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Author(s): Li Chen 1, Yi Xing 1, Yi Zhang 1, Junqing Xie 2, Binbin Su 3, Jianuo Jiang 1, Mengjie Geng 4, Xiang Ren 4, Tongjun Guo 1, Wen Yuan [...], Background An accelerated epidemiological transition, spurred by economic development and urbanization, has led to a rapid transformation of the disease spectrum. However, this transition has resulted in a divergent change in the burden of infectious diseases between urban and rural areas. The objective of our study was to evaluate the long-term urban-rural disparities in infectious diseases among children, adolescents, and youths in China, while also examining the specific diseases driving these disparities. Methods and findings This observational study examined data on 43 notifiable infectious diseases from 8,442,956 cases from individuals aged 4 to 24 years, with 4,487,043 cases in urban areas and 3,955,913 in rural areas. The data from 2013 to 2021 were obtained from China&apos;s Notifiable Infectious Disease Surveillance System. The 43 infectious diseases were categorized into 7 categories: vaccine-preventable, bacterial, gastrointestinal and enterovirus, sexually transmitted and bloodborne, vectorborne, zoonotic, and quarantinable diseases. The calculation of infectious disease incidence was stratified by urban and rural areas. We used the index of incidence rate ratio (IRR), calculated by dividing the urban incidence rate by the rural incidence rate for each disease category, to assess the urban-rural disparity. During the nine-year study period, most notifiable infectious diseases in both urban and rural areas exhibited either a decreased or stable pattern. However, a significant and progressively widening urban-rural disparity in notifiable infectious diseases was observed. Children, adolescents, and youths in urban areas experienced a higher average yearly incidence compared to their rural counterparts, with rates of 439 per 100,000 compared to 211 per 100,000, respectively (IRR: 2.078, 95% CI [2.075, 2.081]; p < 0.001). From 2013 to 2021, this disparity was primarily driven by higher incidences of pertussis (IRR: 1.782, 95% CI [1.705, 1.862]; p < 0.001) and seasonal influenza (IRR: 3.213, 95% CI [3.205, 3.220]; p < 0.001) among vaccine-preventable diseases, tuberculosis (IRR: 1.011, 95% CI [1.006, 1.015]; p < 0.001), and scarlet fever (IRR: 2.942, 95% CI [2.918, 2.966]; p < 0.001) among bacterial diseases, infectious diarrhea (IRR: 1.932, 95% CI [1.924, 1.939]; p < 0.001), and hand, foot, and mouth disease (IRR: 2.501, 95% CI [2.491, 2.510]; p < 0.001) among gastrointestinal and enterovirus diseases, dengue (IRR: 11.952, 95% CI [11.313, 12.628]; p < 0.001) among vectorborne diseases, and 4 sexually transmitted and bloodborne diseases (syphilis: IRR 1.743, 95% CI [1.731, 1.755], p < 0.001; gonorrhea: IRR 2.658, 95% CI [2.635, 2.682], p < 0.001; HIV/AIDS: IRR 2.269, 95% CI [2.239, 2.299], p < 0.001; hepatitis C: IRR 1.540, 95% CI [1.506, 1.575], p < 0.001), but was partially offset by lower incidences of most zoonotic and quarantinable diseases in urban areas (for example, brucellosis among zoonotic: IRR 0.516, 95% CI [0.498, 0.534], p < 0.001; hemorrhagic fever among quarantinable: IRR 0.930, 95% CI [0.881, 0.981], p = 0.008). Additionally, the overall urban-rural disparity was particularly pronounced in the middle (IRR: 1.704, 95% CI [1.699, 1.708]; p < 0.001) and northeastern regions (IRR: 1.713, 95% CI [1.700, 1.726]; p < 0.001) of China. A primary limitation of our study is that the incidence was calculated based on annual average population data without accounting for population mobility. Conclusions A significant urban-rural disparity in notifiable infectious diseases among children, adolescents, and youths was evident from our study. The burden in urban areas exceeded that in rural areas by more than 2-fold, and this gap appears to be widening, particularly influenced by tuberculosis, scarlet fever, infectious diarrhea, and typhus. These findings underscore the urgent need for interventions to mitigate infectious diseases and address the growing urban-rural disparity.

Background: The aim of this study was to explore the association between long-term exposure to particulate matter with an aerodynamic diameter <2.5 μm (PM2.5) and its components and severe obesity in children and adolescents. Methods: Data for children and adolescents aged 9–18 in this cross-sectional study were obtained from the 2019 Chinese National Survey on Students' Constitution and Health (CNSSCH). Data for PM2.5 and its components were obtained from the Tracking Air Pollution in China (TAP) dataset and matched with information on these children. Logistic regression models were used to assess the risk of severe obesity associated with long-term exposure to PM2.5 and its components. Results: A total of 160,205 children were included in the analysis. Long-term exposure to PM2.5 may increase the odds of severe childhood obesity, with this effect being more pronounced in girls. Among boys, the component with the most significant impact on severe obesity was organic matter (OM). The impact of PM2.5 and its components on severe obesity was greater in children from low economic and low parental education level households. Children with unhealthy lifestyle habits have higher odds of severe obesity due to long-term exposure to PM2.5 and its components. Conclusions: The findings of this research support the development of strategies aimed at addressing severe obesity in children, suggesting that adopting healthy lifestyle practices could mitigate the odds of severe obesity due to PM2.5 and its components. There is a need for an increased focus on children in economically underdeveloped areas and those with unhealthy lifestyle habits, particularly those in rural areas and those who do not engage in adequate physical activity or get enough sleep. [ABSTRACT FROM AUTHOR]

Background: This study aims to investigate the potential modifying effects of lifestyle behavior on the association between drinking water micronutrients and body mass index (BMI) in a large population of children and adolescents. Methods: Data of the present analysis came from a comprehensive regional large-scale surveillance study in 2022, involving 172,880 children and adolescents (50.71% boys vs. 49.29% girls) aged seven to seventeen. A restricted cubic spline (RCS) analysis was utilized to examine the exposure-response association of regular drinking water indices (including fluoride, nitrate nitrogen, pH, chloride, sulfates, and total dissolved solids (TDS), total hardness (TH), and chemical oxygen demand (COD)) with BMI. Generalized linear model and logistic regression were conducted to relate BMI and quartiles of drinking water micronutrients. Results: Our findings reveal a nonlinear association between nitrate nitrogen (P for nonlinear < 0.001) and pH (P for nonlinear < 0.001) with BMI. High TH and COD levels significantly increase BMI. Notably, fluoride and chloride were associated with BMI Z-scores but not with overweight and obesity (OB). The BMI Z-score showed a more pronounced association with low and high pH levels in girls. For urban participants, increased TH levels were associated with a higher risk of OB. This study also found that adopting healthy lifestyles could mitigate the negative effects of fluoride, chloride, and sulfate on BMI Z-scores. Conclusions: This large surveillance study provides new insights into the complex interplay between drinking water micronutrients and BMI in children and adolescents. The association of various drinking water parameters on BMI varies, necessitating ongoing focus on their effects, particularly among girls and urban individuals. Healthy lifestyle behavior could mitigate the effects of fluoride, chloride, and sulfate on BMI Z-score. [ABSTRACT FROM AUTHOR]

Summary: Background and Objectives: This study aimed to examine the associations between breastfeeding duration and metabolic syndrome (MetS) in adolescents and to further investigate the role of birth weight for gestational age (GA) on these associations. Methods: A total of 10 275 participants aged 7 to 18 years were included applying multistage cluster random sampling from a Chinese national survey. Birth weight was classified into small for GA (SGA), appropriate for GA (AGA) and large for GA (LGA). Information was collected through a self‐administered questionnaire, physical examination and blood biochemical examination. Multivariable linear regression, logistic regression models, restricted cubic spline models were applied to assess the relationships of breastfeeding duration and MetS with different birth weight for GA. Results: The prevalence of non‐breastfeeding, 0–5, 6–12 and >12 months groups were 16.2%, 23.1%, 42.5% and 18.2%, and the prevalence of SGA and LGA was 11.9% and 12.7%, respectively. Prolonged breastfeeding duration was associated with higher odds of MetS (β: 0.08, 95% CI: 0.03, 0.13), WC (β: 3.49, 95% CI: 2.82, 4.16) and SBP (β: 2.34, 95% CI: 1.80, 2.89). SGA and prolonged breastfeeding synergistically increased MetS risks, but LGA appeared to offset the adverse effects of prolonged breastfeeding. Conclusion: Prolonged breastfeeding may increase children's MetS risks. SGA synergies with prolonged breastfeeding increased MetS burden in children and adolescents, while LGA mitigated the risks. This reminds us that intensive attention should be paid to both early birth weight and subsequent living environment for children and adolescents' lifelong health. [ABSTRACT FROM AUTHOR]

To investigate the progress of disparities in human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS), gonorrhea, and syphilis among children and adolescents aged 6–22 years in China during 2013–2021. A total of 614 325 cases data were extracted from the Chinese Information System for Infectious Diseases Control and Prevention during 2013–2021. Puberty health education data were drew from the Student Health Surveillance in 2021. Disparity patterns and average annual percentage changes (AAPCs) in sexually transmitted infections (STIs) incidence or new cases in China were examined using descriptive statistics and joinpoint regression. The incidence across 345 cities was stratified by gross domestic product (GDP). Between 2013 and 2021, there were 614 325 reported cases of HIV/AIDS, gonorrhea, and syphilis among children and adolescents aged 6–22, with an annual average incidence of 24.0967 per 100 000. The expansion of HIV/AIDS has halted, yet the surge in gonorrhea and syphilis remains notably pronounced. The ratio of male to female AIDS incidence increased from 2.75 (2.60, 2.90) to 7.13 (6.68, 7.62), but that of syphilis changed from 0.33 (0.32, 0.34) to 0.56 (0.55, 0.57). Students and out‐of‐school individuals aged 13–15 experienced a notably high increase in STI cases, surpassing other age groups, with an average annual percentage increase of 29.2% and 26.3%, respectively. Nonstudents consistently had a higher incidence rate than students, with an IRR reaching 31.80 (31.24, 32.37) in 2021. A noticeable clustering pattern of new cases emerged in the southeastern region of the Heihe‐Tengchong line, extending inland from the coastal areas. Districts and counties with lower rates of puberty sexual health education tended to have higher average STI incidence rates. At the prefecture and city levels, there was a noticeable upward trend on average STI incidence rates in cities with per capita GDPs. Strategies to address those disparities include promoting equitable health education, and widespread sexual health education, particularly in areas with limited access to education and experiencing rapid economic development. The effectiveness of sexual health education intervention needs to be further evaluated in well‐designed studies. [ABSTRACT FROM AUTHOR]