmental measures.

Background: With the continuous development of society and the economy, population aging has become an inevitable global development trend, triggering a series of social problems and having a more serious impact on the physical and mental health of middle-aged and older adults. Physical exercise is one of the key factors for improving the overall health and quality of life of individuals, but the role of square dance exercise and the quality of life of middle-aged and older adults have not yet been clarified., Purpose: This study aimed to investigate the associations between square dance exercise and the quality of life of middle-aged and older adults and its mechanism of action, including its effects on physical health and mental health, with negative emotions and attitudes towards aging as mediating variables., Method: This study adopted a cross-sectional research method, using the Physical Activity Rating Scale (PARS-3), Depression-Anxiety-Stress Scale in Simplified Chinese (DASS-21), Attitudes toward Aging Questionnaire (AAQ), and 12-item Short Form of the Health Survey (SF-12), and launched an online survey on the QuestionStar platform from August-September 2023 for 4,636 middle and older adults aged 45-74 years. The survey results were analyzed via Pearson correlation analysis via SPSS 27.0 and structural equation modeling analysis via Mplus 8.3 to test the model fit and mediation effects., Results: Square dance exercise was significantly correlated with negative emotions, attitudes towards aging, and quality of life ( r  = -0.042-0.878, p  < 0.01). Square dance exercise significantly and positively predicted quality of life ( β  = 0. 202, p  < 0.001). Negative emotions and attitudes towards aging are chain mediators of square dance exercise and quality of life, and the mediation consists of three pathways: separate mediation of negative emotions, separate mediation of attitudes towards aging, and chain mediation of negative emotions-attitudes towards aging., Conclusion: This study is dedicated to deepening the scientific role of how square dancing, as a health-promoting activity, can optimize the quality of life of middle-aged and older adults through the mediating mechanism of negative emotion alleviation and positive attitudes towards aging and then optimize the quality of life of middle-aged and older adults. This process not only enriches the theoretical framework of the complex interactions between psychosocial factors and healthy aging but also provides a solid empirical foundation for the development of health intervention strategies aimed at enhancing the overall well-being and quality of life of the middle-aged and older adults., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Ouyang, Qu, Du, Fan and Wang.)

Background: To address the growing burden of older adult care, the Chinese government has introduced a policy that integrates medical care with elder care, launching two batches of national pilot projects. A majority of the older adult population suffers from one or more chronic diseases, with many experiencing multiple chronic conditions, necessitating support from both elder care and medical services., Methods: Using panel data from the China Health and Retirement Longitudinal Study (CHARLS) spanning 2011 to 2020, this study employs the difference-in-difference (DID) model to analyze the impact of the integrated medical-nursing policy on the physical health of older patients with chronic diseases., Results: The study found that the average annual number of hospitalizations for older individuals with one or more chronic diseases was 0.276. The integrated medical-nursing policy reduced hospitalizations by 0.0405. Additionally, the average annual hospitalization rate for older individuals with two or more chronic diseases was 0.339, higher than the former group. The integrated medical-nursing policy reduced hospitalizations by 0.0738 in this group., Conclusion: The pilot study demonstrates that the implementation of the integrated medical-nursing policy has significantly improved the physical health of older patients with chronic diseases. The government should promote these policies on a larger scale, explore various forms of integrated medical care, and provide more comprehensive medical and elder care services for older patients with chronic diseases., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Fan, Li, Xu and Rong.)

Objective: This study aims to explore the relationship between internet use and self-rated health among middle-aged and older adults and further investigates the mediating role of health service utilization between internet use and self-rated health, providing a reference for more effectively utilizing the internet to improve the health status of middle-aged and older adults., Method: We analyzed data from the 2018 and 2020 waves of the China Health and Retirement Longitudinal Study (CHARLS), this includes 10,011 in 2018 and 7,080 in 2020 over the age of 45. To explore the relationship between internet use and self-rated health, we employed propensity score matching (PSM) and instrumental variable regression analysis, accounting for a wide range of potential covariates. Additionally, the Sobel test was used to examine the mediating effect of health service utilization on this relationship., Results: According to the fully adjusted propensity score matching and instrumental variable regression model, internet use significantly enhanced self-rated health among middle-aged and older adults (β = 0.348, P < 0.01; β = 0.293, P < 0.1). However, subgroup analyses revealed that this positive effect was not significant among middle-aged and older adults who were divorced (β = 0.190, P > 0.05), lived in special zone (β = -1.379, P > 0.05), and lacked medical insurance (β = 0.314, P > 0.05). Furthermore, mediation analysis revealed that inpatient services (β = 0.0215, P < 0.01) acted as a mediator in the relationship between internet use and self-rated health., Conclusion: Internet use positively correlates with self-rated health among middle-aged and older adults. Additionally, the utilization of health services can significantly influence this relationship. These findings underscore the importance of developing targeted government strategies to promote internet access and create a supportive online environment, thereby enhancing the health outcomes of this demographic group., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Ma, Hu, He, Wang, Chen and Qiao.)

Objective: To explore the trajectories of cognitive function development and predictive factors in disabled middle-aged and older adults., Methods: Utilizing data from 983 disabled middle-aged and older adults in the China Health and Retirement Longitudinal Study (CHARLS) from 2013 to 2020, latent growth mixture models were constructed to analyze the categories of cognitive function development trajectories and their predictive factors., Results: The cognitive function trajectories of the disabled middle-aged and older adults were classified into three categories: rapid decline (32.6%), Slow decline (36.1%), and Stable (31.2%). Multinomial logistic regression analysis identified age, gender, residence, education, marital status, household income, sleep duration, depression, hearing ability, and social participation as predictors of these trajectories., Conclusion: There is heterogeneity in the cognitive function development trajectories among disabled middle-aged and older adults. Healthcare professionals can implement targeted health management based on the characteristics of different groups to prevent the deterioration of cognitive function in this population., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Pang, Xu, Liu, Huang, Li, Ma, Zeng, Ma and Xie.)

Background: Previous studies indicated that exposure to ambient fine particulate matter (PM 2.5 ) could increase the risk of metabolic syndrome (MetS). However, the specific impact of PM 2.5 chemical components remains uncertain., Methods: A national cross-sectional study of 12,846 Chinese middle-aged and older adults was conducted. Satellite-based spatiotemporal models were employed to determine the 3-year average PM 2.5 components exposure, including sulfates (SO 4 2- ), nitrates (NO 3 - ), ammonia (NH 4 + ), black carbon (BC), and organic matter (OM). Generalized linear models were used to investigate the associations of PM 2.5 components with MetS and the components of MetS, and restricted cubic splines curves were used to establish the exposure-response relationships between PM 2.5 components with MetS, as well as the components of MetS., Results: MetS risk increased by 35.1, 33.5, 33.6, 31.2, 32.4, and 31.4% for every inter-quartile range rise in PM 2.5 , SO 4 2- , NO 3 - , NH 4 + , OM and BC, respectively. For MetS components, PM 2.5 chemical components were associated with evaluated risks of central obesity, high blood pressure (high-BP), high fasting glucose (high-FBG), and low high-density lipoprotein cholesterol (low-HDL)., Conclusion: This study indicated that exposure to PM 2.5 components is related to increased risk of MetS and its components, including central obesity, high-BP, high-FBG, and low-HDL. Moreover, we found that the adverse effect of PM 2.5 chemical components on MetS was more sensitive to people who were single, divorced, or widowed than married people., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Zhang, Zhang, Duan, Nie, Li, Yu, Niu and Yan.)

Background: It has been shown that diabetes is associated with insufficient physical activity among middle-aged and older adults, but the association between different physical activity levels (PAL) and diabetes incidence needs to be further explored., Objective: This study aims to explore the correlation and dose-response relationship between different PAL and the diabetes incidence in middle-aged and older adults., Methods: Utilizing data from the 2018 China Health and Retirement Longitudinal Study (CHARLS), this cross-sectional analysis included 17,226 middle-aged and older adults aged 45 and above. Binary logistic regression models and restricted cubic spline (RCS) were used to explore the correlation and dose-response relationship between different PAL and the incidence of diabetes in the total middle-aged and older adults population as well as in subgroups. Sensitivity analyses were also performed to verify the robustness of the findings., Results: In the entire study population, compared with the lowest PAL, participants in the third and fourth quartiles PAL saw diabetes incidence significantly reduced by 16% ( p  = 0.005) and 33% ( p  < 0.001), respectively ( p for trend  < 0.001). In subgroup analyses, the fourth quartile PAL significantly reduced the diabetes incidence among females, individuals aged 60-69, and rural residents by 25% ( p  = 0.011), 38% ( p  < 0.001) and 28% ( p  < 0.001), respectively. For males, middle-aged (45-59 years), and urban residents, the third quartile PAL reduced diabetes incidence by 22% ( p  = 0.004), 24% ( p  = 0.012), 21% ( p  = 0.013), respectively. When the fourth quartile PAL was reached, the diabetes incidence was significantly reduced in these populations by 41% ( p  < 0.001), 39% ( p  < 0.001), respectively. There was a negative dose-response relationship between physical activity and diabetes incidence in specific Chinese middle-aged and older adults population. In addition, sensitivity analyses indicated the robustness of the findings.p  < 0.001), respectively. There was a negative dose-response relationship between physical activity and diabetes incidence in specific Chinese middle-aged and older adults population. In addition, sensitivity analyses indicated the robustness of the findings., Conclusion: Higher PAL was associated with lower diabetes incidence in specific Chinese middle-aged and older adults population. It is feasible to use physical activity to predict diabetes incidence in this demographic, and high PAL may be an effective means of preventing and controlling diabetes., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Zhang, Meng, Fei, Wang, Wu and Wang.)

Background: Multimorbidity has become a major public health problem among Chinese middle-aged and older adults, and the most costly to the health care system. However, most previous population-based studies of multimorbidity have focused on a limited number of chronic diseases, and diagnosis was based on participants' self-report, which may oversimplify the problem. At the same time, there were few reports on the relationship between multimorbidity patterns and health care costs. This study analyzed the multimorbidity patterns and changes among middle-aged and older people in China over the past decade, and their association with medical costs, based on representative hospital electronic medical record data., Methods: Two cross-sectional surveys based on representative hospital data were used to obtain adults aged 45 years and older in Xiangyang in 2013 ( n  = 20,218) and 2023 ( n  = 63,517). Latent Class Analysis was used to analyze changes in the patterns of multimorbidity, gray correlation analysis and ordered logistics model were used to assess the association of multimorbidity patterns with medical expenses. The diagnosis and classification of chronic diseases were based on the International Classification of Diseases, Tenth Revision codes (ICD-10)., Results: The detection rate of chronic disease multimorbidity has increased (70.74 vs. 76.63%, p  < 0.001), and multimorbidity patterns have increased from 6 to 9 (2013: Malignant tumors pattern, non-specific multimorbidity pattern, ischemic heart disease + hypertension pattern, cerebral infarction + hypertension pattern, kidney disease + hypertension pattern, lens disease + hypertension pattern; new in 2023: Nutritional metabolism disorders + hypertension pattern, chronic lower respiratory diseases + malignant tumors pattern, and gastrointestinal diseases pattern) in China. The medical cost of all multimorbidity patients have been reduced between 2013 and 2023 (RMB: 8216.74 vs. 7247.96, IQR: 5802.28-15,737 vs. 5014.63-15434.06). The top three specific multimorbidity patterns in both surveys were malignancy tumor pattern, ischemic heart disease + hypertension pattern, and cerebral infarction + hypertension pattern. Hypertension and type 2 diabetes are important components of multimorbidity patterns. Compared with patients with a single disease, only lens disorders + hypertension pattern were at risk of higher medical costs in 2013 (aOR:1.23, 95% CI: 1.03, 1.47), whereas all multimorbidity patterns were significantly associated with increased medical costs in 2023, except for lens disorders + hypertension (aOR:0.35, 95% CI: 0.32, 0.39). Moreover, the odds of higher medical costs were not consistent across multimorbidity patterns. Among them, ischemic heart disease + hypertension pattern [adjusted odds ratio (aOR):4.66, 95%CI: 4.31, 5.05] and cerebral infarction + hypertension pattern (aOR: 3.63, 95% CI: 3.35, 3.92) were the two patterns with the highest risk. Meanwhile, men (aOR:1.12, 95CI:1.09, 1.16), no spouse (aOR:1.09, 95CI: 1.03, 1.16) had a positive effect on medical costs, while patients with total self-pay (aOR: 0.45, 95CI: 0.29, 0.70), no surgery (aOR: 0.05, 95CI: 0.05, 0.05), rural residence (aOR: 0.92, 95CI: 0.89, 0.95), hospitalization days 1-5 (aOR: 0.04, 95CI: 0.04, 0.04), and hospitalization days 6-9 (aOR: 0.15, 95CI: 0.15, 0.16) had a negative impact on medical costs., Conclusion: Multimorbidity patterns among middle-aged and older adults in China have diversified over the past decade and are associated with rising health care costs in China. Smart, decisive and comprehensive policy and care interventions are needed to effectively manage NCDS and their risk factors and to reduce the economic burden of multimorbidity on patients and the country., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Ju, Liu, Gong, Guo, Ge, Liu, Luo, Yang, Li, Liu, Li, He, Liu, Huang, Xu and Liu.)

Objective: Frailty and activities of daily living (ADL) disability are common conditions among older population. Studies on the bidirectional relationship between frailty and ADL are limited. The current study examined the cross-sectional and longitudinal associations between frailty and ADL in middle-aged and older Chinese individuals., Methods: The data was collected through the China Health and Retirement Longitudinal Study (CHARLS), conducted in 2011, 2013, and 2015, encompassing 17,284 individuals aged ≥45 years. We excluded individuals without follow-up data. 2,631 participants finished the baseline survey. The definition of ADL disability encompasses difficulty in engaging in either basic activities of daily living (BADL) or instrumental activities of daily living (IADL). Frailty was assessed according to the Fried criteria. Logistic regression was utilized to examine odds ratios (ORs) and 95% confidence intervals (CIs) for assessing the cross-sectional relationships between ADL with frailty at baseline. The prediction effects were explored using Cox proportional hazards analysis, testing hazard ratios (HRs) and 95%CIs., Results: In cross-sectional analysis, BADL [OR = 6.660 (4.519-9.815)], IADL [OR = 5.950 (4.490-7.866)], and ADL [OR = 5.658 (4.278-7.483)] exhibited significant associations with frailty; frailty demonstrated significant associations with BADL [OR = 6.741 (4.574-9.933)], IADL [OR = 6.042 (4.555-8.016)] and ADL [OR = 5.735 (4.333-7.591)]. In longitudinal analysis, IADL and ADL were significantly associated with frailty in participants without baseline frailty in the short-term period [IADL: HR = 1.971 (1.150-3.379), ADL: HR = 1.920 (1.146-3.215)], IADL exhibited a significant association with frailty in the long-term period [HR = 2.056 (1.085-3.895)]. There was no significant link observed between frailty and an elevated risk of disability onset in BADL, IADL and ADL during the short-term period. When considering the long-term perspective, frailty exhibited a significant association with an elevated risk of disability onset in BADL [HR= 1.820 (1.126-2.939)] and IADL [HR = 1.724 (1.103-2.694)]., Conclusion: In middle-aged and older adults, ADL and IADL disability predicted frailty after 2-year follow-up, IADL disability predicted frailty after 4-year follow-up. Moreover, frailty did not predict BADL, IADL and ADL disability after 2-year follow-up. However, frailty predicted BADL and IADL disability after 4-year follow-up., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Li, Li, Sun, Yang, Wang, Yuan, Lei, Li, Liu, Zhang, Hua, Liu and Zhang.)

Objective: China's middle-aged and older population is a rich source of human capital. Therefore, considering the health of this group is important when creating and using human resources., Methods: Using data from the nationwide China Health and Retirement Longitudinal Study (CHARLS) 2018 baseline survey of 19,000 adults ages 45 years and older, this study was an objective investigation of the effects of work on the physical and mental health of middle-aged and older adults. We conducted several types of analyses using details of participants' lifestyles and demographic characteristics (living environment, education, financial level, and access to medical services) with work (i.e., employment or volunteer work) as a primary input component of health production to examine their effects on the health status of middle-aged and older individuals., Results: Six primary outcomes were identified: (1) Employment positively affects both the physical and mental health of middle-aged and older people; (2) Employment can influence the physical and mental health of middle-aged and older people through income, cognitive level, and social support networks; (3) Compared to non-self-employment, self-employment dramatically worsens physical health but has no apparent detrimental effects on mental health. Compared to non-agricultural employment, agricultural labor affects both physical and mental health. (4) Employment has more positive physical and mental health effects in Individuals with higher rather than lower levels of education. (5) Employment opportunities in the eastern region are more likely to promote better physical health than those in the central and western regions of China, although the effects on mental health are negative. (6) When considering groups at different ages of the lifespan, the 60-65-year-old group, who are just entering retirement probably benefit more from continuing work., Conclusion: We provide some recommendations to encourage middle-aged and older people to work and utilize their experience, which will enhance their physical and mental well-being and help them in realize their own value and social integration., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Fu and Li.)

Background: China has by far one of the fastest-aging populations in the world. Increasing age is often accompanied by an increasing prevalence of chronic diseases and impaired Activities of Daily Living (ADL). The aim of this study was to analyze the effects of chronic diseases on ADL in Chinese middle-aged and older adults and to provide a scientific basis for delaying the impairment of ADL and prolonging the self-care life expectancy of middle-aged and older adults., Methods: This investigation utilized the survey information of 10,096 middle-aged and older adults from the China Health and Aging Tracking Survey (CHARLS) of 2011 as baseline data, then followed up this cohort until 2018, and performed multifactorial analyses using Cox proportional risk models to explore the strength of the associations between chronic diseases and the risk of impaired ADL in middle-aged and older adults., Results: Among the middle-aged and older adult population, the presence of hypertension was associated with a 38% higher risk of impaired ADL compared to those without the condition ( HR = 1.38,95% CI :1.24-1.54); the involvement of heart disease was associated with a 27% higher risk of impaired ADL compared to those without the condition ( HR = 1.27,95% CI :1.10- 1.46); the existence of arthritis was associated with a 38% higher risk of impaired ADL in middle-aged and older adults compared to those without arthritis ( HR = 1.38,95% CI :1.25-2.08); additionally, the risk of impaired ADL with one or ≥ 2 chronic diseases was increased by 34% ( HR = 1.34, 95% CI :1.18-1.52) and 84% ( HR = 1.84, 95% CI :1.63-2.08) in middle-aged and older adult individuals, respectively., Conclusion: Hypertension is a risk factor for impaired ADL at any age in the subjects of this study. Examining the association between the number of chronic diseases and impairment in activities of daily living, it was revealed that the risk of ADL impairment increased with the number of chronic diseases in both the middle-aged (45-59 years) and older adult (60-74 years) groups., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Ai, Tang, Wen, Kartheepan and Tang.)

Objective: This study aims to develop and validate a prediction model for evaluating the social participation in the community middle-aged and older adult stroke survivors., Methods: The predictive model is based on data from the China Health and Retirement Longitudinal Study (CHARLS), which focused on individuals aged 45 years or older. The study utilized subjects from the CHARLS 2015 and 2018 wave, eighteen factors including socio-demographic variables, behavioral and health status, mental health parameters, were analyzed in this study. To ensure the reliability of the model, the study cohort was randomly split into a training set (70%) and a validation set (30%). The Least Absolute Shrinkage and Selection Operator (LASSO) regression analysis was used to identify the most effective predictors of the model through a 10-fold cross-validation. The logistic regression model was employed to investigate the factors associated with social participation in stroke patients. A nomogram was constructed to develop a prediction model. Calibration curves were used to assess the accuracy of the nomogram model. The model's performance was evaluated using the area under the curve (AUC) and decision curve analysis (DCA)., Result: A total of 1,239 subjects with stroke from the CHARLS database collected in 2013 and 2015 wave were eligible in the final analysis. Out of these, 539 (43.5%) subjects had social participation. The model considered nineteen factors, the LASSO regression selected eleven factors, including age, gender, residence type, education level, pension, insurance, financial dependence, physical function (PF), self-reported healthy,cognition and satisfaction in the prediction model. These factors were used to construct the nomogram model, which showed a certain extent good concordance and accuracy. The AUC values of training and internal validation sets were 0.669 (95%CI 0.631-0.707) and 0.635 (95% CI 0.573-0.698), respectively. Hosmer-Lemeshow test values were p  = 0.588 and p  = 0.563. Calibration curves showed agreement between the nomogram model and actual observations. ROC and DCA indicated that the nomogram had predictive performance., Conclusion: The nomogram constructed in this study can be used to evaluate the probability of social participation in middle-aged individuals and identify those who may have low social participation after experiencing a stroke., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Liu, Li, Ding, Cai and Nie.)

Introduction: Urban green space is one of the most closely related ecosystem services to residents' lives, and it can be regarded as a preventive public health measure. Residents living in parks and other green environments can help improve their physical and mental health, reduce stress and even prevent crime and violence. Therefore, based on the actual situation in China, this paper analyzes the relationship between urban green space and the health of middle-aged and older adults and its mechanisms., Methods: This study used multiple linear regression, based the data from the China Health and Retirement Longitudinal Study (CHARLS) in 2013, 2015, and 2018, to explore the relationship between urban green space and the health of middle-aged and older adults. At the same time, group regression was conducted to identify the heterogeneity of health effects of urban green space., Results: The research shows that the increase of urban green space areas can significantly improve the health status of middle-aged and older adults. After a series of robustness tests, the results are still valid. In addition, the health effects of urban green space are different because of gender, age, education level, marital status residence, geographical location of the respondents and park quantity distribution. Further research found that reducing hot weather and optimizing air quality are the potential mechanisms of urban green space affecting the health of middle-aged and older adults, providing new evidence for the causal mechanism between urban green space and the health of middle-aged and older adults., Discussion: This study expanded the research scope of the impact of urban green space on the health of middle-aged and older adults, covering a representative sample in China. The results show that urban green space has an important impact on the health of middle-aged and older adults. Policy suggestions are made to help cities optimize the landscape and residents to enjoy ecology., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Li, Liu, Yang, Ge, Chang and Zhang.)

Objective: The aging trend of China's population is severe and successful aging (SA) is imminent. Aging can lead to various chronic diseases, with hypertension being the most common. Due to this lifelong disease, patients suffer from many anxieties, as death anxiety (DA) can be the most prevalent. Studies have exhibited that middle-aged adults approaching the transition to an older state show more pronounced DA than the more senior. It has been suggested that psychological resilience (PR) can reduce DA. Therefore, this study aimed to analyze the mediating effect of SA between PR and DA in middle-aged and older adults with hypertension., Methods: A cross-sectional survey was designed. From August to December 2021, 298 middle-aged and older adults with hypertension were selected by multistage cluster random sampling in three districts (Ling he District, Gu ta District, and Tai He District) of Jinzhou City, Liaoning Province. They were surveyed using the demographic questionnaires, the Conner-Davidson Resilience Scale, the Successful Aging Inventory, and the Chinese version of a Likert-type Templer-Death Anxiety Scale. Descriptive analyses, independent sample T -test, and one-way analysis of variance (ANOVA) were used to describe demographic characteristics among hypertensive patients with different characteristics, respectively. Statistics were considered significant when P < 0.05. Pearson correlation coefficients describe the relationship between PR, SA, and DA. The research model was shaped through Structural Equation Modeling (SEM). SPSS PROCESS macro was used to verify the mediation model. A binary logistic regression model was used with DA as the dependent variable., Results: The scores for PR, SA, and DA in hypertensive patients are (49.52 ± 14.38) points, (51.22 ± 7.63) points, and (46.67 ± 9.03) points. PR was negatively correlated with DA ( r = -0.307, P < 0.01). Moreover, incorporating SA as a mediating variable in PR and DA, SA was positively correlated with PR ( r = 0.335, P < 0.01) and DA ( r = 0.085, P > 0.05). The direct effect is opposite to the sign of the indirect effect. There is a suppression between PR and DA with a percentage of 20.7%. Good self-assessed health status [0.057 (0.018, 0.183)] may be a protective factor for DA., Conclusion: Healthcare providers should improve the PR of middle-aged and older adults with hypertension through interventions that reduce DA and increase the likelihood of SA., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Wang, Zhang, Ma, Sun, Gao, Hu, Liu and Guo.)

Objective: The popularization of the internet provides the possibility to improve the depressive symptoms (DS) and social isolation of middle-aged and older adults with functional disability. There was a significant correlation between internet use and DS in middle-aged and older adults with functional disability, but the relationship between internet use, social isolation, and DS remains to be confirmed., Methods: Data were obtained from 7,955 middle-aged and older adults aged 45 years and older from the 2018 China Health and Retirement Longitudinal Study (CHARLS). Multiple linear regression models were used to analyze the association between internet use and DS, and the Sobel test was used to explore mediating models., Results: Results showed that internet use was negatively associated with DS among Chinese middle-aged and older adults. Among them, social needs (B = -0.770, p = 0.041), and information reception (B = -1.067, p = 0.007) were significantly related to DS in middle-aged and older adults. Only information reception (B = -3.161, p = 0.031) was significantly related to DS among middle-aged and older adults with functional disability. Social isolation partially mediated the association between internet use and DS in middle-aged and older adults without functional disability, whereas it was fully mediated in middle-aged and older adults with functional disability., Conclusion: This study indicates that when formulating health policies to promote the mental health of Chinese middle-aged and older adults, the use of the internet should not be overlooked., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Wu, Li, Zhao, Hu, Zeng, Yu, Yang and Han.)

Introduction: The impact of intergenerational caregiving on the mental health of providers remains a controversial topic, especially in countries like China where it is prevalent. Given the country's aging population and recent liberalization of the two-child policy, understanding the effects of intergenerational caregiving on the mental health of middle-aged and older adult(s) individuals is crucial. This study aimed to explore the impact of intergenerational caregiving on mental health among middle-aged and older adult(s) individuals., Methods: We analyzed data from the China Health and Aging Tracking Survey (CHARLS) 2013, consisting of 6602 participants finally. Personal information, family structure, financial support, health status, and physical measurements were selected for analysis. Correlation and regression analyses were used for relationships among variables controlling for potential confounding variables. Mental health status was evaluated using the depression self-rating scale., Results: There is a significant positive effect of intergenerational care on the mental health of middle-aged and older adult(s) people. Additionally, we re-profiled intergenerational care variables by considering the number and length of intergenerational caregivers, and found that the effects remained significant. Furthermore, the effects of intergenerational care vary across subgroups based on gender, age, nature of usual residence, marital status, and physical health status. Finally, we identified two mechanisms through which intergenerational caregiving positively affects mental health: intergenerational financial support and intergenerational spiritual support., Discussion: These findings have important implications for policymakers, healthcare professionals, and family members in promoting the mental health of middle-aged and older adult(s) individuals in China., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Yan, Wu, Chen, Xu, Yu and Li.)

Background: Chronic comorbidity has become a major challenge in chronic disease prevention and control. This issue is particularly pronounced in rural areas of developing countries, where the prevalence of chronic disease comorbidity is high, especially among middle-aged and older adults populations. However, the health status of middle-aged and older adults individuals in rural areas of China has received inadequate attention. Therefore, it is crucial to investigate the correlation among chronic diseases to establish a reference basis for adjusting health policies aimed at promoting the prevention and management of chronic diseases among middle-aged and older adults individuals., Methods: This study selected 2,262 middle-aged and older adults residents aged 50 years or older in Shangang Village, Jiangsu Province, China, as the study population. To analyze the chronic comorbidity of middle-aged and older adults residents with different characteristics, we used the χ test with SPSS statistical software. Data analysis was conducted using the Apriori algorithm of Python software, set to mine the strong association rules of positive correlation between chronic disease comorbidities of middle-aged and older adults residents.2 test with SPSS statistical software. Data analysis was conducted using the Apriori algorithm of Python software, set to mine the strong association rules of positive correlation between chronic disease comorbidities of middle-aged and older adults residents., Results: The prevalence of chronic comorbidity was 56.6%. The chronic disease comorbidity group with the highest prevalence rate was the lumbar osteopenia + hypertension group. There were significant differences in the prevalence of chronic disease comorbidity among middle-aged and older adults residents in terms of gender, BMI, and chronic disease management. The Apriori algorithm was used to screen 15 association rules for the whole population, 11 for genders, and 15 for age groups. According to the order of support, the most common association rules of comorbidity of three chronic diseases were: {lumbar osteopenia} → {hypertension} (support: 29.22%, confidence: 58.44%), {dyslipidemia} → {hypertension} (support: 19.14%, confidence: 65.91%) and {fatty liver} → {hypertension} (support: 17.82%, confidence: 64.17%)., Conclusion: The prevalence of chronic comorbidity among middle-aged and older adults rural residents in China is relatively high. We identified many association rules among chronic diseases, dyslipidemia is mostly the antecedent, and hypertension is primarily the result. In particular, the majority of comorbidity aggregation patterns consisted of hypertension and dyslipidemia. By implementing scientifically-proven prevention and control strategies, the development of healthy aging can be promoted., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Yu, Chen, Xia, Qu and Dai.)

Background: Long-term exposure to air pollution and physical activity (PA) are linked to blood pressure and hypertension. However, the joint effect of air pollution and PA on blood pressure and hypertension are still unknown in Chinese middle-aged and older adults., Methods: A total of 14,622 middle-aged and older adults from the China Health and Retirement Longitudinal Study wave 3 were included in this study. Ambient air pollution [particulate matter with diameter ≤ 2.5 μm (PM 2.5 ), or ≤10 μm (PM 10 ), sulfur dioxide (SO 2 ), nitrogen dioxide (NO 2 ), carbonic oxide (CO)] were estimated using satellite-based spatiotemporal models. PA was investigated using International Physical Activity Questionnaire. Generalized linear models were used to examine the associations of air pollution, PA score with blood pressure [systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP)], and the prevalence of hypertension. Subgroup analysis was conducted to investigate the effects of air pollution on blood pressure and the prevalence of hypertension in different PA groups., Results: The results showed that for each inter-quartile range (IQR) increase in PM 2.5 (25.45 μg/m 3 ), PM 10 (40.56 μg/m 3 ), SO 2 (18.61 μg/m 3 ), NO 2 (11.16 μg/m 3 ), CO (0.42 mg/m 3 ) and PA score (161.3 MET/h-week), the adjusted odd ratio (OR) of hypertension was 1.207 (95% confidence interval (CI): 1.137, 1.281), 1.189 (95%CI: 1.122, 1.260), 1.186 (95%CI: 1.112, 1.266), 1.186 (95%CI: 1.116, 1.260), 1.288 (95%CI: 1.223, 1.357), 0.948 (95%CI: 0.899, 0.999), respectively. Long-term exposure to PM 2.5 , PM 10 , SO 2 , NO 2 , and CO was associated with increased SBP, DBP, and MAP levels. For example, each IQR increase in PM 2.5 was associated with 1.20 mmHg (95%CI: 0.69, 1.72) change in SBP, 0.66 mmHg (95%CI: 0.36, 0.97) change in DBP, and 0.84 mmHg (95%CI: 0.49, 1.19) change in MAP levels, respectively. Each IQR increase in PA score was associated with -0.56 mmHg (95%CI: -1.03, -0.09) change in SBP, -0.32 mmHg (95%CI: -0.59, -0.05) change in DBP, and -0.33 mmHg (95%CI: -0.64, -0.02) change in MAP levels, respectively. Subgroup analysis found that the estimated effects in the sufficient PA group were lower than that in the insufficient PA group., Conclusion: Long-term exposure to air pollutants is associated with increased blood pressure and hypertension risk, while high-level PA is associated with decreased blood pressure and hypertension risk. Strengthening PA might attenuate the adverse effects of air pollution on blood pressure and hypertension risk., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Zhang, Zhang, Xin, Duan, Wei, Zhang, Han and Niu.)

Background: With China's rapidly aging population, chronic pain has become a major public health issue. This article aims at determining associations between chronic pain and multiple factors, including demographic characteristics, health status, and health service utilization of middle-aged and older adults in China., Methods: We selected all the 19,829 respondents who were over 45 years old from the China Health and Aging Tracking Survey 2018 (CHARLS) as our study population. The key information in terms of the body pain, demographic characteristics, health status, behaviors and health services use was extracted and analyzed. Logistic regression model was used to determine the influencing factors of chronic pain., Results: Analysis revealed that 60.02% (9,257) of the data from this survey reported physical pain, with pain sites concentrated at the head (40.9%), lower back (62.2%) and knees (47.2%). Pain was positively associated with influencing factors for pain: being a female (OR = 2.10, 95% CI 1.90-2.33, p < 0.001), living in a western region (OR = 1.28, 95% CI 1.16-1.41, p < 0.001), living in a rural area (OR = 1.14, 95% CI 1.06-1.23, p < 0.001), smoked (OR = 1.26, 95% CI 1.14-1.38, p < 0.001), drank alcohol (OR = 1.16, 95% CI 1.06-1.26, p = 0.001), and had poor self-rated health (OR = 6.84, 95% CI 5.41-8.65, p < 0.001), had hearing problems (OR = 1.23, 95% CI 1.11-3.37, p < 0.001), were depressed (OR = 1.56, 95% CI 1.03-1.29, p < 0.001), had arthritis (OR = 2.21, 95% CI 2.02-2.41, p < 0.001), stomach disorders (OR = 1.69, 95% CI 1.55-1.85, p < 0.001), visited a Western medicine hospital (OR = 1.28, 95% CI 1.10-1.50, p = 0.002), and visits to other medical institutions (OR = 1.42, 95%CI 1.22-1.64, p < 0.001). On the other side, as a protective factor for pain, having nighttime sleep ≥7 h (OR = 0.74, 95%CI 0.68-0.80, p < 0.001) was negatively associated with pain., Conclusion: Physical pain affects many older adults. Women, regional, rural residents, smokers, alcohol drinkers, people with poor self-rated health, those having <7 h of sleep at night, those with hearing problems, depression, arthritis, stomach disorders, and people who visits Western hospitals or other medical institutions are at greater risk for pain and deserve the attention of health care providers and policy makers to focus on pain prevention and management in middle-aged and older adults. Future research studies should also focus on the impact of health literacy on pain prevention and management outcomes., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Ai, Tang, Peng, Wen and Tang.)

Aims: Urbanization plays an important role in individuals' health. However, it is difficult to isolate healthy migrant effect between urbanization and health. This study examined the effects of urbanization on depressive symptoms and its possible pathways among Chinese middle-aged and older adults independent of the influence of health-selective migration., Methods: Using the baseline survey of the China Health and Retirement Longitudinal Study, this study compared the depressive symptoms among three groups (urbanized rural residents, rural non-migrants and urban non-migrants). The 10-item Center for Epidemiologic Studies Depression Scale (CESD-10) short form was used to measure depressive symptoms. Logistic regression models and Structural Equation Model (SEM) were applied to examine the association between urbanization and depressive symptoms and the corresponding potential mechanisms., Results: Our final sample contained 11,156 respondents with an average age of 58.91 (SD = 9.48), with 5,142 males (46.09%) and 6,014 females (53.91%). Compared with urbanized rural residents, rural residents were more likely to have depressive symptoms (OR = 1.19, 95% CI = 1.07, 1.32), and urban residents were associated with a decreased risk of depressive symptoms (OR = 0.81, 95% CI: 0.70, 0.94). A large proportion of the association between urbanization and depressive symptoms were mainly mediated by social participation, income and living conditions., Conclusions: Planned urbanization had an independent impact on decreased depressive symptoms. Improvements in social participation, income and living conditions are the main drivers behind this relationship. Additionally, urbanization compensates for the negative impact of depressive symptoms from disadvantaged early life conditions, but it cannot eliminate the gap between urbanized rural people and urban non-migrants., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Hong, Xiong, Li, Ning, Qi, Yang, Liu and Luo.)

Background: Lifestyle factors may could help maintain cognitive function and reduce the risk of dementia. The application of the Health Belief Model (HBM) has been verified by incorporating lifestyle changes for dementia risk reduction; however, the influence of health beliefs on cognitive aging through lifestyle remains unknown. To facilitate research-based interventions to promote successful cognitive aging, we explored the relationship between health beliefs, lifestyle, and cognitive aging based on the HBM using path analysis., Methods: This cross-sectional study recruited middle-aged and older community residents from a community health service center in Chongqing, China, through convenience sampling. Motivation to Change Lifestyle and Health Behaviors for Dementia Risk Reduction (MCLHB-DRR), Lifestyle for Dementia Risk Reduction (LDRR), and the Montreal Cognitive Assessment (MoCA) were employed to measure participants' beliefs, lifestyle, and cognitive function, respectively. The associations between the beliefs, lifestyle, and cognitive function were analyzed, and a structural equation model was constructed., Results: A total of 202 participants completed the questionnaires, of whom only 17 (8.4%) were classified as having successful cognitive aging. The model demonstrated the data to have an acceptable fit and elucidated 39.3 and 18.2% of the variance in lifestyle and the grade of cognitive aging, respectively. Positive and negative beliefs had opposite effects on the grade of cognitive aging through lifestyle. Cues to action had opposite effects on the grades of cognitive aging through positive and negative beliefs; however, the total effects canceled each other out., Conclusions: Positive beliefs have a positive effect on lifestyle, thereby promoting successful cognitive aging, whereas negative beliefs have a negative effect on lifestyle, thereby hindering successful cognitive aging. Health education and media publicity, as specific aspects of cues to action, can have a meaningful impact on healthy behavior and successful cognitive aging by promoting positive beliefs and controlling negative beliefs. The model suggests the strengthening and weakening of the positive and negative beliefs, respectively, of middle-aged and older community residents in the formulation of relevant public health strategies in the future, thereby enabling them to adapt to a healthy lifestyle promoting successful cognitive aging., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Zhang, Liu, Gong, Peng, Li and Yang.)

Objectives: This study examined the mutual effects of social participation and depressive symptoms in middle-aged and older Chinese adults from offline and online perspectives. Reciprocal relationships between depressive symptoms and the four subtypes of offline participation were also examined., Methods: Based on China Health and Retirement Longitudinal Study data (CHARLS), this study conducted ID matching for three waves of data from 2013, 2015, and 2018. One thousand nine hundred ninety-nine samples for individuals over 50 were obtained. A series of cross-lagged analyses were conducted to examine the mutual influence of social participation and depressive symptoms. Depressive symptoms were assessed using the short version of the Center for Epidemiologic Studies Depression Scale (CESD-10). The social participation questionnaire included nine items referring to offline participation (eight items) and online participation (one item). Several demographic variables were adjusted when conducting the cross-lagged analyses., Results: Social and offline participation had significant two-way associations with depressive symptoms. Depressive symptoms had greater impacts on social and offline participation than in the opposite direction. Online participation has a significant one-way impact on depressive symptoms. The relationship between specific types of offline participation and depressive symptoms varied in existence and direction., Discussion: Overall, there was significant bidirectional causality between social participation and depressive symptoms. Social participation, both offline and online, played a positive role in alleviating depressive symptoms. Depressive symptoms also affected the level of social participation to some extent among middle-aged and older Chinese adults over time., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Ding, Chen and Zhang.)

Prior research has shown that environmental hazards, such as limited green space, air pollution, and harmful weather, have the strong adverse impact on older adults' cognitive function; however, most of the studies were conducted in developed countries and limited to cross-sectional analyses. China has the largest aging population in the world so the research evidence from it can offer an insight to the study in other developing countries facing similar issues and inform future public health policy and disease control. This study examined the long-term impact of environmental factors, namely, green space coverage, air pollution, and weather conditions on cognitive function using a nationally representative sample consisting of adults aged 45 years and older selected from the China Health and Retirement Longitudinal Study (CHARLS 2011-2018), the China City Statistical Yearbook, and other sources. Multilevel growth curve models were utilized for analysis and the mediator effects of physical activity and social engagement on the relationship between environmental factors and cognitive function were examined. Findings of this study showed that after controlling for sociodemographic characteristics, annual precipitation of 80 cm or more, living in areas with July temperature of 28°C or higher, urban community, and green space coverage were positively associated with cognition score at the baseline and lower precipitation, urban community, and greater green space coverage were associated with slower cognitive decline over a 7-year period. The impact of gross domestic product (GDP) seemed to take into effect more and more over time. These effects did not substantially change after weekly total hours of physical activities and levels of social engagement were added. More research on the mechanisms of the effect of environmental factors on cognition is needed such as the subgroup analyses and/or with more aspects of environmental measures., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Zhang, Luo, Zhang, Pan, Zhao and Wang.)