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Li Z, Ding Z, Zhao P. Comparison of functional disabilities, place of death and end-of-life medical expenditures among centenarians and non-centenarians in China: a series of cross-sectional studies. BMC Geriatr 2023; 23:402. [PMID: 37391725 PMCID: PMC10311848 DOI: 10.1186/s12877-023-04111-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 06/15/2023] [Indexed: 07/02/2023] Open
Abstract
BACKGROUND Long-term and end-of-life (EOL) care for older adults has become a global concern due to extended longevity, which is generally accompanied by increased rates of disability. However, differences in the rates of disability in activities of daily living (ADLs), place of death and medical expenditures during the last year of life between centenarians and non-centenarians in China remain unknown. This study aims to fill this research gap to inform policy efforts for the capacity-building of long-term and EOL care for the oldest-old, especially for centenarians in China. METHODS Data from 20,228 decedents were derived from the 1998-2018 Chinese Longitudinal Healthy Longevity Survey. Weighted logistic and Tobit regression models were used to estimate differences in the prevalence of functional disability, rate of death in hospitals and EOL medical expenditures by age groups among oldest-old individuals. RESULTS Of the 20,228 samples, 12,537 oldest-old individuals were female (weighted, 58.6%, hereafter); 3,767 were octogenarians, 8,260 were nonagenarians, and 8,201 were centenarians. After controlling for other covariates, nonagenarians and centenarians experienced a greater prevalence of full dependence (average marginal differences [95% CI]: 2.7% [0%, 5.3%]; 3.8% [0.3%, 7.9%]) and partial dependence (6.9% [3.4%, 10.3%]; 15.1% [10.5%, 19.8%]) but a smaller prevalence of partial independence (-8.9% [-11.6%, -6.2%]; -16.0% [-19.1%, -12.8%]) in ADLs than octogenarians. Nonagenarians and centenarians were less likely to die in hospitals (-3.0% [-4.7%, -1.2%]; -4.3% [-6.3%, -2.2%]). Additionally, nonagenarians and centenarians reported more medical expenditures during the last year of life than octogenarians with no statistically significant differences. CONCLUSION The oldest-old experienced an increased prevalence of full and partial dependence in ADLs with increasing age and reported a decline in the prevalence of full independence. Compared with octogenarians, nonagenarians and centenarians were less likely to die in hospitals. Therefore, future policy efforts are warranted to optimise the service provision of long-term and EOL care by age patterns for the oldest-old population in China.
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Affiliation(s)
- Zhong Li
- School of Health Policy and Management, Nanjing Medical University, Nanjing, Jiangsu China
| | - Ziqin Ding
- The First School of Clinical Medicine, Nanjing Medical University, Nanjing, Jiangsu China
| | - Panpan Zhao
- The First Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu China
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2
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Li X, Gao M, Chu M, Huang S, Fang Z, Chen T, Lee CY, Chiang YC. Promoting the well-being of rural elderly people for longevity among different birth generations: A healthy lifestyle perspective. Front Public Health 2023; 11:1050789. [PMID: 36908453 PMCID: PMC9995922 DOI: 10.3389/fpubh.2023.1050789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 02/02/2023] [Indexed: 02/25/2023] Open
Abstract
Background Wellbeing may have a protective role in health maintenance. However, no specific study clarified the particular protective effect of the subjective wellbeing of rural elderly people on survival probability. Few studies have examined the effect of the lifestyle of rural elderly people on their subjective wellbeing from different perspectives. We investigated whether improving subjective wellbeing increased the probability of longevity of rural elderly people and the effects of lifestyle behaviors on the subjective wellbeing of rural elderly people in different birth generations. Materials and methods Data were derived from the China Health and Nutrition Survey (CHNS), which is an ongoing open cohort study that adopts a multistage, random clustered sampling process. We used the data of elderly people who were aged 65 or over during 2006-2015 for analysis. The Kaplan-Meier method and log-rank test found that the survival probability of rural elderly people was significantly lower than urban elderly people. Based on a sample of rural elderly people, Cox regression and generalized estimating equations were performed as further analyses. Results A total of 892 rural elderly people aged 65 or over were included in the sample in 2006. High subjective wellbeing was a protective factor against death. The subjective wellbeing of rural elderly people born in the 1940s/1930s/1908-1920s birth generations first decreased then increased. For rural elderly people born in the 1940s, there were significant positive effects of a preference for eating vegetables and walking/Tai Chi on subjective wellbeing. For rural elderly people born in the 1930s, preferences for eating vegetables, reading, and watching TV all had significant positive effects on subjective wellbeing. Rural elderly people born in the 1908-1920s who preferred watching TV had more subjective wellbeing. Conclusion Improving subjective wellbeing extended the life span and reduced mortality risk in rural elderly people and may be achieved by the shaping of a healthy lifestyle, such as preferences for eating vegetables, walking/Tai Chi, and reading.
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Affiliation(s)
- Xian Li
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, China
| | - Min Gao
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, China
| | - Meijie Chu
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, China
| | - Shiling Huang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, China
| | - Zhiwei Fang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, China
| | - Tianmu Chen
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, China
| | - Chun-Yang Lee
- School of International Business, Xiamen University Tan Kah Kee College, Zhangzhou, China
| | - Yi-Chen Chiang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, China
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Trudel-Fitzgerald C, Chen R, Lee LO, Kubzansky LD. Are coping strategies and variability in their use associated with lifespan? J Psychosom Res 2022; 162:111035. [PMID: 36152346 PMCID: PMC10410682 DOI: 10.1016/j.jpsychores.2022.111035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 09/06/2022] [Accepted: 09/06/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Some stress-related coping strategies contribute to survival among medical populations, but it is unclear if they relate to longevity in the general population. While coping strategies are characterized as being adaptive or maladaptive, whether capacity to tailor their implementation to different contexts (i.e., flexibility of use) may influence lifespan is unknown. METHOD In 2004-2006, participants from the Midlife Development in the United States study completed a validated coping inventory including 6 strategies and provided information on sociodemographics, health status, and biobehavioral factors (N = 4398). Deaths were ascertained from death registries with follow-up until 2018. Accelerated failure time models estimated percent changes and 95% confidence intervals (CI) in predicted lifespan associated with use of individual coping strategies. As a proxy for flexibility, participants were also classified as having lower, moderate, or greater variability in strategies used, using a standard deviation-based algorithm. RESULTS After controlling for sociodemographics and health status, maladaptive strategies (e.g., per 1-SD increase in Denial = -5.50, 95%CI = -10.50, -0.21) but not adaptive strategies (e.g., Planning) were related to shorter lifespan. Greater versus moderate variability levels were related to a 15% shorter lifespan. Estimates were somewhat attenuated when further controlling for lifestyle factors. CONCLUSION Although most associations were of modest magnitude, use of some maladaptive coping strategies appeared related to shorter lifespan. Compared to moderate levels, greater coping variability levels were also clearly detrimental for lifespan. Although adaptive strategies were unrelated to longevity, future work should examine other favorable strategies (e.g., acceptance) and more direct measures of flexibility (e.g., experience sampling methods).
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Affiliation(s)
- Claudia Trudel-Fitzgerald
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, United States; Lee Kum Sheung Center for Health and Happiness, Harvard T.H. Chan School of Public Health, United States.
| | - Ruijia Chen
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, United States.
| | - Lewina O Lee
- National Center for Posttraumatic Stress Disorder, Veterans Affairs Boston Healthcare System, United States; Department of Psychiatry, Boston University School of Medicine, United States.
| | - Laura D Kubzansky
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, United States; Lee Kum Sheung Center for Health and Happiness, Harvard T.H. Chan School of Public Health, United States.
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Yu Y, Chotipanvithayakul R, Wichaidit W, Cai W. Effects of Character Strength-Based Intervention vs Group Counseling on Post-Traumatic Growth, Well-Being, and Depression Among University Students During the COVID-19 Pandemic in Guangdong, China: A Non-Inferiority Trial. Psychol Res Behav Manag 2022; 15:1517-1529. [PMID: 35734195 PMCID: PMC9208671 DOI: 10.2147/prbm.s359073] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 06/09/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose This study assessed the effects of character strengths-based invention (CSI) vs group counseling (GC) on mental health outcomes (ie, post-traumatic growth, well-being, and depression) among university students in Guangdong Province, China. Materials and Methods We conducted a randomized non-inferiority trial among 124 undergraduates at a medical university during the COVID-19 pandemic. We randomly allocated students to receive either CSI (n=62) or GC (n=62). A qualified psychologist delivered both activities on campus during two consecutive weekends with a total of 7.5 hours and also gave assignments to students during weekdays. We measured the outcomes at pre-intervention, post-intervention, and 1-month follow-up. We then analyzed data using descriptive statistics and a general linear mixed model. Results CSI and GC groups had similar baseline characteristics. Both CSI and GC experienced an increase in post-traumatic growth and well-being. The mean±SD scores for post-traumatic growth were significantly higher in CSI compared to GC groups (87.70±14.22 vs 78.15±20.72, respectively), whereas well-being scores were similar between CSI and GC (82.58±16.57 vs 83.68±15.59, respectively). Neither CSI nor GC experienced a reduction in depression scores. Conclusion CSI had non-inferior effects compared to GC with regards to improvement of post-traumatic growth and well-being during the COVID-19 pandemic. However, caveats regarding lack of blinding of investigator and limited generalizability should be considered in the interpretation of the study findings.
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Affiliation(s)
- Yulan Yu
- Department of Psychology/ Research Center for Quality of Life and Applied Psychology, Guangdong Medical University, Dongguan, People's Republic of China.,Department of Epidemiology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand
| | - Rassamee Chotipanvithayakul
- Department of Epidemiology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand.,Research Center for Child and Youth Development, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand
| | - Wit Wichaidit
- Department of Epidemiology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand
| | - Wei Cai
- Department of Psychology/ Research Center for Quality of Life and Applied Psychology, Guangdong Medical University, Dongguan, People's Republic of China
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Cheng A, Leung Y, Brodaty H. A systematic review of the associations, mediators and moderators of life satisfaction, positive affect and happiness in near-centenarians and centenarians. Aging Ment Health 2022; 26:651-666. [PMID: 33645362 DOI: 10.1080/13607863.2021.1891197] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Results from studies investigating life satisfaction, positive affect and happiness of near-centenarians (95+) and centenarians are inconsistent. This is the first systematic review to summarise the extant literature on the subjective well-being of this unique age group. METHOD Seven electronic databases (PubMed, MEDLINE, EMBASE, PsycINFO, CINAHL, Web of Science and the Cochrane database for systematic reviews) were systematically searched. Subjective well-being was defined as life satisfaction, positive affect and happiness. A narrative synthesis of relevant articles was undertaken. RESULTS Of 28 studies eligible for inclusion in this review, 20 predominantly examined life satisfaction, 11 positive affect and 4 happiness. Sex and other demographic variables were not significant predictors of subjective well-being. In contrast, greater perceived health was significantly associated with higher levels of life satisfaction and positive affect. Fatigue and visual impairment were significantly correlated with lower levels of life satisfaction and positive affect. However, there was considerable heterogeneity in the findings on physical, cognitive and social associations, mediators and moderators. CONCLUSION The large discrepancy of results in the literature may be explained by methodological differences between studies. Centenarian research needs a clearer definition of life satisfaction, positive affect and happiness as their operationalisation is inconsistent. An international consortium of centenarian studies could facilitate cross-cultural comparisons on subjective well-being. Future research should be directed towards interventions that promote subjective well-being in the oldest-old.
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Affiliation(s)
- Adrian Cheng
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, Australia.,Dementia Collaborative Research Centre, School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Yvonne Leung
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, Australia.,School of Psychology, University of Nottingham Malaysia, Semenyih, Malaysia
| | - Henry Brodaty
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, Australia.,Dementia Collaborative Research Centre, School of Psychiatry, University of New South Wales, Sydney, Australia
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Holder M. The Contribution of Food Consumption to Well-Being. ANNALS OF NUTRITION AND METABOLISM 2019; 74 Suppl 2:44-52. [DOI: 10.1159/000499147] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The newly emerging field of positive psychology focuses on the positive facets of life, including happiness, life satisfaction, personal strengths, and flourishing. Research in this field has empirically identified many important benefits of enhanced well-being, including improvements in blood pressure, immune competence, longevity, career success, and satisfaction with personal relationships. Recognizing these benefits has motivated researchers to identify the correlates and causes of well-being to inform them in the development and testing of strategies and interventions to elevate well-being. As positive psychology researchers throughout the world have turned their attention toward facets of food intake, a consensus is developing that the consumption of healthy foods can enhance well-being in a dose-response fashion. The link between unhealthy foods and well-being is less clear. Some studies suggest that under certain conditions, fast food may increase happiness, though other studies demonstrate that fast food can indirectly undermine happiness. The positive impact of food consumption on well-being is not limited to what people consume but extends to how they consume it and social factors related to eating. Though the research suggests that our food intake, particularly fruits and vegetables, increases our well-being, this research is in its infancy. Research specifically focused on subpopulations, including infants and pregnant mothers, is mostly lacking, and the mechanisms that underlie the relationship between food consumption and well-being remain to be elucidated.
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Li YX, Jiang XY, Stone C, Ma YJ, Liu Q, Hu ZH, Li XD, Wang XF, Li SJ. A new physical-cognitive scale for assessment of frailty in Chinese Han elderly. Neurol Res 2019; 41:728-733. [PMID: 31030646 DOI: 10.1080/01616412.2019.1609164] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Objective: To develop a physical- cognitive scale for assessment of frailty and compare the clinical features between the new scale and the conventional Fried criteria. Methods: 1757 individuals aged 70-84 were analyzed. Participants reporting three or more Fried phenotypes were grouped as frail patients (FP) whereas others as non-frail (NF). A score of Hasegawa's dementia scale (HDS-R) higher than 21.5 were classified as non-cognitive impairment group (NCI) group. By combining the cognitive and frailty criteria, participants manifesting three or more positive components out of the six were categorized into the Physical-cognitive frailty group (Pc-F) while others into non- Pc-F (Pc-NF). Results: Of all the participants, 46.7% (820) were males and 53.3% (937) were females. The mean age was 75.33 ± 3.90. 10.1% (178/1757) were evaluated as FP patients. The prevalence of CI was 53.2%; CI was much higher in the frail group (77.0%) than in the non-frail group (50.5%). Based on the new Pc-F scale, 163 out of 1579 NF participants were identified as Pc-F, and the prevalence of Pc-F reached 19.4% (341/1757). In the Pc-F group, there are more females, patients of advanced age, diabetes, stroke, CHD, CKD, metabolic syndrome, and high hs-CRP. Within the Pc-F group, patients with CI showed a higher incidence of exhaustion, low activity, weakness, and slowness than those without CI. Conclusions: Our study revealed a significantly worse status in frail participants with CI than without. Our new scale shows a stronger correlation between frailty and complications than the classic phenotype.
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Affiliation(s)
- Yan-Xun Li
- a Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University , Beijing , China
| | - Xiao-Yan Jiang
- b Department of Pathology and Pathophysiology, Tongji University School of Medicine , Shanghai , China.,c Key Laboratory of Arrhythmia of the Ministry of Education of China, Tongji University School of Medicine , Shanghai , China
| | - Christopher Stone
- d Department of Neurological Surgery, Wayne State University School of Medicine , Detroit , MI , USA
| | - Ya-Jun Ma
- a Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University , Beijing , China
| | - Qian Liu
- a Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University , Beijing , China
| | - Zhi-Hao Hu
- a Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University , Beijing , China
| | - Xiao-Dong Li
- a Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University , Beijing , China
| | - Xiao-Feng Wang
- e Unit of Epidemiology, MOE Key Laboratory of Contemporary Anthropology, State Key Laboratory of Genetic Engineering School of Life Sciences, Institutes of Biomedical Sciences, Fudan University , Shanghai , China
| | - Shu-Juan Li
- a Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University , Beijing , China
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Wang Y, Ma T, Zhu YS, Chu XF, Yao S, Wang HF, Cai J, Wang XF, Jiang XY. The KSR2-rs7973260 Polymorphism is Associated with Metabolic Phenotypes, but Not Psychological Phenotypes, in Chinese Elders. Genet Test Mol Biomarkers 2017; 21:416-421. [PMID: 28537769 DOI: 10.1089/gtmb.2016.0402] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE To examine the associations between genetic variants of KSR2 (kinase suppressor of RAS)-rs7973260, RAPGEF6 (guanine nucleotide exchange factor 6)-rs3756290, LOC105377703-rs4481363, and subjective well-being (SWB) and depressive symptoms (DSs) in Chinese elders, which were recently associated in a genome-wide association study conducted in Caucasians. The pleiotropic effects of KSR2-rs7973260 on metabolic phenotypes were also explored. MATERIALS AND METHODS We used data from 1788 older individuals aged 70-84 years from the aging arm of the Rugao Longevity and Aging Study, a population-based cohort study conducted in the Jiangsu province of China. RESULTS No significant distributions of genotype frequencies were observed between life-satisfied and -unsatisfied groups across those with the three polymorphisms. The level of SWB components (positive affect, negative affect, and affect balance) and DSs did not differ among genotypes of the three variants. However, the presence of GA+AA of KSR2-rs7973260 was significantly higher in the metabolic syndrome (MetS), severe hypertriglyceridemia (HTG), and diabetes groups than in control groups (43.7% vs. 37.6%, 46.4% vs. 37.6%, 45.8% vs. 37.9%, respectively). The A allele of rs7973260 was associated with increased risk of MetS, severe HTG, and diabetes with an odds ratios (95% confidence intervals) of 1.289 (1.002-1.658), 1.438 (1.076-1.921), and 1.384 (1.022-1.875), which remained significant after multiple adjustments. CONCLUSION Rs7973260, rs3756290, and rs4481363 were not associated with SWB and DSs in Chinese elders. However, the KSR2-rs7973260 A allele exhibited pleiotropic effects on some metabolic phenotypes in Chinese elders. These effects should be validated in future studies.
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Affiliation(s)
- Yong Wang
- 1 Rugao People's Hospital , Rugao, China
| | - Teng Ma
- 2 Unit of Epidemiology, MOE Key Laboratory of Contemporary Anthropology, State Key Laboratory of Genetic Engineering School of Life Sciences, Institutes of Biomedical Sciences, Fudan University , Shanghai, China
| | | | | | - Shun Yao
- 2 Unit of Epidemiology, MOE Key Laboratory of Contemporary Anthropology, State Key Laboratory of Genetic Engineering School of Life Sciences, Institutes of Biomedical Sciences, Fudan University , Shanghai, China
| | - Hong-Fei Wang
- 3 Department of Vascular Surgery, Changhai Hospital, Second Military Medical University , Shanghai, China
| | - Jian Cai
- 4 Department of Neurology, First Affiliated Hospital, Xinjiang Medical University , Urumqi, China
| | - Xiao-Feng Wang
- 2 Unit of Epidemiology, MOE Key Laboratory of Contemporary Anthropology, State Key Laboratory of Genetic Engineering School of Life Sciences, Institutes of Biomedical Sciences, Fudan University , Shanghai, China
| | - Xiao-Yan Jiang
- 5 Key Laboratory of Arrhythmias of the Ministry of Education of China, Tongji University School of Medicine , Shanghai, China .,6 Department of Pathology and Pathophysiology, Tongji University School of Medicine , Shanghai, China .,7 Institute of Medical Genetics, Tongji University , Shanghai, China
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Zhi TF, Sun XM, Li SJ, Wang QS, Cai J, Li LZ, Li YX, Xu MJ, Wang Y, Chu XF, Wang ZD, Jiang XY. Associations of sleep duration and sleep quality with life satisfaction in elderly Chinese: The mediating role of depression. Arch Gerontol Geriatr 2016; 65:211-7. [PMID: 27100684 DOI: 10.1016/j.archger.2016.03.023] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 03/25/2016] [Accepted: 03/29/2016] [Indexed: 10/22/2022]
Abstract
This study investigated whether sleep duration and quality were related to life satisfaction (LS) among older Chinese adults and whether depression mediated those relationships. Cross-sectional data from the aging arm of the Rugao Longevity and Aging Study were used. Sleep duration, sleep quality, depression, LS and covariates were analyzed using logistic regressions. To assess the potential mediation of depression on the association between sleep duration and quality and LS, Aroian tests were used. Of 1756 older Chinese adults aged 70-84 years, 90.7% of the men and 83.3% of the women reported being satisfied with their lives. After adjusting for covariates, older adults who slept ≤6h per night were more likely to suffer from life dissatisfaction compared with those who slept 7-8h (OR=2.67, 95% CI 1.86-3.79), and individuals who slept poorly were almost 2 times (OR=2.91, 95% CI 2.16-3.91) more likely to have life dissatisfaction. The Aroian tests confirmed that these relationships were partially mediated by depression (p<0.001). Between short sleep and LS, the mediating effect of depression accounted for 13.9% of the total effects. Moreover, the mediating effect of depression on the association between sleep quality and LS was 13.3%. Short sleep duration and poor sleep quality were inversely associated with LS, and the relationships were partially mediated by depression. Our study suggests that both sleep and depression status are important factors for LS among the elderly.
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Affiliation(s)
- Ting-Fan Zhi
- Key Laboratory of Arrhythmias of the Ministry of Education of China, Tongji University School of Medicine, Shanghai 200092, China; Department of Pathology and Pathophysiology, Tongji University School of Medicine, Shanghai 200092, China
| | - Xun-Ming Sun
- Unit of epidemiology, State Key Laboratory of Genetic Engineering and MOE Key Laboratory of Contemporary Anthropology, School of Life Sciences and Institutes of Biomedical Sciences, Fudan University 200433 Shanghai, China
| | - Shu-Juan Li
- Department of Neurology, Beijing Chaoyang Hospital, Capital University of Medical Sciences, Beijing 100020, China
| | - Qun-Shan Wang
- Department of Cardiology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, 200092 Shanghai, China
| | - Jian Cai
- Department of Neurology, First Affiliated Hospital, Xinjiang Medical University, Urumqi 830011, China
| | - Lin-Zi Li
- Unit of epidemiology, State Key Laboratory of Genetic Engineering and MOE Key Laboratory of Contemporary Anthropology, School of Life Sciences and Institutes of Biomedical Sciences, Fudan University 200433 Shanghai, China
| | - Yan-Xun Li
- Unit of epidemiology, State Key Laboratory of Genetic Engineering and MOE Key Laboratory of Contemporary Anthropology, School of Life Sciences and Institutes of Biomedical Sciences, Fudan University 200433 Shanghai, China
| | - Min-Jie Xu
- Key Laboratory of Arrhythmias of the Ministry of Education of China, Tongji University School of Medicine, Shanghai 200092, China; Department of Pathology and Pathophysiology, Tongji University School of Medicine, Shanghai 200092, China
| | - Yong Wang
- Rugao People's Hospital, Rugao 226500 Jiangsu, China
| | - Xue-Feng Chu
- Rugao People's Hospital, Rugao 226500 Jiangsu, China
| | | | - Xiao-Yan Jiang
- Key Laboratory of Arrhythmias of the Ministry of Education of China, Tongji University School of Medicine, Shanghai 200092, China; Department of Pathology and Pathophysiology, Tongji University School of Medicine, Shanghai 200092, China.
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Liu Z, Huang J, Qian D, Chen F, Xu J, Li S, Jin L, Wang X. Does Low Body Mass Index Matter? Relationship between Body Mass Index and Subjective Well-Being among Long-Lived Women over 95 Years of Age. J Nutr Health Aging 2016; 20:99-105. [PMID: 26812504 DOI: 10.1007/s12603-015-0556-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVES To examine the relationship between body mass index (BMI) and subjective well-being (SWB) among long-lived women over 95 years of age and evaluate whether this relationship is mediated by functional ability. DESIGN Retrospective cohort study. SETTING Data from the Rugao longevity cohort, a population-based study in Rugao, China. PARTICIPANTS A sample of 342 long-lived women (mean age 97.4 ± 2.1, range 95-107) whose SWB and other covariates were available were included in this study. MEASUREMENTS BMI was calculated as weight in kilograms divided by height in meters-squared (kg/m(2)). SWB was measured by life satisfaction (LS), positive affect (PA), negative affect (NA) and affect balance (AB). Functional ability was assessed by the Katz Index of Activities of Daily Living (ADL). RESULTS According to BMI classification standards for China, the underweight group had lower levels of LS than the normal and overweight groups (28.62 vs. 30.51 and 31.57, respectively; p<.05). Correlation analysis showed that BMI was significantly related to LS (r = 0.166, p<.01). The strength of the BMI and LS association was diminished when ADL was included in the general linear regression models. Mediation analysis revealed that ADL mediated this relationship (effect size = 22.6%). We did not observe significant associations of BMI with other SWB components (PA, NA, and AB). CONCLUSION For long-lived women, low BMI, rather than elevated BMI, is an indicator of poor psychological well-being. The findings call for public health awareness about low body weight in long-lived women, especially in those with physical disabilities when focusing on quality of life.
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Affiliation(s)
- Z Liu
- Xiaofeng Wang, School of Life Sciences, Fudan University, 220 Handan Rd., Shanghai 200433, China. Tel+86 21 65643714; Fax: +86 21 65642426; E-mail address:
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Liu Z, Wu D, Huang J, Qian D, Chen F, Xu J, Li S, Jin L, Wang X. Visual impairment, but not hearing impairment, is independently associated with lower subjective well-being among individuals over 95 years of age: A population-based study. Arch Gerontol Geriatr 2015; 62:30-5. [PMID: 26553484 DOI: 10.1016/j.archger.2015.10.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 10/20/2015] [Accepted: 10/23/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND Sensory impairment affects an increasing number of elderly adults, with a negative psychological impact. Our objective was to examine the associations of visual and hearing impairment with subjective well-being (SWB), an important psychological concept defined by life satisfaction [LS], positive affect [PA], negative affect [NA], and affect balance [AB] among long-lived individuals (LLIs) over 95 years of age. METHODS Data on 442 LLIs from the Rugao longevity cohort, a population-based study in Rugao, China, were analyzed. Graded classifications of visual and hearing impairment (none, mild, moderate, and severe) were constructed from self-reported items. Bivariate correlation and multiple regression analysis were performed to test the associations. RESULTS Approximately 66.1% and 87.3% of the subjects reported varying degrees of visual and hearing impairment. Following the degree of vision impairment, LS, PA, and AB decreased linearly, whereas NA increased linearly (all p for trend<0.05). Vision was significantly related to LS (r=0.238, p<0.001), PA (r=0.142, p<0.01), NA (r=-0.157, p<0.001), and AB (r=0.206, p<0.001). After adjustment for multiple variables including functional ability, an important factor of SWB, the associations of vision impairment with LS, NA, and AB, while diminished, still existed. CONCLUSIONS Visual impairment, but not hearing impairment, was independently associated with low SWB among LLIs, and functional ability may play a mediating role in the observed relationship. The findings indicate that rehabilitation targeted for those with reduced vision and functioning in long-lived populations may be important for promoting well-being and quality of life.
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Affiliation(s)
- Zuyun Liu
- Unit of epidemiology, State Key Laboratory of Genetic Engineering and MOE Key Laboratory of Contemporary Anthropology, School of Life Sciences and Institutes of Biomedical Sciences, Fudan University, 200433 Shanghai, China
| | - Di Wu
- Unit of epidemiology, State Key Laboratory of Genetic Engineering and MOE Key Laboratory of Contemporary Anthropology, School of Life Sciences and Institutes of Biomedical Sciences, Fudan University, 200433 Shanghai, China; Dean's Office, Shanghai Jiao Tong University School of Medicine, 200025 Shanghai, China
| | - Jiapin Huang
- Unit of epidemiology, State Key Laboratory of Genetic Engineering and MOE Key Laboratory of Contemporary Anthropology, School of Life Sciences and Institutes of Biomedical Sciences, Fudan University, 200433 Shanghai, China
| | - Degui Qian
- Longevity Research Institute of Rugao, 226500 Jiangsu, China
| | - Fei Chen
- Longevity Research Institute of Rugao, 226500 Jiangsu, China
| | - Jun Xu
- Longevity Research Institute of Rugao, 226500 Jiangsu, China
| | - Shilin Li
- Unit of epidemiology, State Key Laboratory of Genetic Engineering and MOE Key Laboratory of Contemporary Anthropology, School of Life Sciences and Institutes of Biomedical Sciences, Fudan University, 200433 Shanghai, China
| | - Li Jin
- Unit of epidemiology, State Key Laboratory of Genetic Engineering and MOE Key Laboratory of Contemporary Anthropology, School of Life Sciences and Institutes of Biomedical Sciences, Fudan University, 200433 Shanghai, China
| | - Xiaofeng Wang
- Unit of epidemiology, State Key Laboratory of Genetic Engineering and MOE Key Laboratory of Contemporary Anthropology, School of Life Sciences and Institutes of Biomedical Sciences, Fudan University, 200433 Shanghai, China.
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Liu Z, Zhong G, Li S, Deng W, Zhang Y, Qian D, Jin L, Wang X. Use of serum albumin and activities of daily living to predict mortality in long-lived individuals over 95 years of age: a population-based study. AGE (DORDRECHT, NETHERLANDS) 2015; 37:9809. [PMID: 26178970 PMCID: PMC4503704 DOI: 10.1007/s11357-015-9809-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Accepted: 06/22/2015] [Indexed: 06/04/2023]
Abstract
Both activities of daily living (ADL) and some blood biomarkers (such as albumin) have been associated with mortality in very elderly people, but scarce data is available on the predictive performance of them in isolation or in combination, which is important for clinicians in decision making. Here, based on prospective mortality data over a 6-year follow-up period from 433 long-lived individuals (LLIs) aged 95+ years in the Rugao longevity cohort, we aimed to evaluate Cox proportional hazard ratios (HRs) and discriminative power (ROC curve) of 14 biomarkers and ADL for all-cause mortality. We found that six biomarkers (total triglyceride, albumin, low-density lipoprotein cholesterol, platelet count, lymphocyte count, and neutrophil count) were associated with mortality with a p < .10 in the univariate model. Significant associations of albumin and neutrophil count with mortality were observed when they were simultaneously included in a multivariate model, with HRs of 0.97 (95 % CI 0.94, 0.99; p = .005) and 1.09 (95 % CI 1.00, 1.18; p = .043). With respect to ADL, the corresponding HR was 1.10 (95 % CI 1.07, 1.14; p < .001). Low albumin (<40 g/L) combined with ADL dependent had a significantly increased mortality risk (HR = 2.19; 95 % CI 1.63, 2.95). Albumin and ADL separately showed good discriminative accuracies (area under the curve [AUC] = 0.68 and 0.66, respectively), and their combination had an increased predictive utility (AUC = 0.73). In conclusion, both albumin and ADL are efficient predictors of all-cause mortality in long-lived populations and their combination further increases discriminative power. The preliminary findings, if validated and translated, would help clinicians to identify the elderly people at varying mortality risk.
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Affiliation(s)
- Zuyun Liu
- />Unit of Epidemiology, State Key Laboratory of Genetic Engineering and MOE Key Laboratory of Contemporary Anthropology, School of Life Sciences and Institutes of Biomedical Sciences, Fudan University, 220 Handan Rd., Shanghai, 200433 China
| | - Guangzhen Zhong
- />Heart Center, Beijing Chaoyang Hospital, Institute of Cardiovascular Disease, Capital University of Medical Sciences, Beijing, 100020 China
| | - Shujuan Li
- />Heart Center, Beijing Chaoyang Hospital, Institute of Cardiovascular Disease, Capital University of Medical Sciences, Beijing, 100020 China
| | - Wan Deng
- />Unit of Epidemiology, State Key Laboratory of Genetic Engineering and MOE Key Laboratory of Contemporary Anthropology, School of Life Sciences and Institutes of Biomedical Sciences, Fudan University, 220 Handan Rd., Shanghai, 200433 China
| | - Yuechan Zhang
- />Unit of Epidemiology, State Key Laboratory of Genetic Engineering and MOE Key Laboratory of Contemporary Anthropology, School of Life Sciences and Institutes of Biomedical Sciences, Fudan University, 220 Handan Rd., Shanghai, 200433 China
| | - Degui Qian
- />Longevity Research Institute of Rugao, Rugao, Jiangsu 226500 China
| | - Li Jin
- />Unit of Epidemiology, State Key Laboratory of Genetic Engineering and MOE Key Laboratory of Contemporary Anthropology, School of Life Sciences and Institutes of Biomedical Sciences, Fudan University, 220 Handan Rd., Shanghai, 200433 China
| | - Xiaofeng Wang
- />Unit of Epidemiology, State Key Laboratory of Genetic Engineering and MOE Key Laboratory of Contemporary Anthropology, School of Life Sciences and Institutes of Biomedical Sciences, Fudan University, 220 Handan Rd., Shanghai, 200433 China
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13
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Liu Z, Wang Y, Zhang Y, Chu X, Wang Z, Qian D, Chen F, Xu J, Li S, Jin L, Wang X. Cohort Profile: The Rugao Longevity and Ageing Study (RuLAS). Int J Epidemiol 2015; 45:1064-1073. [PMID: 26066327 DOI: 10.1093/ije/dyv101] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Zuyun Liu
- State Key Laboratory of Genetic Engineering and MOE Key Laboratory of Contemporary Anthropology, School of Life Sciences and Institutes of Biomedical Sciences, Fudan University 200433, Shanghai, China
| | - Yong Wang
- Rugao People's Hospital, Rugao 226500, Jiangsu, China and
| | - Yuechan Zhang
- State Key Laboratory of Genetic Engineering and MOE Key Laboratory of Contemporary Anthropology, School of Life Sciences and Institutes of Biomedical Sciences, Fudan University 200433, Shanghai, China
| | - Xuefeng Chu
- Rugao People's Hospital, Rugao 226500, Jiangsu, China and
| | - Zhengdong Wang
- Rugao People's Hospital, Rugao 226500, Jiangsu, China and
| | - Degui Qian
- Longevity Research Institute of Rugao 226500, Jiangsu, China
| | - Fei Chen
- Longevity Research Institute of Rugao 226500, Jiangsu, China
| | - Jun Xu
- Longevity Research Institute of Rugao 226500, Jiangsu, China
| | - Shilin Li
- State Key Laboratory of Genetic Engineering and MOE Key Laboratory of Contemporary Anthropology, School of Life Sciences and Institutes of Biomedical Sciences, Fudan University 200433, Shanghai, China
| | - Li Jin
- State Key Laboratory of Genetic Engineering and MOE Key Laboratory of Contemporary Anthropology, School of Life Sciences and Institutes of Biomedical Sciences, Fudan University 200433, Shanghai, China
| | - Xiaofeng Wang
- State Key Laboratory of Genetic Engineering and MOE Key Laboratory of Contemporary Anthropology, School of Life Sciences and Institutes of Biomedical Sciences, Fudan University 200433, Shanghai, China,
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14
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Liu Z, Wang Y, Huang J, Chu X, Qian D, Wang Z, Sun X, Chen F, Xu J, Li S, Jin L, Wang X. Blood biomarkers and functional disability among extremely longevous individuals: a population-based study. J Gerontol A Biol Sci Med Sci 2014; 70:623-7. [PMID: 25512568 DOI: 10.1093/gerona/glu229] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Accepted: 11/12/2014] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Several blood biomarkers have been linked to functional disability, a health problem in general populations. However, there are limited data for evaluating the potential association of biomarkers with functional disability in an extremely longevous (95+) population. METHODS We used data from 420 extremely longevous individuals from the Rugao longevity cohort, a population-based association study conducted in Rugao, a longevity town in China. Functional disability was assessed by the Katz Index of Independence in activities of daily living. Blood biomarkers, including serum lipid, lipoprotein cholesterol, serum albumin, and lymphocyte count, were correlated with activities of daily living. RESULTS Among extremely longevous women, following the degree of functional disability, serum albumin and lymphocyte count decreased significantly (all p for trend < .001). In a univariate model, serum albumin (β = -0.279, p < .001), lymphocyte count (β = -0.187, p < .001), and neutrophil count (β = 0.140, p = .012) were found to be significantly associated with activities of daily living in women. After adjustment for other covariates, the significance remained. Notably, multivariate regression analysis revealed independent effects of all the three biomarkers on activities of daily living (β = -0.242, -0.185, and 0.143, all p < .05). We did not observe any association in men. CONCLUSIONS We found significant associations between serum albumin, lymphocyte count, and neutrophil count and physical disability even after adjustment for potential confounders in extremely longevous women, which call for further study. The findings provide preliminary but crucial clues for future studies specifically aimed at exploring the longitudinal relationships of interest before proceeding with interventions.
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Affiliation(s)
- Zuyun Liu
- Unit of Epidemiology, State Key Laboratory of Genetic Engineering and MOE Key Laboratory of Contemporary Anthropology, School of Life Sciences and Institutes of Biomedical Sciences, Fudan University, Shanghai, China
| | - Yong Wang
- Rugao People's Hospital, Jiangsu, China
| | - Jiapin Huang
- Unit of Epidemiology, State Key Laboratory of Genetic Engineering and MOE Key Laboratory of Contemporary Anthropology, School of Life Sciences and Institutes of Biomedical Sciences, Fudan University, Shanghai, China
| | | | - Degui Qian
- Longevity Research Institute of Rugao, Jiangsu, China
| | | | - Xunming Sun
- Unit of Epidemiology, State Key Laboratory of Genetic Engineering and MOE Key Laboratory of Contemporary Anthropology, School of Life Sciences and Institutes of Biomedical Sciences, Fudan University, Shanghai, China
| | - Fei Chen
- Longevity Research Institute of Rugao, Jiangsu, China
| | - Jun Xu
- Longevity Research Institute of Rugao, Jiangsu, China
| | - Shilin Li
- Unit of Epidemiology, State Key Laboratory of Genetic Engineering and MOE Key Laboratory of Contemporary Anthropology, School of Life Sciences and Institutes of Biomedical Sciences, Fudan University, Shanghai, China
| | - Li Jin
- Unit of Epidemiology, State Key Laboratory of Genetic Engineering and MOE Key Laboratory of Contemporary Anthropology, School of Life Sciences and Institutes of Biomedical Sciences, Fudan University, Shanghai, China
| | - Xiaofeng Wang
- Unit of Epidemiology, State Key Laboratory of Genetic Engineering and MOE Key Laboratory of Contemporary Anthropology, School of Life Sciences and Institutes of Biomedical Sciences, Fudan University, Shanghai, China.
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15
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Liu Z, Huang J, Qian D, Chen F, Xu J, Li S, Jin L, Chu X, Wang X. Prevalence and related factors of chronic kidney disease (CKD) among long-lived individuals (LLI) over 95 years of age. Arch Gerontol Geriatr 2014; 60:354-8. [PMID: 25541470 DOI: 10.1016/j.archger.2014.12.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2014] [Revised: 11/24/2014] [Accepted: 12/02/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND CKD, a functional decline or break down of kidney, has been increasingly recognized as a public health problem and a predictor of poor outcomes (i.e., cardiovascular disease, dementia) and mortality among general populations. However, little is known regarding the prevalence and related factors of CKD among Chinese LLI over 95 years of age. METHODS We used data of LLI from the Rugao longevity cohort, a population-based association study conducted in Rugao, a longevity town of China. CKD was defined as an estimated glomerular filtration rate (eGFR) of <60 mL/min/1.73 m2. Demographic exposures and biochemical markers were correlated with CKD. RESULTS The prevalence of CKD among LLI in Rugao is 23.8%. Traditional risk factors for CKD among general population, such as hypertension, diabetes, and dyslipidemia, did not have associations with CKD. However, overweight, central adiposity, and hyperuricemia were associated with increased risk of CKD, with crude odds ratios of 2.41 (95% CI=1.23-4.69), 2.61 (95% CI=1.42-4.77), and 5.69 (95% CI=2.75-11.76), respectively. In addition, higher magnesium and filtration marker β2 microglobulin (β2M) were associated with CKD, with crude odds ratios of 2.47 (95% CI=1.38-4.43) and 16.38 (95% CI=6.76-39.64), respectively. CONCLUSIONS We observe a high prevalence and unique related factors of CKD among the LLI in Rugao, which suggest that early screening and risk intervention of CKD are imperative to maintain a high quality of life and postpone the occurrence of poor outcomes.
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Affiliation(s)
- Zuyun Liu
- Unit of Epidemiology, State Key Laboratory of Genetic Engineering and MOE Key Laboratory of Contemporary Anthropology, School of Life Sciences and Institutes of Biomedical Sciences, Fudan University, 200433 Shanghai, China
| | - Jiapin Huang
- Unit of Epidemiology, State Key Laboratory of Genetic Engineering and MOE Key Laboratory of Contemporary Anthropology, School of Life Sciences and Institutes of Biomedical Sciences, Fudan University, 200433 Shanghai, China
| | - Degui Qian
- Longevity Research Institute of Rugao, 226500 Jiangsu, China
| | - Fei Chen
- Longevity Research Institute of Rugao, 226500 Jiangsu, China
| | - Jun Xu
- Longevity Research Institute of Rugao, 226500 Jiangsu, China
| | - Shilin Li
- Unit of Epidemiology, State Key Laboratory of Genetic Engineering and MOE Key Laboratory of Contemporary Anthropology, School of Life Sciences and Institutes of Biomedical Sciences, Fudan University, 200433 Shanghai, China
| | - Li Jin
- Unit of Epidemiology, State Key Laboratory of Genetic Engineering and MOE Key Laboratory of Contemporary Anthropology, School of Life Sciences and Institutes of Biomedical Sciences, Fudan University, 200433 Shanghai, China
| | - Xuefeng Chu
- Longevity Research Institute of Rugao, 226500 Jiangsu, China; Rugao People's Hospital, Rugao 226500, Jiangsu, China.
| | - Xiaofeng Wang
- Unit of Epidemiology, State Key Laboratory of Genetic Engineering and MOE Key Laboratory of Contemporary Anthropology, School of Life Sciences and Institutes of Biomedical Sciences, Fudan University, 200433 Shanghai, China.
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