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Nationwide longitudinal evidence linking cognitive decline with exposure to fine particulate matter (PM2.5) constituents remains scarce in China. By constructing a dynamic cohort based on the China Health and Retirement Longitudinal Study, we aimed to assess individual and joint associations of PM2.5constituents with cognitive function among middle-aged and older adults in China. Linear mixed-effects models incorporated with quantile-based g-computation were applied to investigate individual and joint associations of long-term exposures to PM2.5constituents with cognitive function. Among 13,507 respondents, we evaluated 38,950 follow-up records of cognitive function tests. Declines in global cognitive score associated with an interquartile range (IQR) increase in exposure were −1.477 (95% CI: −1.722, −1.232) for nitrate, followed by −1.331 (−1.529, −1.133) for ammonium, −1.033 (−1.184, −0.883) for sulfate, −0.988 (−1.144, −0.832) for organic matter and −0.822 (−0.946, −0.699) for black carbon. An IQR-equivalent increase in joint exposure to these PM2.5constituents was associated with a decline of −1.353 (−1.659, −1.048) in global cognitive score. Female, younger, and well-educated individuals were at greater vulnerability to cognitive impairment related to individual and joint exposure to PM2.5constituents. This study suggested that later-life exposures to PM2.5constituents were associated with cognitive decline in middle-aged and older adults in China.

Aim & methods:A decision-analytic model was constructed to simulate a real-world cohort of Chinese patients visiting a Chinese regional mental health center for long-term health outcomes and direct medical costs. Results:When compared with age and gender-matched general population, the Chinese patients with schizophrenia were associated with reduced overall survival by 20.6 years (27.6 vs 48.2 years) and reduced quality-adjusted life years (QALY) by 18.4 QALY (18.4 vs 36.8 QALY), respectively, and increased lifetime direct medical costs by about three-times (US$84,324 vs 33,387 as of 31 December 2017) on average. Conclusion:The burden of schizophrenia was mainly driven by the mortality associated with relapsed schizophrenia and direct medical costs for schizophrenia in local mental health rehabilitation institutes.