Aging tsunami coming: the main finding from China's seventh national population census

Independent and combined associations of handgrip strength and walking speed with cognitive function in older adults: evidence from a national cross-sectional study

OBJECTIVES

Although there have been studies on the association of handgrip strength or walking speed alone with cognitive abilities, few studies have determined the combined associations of handgrip strength and walking speed with cognitive function. Therefore we aimed to explore the independent and combined associations of handgrip strength and walking speed with cognitive function in Chinese older adults using a nationally representative sample.

METHOD

This cross-sectional study included 4,577 adults aged 60 and older. Handgrip strength was measured using a dynamometer and walking speed was assessed using a 2.5-meter walking test. Both handgrip strength and walking speed were organized into low, normal, and high tertiles according to the sample distribution. Cognitive function was measured using the Telephone Interview for Cognitive Status.

RESULTS

Handgrip strength and walking speed were significantly associated with cognitive function. Participants with low handgrip strength or low walking speed separately had a higher rate of lower cognitive function (adjusted odds ratio (OR): 1.22 (95% CI: 1.04 - 1.44) for low handgrip strength; 1.54 (95% CI: 1.31 - 1.81) for low walking speed). Those with both low handgrip strength and low walking speed had an additively higher rate of lower cognitive function (adjusted OR: 1.72 (95% CI: 1.32 - 2.24)).

CONCLUSION

Having low handgrip strength or low walking speed is associated with a greater likelihood of lower cognitive function and vice versa. The concurrence of having low handgrip strength and low walking speed has an additive effect on cognitive function in older adults.

Ethnic disparities and lifestyle determinants in the prevalence of cardiovascular disease among Han majority and Ha Ni ethnic minority older adults in rural Southwest China

OBJECTIVES

Cardiovascular disease (CVD) is the leading cause of death in China. This study compared ethnic disparities and lifestyle determinants in the prevalence of CVD (hypertension, coronary heart disease [CHD], and stroke) among older adults of the Han majority and Ha Ni ethnic minority in rural southwest China, to provide evidence for preventing and controlling CVD among older-adult minority communities.

METHODS

A multi-stage stratified random sampling method was used to select 1,413 Han majority participants and 1,402 Ha Ni ethnic minority participants aged ≥ 60 years in rural Southwest China. Data on general demographic characteristics, behavioral lifestyle, and self-reported diagnostic information for patients with CHD and stroke were collected using a standardized questionnaire. The height, weight, waist circumference, and blood pressure of each participant were recorded. The relationship between lifestyle factors and CVD was analyzed using multivariate logistic regression.

RESULTS

Han majority older adults had a higher prevalence of CHD (6.4% vs. 3.6%) and stroke (7.9% vs. 2.9%) than their Ha Ni minority counterparts (P < 0.01). Han majority participants had a markedly higher prevalence of obesity, central obesity, and physical inactivity than their Ha Ni ethnic minority counterparts (9.2%, 48.3%, and 55.1% vs. 3.4%, 19.1%, and 49.2%, respectively, P < 0.01). By contrast, Ha Ni ethnic minority participants had a higher prevalence of current drinking than Han majority participants (31.2% vs. 14.4%, P < 0.01). Among Han majority and Ha Ni ethnic minority older adults, participants with central obesity (OR = 2.09, 95% CI: 1.62-2.69 vs. OR = 2.66, 95% CI: 1.88-3.76) had a higher risk of hypertension, participants with obesity (OR = 1.99, 95% CI: 1.02-3.67 vs. OR = 3.66, 95% CI: 1.39-9.66) were more likely to suffer from CHD, and participants with physical inactivity (OR = 1.88, 95% CI: 1.18-2.98 vs. OR = 2.29, 95% CI: 1.13-4.64) had a higher probability of suffering from stroke. Furthermore, Current drinking status increased the risk of CHD (OR = 2.31, 95% CI: 1.05-5.08), but decreased the risk of stroke (OR = 0.33, 95% CI: 0.13-0.83) in Ha Ni ethnic minority participants.

CONCLUSION

CHD and stroke are more prevalent among the Han majority older adults in rural Southwest China, and lifestyle factors significantly influence CVD.

Heterogeneous subgroups of psychological, physical and social condition and their predictors in Chinese older patients with coronary heart disease after stent implantation

OBJECTIVES

To explore heterogeneous subgroups of the overall health condition in the older coronary heart disease patients with stent implantation and identify their predictors.

METHODS

A cross-sectional study was surveyed in Hunan, China. Participants completed the general information questionnaire and PROMIS Profile-57. Latent class analysis was performed, followed by analysis of variance, chi-square test, Fisher's exact test and multinomial logistic regression.

RESULTS

A total of 564 patients were investigated and three classes of health condition were identified. The heterogeneity was correlated with age, gender, residence, education background, occupation property before retirement, drinking situation, duration of CHD diagnosis, cardiac function class and duration after stent implantation. Additionally, all older adults who have undergone stenting reported poor physical function.

CONCLUSIONS

75 years or older, female, low level of education, serious cardiac dysfunction characterize the subgroup with the heaviest burden. Precise management should be performed for older adult patients with different health condition based on their predictors.

Advancements in Research on Mesenchymal Stem-Cell-Derived Exosomal miRNAs: A Pivotal Insight into Aging and Age-Related Diseases

Mesenchymal stem cells (MSCs) are capable of differentiating into various cell types and play a crucial role in repairing aging tissues and diseased organs. Aging manifests as a gradual loss of cellular, tissue, and organ function, leading to the progression of pathologies. Exosomes (Exos) are extracellular vesicles secreted by cells, which maintain cellular homeostasis, clear cellular debris, and facilitate communication between cells and organs. This review provides a comprehensive summary of the mechanisms for the synthesis and sorting of MSC-Exo miRNAs and summarizes the current research status of MSCs-Exos in mitigating aging and age-related diseases. It delves into the underlying molecular mechanisms, which encompass antioxidative stress, anti-inflammatory response, and the promotion of angiogenesis. Additionally, this review also discusses potential challenges in and future strategies for advancing MSC-Exo miRNA-based therapies in the treatment of aging and age-related diseases.

Relationship between anthropometric indicators and cognitive function in older women

The authors aimed to explore the association between anthropometric indicators and cognitive function and determine which aspects of anthropometric indicators are most closely related to cognitive function. A sum of 3269 older women were included in this study. Body mass index (BMI), waist circumference, hip circumference, calf circumference, and waist-to-hip ratio were obtained to reflect anthropometric indicators. Cognitive function was assessed using Mini-Mental State Examination (MMSE). Researchers revealed statistically significant differences in total MMSE scores among the low, medium, and high groups of BMI, waist circumference, hip circumference, and calf circumference. Researchers also observed that calf circumference, hip circumference, and waist circumference are significantly associated with the total MMSE score. Our findings highlighted that older women with greater BMI, waist circumference, hip circumference, and calf circumference have a better level of cognitive function. Calf circumference is the most closely anthropometric indicator related to cognitive function in Chinese older women.

Emotional design for pro-environmental life: Visual appeal and user interactivity influence sustainable consumption intention with moderating effect of positive emotion

As the public pursues sustainable consumption patterns, pro-environmental mobile applications are being developed to promote green lifestyles. Ant Forest has attracted a large number of users to participate due to its gamified interactive design. The objectives of this study are to understand the process by which visual appeal and user interactivity in pro-environmental mobile applications influence the user's sustainable consumption intention and to analyse the moderating effect of the user's positive emotion on this process. The researchers constructed a theoretical framework based on the Stimulus-Organism-Response (S-O-R) theory in this study and used the Partial Least Squares Structural Equation Modelling (PLS-SEM) for quantitative analysis with an online questionnaire survey of 586 Ant Forest users. Findings for this study include: 1) Visual appeal shows a large positive effect on the perceived usefulness of Ant Forest; 2) Ant Forest's perceived usefulness shows a significant positive effect on the user's sustainable consumption intention; 3) Ant Forest's perceived usefulness fully mediates the relationship between visual appeal and the user's sustainable consumption intention; 4) Positive emotion moderates the relationship between perceived usefulness and sustainable consumption intention. This study improves the application of the S-O-R theory in emotional design research, while emphasising the importance of optimising the visual appeal of design elements and guiding users' positive emotions in the development of pro-environmental mobile applications. The findings of this study highlight the importance of incorporating positive emotions into visual design for designers and developers of pro-environmental applications, further clarifying the focus of emotional design.

The Association Between Inflammatory Dietary Pattern and Risk of Cognitive Impairment Among Older Adults with Chronic Diseases and Its Multimorbidity: A Cross-Sectional Study

Background

The present study aimed to explore the association between the inflammatory potential of diet, assessed by energy-adjusted dietary inflammatory index (E-DII) and reduced rank regression (RRR)-derived inflammatory dietary pattern, and the risk for cognitive impairment (CI) in community-dwelling older adults, especially in older adults with chronic diseases and multimorbidity.

Methods

A total of 549 older adults from Taiyuan city were included in the present cross-sectional study. The Chinese Version of the Mini-Mental State Examination (CMMSE) was used for the evaluation of cognitive function. E-DII score was calculated based on semi-quantitative food frequency questionnaire (FFQ). Blood samples, including interleukin (IL)-1β, interleukin (IL)-18, tumor necrosis factor-α (TNF-α) and C-reactive protein (CRP), were tested for calculating RRR-derived inflammatory dietary pattern. Logistic regression was used to assess the association between inflammatory dietary pattern and risk of CI. In addition, patients with diabetes, hypertension, hyperlipidemia and multimorbidity were screened for further analysis among 549 older adults.

Results

In those 549 older adults, adjusting for demographic characteristics and chronic disease status, there was no association between E-DII score tertile (OR T3VST1 : 1.357, 95%CI:0.813~2.265, P trend = 0.267), RRR-derived inflammatory dietary pattern score tertile (OR T3VST1 : 1.092, 95%CI:0.679~ 1.758, P trend = 0.737) and risk of CI. However, in older adults with diabetes and multimorbidity, the score tertile of E-DII and RRR-derived inflammatory dietary pattern were positively correlated with risk of CI in a dose-responsive manner (All P trend < 0.05). There is insufficient evidence to reach similar conclusion in patients with hypertension and hyperlipidemia (All P trend > 0.05).

Conclusion

In the present study, pro-inflammatory diet contributed to the increased risk of CI in older adults with diabetes and multimorbidity. These results supplemented vital evidence for the prevention and treatment of CI in older adults with chronic diseases.

Linking personal initiative and family help as well as social support: a case study of learning challenges and solutions for older adults in rural China during the COVID-19 pandemic

Background

The sudden outbreak of the COVID-19 Pandemic has caused serious damage to the continuous learning of older adults around the world. While the existing literature focused more on older adults' learning in developed countries, few studies explored older adults' learning in developing countries with low social and cultural capital.

Methods

This study took family-school cooperation in China as the platform and explored learning challenges and solutions through unstructured interviews with 12 older adults.

Results

The study found that due to policies of working and studying from home, older adults face obstacles in accessing physical learning institutions and digital learning knowledge, skills, and psychology. I further found that the older adults were not forced to accept the challenge passively, but created a lifelong learning model with Chinese characteristics by building self-learning based on personal initiative, developing sustainable intergenerational learning rooted in Chinese family culture, and participating in online learning in schools and enterprises under the government guidance.

Conclusion

This study provided new knowledge for understanding the learning challenges and solutions of older adults in rural China. It is emphasized that policy value and practice enlightenment were highlighted and discussed in conversations with active aging, intergenerational learning, and harmonious societies.

Chewing ability and its associated factors among community-dwelling older adults in Chengdu, China: A cross-sectional study

AIM

To investigate the current status of chewing ability and analyze the risk factors among Chinese community-dwelling older adults.

METHODS

In this cross-sectional study, color-changeable gum and a color difference meter were used to assess chewing ability in the population. The statistical analysis employed multivariate logistic regression models to identify and quantify the factors influencing chewing ability.

RESULTS

A total of 373 community-dwelling adults aged 65 and older in Chengdu, in the west of China, were included in this study; 64 individuals (17.2%) exhibited signs of poor chewing ability. Female (odds ratio [OR]: 0.124, 95% CI: 0.057-0.268, p < .001), education level with college degree and above (OR: 0.114, 95% CI: 0.030-0.434, p = .001), number of teeth less than 20 (OR: 5.401, 95% CI: 2.509-11.626, p < .001), and decreased oral diadochokinesis (OR: 4.445, 95% CI: 1.775-11.132, p = .001) were significant factors in chewing ability in this study, after adjustment for potential variables.

CONCLUSIONS

The prevalence of decreased chewing ability among Chinese community-dwelling older adults was 17.2% and decreased chewing ability was associated with men, lower education level, less than 20 teeth and decreased oral diadochokinesis.

Effects of soy protein-rich meals on muscle health of older adults in long-term care: A randomized clinical trial

OBJECTIVE

This study investigated the effects of a soy protein-rich meal intervention on the muscle health of older adults in long-term care facilities.

METHODS

A 12-week single-center randomized controlled trial with a control-group and open-label design was conducted. Eighty-four older adults from a long-term care facility participated in the study. The chefs at the facility cooked three meals using soy protein-rich recipes designed by dieticians. For 12 weeks, the intervention group participants consumed three meals with 30 g of soy protein (10 g/meal) per day, and the control group participants maintained their habitual diets.

RESULTS

The 84 participants (mean age, 84.9 ± 7.0 years; 61.9% female) were randomly assigned to an intervention group (43 participants) and a control group (41 participants). The intervention group exhibited significant increases in several lean mass indicators, namely soft lean mass (mean, 1.43 kg; 95% confidence interval [CI]: 0.20-1.65 kg), skeletal muscle mass (mean, 1.20 kg; 95% CI: 0.43-1.96 kg), appendicular skeletal muscle mass (mean, 0.79 kg; 95% CI: 0.07-1.52 kg), and skeletal muscle index (mean, 0.37 kg/m2; 95% CI: 0.05-0.68 kg/m2) (all P < 0.05). These changes were not observed in the control group (all P > 0.05). Notably, calf circumference decreased significantly in the control group (mean, -0.98 cm; 95% CI: -1.61 to -0.36 cm) but was maintained in the intervention group. The differences in the calf circumference and 6-m walk performance of the two groups were significant (P < 0.05).

CONCLUSIONS

The 12-week soy protein-rich meal intervention improved the muscle mass and 6-m walk performance of older adults in a long-term care facility.

Dietary Polyphenols as Anti-Aging Agents: Targeting the Hallmarks of Aging

Background: Aging is a natural biological process influenced by multiple factors and is a significant contributor to various chronic diseases. Slowing down the aging process and extending health span have been pursuits of the scientific field. Methods: Examination of the effects of dietary polyphenols on hallmarks of aging such as genomic instability, telomere attrition, epigenetic alterations, loss of proteostasis, disabled macroautophagy, deregulated nutrient-sensing, mitochondrial dysfunction, cellular senescence, stem cell exhaustion, altered intercellular communication, chronic inflammation, and dysbiosis. Results: Polyphenols, abundant in nature, exhibit numerous biological activities, including antioxidant effects, free radical scavenging, neuroprotection, and anti-aging properties. These compounds are generally safe and effective in potentially slowing aging and preventing age-related disorders. Conclusions: The review encourages the development of novel therapeutic strategies using dietary polyphenols to create holistic anti-aging therapies and nutritional supplements.

Association of Tai Chi and Square Dance with Cognitive Function in Chinese Older Adults

OBJECTIVE

This study explores the association of Tai Chi and square dance with cognitive function and compares the effects of the two fitness programs on cognitive function in Chinese older adults.

METHODS

A total of 1732 older people (aged 60 years and over) met the inclusion criteria from the 2018 Chinese Longitudinal Healthy Longevity Survey. Based on the frequency of participating in Tai Chi and square dance, older adults were divided into three groups: a Tai Chi group (n = 234), a square dance group (n = 345), and a control group (n = 1153). Cognitive function was measured using a modified Mini-Mental State Examination (MMSE). Participation in Tai Chi or square dance was investigated by asking the subjects to report how often they participated in the fitness programs.

RESULTS

Older adults in both the Tai Chi group and the square dance group had higher scores in all MMSE items, including orientation, registration, attention and calculation, recall, and language, compared to those in the control group. But there were no significant differences in any MMSE items between the Tai Chi group and the square dance group. Multiple regression analysis showed that participating in Tai Chi or square dance, age, educational level, and sex can predict cognitive function in older people.

CONCLUSION

Our findings suggest that participating in Tai Chi and square dance are associated with better cognitive function, and Tai Chi and square dance have similar effects on cognitive function in the Chinese older population.

Quantitative assessment of rotator cuff injuries using synthetic MRI and IDEAL-IQ imaging techniques

Purpose

To evaluate synthetic magnetic resonance imaging (SyMRI) and iterative decomposition of water and fat with echo asymmetry and least squares estimation (IDEAL-IQ) imaging for a comprehensive evaluation of rotator cuff injuries (RCI).

Methods

Ninety-seven patients with RCI were classified into four groups based on the arthroscopic results: (grade II), partial tear (grade III), complete tear (grade IV), and controls (grade I). T1 (Transverse Relaxation Time 1), T2 (Transverse Relaxation Time 2), proton density (PD), and fat fraction (FF) were evaluated using SyMRI and IDEAL-IQ. Measurement reliability was assessed using intraclass correlation coefficients (ICC). The diagnostic potential for grading RCI was evaluated using ordinal regression and ROC analyses.

Results

A high measurement reliability (ICC > 0.7) was observed across subregions. T1 and T2 significantly varied across grades, particularly T2 in the lateral subregion between grades III and IV (P < 0.001) and the central subregion between grades II and III (P < 0.001). ROC analyses yielded valuable diagnostic accuracy, including T2 in the lateral subregion with an AUC of 0.891, distinguishing grade I from grade IV. Positive correlations were found between T2 values in specific shoulder subregions and injury grade (r = 0.615 for lateral, r = 0.542 for medial, both P < 0.001). In grade IV, FF was notably increased in the supraspinatus, infraspinatus, and subscapularis muscles compared with grades I-III. There were no significant FF variations in the teres minor muscle among grades.

Conclusions

Quantitative MRI parameters from SyMRI and IDEAL-IQ, especially T2 and FF, may classify and assess RCI severity. The results could help improve the accuracy of diagnosing different grades of RCI, offering clinicians additional tools for improving patient outcomes through personalized medicine.

Toward a Medication Information Literacy Indicator System for Older Adults: A Delphi Study

BACKGROUND

The safety of medication use among older adults is a growing concern, given the aging population. Despite widespread attention, the exploration of medication literacy in older adults, particularly from the perspective of information literacy, is in its nascent stages.

METHODS

This study utilized the existing literature to define medication information literacy (MIL) as a theoretical framework. A two-round Delphi survey was conducted to identify the essential components of a MIL indicator system for older adults. The analytic hierarchy process (AHP) was then used to assign weights to each indicator.

RESULTS

The study observed relatively high response rates in both rounds of the questionnaire, which, along with expert authority coefficients (Cr) of 0.86 and 0.89, underscores the credibility and expertise of the panellists. Additionally, Kendall's coefficient of concordance (Kendall's W) ranging from 0.157 to 0.33 (p < 0.05) indicates a consensus among experts on the identified indicators. Utilizing the Delphi process, a MIL indicator system for older adults was developed, comprising five primary and 23 secondary indicators. These indicators were weighted, with medication information cognition and acquisition emerging as pivotal factors in enhancing medication literacy among older adults.

CONCLUSIONS

This study developed a MIL indicator system tailored for older adults using the Delphi approach. The findings can inform healthcare professionals in providing customized medication guidance and assist policymakers in crafting policies to enhance medication safety among older adults.

PATIENT OR PUBLIC CONTRIBUTION

Patient and public engagement played a pivotal role in the development of our medication information literacy indicator system for older adults. Their involvement contributed to shaping research questions, facilitating study participation, and enriching evidence interpretation. Collaborations with experts in geriatric nursing, medicine, and public health, along with discussions with caregivers and individuals with lived experience, provided invaluable insights into medication management among older adults. Their input guided our research direction and ensured the relevance and comprehensiveness of our findings.

Development and Validation of a Community-Based Prediction Model for Depression in Elderly Patients with Diabetes: A Cross-Sectional Study

Background

In elderly diabetic patients, depression is often overlooked because professional evaluation requires psychiatrists, but such specialists are lacking in the community. Therefore, we aimed to create a simple depression screening model that allows earlier detection of depressive disorders in elderly diabetic patients by community health workers.

Methods

The prediction model was developed in a primary cohort that consisted of 210 patients with diabetes, and data were gathered from December 2022 to February 2023. The independent validation cohort included 99 consecutive patients from February 2023 to March 2023. Multivariable logistic regression analysis was used to develop the predictive model. We incorporated common demographic characteristics, diabetes-specific factors, family structure characteristics, the self-perceived burden scale (SPBS) score, and the family APGAR (adaptation, partnership, growth, affection, resolution) score. The performance of the nomogram was assessed with respect to its calibration (calibration curve, the Hosmer-Lemeshow test), discrimination (the area under the curve (AUC)), and clinical usefulness (Decision curve analysis (DCA)).

Results

The prediction nomogram incorporated 5 crucial factors such as glucose monitoring status, exercise status, monthly income, sleep disorder status, and the SPBS score. The model demonstrated strong discrimination in the primary cohort, with an AUC of 0.839 (95% CI, 0.781-0.897). This discriminative ability was further validated in the validation cohort, with an AUC of 0.857 (95% CI, 0.779-0.935). Moreover, the nomogram exhibited satisfactory calibration. DCA suggested that the prediction of depression in elderly patients with diabetes mellitus was of great clinical value.

Conclusion

The prediction model provides precise and user-friendly guidance for community health workers in preliminary screenings for depression among elderly patients with diabetes.

Personal exposure to airborne organic pollutants and lung function changes among healthy older adults

Epidemiological evidence on the impact of airborne organic pollutants on lung function among the elderly is limited, and their underlying biological mechanisms remain largely unexplored. Herein, a longitudinal panel study was conducted in Jinan, Shandong Province, China, involving 76 healthy older adults monitored over a span of five months repetitively. We systematically evaluated personal exposure to a diverse range of airborne organic pollutants using a wearable passive sampler and their effects on lung function. Participants' pulmonary function indicators were assessed, complemented by comprehensive multi-omics analyses of blood and urine samples. Leveraging the power of interaction analysis, causal inference test (CIT), and integrative pathway analysis (IPA), we explored intricate relationships between specific organic pollutants, biomolecules, and lung function deterioration, elucidating the biological mechanisms underpinning the adverse impacts of these pollutants. We observed that bis (2-chloro-1-methylethyl) ether (BCIE) was significantly associated with negative changes in the forced vital capacity (FVC), with glycerolipids mitigating this adverse effect. Additionally, 31 canonical pathways [e.g., high mobility group box 1 (HMGB1) signaling, phosphatidylinositol 3-kinase (PI3K)/AKT pathway, epithelial mesenchymal transition, and heme and nicotinamide adenine dinucleotide (NAD) biosynthesis] were identified as potential mechanisms. These findings may hold significant implications for developing effective strategies to prevent and mitigate respiratory health risks arising from exposure to such airborne pollutants. However, due to certain limitations of the study, our results should be interpreted with caution.

Notable dysthymia: evolving trends of major depressive disorders and dysthymia in China from 1990 to 2019, and projections until 2030

BACKGROUND

Depressive disorders have been identified as a significant contributor to non-fatal health loss in China. Among the various subtypes of depressive disorders, dysthymia is gaining attention due to its similarity in clinical severity and disability to major depressive disorders (MDD). However, national epidemiological data on the burden of disease and risk factors of MDD and dysthymia in China are scarce.

METHODS

This study aimed to evaluate and compare the incidence, prevalence, and disability-adjusted life-years (DALYs) caused by MDD and dysthymia in China between 1990 and 2019. The temporal trends of the depressive disorder burden were evaluated using the average annual percentage change. The comparative risk assessment framework was used to estimate the proportion of DALYs attributed to risk factors, and a Bayesian age-period-cohort model was applied to project the burden of depressive disorders.

RESULTS

From 1990 to 2019, the overall age-standardized estimates of dysthymia in China remained stable, while MDD showed a decreasing trend. Since 2006, the raw prevalence of dysthymia exceeded that of MDD for the first time, and increased alternately with MDD in recent years. Moreover, while the prevalence and burden of MDD decreased in younger age groups, it increased in the aged population. In contrast, the prevalence and burden of dysthymia remained stable across different ages. In females, 11.34% of the DALYs attributable to depressive disorders in 2019 in China were caused by intimate partner violence, which has increasingly become prominent among older women. From 2020 to 2030, the age-standardized incidence, prevalence, and DALYs of dysthymia in China are projected to remain stable, while MDD is expected to continue declining.

CONCLUSIONS

To reduce the burden of depressive disorders in China, more attention and targeted strategies are needed for dysthymia. It's also urgent to control potential risk factors like intimate partner violence and develop intervention strategies for older women. These efforts are crucial for improving mental health outcomes in China.

Prevalence rate of primary osteoporosis in China: a meta-analysis

BACKGROUND

Primary osteoporosis (POP) is recognized as a "silent disease" and often ignored. This meta-analysis aimed to determine the prevalence of POP in the Chinese population over the past 20 years to raise awareness of the disease's epidemiology, which is hoped to help prevent and treat the condition better.

METHODS

Eight English and three Chinese language databases were searched systematically from January 2002 to December 2023. Relevant data were analysed using Stata 16.0. Meta-regression and subgroup analyses were performed to explore causes of heterogeneity. A funnel plot was further drawn in combination with Egger and Begg tests to determine publication bias.

RESULTS

A total of 45 studies (241,813 participants) were included. The meta-analysis revealed that the overall prevalence of POP in the Chinese population was 18.2% (95% CI: 14.7-21.7%), showing a positive correlation with age. Specifically, prevalence rates were 23.4% (18.3-28.5%) in women and 11.5% (9.1-13.9%) in men. A notable increase was observed within the span of 20 years (16.9% before 2010 and 20.3% in 2011-2020). Notably, regional variations were observed, with southern China reporting a lower prevalence of 16.4% compared to 20.2% in northern China. Meta-regression suggested that sample size significantly influenced the estimation of point prevalence (P = 0.037).

CONCLUSIONS

Over the past two decades, there has been an increase in the prevalence of POP within the Chinese population. The growing prevalence of older individuals and women further highlights the urgency for tailored disease prevention and control measures.

Understanding key contributing factors on the severity of traffic violations by elderly drivers: a hybrid approach of latent class analysis and XGBoost based SHAP

Traffic violation is one of the leading causes of traffic crashes. In the context of global aging, it is important to study traffic violations by elderly drivers for improving traffic safety in preparation for a worldwide aging population. In this study, a hybrid approach of Latent Class Analysis (LCA) and XGBoost based SHAP is proposed to identify hidden clusters and to understand the key contributing factors on the severity of traffic violations by elderly drivers, based on the police-reported traffic violation dataset of Beijing (China). First, LCA is applied to segment the dataset into several latent homogeneous clusters, then XGBoost based SHAP is established on each cluster to identify feature contributions and the interaction effects of the key contributing factors on the severity of traffic violations by elderly drivers. Two comparison groups were set up to analyze factors, which are responsible for the different severities of traffic violations. The results show that elderly drivers can be classified into four groups by age, urban or not, license, and season; factors such as less annual number of traffic violations, national & provincial highway, night and winter are key contributing factors for higher severity of traffic violations, which are consistent with common cognition; key contributing factors for all clusters are similar but not identical, for example, more annual number of traffic violations contribute to more severe violation for all clusters except for Cluster 2; some factors which are not key contributing factors may affect the severity of traffic violations when they are combined with other factors, for example, the combination of lower annual number of traffic violations and county & township highway contributes to more severe violation for Cluster 1. These findings can help government to formulate targeted countermeasures to decrease the severity of traffic violations by specific elderly groups and improve road service for the driving population.

Perceptions and experience of rural older people in oral health management in China: a qualitative study

BACKGROUND

To explore the perceptions and experience of oral health management among rural older people in China.

METHODS

Qualitative methodologies were used in this study. Face-to-face semi-structured interviews were conducted. Thirteen older adults in rural areas were purposively sampled at two metropolitan hospitals in Hunan, China. The data were transcribed and thematically analyzed, and MAXQDA software was used to assist with coding.

RESULTS

Three overarching major themes and ten sub‑themes capturing the perceptions and experience of oral health management among rural older people were identified. Three themes emerged from the thematic analysis: oral health cognitive bias, poor management behaviors, and limited oral health services. Oral health management as a whole is negative, oral health behaviors are poor, oral health service utilization is limited.

CONCLUSIONS

Based on these findings, there is great scope here for improving the current status of oral health for rural older people around awareness, behavior, and access. Oral health education, improved oral health services and primary oral health promotion are warranted.

Geographic and ethnicity variation in the prevalence of middle-aged and elderly adult obesity in China in 2020

AIM

The objective of this study is to evaluate the mean body mass index (BMI), general obesity and abdominal obesity in adults aged ≥40 years residing in China in 2020, and to analyse variations in these factors across different geographic areas and subpopulations.

METHODS

We utilized data from the National Stroke High-Risk Population Screening programme to calculate and compare the mean BMI and prevalence of obesity across various demographics, including sex, age, urban-rural locality, geographical region (province) and ethnicity status.

RESULTS

In our study, we found that the standardized mean BMI level was 24.65 kg/m2 [95% confidence interval (CI): 24.50-22.84] in men and 24.31 kg/m2 (95% CI: 24.15-24.45) in women. Using the criteria from China, we found that the standardized prevalence of general obesity and abdominal obesity was 13.13% (95% CI: 13.05-13.21%) and 33.03% (95 CI: 32.92-33.14%), respectively. Our study also identified significant effects of age, sex, urban-rural locality, province and ethnicity status on the prevalence of obesity. Overall, our study estimated that in 2020, approximately 91.1 million adults aged ≥40 years in China were obese (46.5 million men and 44.6 million women), while 229.2 million adults (110.4 million men and 118.8 million women) were diagnosed with abdominal obesity.

CONCLUSION

Our research has revealed compelling new evidence about the obesity epidemic among Chinese adults aged ≥40 years, particularly at the provincial and ethnic levels. As a result, more targeted and effective prevention strategies should be developed to alleviate the burden of obesity.

Uptake and detection rate of colorectal cancer screening with colonoscopy in China: A population-based, prospective cohort study

BACKGROUND

Colorectal cancer is the leading cause of cancer-related death worldwide. Colonoscopy is widely used as a screening test for detecting colorectal cancer in many countries. However, there is little evidence regarding the uptake and diagnostic yields of colonoscopy in population-based screening programs in countries with limited medical resources.

OBJECTIVE

We reported the uptake of colonoscopy and the detection of colorectal lesions and explored related factors based on a colorectal cancer screening program in China.

DESIGN

Individuals aged 45-74 years who were asymptomatic for colorectal cancer and had no history of colorectal cancer were recruited. An established risk score system was used to identify individuals at high risk for colorectal cancer, and they were subsequently recommended for colonoscopy.

SETTING

A population-based, prospective cohort study was implemented in 169 communities, 14 districts of Chongqing, Southwest China.

PARTICIPANTS

A total of 288,150 eligible participants were recruited from November 2013 to June 2021, and 41,315 participants were identified to be at high risk of colorectal cancer.

METHODS

Generalized linear mixed model was used to explore the individual and community structural characteristics associated with uptake of colonoscopy. Additionally, the detection rate of colorectal lesions under colonoscopy screening was also reported, and their associated factors were explored.

RESULTS

7859 subjects underwent colonoscopy, with an uptake rate of 19.02 % (95 % CI 18.64 %-19.40 %). Lower uptake rates were associated with older age, lower education, more physical activity, and structural characteristics, including residing in developing areas (OR 0.73, 95 % CI 0.69-0.78), residing more than 5 km from screening hospital (5-10 km: OR 0.85, 95 % CI 0.79-0.91; >10 km: OR 0.85, 95 % CI 0.80-0.91), and not being exposed to social media publicity (OR 0.63, 95 % CI 0.53-0.75). Overall, 8 colorectal cancers (0.10 %), 423 advanced adenomas (5.38 %), 820 nonadvanced adenomas (10.43 %), and 684 hyperplastic polyps (8.70 %) were detected, with an adenoma detection rate of 15.92 %. Several factors, including older age, male, current smoking and a family history of colorectal cancer, were positively related to colorectal neoplasms.

CONCLUSIONS

The uptake of colonoscopy for colorectal cancer screening was not optimal among a socioeconomically diverse high-risk population. The screening strategy should attempt to ensure equitable access to screening according to regional characteristics, and enhance the uptake of colonoscopy by recommended multifaceted interventions, which focus on individuals with poor compliance, select a closer screening hospital, and strengthen social media publicity at the structural level.

Population Pharmacokinetics and Individualized Medication of Azithromycin for Injection in Children Under 6 Years Old

Pharmacokinetic data for injectable azithromycin in children remain limited. This study aims to develop and validate a population pharmacokinetic model of azithromycin for injection in children under 6 years old and optimize its dosage regimen in this population. We prospectively enrolled patients under 6 years old who received azithromycin for injection at Beijing Friendship Hospital, Capital Medical University. Demographic information, clinical characteristics, and venous blood samples were collected in accordance with the research protocol. Azithromycin concentrations were determined using a validated UPLC-MS/MS method. The population pharmacokinetic model was structured using Phoenix NLME. The adequacy and robustness of the model was evaluated using VPC and bootstrap. We optimized azithromycin's dosing regimen for injection through Monte Carlo simulations. We included 254 plasma concentration data from 148 patients to establish the model. The clearance and volume were 1.27 L/h/kg and 45.6 L/kg, respectively. The covariates included were weight and age. VPC plots and nonparametric bootstrap showed that the final PPK model was reliable and robust. Based on Monte Carlo simulation, we derived a simple and practical dosing scheme. The results provided reference for individualized dosing in this population. The individualized dosing scheme based on Monte Carlo simulation can optimize clinical decision-making and guide personalized therapy.

Biomaterial design for regenerating aged bone: materiobiological advances and paradigmatic shifts

China's aging demographic poses a challenge for treating prevalent bone diseases impacting life quality. As bone regeneration capacity diminishes with age due to cellular dysfunction and inflammation, advanced biomaterials-based approaches offer hope for aged bone regeneration. This review synthesizes materiobiology principles, focusing on biomaterials that target specific biological functions to restore tissue integrity. It covers strategies for stem cell manipulation, regulation of the inflammatory microenvironment, blood vessel regeneration, intervention in bone anabolism and catabolism, and nerve regulation. The review also explores molecular and cellular mechanisms underlying aged bone regeneration and proposes a database-driven design process for future biomaterial development. These insights may also guide therapies for other age-related conditions, contributing to the pursuit of 'healthy aging'.

What is driving the global decline of human fertility? Need for a multidisciplinary approach to the underlying mechanisms

An intense period of human population expansion over the past 250 years is about to cease. Total fertility rates are falling dramatically all over the world such that highly industrialized nations, including China and the tiger economies of SE Asia, will see their populations decline significantly in the coming decades. The socioeconomic, geopolitical and environmental ramifications of this change are considerable and invite a multidisciplinary consideration of the underlying mechanisms. In the short-term, socioeconomic factors, particularly urbanization and delayed childbearing are powerful drivers of reduced fertility. In parallel, lifestyle factors such as obesity and the presence of numerous reproductive toxicants in the environment, including air-borne pollutants, nanoplastics and electromagnetic radiation, are seriously compromising reproductive health. In the longer term, it is hypothesized that the reduction in family size that accompanies the demographic transition will decrease selection pressure on high fertility genes leading to a progressive loss of human fecundity. Paradoxically, the uptake of assisted reproductive technologies at scale, may also contribute to such fecundity loss by encouraging the retention of poor fertility genotypes within the population. Since the decline in fertility rate that accompanies the demographic transition appears to be ubiquitous, the public health implications for our species are potentially devastating.

Association of Sarcopenia, as Defined Based on the Skeletal Muscle Index, With Mortality and Morbidity After Cardiac Surgery: A Retrospective Cohort Study

OBJECTIVE

To investigate whether "sarcopenia," defined based on the preoperative skeletal muscle index (SMI), can predict major postoperative morbidity and all-cause mortality.

DESIGN

A retrospective observational cohort study.

SETTING

At the authors' Department of Critical Care Medicine.

PARTICIPANTS

A total of 986 adult Chinese patients underwent cardiac surgery (coronary artery bypass graft, valve surgery, combined surgery, or aortic surgery) between January 2019 and August 2022.

MEASUREMENTS AND MAIN RESULTS

The skeletal muscle area at the third lumbar level (L3) was measured via preoperative computed tomography (up to 3 months from the date of imaging to the date of surgery) and normalized to patient height (skeletal muscle index). Sarcopenia was determined based on the skeletal muscle index being in the lowest sex-specific quartile. The primary outcome was all-cause mortality. The secondary outcome was major morbidity. A total of 968 patients were followed for a median of 2.00 years, ranging from 1.06 to 2.90 years. After the follow-up, 76 patients died during the follow-up period. Multivariate Cox proportional analysis showed a relationship between sarcopenia (adjusted hazard ratio 1.80, 95% CI 1.04-3.11; p = 0.034) and all-cause mortality. Kaplan-Meier curves revealed a significantly lower survival rate in the sarcopenia group than in the nonsarcopenia group. Overall, 199 (20.6%) patients had major morbidity. Multivariate analysis showed a significant relationship between sarcopenia (adjusted odds ratio = 2.21, 95% CI 1.52∼3.22, p < 0.001) and major morbidity.

CONCLUSIONS

Sarcopenia, defined by the skeletal muscle index, is associated with all-cause mortality and major morbidity after cardiac surgery, thereby suggesting the need for perioperative sarcopenia risk assessment for patients undergoing cardiac surgery to guide the prevention and management of adverse outcomes.

Green autofluorescence of the skin and fingernails is a novel biomarker for evaluating the risk for developing acute ischemic stroke

The only existing approach for assessing the risk of developing acute ischemic stroke (AIS) necessitates that individuals possess a strong understanding of their health status. Our research gathered compelling evidence in favor of our hypothesis, suggesting that the likelihood of developing AIS can be assessed by analyzing the green autofluorescence (AF) of the skin and fingernails. Utilizing machine learning-based analyses of AF images, we found that the area under the curve (AUC) for distinguishing subjects with three risk factors from those with zero, one, or two risk factors was 0.79, 0.76, and 0.75, respectively. Our research has revealed that green AF serves as an innovative biomarker for assessing the risk of developing AIS. Our method is objective, non-invasive, efficient, and economic, which shows great promise to boost a technology for screening natural populations for risk of developing AIS.

Geriatric Nursing: Relationship Among Death Attitude, Meaning in Life, and Career Choice Motivation

BACKGROUND

Aging populations require higher quality care. However, few undergraduate nursing students choose careers in aged care. Negative death attitudes and loss of meaning in life may reduce motivation to choose geriatric nursing (GN) as a career. The relationships among these variables have yet to be clarified in the literature.

PURPOSE

The purpose of this study was to investigate the relationships among death attitude, meaning in life, and motivation to choose a career in GN among undergraduate nursing students in China.

METHODS

This cross-sectional study was conducted using an online survey. Five hundred ninety-five final-year undergraduate nursing students in four nursing schools completed the Career Choice Motivation Questionnaire for Geriatric Nursing, Death Attitude Profile-Revised, and Meaning in Life Questionnaire. A t test, analysis of variance, Pearson's correlation, and multiple linear regression model were used to analyze the data using SPSS Version 22.0.

RESULTS

The mean Career Choice Motivation Questionnaire for Geriatric Nursing item score was 3.15 ( SD = 0.49; 1-5 points), indicating the participants were moderately motivated to choose GN as a career. The multiple linear regression revealed statistically significant associations among death attitude, meaning in life, and motivation to care for older adults, explaining 14.5% of the total variance ( R2 = .15, F = 9.01, p < .001). Perceiving meaning in life, having escape acceptance, and having approach acceptance were each shown to be positively associated with choosing a career in GN. Conversely, fear of death and death avoidance were found to be negatively associated with choosing this career path.

CONCLUSIONS

Death attitude and perceptions regarding the meaning of life are associated with the motivation of nursing students to care for older adults.

The burden of vision loss due to cataract in China: findings from the Global Burden of Disease Study 2019

OBJECTIVE

To provide a reference for future policy and measure formulation by conducting a detailed analysis of the burden of vision loss due to cataract by year, age, and gender in China from 1990 to 2019.

METHODS

Data on the prevalence and disability-adjusted life-years (DALYs) due to cataract in China and neighboring and other G20 countries were extracted from the 2019 Global Burden of Disease (GBD) study to observe the changing trends of vision loss.

RESULTS

The number and rate of all-age prevalence and DALYs for cataract in China increased significantly from 1990 to 2019. The age-standardized DALYs rate witnessed a slowly declining trend by 10.16%. And the age-standardized prevalence increased by 14.35% over the 30-year period. Higher prevalence and DALYs were observed in female population from 1990 through 2019, with little improvement over the decades(all p < 0.001). The disease burden of cataract is higher in middle-aged and elderly people. Blindness accounted for the largest proportion of vision impairment burden caused by cataract in China. The age-standardized prevalence and DALY rate of cataract in China were lower than those in India and Pakistan, but higher than those in Russia, South Korea, North Korea, Singapore, and Japan.

CONCLUSIONS

In the past 30 years, although the age-standardized DALYs rate has decreased slightly in China, the all-age prevalence and DALYs have both increased. This study highlights the importance of reducing cataract burden by providing timely and easily accessible quality care, especially in females and the elderly population.

Analysis of health risk factors for older adults living alone in China and establishment and evaluation of a nomogram prediction model

Objective

To understand the health status of older adults living alone in China and analyze the influencing factors, so as to provide reference for improving the health status of older adults living alone.

Methods

Based on CGSS data from China General Social Survey (2017), the influencing factors of health status of older adults living alone were analyzed by unconditional Logistic regression, and the R software was used to develop a nomogram for predicting the risk of self-assessed unhealthy adverse outcomes.

Results

Gender, annual income, mandarin listening level and participation in medical insurance were the influencing factors of self-rated health of older adults living alone. Age and annual income are the influencing factors of physiological health. Annual income and Internet use were influential factors for mental health. C-Statistic of nomogram prediction model was 0.645. The calibration curve showed that goodness of fit test (χ2 = 58.09, p < 0.001), and the overall prediction ability of the model was good.

Conclusion

The health status of older adults living alone in the home-based older adults care is worrying, and it is affected by various factors. We should pay more attention to older adults living alone, improve the ability of listening and distinguishing mandarin and the use of health information platforms for older adults living alone, and further implement medical insurance policies and health services. Announcing the solution to promote healthy home-based care for older adults living alone.

Association between cognitive dysfunction and diabetes in patients over 65 years old: a cross-sectional study using propensity score matching

OBJECTIVES

To investigate the association between diabetes and cognitive dysfunction in the elderly population, and examine the impact of cognitive dysfunction on level of activities of daily living (ADL) in patients with diabetes.

METHODS

Data analysis was conducted on 2,951 individuals aged over 65 years from the Chinese Longitudinal Healthy Longevity Survey cohort. Propensity score matching was utilized to mitigate selection bias. Multivariate binary logistic regression was performed to analyse the association between diabetes and cognitive dysfunction in the study subjects. In addition, the relationship between ADL and cognitive function in patients with diabetes was analysed using the Wilcoxon rank-sum test.

RESULTS

A significant association (p = 0.017) was found between diabetes and the occurrence of cognitive dysfunction in older adults. Subgroup analyses revealed that diabetes patients with cognitive dysfunction exhibited a worse ADL dependence compared with those without cognitive dysfunction (p < 0.001).

CONCLUSION

These findings indicate that diabetes is associated with cognitive dysfunction in older adults. Meanwhile, there is an association between cognitive impairment and ADL level in subjects with diabetes. As such, healthcare professionals should pay close attention to the occurrence of cognitive dysfunction and ADL decline during diagnosis and treatment, and proactive prevention and intervention strategies should be implemented.

The expectations and acceptability of a smart nursing home model among Chinese older adults: a mixed methods study

BACKGROUND

Smart nursing homes (SNHs) integrate advanced technologies, including IoT, digital health, big data, AI, and cloud computing to optimise remote clinical services, monitor abnormal events, enhance decision-making, and support daily activities for older residents, ensuring overall well-being in a safe and cost-effective environment. This study developed and validated a 24-item Expectation and Acceptability of Smart Nursing Homes Questionnaire (EASNH-Q), and examined the levels of expectations and acceptability of SNHs and associated factors among older adults in China.

METHODS

This was an exploratory sequential mixed methods study, where the qualitative case study was conducted in Hainan and Dalian, while the survey was conducted in Xi'an, Nanjing, Shenyang, and Xiamen. The validation of EASNH-Q also included exploratory and confirmatory factor analyses. Multinomial logistic regression analysis was used to estimate the determinants of expectations and acceptability of SNHs.

RESULTS

The newly developed EASNH-Q uses a Likert Scale ranging from 1 (strongly disagree) to 5 (strongly agree), and underwent validation and refinement from 49 items to the final 24 items. The content validity indices for relevance, comprehensibility, and comprehensiveness were all above 0.95. The expectations and acceptability of SNHs exhibited a strong correlation (r = 0.85, p < 0.01), and good test-retest reliability for expectation (0.90) and acceptability (0.81). The highest tertile of expectations (X2=28.89, p < 0.001) and acceptability (X2=25.64, p < 0.001) towards SNHs were significantly associated with the willingness to relocate to such facilities. Older adults with self-efficacy in applying smart technologies (OR: 28.0) and those expressing a willingness to move to a nursing home (OR: 3.0) were more likely to have the highest tertile of expectations compared to those in the lowest tertile. Similarly, older adults with self-efficacy in applying smart technologies were more likely to be in the highest tertile of acceptability of SNHs (OR: 13.8).

CONCLUSIONS

EASNH-Q demonstrated commendable validity, reliability, and stability. The majority of Chinese older adults have high expectations for and accept SNHs. Self-efficacy in applying smart technologies and willingness to relocate to a nursing home associated with high expectations and acceptability of SNHs.

Challenges and coping experiences faced by nursing staff in long-term care facilities in China: a qualitative meta-analysis

Objective

The aim of this study is to discern the challenges and coping experiences encountered by nursing staff in long-term care facilities in China. This will be achieved through the identification, evaluation, and qualitative synthesis of comprehensive data.

Design

This is a qualitative meta-analysis.

Methods

The research systematically examined relevant literature sourced from six databases, concluding the search in August 2023. The inclusion criteria encompassed qualitative and mixed-methods studies in both Chinese and English, focusing on challenges faced by nursing staff in long-term care facilities and their corresponding coping strategies. The application of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework facilitated the qualitative meta-integration process. Three independent researchers meticulously screened and assessed the quality of the chosen studies. The synthesis process sought to amalgamate and structure analogous findings into novel categories through multiple readings of the original literature. These categories were subsequently distilled into comprehensive themes.

Results

Analyzed 15 articles revealed 14 sub-themes and 4 overarching analytical themes. These encompassed Sources of Challenges such as multitasking, clinical emergencies, workplace conflict, demand exceeding resources, and occupational discrimination. Psychological impacts included suppressed emotion, compassion fatigue, and self-doubt. Practical consequences involved damaged health, imbalanced life, and occupational disappointment. Coping strategies identified were self-adjusting, feeling validation and belonging, and finding support.

Conclusion

Our research identified the challenges faced by nursing staff in Chinese long-term care facilities and their coping experiences. We found that most challenges could be mitigated through appropriate adjustments in managerial strategies, such as reasonable human resources planning, and providing resource support, including material, emotional, and informational support. Similarly, institutions should have offered necessary emotional and psychological support to nursing staff to overcome the negative impacts of challenges and encourage them to adopt positive coping strategies.

Association of physical activity with socio-economic status and chronic disease in older adults in China: cross-sectional findings from the survey of CLASS 2020 after the outbreak of COVID-19

BACKGROUND

In 2021, China had a population of 264·01 million individuals over the age of 60, indicating a high prevalence of chronic diseases. Among older adults, physical inactivity (PI) is a significant risk factor for chronic diseases. However, few studies have been conducted on the correlation of physical activity (PA) with the economic status, geography and chronic disease risks in Chinese elderly. The objectives of this study were to better understand the distribution of PA among older adults in China and its relationship with economic status, geography, and chronic disease risks.

METHODS

This study utilized data from the China Longitudinal Aging Social Survey (CLASS) in 2020, post-COVID-19. The study employed a stratified, multistage, probabilistic sampling approach and included 11,396 adults over the age of 59 from 28 provinces in China. Data on demographics, the duration and intensity of PA, history of diseases and personalized factors influencing PA were collected via structured interviews by researchers. In this study, we conducted a comprehensive analysis, employing a range of statistical methods including descriptive analysis, Wilcoxon rank-sum tests, Bayesian networks, and chi-square tests.

RESULTS

The prevalence of PI among older adults over 59 in China is 28·82%. Significant regional differences were observed in the duration of PA at different intensities. Older adults residing in more economically developed areas were more likely to engage in moderate-to-vigorous physical activity (MVPA) and exhibited longer sedentary behavior. Economic status and urban-rural disparities consistently emerged as direct influential factors across all intensity types. Chronic disease risks were significantly lower in active older adults compared to inactive ones. Lack of social guidance, family support, and personal inclination towards sedentary behavior were the main personalized factors affecting PA among older adults, and these factors could be relatively easily modified.

CONCLUSIONS

Economic status, geography, and living areas (urban and rural) significantly influenced the distribution of physical activities in China. Particularly, economic status and living areas acted as direct factors. Older adults reaching the recommended standards for PA had significantly lower chronic disease risks, highlighting the importance of improving personalized factors which are crucial for promoting PA.

Urban-rural differences in key factors of depressive symptoms among Chinese older adults based on random forest model

BACKGROUND

Depression is a major challenge in the global healthy aging process, and exploring the key factors of depression in urban and rural older adults is essential for differentiated and precise interventions.

OBJECTIVE

To explore the urban-rural differences and key influencing factors of depressive symptoms among Chinese older adults.

METHODS

The data of 5267 older adults were obtained from the China Health and Retirement Longitudinal Survey (CHARLS2018). Random forest model and logistic regression were used to analyze the key factors influencing depressive symptoms 19 variables.

RESULTS

The detection rate of depressive symptoms in older adults was 31.0 %, with 22.3 % and 34.8 % in urban and rural areas, respectively. Education, self-rated health, self-rated pain, and self-rated vision were common factors. Physical activity (OR = 0.716 for Moderate PA), social activity (OR = 0.671 for social activity), and self-rated hearing (OR = 0.602 for good) were key factors specific to urban older adults, and alcohol consumption (OR = 0.716 for drinking more than once a month) and marital status (OR = 0.689 for cohabitation) were key factors specific to depressive symptoms in rural older adults (all P < 0.05).

LIMITATION

Cross-sectional data cannot reflect dynamic processes among variables; The cultural background might affect the cross-cultural validity of the study.

CONCLUSION

The key factors of depressive symptoms among older adults in urban and rural areas differed, which provides priority and references for differential prevention and precise intervention of depressive symptoms to promote the process of healthy aging.

Comprehensive geriatric assessment to predict adverse events in elderly patients undergoing posterior lumbar fusion surgery

PURPOSE

Although comprehensive geriatric assessment (CGA) has been used widely, its impact on adverse events in elderly patients has not been fully examined. The present study aimed to investigate the relationships between subcomponents of CGA and adverse events (AEs) in elderly patients undergoing posterior lumbar fusion surgery.

METHODS

A total of 242 eligible elderly patients enrolled. Our CGA included activities of daily living, instrumental activities of daily living, nutritional status, cardiac function, pulmonary function, renal function, frailty, cognition, anxiety, depression, delirium, chronic pain score, comorbidity and polypharmacy. Comprehensive complication index was used to summarize postoperative complications and its severity. Logistic regression was performed to determine the relationships between subcomponents of a CGA and postoperative AEs.

RESULTS

Present study found that female were more vulnerable to have AEs. Postoperative major AEs were associated with delirium (odds ratio (OR): 4.302, 95% confidence interval (CI) 1.720-10.761, p = 0.002), nutritional status (OR: 3.030, 95%CI 1.218-7.541, p = 0.017), cognitive impairment (OR: 4.122, 95%CI 1.179-14.407, p = 0.027), Charlson comorbidity index (CCI) (OR: 4.800, 95%CI 1.852-12.440, p = 0.001) and severe dependent (OR: 3.772, 95%CI 1.116-9.841, p = 0.007). Further analysis showed that delirium (OR: 2.824, 95%CI 1.068-7.467, p = 0.036) and CCI (OR: 3.221, 95%CI 1.184-8.766, p = 0.022) were independently related to major AEs.

CONCLUSIONS

These results indicate that preoperative screening preoperative delirium, cognitive, nutrition and CCI are essential to prevent postoperative major AEs of the surgical elderly.

Comparison of Transradial Access and Transfemoral Access for Diagnostic Cerebral Angiography in the Elderly Population

OBJECTIVE

Evaluate the efficacy, safety, and patient satisfaction of transradial access (TRA) compared with conventional transfemoral access (TFA) for diagnostic cerebral angiography in elderly patients (≥65 years of age).

METHODS

We performed a retrospective review of patients receiving cerebral angiography via TRA or TFA between October 2020 and December 2021 at 3 institutions. Basic patient characteristics, angiographic data, postoperative complications, and patient satisfaction were collected for analysis.

RESULTS

Of the 357 enrolled elderly patients, 175 were performed through TRA and 182 were performed through TFA. There was no significant difference in mean fluoroscopy time (8.6 ± 3.8 minutes vs. 9.1 ± 3.1 minutes; P = 0.103) and radiation exposure (47.7 ± 10.8 Gy-cm2 vs. 49.8 ± 11.3 Gy-cm2; P = 0.068) between the TRA and TFA groups. However, the TRA group had a shorter procedural time (54.7 ± 6.2 minutes vs. 61.1 ± 5.6 minutes; P < 0.001) and less contrast agent (83.2 ± 28.1 mL vs. 100.1 ± 26.2 mL; P < 0.001) than the TFA group. In terms of safety, the incidence of minor vascular access complications in the TRA group was lower than that in the TFA group (1.7% vs. 8.8%; P = 0.003). The incidence of serious complications and neurologic complications in the TRA group was also lower, although the difference was not statistically significant. Overall patient satisfaction was higher in the TRA group than that in the TFA group.

CONCLUSIONS

TRA was an efficient and safe alternative to conventional TFA in elderly patients who underwent diagnostic cerebral angiography and who underwent TRA were more satisfied. Findings supported the radial-first strategy for cerebral angiography in elderly populations.

Transmission network and phylogenetic analysis reveal older male-centered transmission of CRF01_AE and CRF07_BC in Guangxi, China

In China, the number of newly reported HIV infections in older people is increasing rapidly. However, clear information on the impact of older people on HIV transmission is limited. This study aims to reveal the local HIV transmission patterns, especially how older people affect virus transmission. Subtype analysis based on available pol sequences obtained from HIV patients revealed that CRF01_AE and CRF08_BC were predominant in patients aged <50 years, whereas CRF01_AE was predominant in older people aged ≥50 years (χ²= 29.299, P < 0.001). A total of 25 patients (5.2%, 25/484) were identified with recent HIV infection (RHI). Transmission network analysis found 267 genetically linked individuals forming 55 clusters (2-63 individuals), including 5 large transmission clusters and 12 transmission clusters containing RHI. Bayesian phylogenetic analysis suggested that transmission events in CRF01_AE and CRF07_BC were centred on older males, while transmission events in CRF08_BC were centred on younger males. Multivariable logistic regression analysis showed that older people were more likely to cluster within networks (AOR = 2.303, 95% CI: 1.012-5.241) and that RHI was a significant factor associated with high linkage (AOR = 3.468, 95% CI: 1.315-9.146). This study provides molecular evidence that older males play a central role in the local transmission of CRF01_AE and CRF07_BC in Guangxi. Given the current widespread of CRF01_AE and CRF07_BC in Guangxi, there is a need to recommend HIV screening as part of free national medical examinations for older people to improve early detection, timely treatment, and further reduce second-generation transmission.

Application of tissue engineering techniques in tracheal repair: a bibliometric study

Transplantation of tissue-engineered trachea is an effective treatment for long-segment tracheal injury. This technology avoids problems associated with a lack of donor resources and immune rejection, generating an artificial trachea with good biocompatibility. To our knowledge, a systematic summary of basic and clinical research on tissue-engineered trachea in the last 20 years has not been conducted. Here, we analyzed the development trends of tissue-engineered trachea research by bibliometric means and outlined the future perspectives in this field. The Web of Science portal was selected as the data source. CiteSpace, VOSviewer, and the Bibliometric Online Analysis Platform were used to analyze the number of publications, journals, countries, institutions, authors, and keywords from 475 screened studies. Between 2000 and 2023, the number of published studies on tissue-engineered trachea has been increasing. Biomaterials published the largest number of papers. The United States and China have made the largest contributions to this field. University College London published the highest number of studies, and the most productive researcher was an Italian scholar, Paolo Macchiarini. However, close collaborations between various researchers and institutions from different countries were generally lacking. Despite this, keyword analysis showed that manufacturing methods for tracheal stents, hydrogel materials, and 3D bioprinting technology are current popular research topics. Our bibliometric study will help scientists in this field gain an in-depth understanding of the current research progress and development trends to guide their future work, and researchers in related fields will benefit from the introduction to transplantation methods of tissue-engineered trachea.

Effects of Linpan nature therapy on health benefits in older women with and without hypertension

Background

Nature therapy can significantly benefit the physiology and psychology of middle-aged and older people, but previous studies have focused on forest environments. The restoration potential of rural environments in urban fringe areas, which are more accessible to older people on a daily basis, has not been fully studied. This study assessed the effects of nature therapy on the physical and mental health of older women in a rural setting (locally known as Linpan) in the urban fringe area of Chengdu, China.

Methods

We recruited a total of 60 older women (65.3 ± 5.5 years old) living in cities for 3 days of nature therapy in the winter (30 subjects) and spring (30 subjects), including 20 hypertensive patients.

Results

The results showed that the overall blood pressure, pulse and sleep dysfunction rating scores of the participants were significantly lower than the pretest levels, and the finger blood oxygen saturation, mid-day salivary alpha-amylase and cortisol were increased post-treatment. Increases in these biomarker indicates and increase in stress. There were significant differences in the changes in systolic blood pressure between the hypertension group (HTN) and the normal group (normal) (HTN decreased by 8.8%, normal decreased by 5.4%), salivary alpha-amylase content (HTN decreased by 0.3%, normal increased by 16.9%), and sleep dysfunction rating scores (HTN decreased by 59.6%, normal decreased by 54%). The decreases in systolic blood pressure and pulse in the winter group were higher than those in the spring group by 1.8 and 4.4%, respectively, while the increases in salivary alpha-amylase content and salivary cortisol content were lower than those in the spring group by 11.7 and 11.2%, respectively, and the decrease in sleep dysfunction rating scores was lower than that in the spring group by 7.1%.

Conclusion

Our study concluded that nature therapy based on various health activities in the Linpan has significant health effects on older women. It can regulate blood pressure and pulse in older women, relieve cardiovascular disease, improve sleep quality. Meanwhile, older women with high blood pressure experienced a more significant effect than the healthy group.

Burden of ischemic stroke in mainland China and Taiwan province from 1990 to 2019: with forecast for the next 11 years

Ischemic stroke is featured with high incidence, mortality, and disability. The aim of this study is to use Global Burden of Disease database to describe and compare the burden of ischemic stroke in mainland China and Taiwan province and to further predict the expected changes in the next 11 years using statistical modeling methods. Information on ischemic stroke incidence and mortality in China (mainland and Taiwan province) during 1990-2019 was obtained from the Global Burden of Disease database to analyze the effects of region, gender, and age on the incidence and mortality of ischemic stroke in China. The autoregressive integrated moving average model was used to predict the age-standardized incidence rate and age-standardized mortality rate of ischemic stroke in males and females in mainland China and Taiwan province in the next 11 years. The period from 1990 to 2019 witnessed an overall upward trend in the number of incidence and deaths in mainland China and Taiwan province. In 2019, there were nearly 2.87 million ischemic incidence cases with stroke in mainland China, with more female patients than male in the age group of over 60 years. Among the nearly 1.03 million deaths, the death toll of men under the age of 85 years was higher than that of women, while in Taiwan province, the number of incidence was 28 771, with more female patients of all ages than male. Among the 6788 deaths, the death toll of men under the age of 80 years was higher than that of women. In 2019, the age group with the highest number of patients in the two regions was 65-69 years, while the highest number of deaths was found in people aged 85 years and above. As our autoregressive integrated moving average model predicted, the age-standardized incidence rate value of ischemic stroke is expected to be 163.23/100 000 persons in mainland China by 2030, which would continue to increase, while the age-standardized mortality rate value of ischemic stroke is expected to be 16.41/100 000 persons in Taiwan province by 2030, which showed a decreasing trend. Disease burden of ischemic stroke is still increasing in mainland China and Taiwan province, and health resources should be deployed to implement effective prevention and control strategies, taking into account region, gender, and age.

Exploring configurations of social determinants for enhancing older adult health in China: an fuzzy-set qualitative comparative analysis based on 31 provinces in China

With China's aging population on the rise, addressing population aging has become a national priority, particularly focusing on improving older adult health. This study employs the social determinants of health framework, considering China's unique macro-social, economic, policy, healthcare, and family cultural factors, to develop a framework for understanding the social determinants of health for older adult in China. Using the fsQCA method and a configurational perspective, the complex relationship between social determinants of health and older adult health status is examined. The findings indicate that individual social determinants alone are insufficient for achieving high levels of older adult health. Instead, three configurations of social determinants have been identified as conducive to high older adult health: Economic Development-Environment - Cultural Dominant Type, Socio-Economic Development - Older Adult Security - Environment - Cultural Dominant Type, and Economic Development Dominant Type. These configurations offer diverse pathways for enhancing older adult health. Conversely, the study identifies two configurations associated with low older adult health levels, exhibiting an asymmetric relationship with the configurations resulting in high older adult health levels. Moreover, economic development consistently emerges as a core condition across all three configurations associated with high older adult health levels, while two configurations associated with low older adult health lack this core condition. These findings underscore the universal contribution of enhancing economic development to improving older adult health.

Acute effects of ambient air pollution exposure on lung function in the elderly in Hangzhou, China

Evidence of an association between acute air pollution exposure and lung function in the elderly is limited. This study is cross-sectional. We quantified the effects of air pollution exposure on lung function among 256 elderly by using a linear mixed model. The results revealed that air pollutants had lag effects on lung function after adjusting for confounders. PM2.5 (Lag03, Lag 03 was defined three-day moving average, and so forth), PM10, NO2 (Lag04-Lag05) were significantly associated with reduced FEV1. PM2.5 (Lag01-Lag02), PM10 (Lag0-Lag07), NO2 (Lag0, Lag04), and SO2 (Lag0) were significantly associated with reduced Forced vital capacity (FVC). PM2.5 (Lag04-Lag07) and NO2 (Lag01-Lag07) were significantly associated with reduced FEF25%-75%. The results showed the adverse change was stronger after adjusting for other pollutants in the PM models, and women were more susceptible to air pollutants. Therefore, we should pay attention to the problem of air pollution in the elderly, especially in women.

The role of intergenerational support in shaping oral healthcare-seeking behavior among older adults in China

Background

This study aimed to explore how intergenerational support affects the oral healthcare or treatment-seeking behaviors of older Chinese adults and provide evidence for improving the oral health of the older adults in an aging society.

Methods

Data from a cross-sectional survey, the 2015 China Health and Retirement Longitudinal Study, were used to explore the relationship between oral healthcare-seeking behavior in older adults and various independent variables, such as marital status, number of children, offspring's education duration, parent-offspring interaction frequency, and financial/material support provided by children. The chi-square test and binary logistic regression were used.

Results

According to the results of data analysis, age, sex, marital status, cohabitation status, number of children, children's education level, and financial support from children affected older adults' oral healthcare-seeking behavior. Interviewees living with a partner and those who had 1-2 or 3-4 children showed different likelihoods of seeking oral healthcare. Moreover, interviewees whose children had higher education duration and those who received more financial/material support from their children were more likely to seek dental treatment.

Conclusion

Regarding the study's outcome, financial and emotional support, as well as practical assistance from family members can significantly promote oral health-seeking behavior among older adult people. Intergenerational support can serve as a crucial mechanism for promoting oral health behaviors among the older adults or act as a valuable complement to social medical assistance, warranting increased attention.

The impact of retirement on body mass index in China: An empirical study based on regression discontinuity design

An aging population is an important trend of social development, and it will be China's basic national condition for a long time. However, the pressure on domestic pension payments and economic operations will increase daily. The delayed retirement policy is gradually implemented as a critical initiative to improve capital and labor force allocation. The impact of retirement on residents' Body Mass Index (BMI) and weight has become a focus issue. This paper investigates the mechanism of the impact of retirement on residents' BMI using microdata from the China Family Panel Studies (CFPS) 2018, combined with a fuzzy regression discontinuity design to measure the potential health impact of China's current retirement policy on residents. The study finds that: (1) Retirement has a significant negative effect on BMI for women, with retirement leading to a significantly increased risk of deviation from normal BMI levels and significantly increasing the weight of retired women. However, retirement does not have a significant effect on men. (2) Retirement policies affect residents' BMI to different degrees depending on their family size, with the negative effect on women being more pronounced in smaller family sizes. (3) Female residents who retire to help their children with intergenerational care are more likely to maintain normal BMI levels, significantly positively affecting their potential health. (4) Retirement negatively affects BMI through channels such as significantly reducing exercise frequency among female residents. The study demonstrates that retirement policy impacts the BMI and weight of female residents, so the formulation and implementation of delayed retirement policy should be flexible, and family factors such as family sizes and intergenerational care should be considered appropriately.

Gender-specific effects of soybean consumption on cardiovascular events in elderly individuals from rural Northeast China - a prospective cohort study

BACKGROUND

The impact of consuming soybean and its products on cardiovascular events (CVEs), cardiovascular mortality, and all-cause mortality remains unclear. This study aimed to examine the prospective association of soybean consumption with CVEs, cardiovascular mortality, and all-cause mortality among the elderly population in rural China.

METHODS

The Northeast China Rural Cardiovascular Health Study included 2477 elderly individuals (mean age 67 ± 6 years, 49.97% men) in the initial phase of the study from 2012 to 2013, with a follow-up period between 2015 and 2017. Soybean consumption was categorized as follows: low-frequency consumption: rare consumption; moderate-frequency consumption: two to three times/week; high-frequency consumption: ≥ four times/week. Cox proportional hazard analysis assessed the potential relationship of soybean consumption with CVEs, cardiovascular mortality, and all-cause mortality.

RESULTS

The prevalence of soybean and its product consumption was as follows: 38.3% for low-frequency consumption (43.8% for women; 32.8% for men), 49.7% for moderate-frequency consumption (45.8% for women; 53.7% for men), and 11.9% for high-frequency consumption (10.4% for women; 13.5% for men). After adjusting for possible confounders, Cox proportional hazard analysis revealed that the frequency of soybean consumption was an effective predictor of CVEs [Hazard ratio (HR) high (95% CI): 0.555 (0.348, 0.883)], stroke [HR moderate (95% CI): 0.672 (0.494, 0.913); HR high (95% CI): 0.483 (0.276, 0.842)], and all-cause mortality [HR high (95% CI): 0.540 (0.310, 0.942)] in the overall older population. High-frequency consumption of soybean [HR (95% CI): 0.467 (0.225, 0.968)] and moderate-frequency consumption [HR (95% CI): 0.458 (0.270, 0.779)] were associated with stroke events in older men and women, respectively. In addition, high-frequency consumption of soybean [HR (95% CI): 0.437 (0.197, 0.968)] decreased the risk of CVEs in older women.

CONCLUSION

Soybean consumption is closely associated with CVEs and all-cause mortality in older individuals residing in rural areas, with a significant gender discrepancy in this relationship. These findings provide new insights into the impact of soybean consumption on cardiovascular well-being in the elderly rural population, thus enhancing our understanding of this field of interest.

The relationship between living alone or not and depressive symptoms in older adults: a parallel mediation effect of sleep quality and anxiety

BACKGROUND

With modernization and ageing in China, the population of older adults living alone is increasing. Living alone may be a potential risk factor for depressive symptoms. However, no parallel mediation model analysis has investigated the mediating factors for living alone or not (living arrangements) and depressive symptoms.

METHODS

This cross-sectional study included a total number of 10,980 participants from the Chinese Longitudinal Healthy Longevity Survey (CLHLS), 1699 of whom lived alone and 9281 of whom did not live alone. Binary logistic regression and parallel mediation effect model were used to explore the relationship between living alone or not and depressive symptoms and possible mediation effects. Bootstrap analysis was used to examine the mediation effect of living alone or not on depressive symptoms.

RESULTS

Compared to the participants who were not living alone, the living alone group had a higher rate of depressive symptoms. The binary logistic regression showed that after adjusting for other covariates, the risk of depressive symptoms was approximately 0.21 times higher for living alone compared to not living alone (OR = 1.21, 95% CI: 1.06, 1.37). Further, the results of the bootstrap analysis supported the partial mediating role of sleep quality and anxiety. Mediation analysis revealed that sleep quality and anxiety partially mediate the relationship between living alone and depressive symptoms (β = 0.008, 95% CI [0.003, 0.014]; β = 0.015, 95% CI [0.008, 0.024], respectively).

CONCLUSIONS

Sleep quality and anxiety were identified as partially parallel mediators between living alone or not and depressive symptoms. Older adults living alone with poorer sleep quality and more pronounced anxiety were positively associated with higher levels of depressive symptoms. Older adults living alone should be encouraged to engage in social activities that may improve sleep quality, relieve anxiety, and improve feelings of loneliness caused by living alone. Meanwhile, older adults living alone should receive attention and support to alleviate their depressive symptoms.

Trend and projection of larynx cancer incidence and mortality in China from 1990 to 2044: A Bayesian age-period-cohort modeling study

BACKGROUND

Larynx cancer is one of the most common cancers in head and neck, and imposes heavy burden on individual and societies. A comprehensive understanding of the burden of larynx cancer is necessary to improve prevention and control strategies. However, the secular trend of larynx cancer incidence and mortality in China remains unclear.

METHODS

The incidence and deaths rates of larynx cancer from 1990 to 2019 were collected from the Global Burden of Disease Study 2019 database. The temporal trend of larynx cancer was analyzed using a joinpoint regression model. The age-period-cohort model was used to explore the age, period, and cohort effects on larynx cancer and predict future trends up to 2044.

RESULTS

From 1990 to 2019, the age-standardized incidence rate of larynx cancer in China increased by 1.3% (95% CI 1.1 to 1.5) in males, but decreased by 0.5% (95% CI -0.1 to 0) in females. The age-standardized mortality rate of larynx cancer in China decreased by 0.9% (95% CI -1.1 to -0.6) and 2.2% (95% CI -2.8 to -1.7) in males and females, respectively. Among the four risk factors, smoking and alcohol use contributed to a heavier burden compared to occupational exposure to asbestos and sulfuric acid with respect to mortality. Age effects showed that the incidence and deaths of larynx cancer were concentrated in people older than 50 years old. Period effects exerted the most significant effect on larynx cancer incidence for males. In terms of cohort effects, people born in the earlier cohorts presented a higher risk of larynx cancer compared with the later cohorts. From 2020 to 2044, the age-standardized incidence rates of larynx cancer continued to increase in males, whereas the age-standardized mortality rates continued to decrease in both males and females.

CONCLUSION

The burden of larynx cancer in China has a significant gender difference. The age-standardized incidence rates will continue to increase in males up to 2044. The disease pattern and risk factors of larynx cancer should be comprehensively studied to promote the development of timely intervention measures and relieve the burden effectively.

China stroke surveillance report 2021

Since 2015, stroke has become the leading cause of death and disability in China, posing a significant threat to the health of its citizens as a major chronic non-communicable disease. According to the China Stroke High-risk Population Screening and Intervention Program, an estimated 17.8 million [95% confidence interval (CI) 17.6-18.0 million] adults in China had experienced a stroke in 2020, with 3.4 million (95% CI 3.3-3.5 million) experiencing their first-ever stroke and another 2.3 million (95% CI 2.2-2.4 million) dying as a result. Additionally, approximately 12.5% (95% CI 12.4-12.5%) of stroke survivors were left disabled, as defined by a modified Rankin Scale score greater than 1, equating to 2.2 million (95% CI 2.1-2.2 million) stroke-related disabilities in 2020. As the population ages and the prevalence of risk factors like diabetes, hypertension, and hyperlipidemia continues to rise and remains poorly controlled, the burden of stroke in China is also increasing. A large national epidemiological survey initiated by the China Hypertension League in 2017 showed that the prevalence of hypertension was 24.7%; the awareness, treatment, and control rates in hypertensive patients were: 60.1%, 42.5%, and 25.4%, respectively. A nationally representative sample of the Chinese mainland population showed that the weighted prevalence of total diabetes diagnosed by the American Diabetes Association criteria was 12.8%, suggesting there are 120 million adults with diabetes in China, and the awareness, treatment, and control rates in diabetic patients were: 43.3%, 49.0%, and 49.4%, respectively. The "Sixth National Health Service Statistical Survey Report in 2018" showed that the proportion of the obese population in China was 37.4%, an increase of 7.2 points from 2013. Data from 1599 hospitals in the Hospital Quality Monitoring System and Bigdata Observatory Platform for Stroke of China (BOSC) showed that a total of 3,418,432 stroke cases [mean age ± standard error (SE) was (65.700 ± 0.006) years, and 59.1% were male] were admitted during 2020. Of those, over 80% (81.9%) were ischemic stroke (IS), 14.9% were intracerebral hemorrhage (ICH) strokes, and 3.1% were subarachnoid hemorrhage (SAH) strokes. The mean ± SE of hospitalization expenditures was Chinese Yuan (CNY) (16,975.6 ± 16.3), ranging from (13,310.1 ± 12.8) in IS to (81,369.8 ± 260.7) in SAH, and out-of-pocket expenses were (5788.9 ± 8.6), ranging from (4449.0 ± 6.6) in IS to (30,778.2 ± 156.8) in SAH. It was estimated that the medical cost of hospitalization for stroke in 2020 was CNY 58.0 billion, of which the patient pays approximately CNY 19.8 billion. In-hospital death/discharge against medical advice rate was 9.2% (95% CI 9.2-9.2%), ranging from 6.4% (95% CI 6.4-6.5%) for IS to 21.8% for ICH (95% CI 21.8-21.9%). From 2019 to 2020, the information about 188,648 patients with acute IS receiving intravenous thrombolytic therapy (IVT), 49,845 patients receiving mechanical thrombectomy (MT), and 14,087 patients receiving bridging (IVT + MT) were collected through BOSC. The incidence of intracranial hemorrhage during treatment was 3.2% (95% CI 3.2-3.3%), 7.7% (95% CI 7.5-8.0%), and 12.9% (95% CI 12.3-13.4%), respectively. And in-hospital death/discharge against medical advice rate was 8.9% (95% CI 8.8-9.0%), 16.5% (95% CI 16.2-16.9%), and 16.8% (95% CI 16.2-17.4%), respectively. A prospective nationwide hospital-based study was conducted at 231 stroke base hospitals (Level III) from 31 provinces in China through BOSC from January 2019 to December 2020 and 136,282 stroke patients were included and finished 12-month follow-up. Of those, over 86.9% were IS, 10.8% were ICH strokes, and 2.3% were SAH strokes. The disability rate [% (95% CI)] in survivors of stroke at 3-month and 12-month was 14.8% (95% CI 14.6-15.0%) and 14.0% (95% CI 13.8-14.2%), respectively. The mortality rate [% (95% CI)] of stroke at 3-month and 12-month was 4.2% (95% CI 4.1-4.3%) and 8.5% (95% CI 8.4-8.6%), respectively. The recurrence rate [% (95% CI)] of stroke at 3-month and 12-month was 3.6% (95% CI 3.5-3.7%) and 5.6% (95% CI 5.4-5.7%), respectively. The Healthy China 2030 Stroke Action Plan was launched as part of this review, and the above data provide valuable guidelines for future stroke prevention and treatment efforts in China.