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Guo Z, Xue H, Fan L, Wu D, Wang Y, Chung Y, Liao Y, Ruan Z, Du W. Differential effects of size-specific particulate matter on frailty transitions among middle-aged and older adults in China: findings from the China Health and Retirement Longitudinal Study (CHARLS), 2015-2018. Int Health 2024; 16:182-193. [PMID: 37161970 PMCID: PMC10939306 DOI: 10.1093/inthealth/ihad033] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 04/07/2023] [Accepted: 05/07/2023] [Indexed: 05/11/2023] Open
Abstract
BACKGROUND This study aimed to assess the long-term effects of size-specific particulate matter (PM) on frailty transitions in middle-aged and older Chinese adults. METHODS We included 13 910 participants ≥45 y of age from the China Health and Retirement Longitudinal Study (CHARLS) for 2015 and 2018 who were classified into three categories in 2015 according to their frailty states: robust, prefrail and frail. Air quality data were obtained from the National Urban Air Quality Real-time Publishing Platform. A two-level logistic regression model was used to examine the association between concentrations of PM and frailty transitions. RESULTS At baseline, the total number of robust, prefrail and frail participants were 7516 (54.0%), 4324 (31.1%) and 2070 (14.9%), respectively. Significant associations were found between PM concentrations and frailty transitions. For each 10 μg/m3 increase in the 3-y averaged 2.5-μm PM (PM2.5) concentrations, the risk of worsening in frailty increased in robust (odds ratio [OR] 1.06 [95% confidence interval {CI} 1.01 to 1.12]) and prefrail (OR 1.07 [95% CI 1.01 to 1.13]) participants, while the probability of improvement in frailty in prefrail (OR 0.91 [95% CI 0.84 to 0.98]) participants decreased. In addition, the associations of PM10 and coarse fraction of PM with frailty transitions showed similar patterns. CONCLUSIONS Long-term exposure to PM was associated with higher risks of worsening and lower risks of improvement in frailty among middle-aged and older adults in China.
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Affiliation(s)
- Zhen Guo
- Department of Epidemiology and Biostatistics, School of Public Health, Southeast University, Nanjing 210009, China
| | - Hui Xue
- Department of Epidemiology and Biostatistics, School of Public Health, Southeast University, Nanjing 210009, China
| | - Lijun Fan
- Department of Medical Insurance, School of Public Health, Southeast University, Nanjing 210009, China
| | - Di Wu
- Department of Epidemiology and Biostatistics, School of Public Health, Southeast University, Nanjing 210009, China
| | - Yiming Wang
- Department of Medical Insurance, School of Public Health, Southeast University, Nanjing 210009, China
| | - Younjin Chung
- National Centre for Epidemiology and Population Health, College of Health and Medicine, Australian National University, Canberra, ACT, Australia
| | - Yilan Liao
- State Key Laboratory of Resources and Environmental Information System, Institute of Geographic Sciences and Natural Resources Research, Chinese Academy of Sciences, Beijing, China
| | - Zengliang Ruan
- Department of Epidemiology and Biostatistics, School of Public Health, Southeast University, Nanjing 210009, China
| | - Wei Du
- Department of Epidemiology and Biostatistics, School of Public Health, Southeast University, Nanjing 210009, China
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Guo X, Su W, Wang X, Hu W, Meng J, Ahmed MA, Qu G, Sun Y. Assessing the effects of air pollution and residential greenness on frailty in older adults: a prospective cohort study from China. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2024; 31:9091-9105. [PMID: 38183550 DOI: 10.1007/s11356-023-31741-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 12/22/2023] [Indexed: 01/08/2024]
Abstract
Many studies have established a correlation between air pollution and green space with age-related diseases, yet the relationship between air pollution, green space, and frailty among older adults is not fully understood. The primary objective of this investigation is to examine the longitudinal association among air pollution, green space, and frailty in older adults, as well as the potential interaction and mediating effect. Analyzed data were obtained from the multi-wave CLHLS investigation (2008-2018). The participants' environmental exposure was evaluated using six air pollutants (PM1, PM2.5, PM10, PM10-2.5, O3, and NO2), and normalized difference vegetation index (NDVI). Annual ambient air pollutants were estimated using satellite-based spatiotemporal models. Time-varying Cox proportional risk models were employed to investigate the longitudinal relationships between air pollutants, greenness, and the onset of frailty in the elderly population. We conducted a variety of subgroup analyses, sensitivity analyses, and assessed potential interaction and causal mediating effects. A total of 6953 eligible elderly individuals were enrolled in our study. In the fully adjusted model, per IQR uptick in levels of PM1, PM2.5, PM10, PM10-2.5, O3, and NO2 corresponded to a 17% (95% CI 1.10-1.24), 25% (95% CI 1.17-1.34), 29% (95% CI 1.20-1.39), 35% (95% CI 1.24-1.47), 12% (95% CI 1.04-1.20), and 11% (95% CI 1.05-1.18) increase in frailty risk, respectively. For NDVI, increased IQR was significantly negatively associated with the risk of frailty (aHR 0.82, 95% CI 0.77-0.87). Our results revealed a significant interaction effect among O3, NO2, and residential greenness. PM1, PM2.5, PM10, and PM10-2.5 play a mediating role in the estimated relationship between residential greenness and frailty. In summary, our study reveals that PM1, PM2.5, PM10, PM10-2.5, O3, and NO2 correspond to elevated risks of frailty in the elderly. Residential greenness is associated with a lower risk of frailty in the elderly. Residential greenness can exert a positive impact on frailty by reducing particulate matter concentrations.
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Affiliation(s)
- Xianwei Guo
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Wenqi Su
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Xingyue Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Wenjing Hu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Jia Meng
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Mubashir Ayaz Ahmed
- Division of Pulmonary Critical Care and Sleep Medicine, Albert Einstein Medical Center, Philadelphia, PA, USA
| | - Guangbo Qu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Yehuan Sun
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei, 230032, Anhui, China.
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Del Río SG, Plans-Beriso E, Ramis R, Ortolá R, Pastor R, Sotos-Prieto M, Castelló A, Requena RO, Moleón JJJ, Félix BMF, Muriel A, Miret M, Mateos JLA, Choi YH, Rodríguez-Artalejo F, Fernández-Navarro P, García-Esquinas E. Exposure to residential traffic and trajectories of unhealthy ageing: results from a nationally-representative cohort of older adults. Environ Health 2024; 23:15. [PMID: 38303067 PMCID: PMC10832178 DOI: 10.1186/s12940-024-01057-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 01/22/2024] [Indexed: 02/03/2024]
Abstract
BACKGROUND Traffic exposure has been associated with biomarkers of increased biological ageing, age-related chronic morbidities, and increased respiratory, cardiovascular, and all-cause mortality. Whether it is associated with functional impairments and unhealthy ageing trajectories is unknown. METHODS Nationally representative population-based cohort with 3,126 community-dwelling individuals aged ≥60 years who contributed 8,291 biannual visits over a 10 year period. Unhealthy ageing was estimated with a deficit accumulation index (DAI) based on the number and severity of 52 health deficits, including 22 objectively-measured impairments in physical and cognitive functioning. Differences in DAI at each follow-up across quintiles of residential traffic density (RTD) at 50 and 100 meters, and closest distance to a petrol station, were estimated using flexible marginal structural models with inverse probability of censoring weights. Models were adjusted for sociodemographic and time-varying lifestyle factors, social deprivation index at the census tract and residential exposure to natural spaces. RESULTS At baseline, the mean (SD) age and DAI score of the participants were 69.0 (6.6) years and 17.02 (11.0) %, and 54.0% were women. The median (IQR) RTD at 50 and 100 meters were 77 (31-467) and 509 (182-1802) vehicles/day, and the mean (SD) distance to the nearest petrol station of 962 (1317) meters. The average increase in DAI (95%CI) for participants in quintiles Q2-Q5 (vs Q1) of RTD at 50 meters was of 1.51 (0.50, 2.53), 0.98 (-0.05, 2.01), 2.20 (1.18, 3.21) and 1.98 (0.90, 3.05), respectively. Consistent findings were observed at 100 meters. By domains, most of the deficits accumulated with increased RTD were of a functional nature, although RTD at 50 meters was also associated with worse self-reported health, increased vitality problems and higher incidence of chronic morbidities. Living closer to a petrol station was associated with a higher incidence of functional impairments and chronic morbidities. CONCLUSIONS Exposure to nearby residential traffic is associated with accelerated trajectories of unhealthy ageing. Diminishing traffic pollution should become a priority intervention for adding healthy years to life in the old age.
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Affiliation(s)
- Sergio Gómez Del Río
- Department of Preventive Medicine, Hospital Central de la Cruz Roja San José y Santa Adela, Madrid, Spain
| | - Elena Plans-Beriso
- Department of Chronic Diseases, National Center for Epidemiology, Carlos III Institute of Health, Madrid, Spain
| | - Rebeca Ramis
- Department of Chronic Diseases, National Center for Epidemiology, Carlos III Institute of Health, Madrid, Spain
- Consortium for Biomedical Research in Epidemiology, Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Madrid, Spain
| | - Rosario Ortolá
- Consortium for Biomedical Research in Epidemiology, Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Madrid, Spain
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| | - Roberto Pastor
- Department of Chronic Diseases, National Center for Epidemiology, Carlos III Institute of Health, Madrid, Spain
- Consortium for Biomedical Research in Epidemiology, Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Madrid, Spain
| | - Mercedes Sotos-Prieto
- Consortium for Biomedical Research in Epidemiology, Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Madrid, Spain
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, United States
- IMDEA-Food Institute (CEI UAM+CSIC), Madrid, Spain
| | - Adela Castelló
- Department of Chronic Diseases, National Center for Epidemiology, Carlos III Institute of Health, Madrid, Spain
- Consortium for Biomedical Research in Epidemiology, Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Madrid, Spain
| | - Rocío Olmedo Requena
- Consortium for Biomedical Research in Epidemiology, Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Madrid, Spain
- Department of Preventive Medicine and Public Health, School of Medicine, University of Granada, Granada, Spain
- Instituto de Investigación Biosanitaria ibs. GRANADA, Granada, Spain
| | - José Juan Jiménez Moleón
- Consortium for Biomedical Research in Epidemiology, Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Madrid, Spain
- Department of Preventive Medicine and Public Health, School of Medicine, University of Granada, Granada, Spain
- Instituto de Investigación Biosanitaria ibs. GRANADA, Granada, Spain
| | - Borja María Fernández Félix
- Consortium for Biomedical Research in Epidemiology, Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Madrid, Spain
- Clinical Biostatistics Unit, Hospital Ramón y Cajal (IRYCIS), Madrid, Spain
| | - Alfonso Muriel
- Consortium for Biomedical Research in Epidemiology, Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Madrid, Spain
- Clinical Biostatistics Unit, Hospital Ramón y Cajal (IRYCIS), Madrid, Spain
- Department of Nursery and Physiotherapy, Universidad de Alcalá, Madrid, Spain
| | - Marta Miret
- Department of Psychiatry, Universidad Autónoma de Madrid, Madrid, Spain
- Consortium for Biomedical Research in Mental Health (CIBER en Salud Mental - CIBERSAM), Madrid, Spain
| | - Jose Luis Ayuso Mateos
- Department of Psychiatry, Universidad Autónoma de Madrid, Madrid, Spain
- Consortium for Biomedical Research in Mental Health (CIBER en Salud Mental - CIBERSAM), Madrid, Spain
- Department of Psychiatry, Hospital Universitario de La Princesa, Madrid, Spain
| | - Yoon-Hyeong Choi
- School of Health and Environmental Science, College of Health Science, Korea University, Seoul, Korea
| | - Fernando Rodríguez-Artalejo
- Consortium for Biomedical Research in Epidemiology, Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Madrid, Spain
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
- IMDEA-Food Institute (CEI UAM+CSIC), Madrid, Spain
| | - Pablo Fernández-Navarro
- Department of Chronic Diseases, National Center for Epidemiology, Carlos III Institute of Health, Madrid, Spain.
- Consortium for Biomedical Research in Epidemiology, Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Madrid, Spain.
| | - Esther García-Esquinas
- Department of Chronic Diseases, National Center for Epidemiology, Carlos III Institute of Health, Madrid, Spain.
- Consortium for Biomedical Research in Epidemiology, Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Madrid, Spain.
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Chen X, Qi L, Li S, Duan X. Long-term NO 2 exposure and mortality: A comprehensive meta-analysis. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2024; 341:122971. [PMID: 37984474 DOI: 10.1016/j.envpol.2023.122971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 10/11/2023] [Accepted: 11/14/2023] [Indexed: 11/22/2023]
Abstract
In response to the World Health Organization's (WHO) revised annual mean nitrogen dioxide (NO2) standard from 40 μg/m3 to 10 μg/m3, reflecting the growing evidence linking long-term exposure to ambient NO2 and excess mortality, we conducted a comprehensive meta-analysis incorporating 11 new studies published since the WHO analysis. Our investigation involved a systematic search of three major databases (PubMed, Web of Science, and Scopus) for articles published until July 1, 2022. We employed random effects models to calculate summarized risk ratios (RR) along with 95% confidence intervals (CIs) for overall and subgroup analyses. Sensitivity analyses were conducted to assess result robustness, and publication bias was evaluated using funnel plots and Egger's linear regression. Out of 2799 identified articles, 56 were included in our meta-analysis. The findings indicate a heightened risk of all-cause, cardiovascular, and respiratory mortality associated with long-term exposure to ambient NO2, with pooled RR values of 1.03 (95% CI: 1.02, 1.05), 1.07 (95% CI: 1.04, 1.10), and 1.03 (95% CI: 1.02, 1.05) per 10 μg/m3 increase, respectively. Substantial heterogeneity (I2 = 84%-96%) among studies was observed. Subgroup analysis revealed significantly elevated RR values in Asia and Oceania (p-value <0.05). The aggregated values for all-cause and cardiovascular mortality were slightly larger than those reported in previous studies. Our study emphasizes the imperative to develop more patient cohorts and conduct age-refined analyses to explore the impact of existing chronic diseases on these associations. Further, additional cohorts in Asia and Oceania are essential to fortify evidence in these regions. Lastly, we recommend using fused multi-source data with higher spatiotemporal resolution for individual exposure representation to minimize heterogeneity among studies in future research.
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Affiliation(s)
- Xiaoshi Chen
- School of Energy and Environmental Engineering, University of Science and Technology Beijing, Beijing, Beijing, 100083, China
| | - Ling Qi
- School of Energy and Environmental Engineering, University of Science and Technology Beijing, Beijing, Beijing, 100083, China
| | - Sai Li
- School of Energy and Environmental Engineering, University of Science and Technology Beijing, Beijing, Beijing, 100083, China
| | - Xiaoli Duan
- School of Energy and Environmental Engineering, University of Science and Technology Beijing, Beijing, Beijing, 100083, China.
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Zhou W, Wang Q, Li R, Zhang Z, Wang W, Zhou F, Ling L. The effects of heatwave on cognitive impairment among older adults: Exploring the combined effects of air pollution and green space. THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 904:166534. [PMID: 37647952 DOI: 10.1016/j.scitotenv.2023.166534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 07/23/2023] [Accepted: 08/22/2023] [Indexed: 09/01/2023]
Abstract
The association between heatwaves and cognitive impairment in older adults, especially the joint effect of air pollution and green space on this association, remains unknown. The present cohort study used data from waves of the Chinese Longitudinal Healthy Longevity Survey (CLHLS) from 2008 to 2018. Heatwaves were defined as having daily maximum temperature ≥ 92.5th, 95th and 97.5th percentile that continued at least two, three and four days, measured as the one-year heatwave days prior to the participants' incident cognitive impairment. Data on the annual average air pollutant concentrations of fine particulate matter (PM2.5) and ozone (O3) as well as green space exposure (according to the Normalized Difference Vegetation Index (NDVI)) were collected. Time-varying Cox proportional hazards models were constructed to examine the independent effect of heatwaves on cognitive impairment and the combined effect of heatwaves, air pollution, and green space on cognitive impairment. Potential multiplicative interactions were examined by adding a product term of air pollutants and NDVI with heatwaves in the models. The relative excess risk due to interaction (RERI) was calculated to reflect additive interactions. We found that heatwave exposure was associated with higher risks of cognitive impairment, with hazard ratios (HRs) and 95 % confidence intervals (CIs) ranging from 1.035 (95 % CI: 1.016-1.055) to 1.058 (95 % CI: 1.040-1.075). We observed a positive interaction of PM2.5 concentrations, O3 concentrations, lack of green space, and heatwave exposure on a multiplicative scale (HRs for product terms >1). Furthermore, we found a synergistic interaction of PM2.5 concentrations, O3, lack of green space, and heatwave exposure on an additive scale, with RERIs >0. These results suggest that extreme heat exposure may be a potential risk factor for cognitive impairment in older adults. Additionally, coexposure to air pollution and lack of green space exacerbated the adverse effects of heatwaves on cognitive function.
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Affiliation(s)
- Wensu Zhou
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Qiong Wang
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Rui Li
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Zhirong Zhang
- School of Mathematics, Sun Yat-Sen University, Sun Yat-sen University, Guangzhou, China
| | - Wenjuan Wang
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Fenfen Zhou
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Li Ling
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China; Clinical Research Design Division, Clinical Research Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China.
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Pan C, Cao N. Patterns of Social Isolation and Low Social Support and Frailty Trajectories Among Chinese Older Adults. J Appl Gerontol 2023; 42:2325-2334. [PMID: 37585676 DOI: 10.1177/07334648231194508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2023] Open
Abstract
Objectives: This study aims to identify patterns of social isolation and low social support, and discover their associations with frailty trajectories among Chinese older adults. Methods: The paper used five waves of the Chinese Longitudinal Healthy Longevity Survey (CLHLS, 2005-2018). The latent class analysis, multi-trajectory modeling, and the multinomial logistic regression approaches were used to perform the analysis. Results: The paper identified five types of social isolation and low social support, and three typical frailty trajectories. Patterns of social isolation and low social support were associated with frailty trajectories among older adults. Conclusions: Distinct patterns of social isolation and low social support were significantly correlated with frailty trajectories. To improve frailty trajectories among older adults, interventions such as Healthy China 2030 should prioritize addressing the interplay between social isolation and low social support.
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Affiliation(s)
- Chaoping Pan
- School of Public Health and Management, Wenzhou Medical University, Wenzhou City, China
| | - Na Cao
- School of Public Health and Management, Wenzhou Medical University, Wenzhou City, China
- School of Public Health, Wuhan University, Wuhan City, China
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Ronaldson A, Stewart R, Mueller C, Das-Munshi J, Newbury JB, Mudway IS, Broadbent M, Fisher HL, Beevers S, Dajnak D, Hotopf M, Hatch SL, Bakolis I. Associations between air pollution and mental health service use in dementia: a retrospective cohort study. BMJ MENTAL HEALTH 2023; 26:e300762. [PMID: 37550086 PMCID: PMC10577765 DOI: 10.1136/bmjment-2023-300762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 06/11/2023] [Indexed: 08/09/2023]
Abstract
BACKGROUND Little is known about the role of air pollution in how people with dementia use mental health services. OBJECTIVE We examined longitudinal associations between air pollution exposure and mental health service use in people with dementia. METHODS In 5024 people aged 65 years or older with dementia in South London, high resolution estimates of nitrogen dioxide (NO2) and particulate matter (PM2.5 and PM10) levels in ambient air were linked to residential addresses. Associations between air pollution and Community Mental Health Team (CMHT) events (recorded over 9 years) were examined using negative binomial regression models. Cognitive function was measured using the Mini Mental State Examination (MMSE) and health and social functioning was measured using the Health of the Nation Outcomes Scale (HoNOS65+). Associations between air pollution and both MMSE and HoNOS65+ scores were assessed using linear regression models. FINDINGS In the first year of follow-up, increased exposure to all air pollutants was associated with an increase in the use of CMHTs in a dose-response manner. These associations were strongest when we compared the highest air pollution quartile (quartile 4: Q4) with the lowest quartile (Q1) (eg, NO2: adjusted incidence rate ratio (aIRR) 1.27, 95% CI 1.11 to 1.45, p<0.001). Dose-response patterns between PM2.5 and CMHT events remained at 5 and 9 years. Associations were strongest for patients with vascular dementia. NO2 levels were linked with poor functional status, but not cognitive function. CONCLUSIONS Residential air pollution exposure is associated with increased CMHT usage among people with dementia. CLINICAL IMPLICATIONS Efforts to reduce pollutant exposures in urban settings might reduce the use of mental health services in people with dementia, freeing up resources in already considerably stretched psychiatric services.
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Affiliation(s)
- Amy Ronaldson
- Health Service and Population Research Department, Institute of Psychiatry, Psychology, and Neuroscience (IoPPN), King's College London, London, UK
| | - Robert Stewart
- Department of Psychological Medicine, IoPPN, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Christoph Mueller
- Department of Psychological Medicine, IoPPN, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Jayati Das-Munshi
- Department of Psychological Medicine, IoPPN, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
- ESRC Centre for Society and Mental Health, King's College London, London, UK
| | - Joanne B Newbury
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Social, Genetic & Developmental Psychiatry Centre, IoPPN, King's College London, London, UK
| | - Ian S Mudway
- MRC Centre for Environment and Health, Imperial College London, London, UK
- NIHR Health Protection Research Unit in Environmental Exposures and Health, Imperial College London, London, UK
| | - Matthew Broadbent
- Department of Psychological Medicine, IoPPN, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Helen L Fisher
- ESRC Centre for Society and Mental Health, King's College London, London, UK
- Social, Genetic & Developmental Psychiatry Centre, IoPPN, King's College London, London, UK
| | - Sean Beevers
- MRC Centre for Environment and Health, Imperial College London, London, UK
- NIHR Health Protection Research Unit in Environmental Exposures and Health, Imperial College London, London, UK
| | - David Dajnak
- MRC Centre for Environment and Health, Imperial College London, London, UK
- NIHR Health Protection Research Unit in Environmental Exposures and Health, Imperial College London, London, UK
| | - Matthew Hotopf
- Department of Psychological Medicine, IoPPN, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Stephani L Hatch
- Department of Psychological Medicine, IoPPN, King's College London, London, UK
- ESRC Centre for Society and Mental Health, King's College London, London, UK
| | - Ioannis Bakolis
- Health Service and Population Research Department, Institute of Psychiatry, Psychology, and Neuroscience (IoPPN), King's College London, London, UK
- Department of Biostatistics and Health Informatics, IoPPN, King's College London, London, UK
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Hu K, He Q. Rural-Urban Disparities in Multimorbidity Associated With Climate Change and Air Pollution: A Longitudinal Analysis Among Chinese Adults Aged 45. Innov Aging 2023; 7:igad060. [PMID: 37663149 PMCID: PMC10473454 DOI: 10.1093/geroni/igad060] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Indexed: 09/05/2023] Open
Abstract
Background and Objectives Chronic conditions and multimorbidity are increasing worldwide. Yet, understanding the relationship between climate change, air pollution, and longitudinal changes in multimorbidity is limited. Here, we examined the effects of sociodemographic and environmental risk factors in multimorbidity among adults aged 45+ and compared the rural-urban disparities in multimorbidity. Research Design and Methods Data on the number of chronic conditions (up to 14), sociodemographic, and environmental factors were collected in 4 waves of the China Health and Retirement Longitudinal Study (2011-2018), linked with the full-coverage particulate matter 2.5 (PM2.5) concentration data set (2000-2018) and temperature records (2000-2018). Air pollution was assessed by the moving average of PM2.5 concentrations in 1, 2, 3, 4, and 5 years; temperature was measured by 1-, 2-, 3-, 4-, and 5-year moving average and their corresponding coefficients of variation. We used the growth curve modeling approach to examine the relationship between climate change, air pollution, and multimorbidity, and conducted a set of stratified analyses to study the rural-urban disparities in multimorbidity related to temperature and PM2.5 exposure. Results We found the higher PM2.5 concentrations and rising temperature were associated with higher multimorbidity, especially in the longer period. Stratified analyses further show the rural-urban disparity in multimorbidity: Rural respondents have a higher prevalence of multimorbidity related to rising temperature, whereas PM2.5-related multimorbidity is more severe among urban ones. We also found temperature is more harmful to multimorbidity than PM2.5 exposure, but PM2.5 exposure or temperature is not associated with the rate of multimorbidity increase with age. Discussion and Implications Our findings indicate that there is a significant relationship between climate change, air pollution, and multimorbidity, but this relationship is not equally distributed in the rural-urban settings in China. The findings highlight the importance of planning interventions and policies to deal with rising temperature and air pollution, especially for rural individuals.
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Affiliation(s)
- Kai Hu
- Department of Sociology, School of Social and Public Administration, East China University of Science and Technology, Shanghai, China
| | - Qingqing He
- School of Resource and Environmental Engineering, Wuhan University of Technology, Wuhan, China
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Zhou W, Wang Q, Li R, Kadier A, Wang W, Zhou F, Ling L. Combined effects of heatwaves and air pollution, green space and blue space on the incidence of hypertension: A national cohort study. THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 867:161560. [PMID: 36640878 DOI: 10.1016/j.scitotenv.2023.161560] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 01/03/2023] [Accepted: 01/08/2023] [Indexed: 06/17/2023]
Abstract
Extreme heat exposure has been associated with hypertension. However, its interactive influences with air pollution, green and blue spaces are unclear. This study aimed to explore the interaction between heatwaves, air pollution, green and blue spaces on hypertension. Cohort data enrolled 6448 Chinese older adults aged 65 years and over were derived from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) between 2008 and 2018. Nine heatwave definitions, combining three heat thresholds (92.5th, 95th, and 97.5th percentiles of daily maximum temperature) and three durations (≥2, 3 and 4 days) were used as time-varying variables in the analysis and were the one-year exposure before survival events. Fine particulate matter (PM ≤2.5 μm in aerodynamic diameter (PM2.5)), the Normalized Difference Vegetation Index (NDVI) and the average proportion of open water bodies were used to reflect the air pollution, green and blue space exposures, respectively. PM2.5, green and blue space exposures were time-varying indicators and contemporaneous with heatwaves. Mixed Cox models with time-varying variables were fitted to assess the multiplicative and additive interaction of heatwaves, PM2.5, and green and blue spaces on hypertension, measured by a traditional product term with the ratio of hazard ratio (HR) and relative risk due to interaction (RERI), respectively. A positive multiplicative (HRs >1) and additive interaction (RERIs >0) between heatwaves and higher PM2.5 levels was observed. There was a synergistic effect between heatwaves and decreasing greenness levels on hypertension incidence on additive and multiplicative scales. No significant interaction between heatwaves and blue space was observed in the analysis. The combined effects of heatwaves, air pollution, green and blue space exposures on the risk of hypertension varied with age, gender, and educational attainment. This study's findings complemented the existing evidence and revealed synergistic harmful impacts for heatwaves with air pollution and lack of green space on hypertension incidence.
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Affiliation(s)
- Wensu Zhou
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Qiong Wang
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Rui Li
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Aimulaguli Kadier
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Wenjuan Wang
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Fenfen Zhou
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Li Ling
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China; Clinical research design division, Clinical research center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China.
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10
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Li X, Lyu Y, Dong W, Xu A. Exploring the relationship between air quality and health shocks to the elderly: A retrospective cross-sectional study in China. Front Public Health 2023; 11:1087626. [PMID: 37050940 PMCID: PMC10084765 DOI: 10.3389/fpubh.2023.1087626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 03/06/2023] [Indexed: 03/29/2023] Open
Abstract
MethodsWe selected 5,172 microdata on individuals from the China Health and Retirement Longitudinal Study (CHARLS) 2018. The binary logit model, the ordered logit model, and the stepwise regression were employed to compare the effects of air pollution on self-rated health (SRH) and activities of daily living (ADL) in an elderly population. The effects on health shocks were explored in different age groups, different gender groups, different regions and different sources of pollutants, respectively.ResultsWe found that air pollution significantly increased the risk of health shocks in the elderly population, especially in the 60–69 year age group, and the eastern/central region, where NO2 and O3 were important pollutant sources.ConclusionTargeted management of the environment is necessary to improve the health status of China's elderly population. In addition, paying attention to the health status of vulnerable populations is needed to achieve social equity.
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Affiliation(s)
- Xinyu Li
- School of Health Economics and Management, Nanjing University of Chinese Medicine, Nanjing, China
| | - Yanxia Lyu
- School of Health Economics and Management, Nanjing University of Chinese Medicine, Nanjing, China
| | - Wanyue Dong
- School of Health Economics and Management, Nanjing University of Chinese Medicine, Nanjing, China
| | - Aijun Xu
- School of Health Economics and Management, Nanjing University of Chinese Medicine, Nanjing, China
- Jiangsu Research Center for Major Health Risk Management and TCM Control Policy, Nanjing University of Chinese Medicine, Nanjing, China
- *Correspondence: Aijun Xu
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11
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Veronese N, Maniscalco L, Matranga D, Lacca G, Dominguez LJ, Barbagallo M. Association Between Pollution and Frailty in Older People: A Cross-Sectional Analysis of the UK Biobank. J Am Med Dir Assoc 2023; 24:475-481.e3. [PMID: 36774967 DOI: 10.1016/j.jamda.2022.12.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 12/22/2022] [Accepted: 12/31/2022] [Indexed: 02/11/2023]
Abstract
OBJECTIVES Frailty is a relevant issue in older people, being associated with several negative outcomes. Increasing literature is reporting that pollution (particularly air pollution) can increase the risk of frailty, but the research is still limited. We aimed to investigate the potential association of pollution (air, noise) with frailty and prefrailty among participants 60 years and older of the UK Biobank study. DESIGN Cross-sectional. SETTINGS AND PARTICIPANTS Older participants (age ≥ 60 years) participating to the UK Biobank. METHODS Frailty and prefrailty presence were ascertained using a model including 5 indicators (weakness, slowness, weight loss, low physical activity, and exhaustion). Air pollution was measured through residential exposures to nitrogen oxides (NOx) and particulate matter (PM2.5, PM2.5-10, PM10). The average residential sound level during the daytime, the evening, and night was used as an index for noise pollution. RESULTS A total of 220,079 subjects, aged 60 years and older, was included. The partial proportional odds model, adjusted for several confounders, showed that the increment in the exposure to NOx was associated with a higher probability of being in both the prefrail and frail category [odds ratio (OR) 1.003; 95% CI 1.001-1.004]. Similarly, the increase in the exposure to PM2.5-10 was associated with a higher probability of being prefrail and frail (OR 1.014; 95% CI 1.001-1.036), such as the increment in the exposure to PM2.5 that was associated with a higher probability of being frail (OR 1.018; 95% CI 1.001-1.037). CONCLUSIONS AND IMPLICATIONS Our study indicates that the exposure to air pollutants as PM2.5, PM2.5-10, or NOx might be associated with frailty and prefrailty, suggesting that air pollution can contribute to frailty and indicating that the frailty prevention and intervention strategies should take into account the dangerous impact of air pollutants.
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Affiliation(s)
- Nicola Veronese
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties, "G. D'Alessandro"-PROMISE-University of Palermo, Palermo, Italy.
| | - Laura Maniscalco
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties, "G. D'Alessandro"-PROMISE-University of Palermo, Palermo, Italy
| | - Domenica Matranga
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties, "G. D'Alessandro"-PROMISE-University of Palermo, Palermo, Italy
| | - Guido Lacca
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties, "G. D'Alessandro"-PROMISE-University of Palermo, Palermo, Italy
| | - Ligia J Dominguez
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties, "G. D'Alessandro"-PROMISE-University of Palermo, Palermo, Italy; School of Medicine and Surgery, University Kore of Enna, Enna, Italy
| | - Mario Barbagallo
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties, "G. D'Alessandro"-PROMISE-University of Palermo, Palermo, Italy
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12
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Zhou W, Wang Q, Kadier A, Wang W, Zhou F, Li R, Ling L. The role of residential greenness levels, green land cover types and diversity in overweight/obesity among older adults: A cohort study. ENVIRONMENTAL RESEARCH 2023; 217:114854. [PMID: 36403655 DOI: 10.1016/j.envres.2022.114854] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 10/27/2022] [Accepted: 11/17/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Few studies have investigated the effects of greenness exposure, green land cover types and diversity and their interaction with particulate matter (PM) to adiposity. METHOD Cohort data were collected from the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Baseline data on greenness levels, green land cover types and diversity were assessed by the Normalized Difference Vegetation Index (NDVI), three greenery types (trees, shrublands and grassland) and Shannon's diversity index, respectively. Body mass index (BMI) and waist circumference (WC) were separately used as dependent variables and represented for peripheral overweight/obesity and central obesity, respectively. The mixed Cox model with random intercept was used to estimate the effects of greenness levels, types and diversity on overweight/obesity using single and multiple exposure models. We also examined the interaction of PM and the aforementioned indicators on overweight/obesity on both additive and multiplicative scales. RESULTS Single exposure models showed that higher levels of residential greenness, tree coverage and ratio of trees to shrublands/grassland were inversely associated with peripheral overweight/obesity and central obesity. An increase in shrublands, grassland and diversity of green was related to lower odds of peripheral overweight/obesity. Multiple exposure models confirmed the association between greenness levels and peripheral overweight/obesity. Males, educated participants and elderly who lived in southern regions and areas with cleaner air environments acquired more benefits from greenspace exposure. Single and multiple exposure models indicated that an antagonistic effect of increasing PM and decreasing greenness levels on peripheral overweight/obesity and central obesity. Single exposure models showed the potential interaction of tree coverage, ratio of trees to grassland and PM2.5 exposures on the risk of peripheral overweight/obesity. CONCLUSION Increasing residential greenness and diversity of green were associated with healthy weight status. The relationship between greenery and overweight/obesity varied, and the effects of greenspace exposure on overweight/obesity were associated with air pollution.
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Affiliation(s)
- Wensu Zhou
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Qiong Wang
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Aimulaguli Kadier
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Wenjuan Wang
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Fenfen Zhou
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Rui Li
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Li Ling
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China; Clinical Research Design Division, Clinical Research Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China.
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13
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Song Q, Dai M, Lin T, Zhao Y, Peng X, Liang R, Su Q, Yue J. Biomass fuel usage for cooking and frailty among older adults in China: a population-based cohort study. Front Public Health 2023; 11:1122243. [PMID: 37124768 PMCID: PMC10131187 DOI: 10.3389/fpubh.2023.1122243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 03/28/2023] [Indexed: 05/02/2023] Open
Abstract
Background Although outdoor air pollution is reported to have a negative effect on frailty, evidence involving household air pollution is sparse. Methods A cohort study on older participants aged ≥65 years from the Chinese Longitudinal Healthy Longevity Survey was conducted between 2011/2012 and 2014. Household cooking fuel types were determined by self-reported questionaries, and were dichotomized into clean or biomass fuels. The frailty status was evaluated via a 46-item frailty index (FI) and the FRAIL scale, respectively. Frailty was identified if FI >0.21 or FRAIL score ≥3. Cox proportional hazards models were employed to examine the relationship between cooking fuels and incident frailty. And the effects of swapping cooking fuels on frailty risk were also explored. Results Among 4,643 participants (mean age at baseline 80.9 ± 9.6 years, 53.7% male) totaling 11,340 person-years, 923 (19.9%) incident frailty was identified using FI. Compared to clean fuels, cooking with biomass fuels was intricately linked to a 23% rise in frailty risk (hazard ratio [HR] 1.23, 95% confidence interval [CI] 1.06-1.43). A similar association was detected between biomass cooking fuels and frailty measured by the FRAIL scale (HR 1.24, 95% CI 1.04-1.50). Sensitive analyses supported the independent relationship between biomass fuels and frailty. Stratified analyses revealed that the frailty risk was higher among town residents (HR 1.44, 95% CI 1.13-1.84) and participants not exercising regularly (HR 1.35, 95% CI 1.11-1.64). In comparison with persistent biomass fuels usage, switching to clean fuels had a trend to reduce the frailty risk, and the opposite effect was observed when swapping from clean to biomass fuels. Conclusion Cooking with biomass fuels was associated with an increased frailty risk in older adults, especially amongst those living in town and those lacking regular exercise. More studies are needed to confirm our findings and to evaluate the potential benefits of reducing indoor biomass fuel usage.
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Affiliation(s)
- Quhong Song
- Department of Geriatrics and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Miao Dai
- Department of Geriatrics, Jiujiang First People's Hospital, Jiujiang, China
| | - Taiping Lin
- Department of Geriatrics and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Yanli Zhao
- Department of Geriatrics and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Xuchao Peng
- Department of Geriatrics and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Rui Liang
- Department of Geriatrics and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Qiaoli Su
- Department of General Practice, West China Hospital, Sichuan University, Chengdu, China
- Qiaoli Su
| | - Jirong Yue
- Department of Geriatrics and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
- *Correspondence: Jirong Yue
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Li J, Li Y, Sun F, Lu C. The influence of environmental awareness and conditions on successful aging: Evidence of air and water pollution in China. Glob Public Health 2023; 18:2236680. [PMID: 37515821 DOI: 10.1080/17441692.2023.2236680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 07/10/2023] [Indexed: 07/31/2023]
Abstract
This study examines three aspects of successful aging including subjective health, cognitive ability, and social participation and their relations with environmental conditions and environmental awareness. We used the seemingly uncorrelated regression and multilevel models to estimate the joint relationship by combining the Chinese General Social Survey (2013 and 2021) (N = 5404 and 1580 accordingly) and the Chinese Statistical Yearbook and used propensity score analysis to identify potential endogenous issues. The first finding is that older people who were men, married, lived in urban areas, or received social security had an edge in aging successfully. Secondly, the adverse effects of environmental pollution on older adults' cognitive ability and social participation can be reduced by the protective effects of environmental awareness. Additionally, air pollution had more apparent effects, and water pollution was more modest in social involvement. This study offers empirical results to enhance the well-being of the older population by lifting their environmental perception and improving environmental quality.
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Affiliation(s)
- Jiyue Li
- Department of Sociology, Xi'an Jiaotong University, Xi'an, People's Republic of China
- Institute for Empirical Social Science Research, Xi'an Jiaotong University, Xi'an, People's Republic of China
| | - Yifei Li
- Department of Sociology, Xi'an Jiaotong University, Xi'an, People's Republic of China
- Institute for Empirical Social Science Research, Xi'an Jiaotong University, Xi'an, People's Republic of China
| | - Fei Sun
- School of Social Work, Michigan State University, East Lansing, MI, USA
| | - Chuntian Lu
- Department of Sociology, Xi'an Jiaotong University, Xi'an, People's Republic of China
- Institute for Empirical Social Science Research, Xi'an Jiaotong University, Xi'an, People's Republic of China
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15
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Zhao Q, Liu X, Liu Z. The impact of air pollution on physical disability in a middle-aged and older Chinese population using regression discontinuity design. Health Place 2023; 79:102958. [PMID: 36565540 DOI: 10.1016/j.healthplace.2022.102958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 12/05/2022] [Accepted: 12/12/2022] [Indexed: 12/24/2022]
Abstract
Emerging evidence has shown the association between ambient air pollution exposure and comorbid chronic diseases, which can subsequently impair physical function. However, less is known about the causal and contextual effect of air pollution on physical disability. Using data from the China Health and Retirement Longitudinal Study (CHARLS), this study employs a geographical regression discontinuity design based on the Huai River Policy to estimate the impact of ambient air pollution on physical disability in activities of daily living (ADL) in China. We find that a 10 μg/m3 increase in particulate matter [particulate matter smaller than 10 μm (PM10)] leads to a 5.4% increase in the incidence of physical disability among middle-aged and older adults. This result is robust to using alternative measurement of key variables, different bandwidths and polynomial functions, and adjustment for a set of sociodemographic covariates. Stroke might be one of the potential pathological pathways linking air pollution and physical disability, with a 10 μg/m3 increase in PM10 leading to a 4.7% increase in the incidence of stroke. In heterogeneity analyses, we find that older adults, males, urban residents, and people with lower socioeconomic status are more vulnerable to air pollution. These results contribute to the limited evidence on the causal and contextual effect of air pollution on physical health, and further provide policy implications for air quality control and health protection for vulnerable populations.
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Affiliation(s)
- Qi Zhao
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Xiaoting Liu
- School of Public Affairs, Zhejiang University, China; Institute of Wenzhou, Zhejiang University, China.
| | - Zuyun Liu
- Department of Big Data in Health Science School of Public Health and Center for Clinical Big Data and Analytics of the Second Affiliated Hospital, School of Medicine, Zhejiang University, China
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16
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Zhou F, Zhou W, Wang W, Fan C, Chen W, Ling L. Associations between Frailty and Ambient Temperature in Winter: Findings from a Population-Based Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:513. [PMID: 36612832 PMCID: PMC9819953 DOI: 10.3390/ijerph20010513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 12/13/2022] [Accepted: 12/23/2022] [Indexed: 06/17/2023]
Abstract
Frailty is an accumulation of deficits characterized by reduced resistance to stressors and increased vulnerability to adverse outcomes. However, there is little known about the effect of ambient temperature in winter on frailty among older adults, a population segment with the highest frailty prevalence. Thus, the objective of this study is to investigate the associations between frailty and ambient temperature in winter among older adults. This study was based on the Chinese Longitudinal Healthy Longevity Survey (CLHLS) of older adults aged ≥65 years from the 2005, 2008, 2011, and 2014 waves. The 39-item accumulation of frailty index (FI) was used to assess the frailty status of the participants. The FI was categorized into three groups as follows: robust (FI ≤ 0.10), prefrail (FI > 0.10 to <0.25), and frail (FI ≥ 0.25). Generalized linear mixed models (GLMMs) were conducted to explore the associations between frailty and ambient temperature in winter. A generalized estimating equation (GEE) modification was applied in the sensitivity analysis. A total of 9421 participants were included with a mean age of 82.81 (SD: 11.32) years. Compared with respondents living in the highest quartile (≥7.5 °C) of average temperature in January, those in the lowest quartile (<−1.9 °C) had higher odds of prefrailty (OR = 1.35, 95% CI 1.17−1.57) and frailty (OR = 1.61, 95%CI 1.32−1.95). The associations were stronger among the low-education groups, agricultural workers before retirement, and non-current exercisers. Additionally, results from the GEE model reported consistent findings. Lower levels of ambient temperature in winter were associated with higher likelihoods of prefrailty and frailty. The findings on vulnerability characteristics could help improve public health practices to tailor cold temperature health education and warning information.
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Wang W, Zhou F, Zhou W, Fan C, Ling L. The impact of household wastewater on the frailty state of the elderly in China: based on a long-term cohort study in China. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:76091-76100. [PMID: 35665878 DOI: 10.1007/s11356-022-20271-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 04/11/2022] [Indexed: 06/15/2023]
Abstract
China's household wastewater discharge has gradually increased, and its composition has become more complex, but the discharge treatment system is not perfect. At present, there is a lack of research on the impact of domestic wastewater on human health, especially on the frailty of the elderly. This study aimed to quantitatively assess the relationship between living wastewater and its main components and the frailty status of the elderly. The research data comes from the Chinese Longitudinal Healthy Longevity Survey (CLHLS), which consists of participants over 60 years old who participated in the three-wave survey in 2008, 2011, and 2014 and combined with domestic wastewater data in the statistical yearbook. A generalized estimating equation (GEE) model was used to assess the link between living wastewater and frailty status in the elderly. The single-pollutant model showed that there was a positive correlation between the discharge of household wastewater and the frailty of the elderly, OR (4.443), 95%CI (3.591, 5.498); ammonia nitrogen had a positive correlation with the frail state of the elderly, OR (4.527), 95%CI (3.587, 5.714); chemical oxygen demand (COD) had a negative association with whether the elderly are frail, OR (0.776), 95%CI (0.609, 0.988). After adjusting for covariates, there was still a positive correlation between household wastewater and the frailty of the elderly, OR (2.792), 95%CI (2.233, 3.492); a positive correlation between ammonia nitrogen and the frail state of the elderly, OR (2.894), 95%CI (2.284, 3.666). The association between COD and the frail state of the elderly, OR (0.823), 95%CI (0.640, 1.058), showed no correlation between the two. The results show that household wastewater may affect the health of the elderly, promote the occurrence of a frail state of the elderly, and increase the medical burden.
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Affiliation(s)
- Wenjuan Wang
- School of Public Health, Sun Yat-Sen University, #74, Zhongshan Road II, Guangzhou, Guangdong, 510080, People's Republic of China
| | - Fenfen Zhou
- School of Public Health, Sun Yat-Sen University, #74, Zhongshan Road II, Guangzhou, Guangdong, 510080, People's Republic of China
| | - Wensu Zhou
- School of Public Health, Sun Yat-Sen University, #74, Zhongshan Road II, Guangzhou, Guangdong, 510080, People's Republic of China
| | - Chaonan Fan
- School of Public Health, Sun Yat-Sen University, #74, Zhongshan Road II, Guangzhou, Guangdong, 510080, People's Republic of China
| | - Li Ling
- School of Public Health, Sun Yat-Sen University, #74, Zhongshan Road II, Guangzhou, Guangdong, 510080, People's Republic of China.
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18
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Zhao D, Zhou Z, Shen C, Zhai X, Zhao Y, Cao D, Deng Q, Liu G, Lim JFY. The Effect of Health Check-Ups on Health Among the Elderly in China: Evidence From 2011–2018 Longitudinal Data. Int J Public Health 2022; 67:1604597. [PMID: 35990189 PMCID: PMC9389946 DOI: 10.3389/ijph.2022.1604597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 07/13/2022] [Indexed: 12/03/2022] Open
Abstract
Objectives: To assess the effect of health check-ups on health among the elderly Chinese. Methods: The first dataset was panel data extracted from the 2011, 2014, and 2018 waves of the Chinese Longitudinal Health Longevity Survey (CLHLS). The second dataset was cross-sectional data come from CLHLS 2018 linked with the lagged term of health check-ups in CLHLS 2011. Health check-ups were measured by a binary variable annual health check-up (AHC). Health was assessed by a binary variable self-rated health (SRH). A coarsened exact matching method and individual fixed-effects models, as well as logistic regressions were employed. Results: AHC attendance among the elderly increased from 2011 to 2018, with higher utilization of AHC also detected in the rural group. AHC had positive effects on SRH among rural respondents (short-term effect: OR = 1.567, p < 0.05; long-term effect: OR = 3.385, p < 0.001). Conclusion: This study highlights a higher utilization of AHC in rural area, and the effectiveness of AHC in SRH improvement among rural participants. It indicates enhanced access to public healthcare services in rural area and underlying implications of health check-ups for reducing urban–rural health inequalities.
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Affiliation(s)
- Dantong Zhao
- School of Public Policy and Administration, Xi’an Jiaotong University, Xi’an, China
| | - Zhongliang Zhou
- School of Public Policy and Administration, Xi’an Jiaotong University, Xi’an, China
- *Correspondence: Zhongliang Zhou,
| | - Chi Shen
- School of Public Policy and Administration, Xi’an Jiaotong University, Xi’an, China
| | - Xiaohui Zhai
- School of Public Health, Health Science Center, Xi’an Jiaotong University, Xi’an, China
| | - Yaxin Zhao
- School of Public Health, Health Science Center, Xi’an Jiaotong University, Xi’an, China
| | - Dan Cao
- School of Public Policy and Administration, Xi’an Jiaotong University, Xi’an, China
| | - Qiwei Deng
- School of Public Health, Health Science Center, Xi’an Jiaotong University, Xi’an, China
| | - Guanping Liu
- School of Public Policy and Administration, Xi’an Jiaotong University, Xi’an, China
| | - Jeremy Fung Yen Lim
- Saw Swee Hock School of Public Health, Leadership Institute for Global Health Transformation, National University of Singapore, Singapore, Singapore
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Wensu Z, Wenjuan W, Fenfen Z, Wen C, Li L. The effects of greenness exposure on hypertension incidence among Chinese oldest-old: a prospective cohort study. Environ Health 2022; 21:66. [PMID: 35820901 PMCID: PMC9277785 DOI: 10.1186/s12940-022-00876-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 06/27/2022] [Indexed: 06/13/2023]
Abstract
BACKGROUND Although the oldest-old (those aged over 80 years) are vulnerable to environmental factors and have the highest prevalence of hypertension, studies focusing on greenness exposure and the development of hypertension among them are insufficient. The aim of this study was to explore the association between residential greenness and hypertension in the oldest-old population. METHODS This cohort study included data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS). The oldest-old were free of hypertension at baseline (2008), and hypertension events were assessed by follow-up surveys in 2011, 2014, and 2018. The one-year averages of the normalized difference vegetation index (NDVI) and enhanced vegetation index (EVI) at 500-m buffer before the interview year of incident hypertension or last censoring interview were collected at the level of 652 residential units (district or county). The linear or nonlinear association between greenness and hypertension incidence was analyzed using the Cox proportional hazards model with penalized splines. The linear links between greenness and hypertension incidence were determined using the Cox proportional hazards model included a random effect term. RESULTS Among 5253 participants, the incidence rate of hypertension was 7.25 (95% confidence interval [CI]: 6.83-7.67) per 100 person-years. We found a nonlinear association between greenness exposure and hypertension risk, and the exposure-response curve showed that 1 change point existed. We examined the linear effect of greenness on hypertension by categorizing the NDVI/EVI into low and high-level exposure areas according to the change point. We found more notable protective effects of each 0.1-unit increase in greenness on hypertension incidence for participants living in the high-level greenness areas (hazard ratio (HR) = 0.60; 95% CI: 0.53-0.70 for NDVI; HR = 0.46; 95% CI: 0.37-0.57 for EVI). In contrast, no significant influence of greenness exposure on hypertension risk was found for participants living in the low-level greenness areas (HR = 0.77; 95% CI: 0.38-1.55 for NDVI; HR = 0.73; 95% CI: 0.33-1.63 for EVI). CONCLUSIONS Greenness exposure is nonlinearly associated with hypertension risk among the oldest-old, presenting its relationship in an inverse "U-shaped" curve. Greenness is a protective factor that decreases the risk of hypertension.
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Affiliation(s)
- Zhou Wensu
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Wang Wenjuan
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Zhou Fenfen
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Chen Wen
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China.
| | - Ling Li
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China.
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20
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Cao L, Zhai D, Kuang M, Xia Y. Indoor air pollution and frailty: A cross-sectional and follow-up study among older Chinese adults. ENVIRONMENTAL RESEARCH 2022; 204:112006. [PMID: 34499891 DOI: 10.1016/j.envres.2021.112006] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 08/31/2021] [Accepted: 09/01/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Previous studies have suggested that ambient air pollution negatively affects frailty, but whether indoor air pollution exposure affects frailty is unknown. METHOD This study was conducted on 4946 older adults (≥60 years) followed from baseline to 4 years in the Chinese Longitudinal Healthy Longevity Survey. Household fuel types and frailty were assessed with self-rated questionnaires and physical examination. The relationships between indoor air pollution and frailty via phenotypic frailty and a frailty index were explored with logistic regression models and Cox proportional hazard regression models in both a cross-sectional and follow-up design. Additionally, the effects of indoor air pollution on phenotypic frailty together with mild cognitive impairment (MCI) were further investigated. RESULTS In the cross-sectional study, the adjusted ORs (95% CIs) for frailty assessment with the frailty index and phenotypic frailty were 1.28 (1.12, 1.46) and 1.36 (1.18, 1.57), respectively. Solid fuel use was a risk factor in prefrail/frail patients with [OR and 95% CI, 1.88 (1.41, 2.50)], or without MCI [OR and 95% CI, 1.37 (1.17, 1.61)], as compared with the groups with no phenotypic prefrailty/frailty and no MCI. Moreover, solid cooking fuel use was positively associated with the incidence of phenotypic prefrailty and frailty. The adjusted HRs (95% CIs) for phenotypic prefrailty and frailty were 1.26 (1.03, 1.55). CONCLUSIONS Solid cooking fuels can be regarded as a risk factor for frailty. Moreover, our findings suggest that more attention should be paid to solid cooking fuel using as it relates to phenotypic frailty together with MCI.
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Affiliation(s)
- Limin Cao
- The Third Central Hospital of Tianjin, 83 Jintang Road, Hedong District, Tianjin, 300170, China; Tianjin Key Laboratory of Extracorporeal Life Support for Critical Disease, China
| | - Daokuan Zhai
- The Third Central Hospital of Tianjin, 83 Jintang Road, Hedong District, Tianjin, 300170, China; Tianjin Key Laboratory of Extracorporeal Life Support for Critical Disease, China
| | - Mingjie Kuang
- Department of Orthopedics, Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, 250014, China.
| | - Yang Xia
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, China.
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21
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Wensu Z, Wen C, Fenfen Z, Wenjuan W, Li L. The Association Between Long-Term Exposure to Particulate Matter and Incidence of Hypertension Among Chinese Elderly: A Retrospective Cohort Study. Front Cardiovasc Med 2022; 8:784800. [PMID: 35087881 PMCID: PMC8788195 DOI: 10.3389/fcvm.2021.784800] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 12/09/2021] [Indexed: 12/25/2022] Open
Abstract
Background and Objectives: Studies that investigate the links between particulate matter ≤2. 5 μm (PM2.5) and hypertension among the elderly population, especially those including aged over 80 years, are limited. Therefore, we aimed to examine the association between PM2.5 exposure and the risk of hypertension incidence among Chinese elderly. Methods: This prospective cohort study used 2008, 2011, 2014, and 2018 wave data from a public database, the Chinese Longitudinal Healthy Longevity Survey, a national survey investigating the health of those aged over 65 years in China. We enrolled cohort participants who were free of hypertension at baseline (2008) from 706 counties (districts) and followed up in the 2011, 2014, and 2018 survey waves. The annual PM2.5 concentration of 706 counties (districts) units was derived from the Atmospheric Composition Analysis Group database as the exposure variable, and exposure to PM2.5 was defined as 1-year average of PM2.5 concentration before hypertension event occurrence or last interview (only for censoring). A Cox proportional hazards model with penalized spline was used to examine the non-linear association between PM2.5 concentration and hypertension risk. A random-effects Cox proportional hazards model was built to explore the relationship between each 1 μg/m3, 10 μg/m3 and quartile increment in PM2.5 concentration and hypertension incidence after adjusting for confounding variables. The modification effects of the different characteristics of the respondents were also explored. Results: A total of 7,432 participants aged 65-116 years were enrolled at baseline. The median of PM2.5 exposure concentration of all the participants was 52.7 (inter-quartile range, IQR = 29.1) μg/m3. Overall, the non-linear association between PM2.5 and hypertension incidence risk indicated that there was no safe threshold for PM2.5 exposure. The higher PM2.5 exposure, the greater risk for hypertension incidence. Each 1 μg/m3 [adjusted hazard ratio (AHR): 1.01; 95% CI: 1.01-1.02] and 10 μg/m3 (AHR: 1.12; 95% CI: 1.09-1.16) increments in PM2.5, were associated with the incidence of hypertension after adjusting for potential confounding variables. Compared to first quartile (Q1) exposure, the adjusted HRs of hypertension incidence for the Q2, Q3 and Q4 exposure of PM2.5 were 1.31 (95% CI: 1.13-1.51), 1.35 (95% CI: 1.15-1.60), and 1.83 (95% CI: 1.53-2.17), respectively. The effects appear to be stronger among those without a pension, living in a rural setting, and located in central/western regions. Conclusion: We found no safe threshold for PM2.5 exposure related to hypertension risk, and more rigorous approaches for PM2.5 control were needed. The elderly without a pension, living in rural and setting in the central/western regions may be more vulnerable to the effects of PM2.5 exposure.
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Affiliation(s)
- Zhou Wensu
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Chen Wen
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Zhou Fenfen
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Wang Wenjuan
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Ling Li
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
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22
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Shen WT, Yu X, Zhong SB, Ge HR. Population Health Effects of Air Pollution: Fresh Evidence From China Health and Retirement Longitudinal Survey. Front Public Health 2022; 9:779552. [PMID: 35004584 PMCID: PMC8733201 DOI: 10.3389/fpubh.2021.779552] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 10/04/2021] [Indexed: 11/13/2022] Open
Abstract
The effects of air pollution on population health are currently a hot topic. However, few studies have examined the physical and mental health effects of air pollution jointly in China. Using data from the China Health and Retirement Longitudinal Study (CHARLS) in 2015 and 2018, this study explores how air pollution affects the physical and mental health of middle-aged and elderly residents. The empirical results highlight that air pollution can negatively affect both physical and mental health. In terms of physical health, those exposed to chronic shock are likely to suffer more adverse effects from air pollution than those exposed to acute shock. In terms of mental health, those exposed to depression suffer greater adverse effects than those exposed to episodic memory and mental cognition. Besides, heterogeneity analysis also shows that air pollution affects the mental and physical health of males more than females. Furthermore, the increase in air pollution is expected to result in huge hospitalization costs. Therefore, the Chinese government should formulate differentiated public health policies to reduce the effects of air pollution on the health of middle-aged and elderly residents.
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Affiliation(s)
- Wei-Teng Shen
- Business School, Zhejiang Wanli University, Ningbo, China
| | - Xuan Yu
- Business School, Ningbo University, Ningbo, China
| | - Shun-Bin Zhong
- School of Information, Central University of Finance and Economics, Beijing, China
| | - Hao-Ran Ge
- Business School, Zhejiang Wanli University, Ningbo, China
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Chen S, Wang Y, Wang Z, Zhang X, Deng C, Ma B, Yang J, Lu Q, Zhao Y. Sleep Duration and Frailty Risk among Older Adults: Evidence from a Retrospective, Population-Based Cohort Study. J Nutr Health Aging 2022; 26:383-390. [PMID: 35450995 DOI: 10.1007/s12603-022-1766-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Frailty and sleep duration complaints are both prevalent and often coexist among older adults. The purpose of this study was to examine the prospective association between sleep duration and frailty risk in a nationally representative cohort study. DESIGN Prospective cohort study, ten-year follow-up. SETTING Community-based setting in 23 provinces of China. PARTICIPANTS A total of 7623 older adults age 65 and over without frailty at baseline were included in the analysis. MEASUREMENTS The participants were divided into three groups according to self-reported sleep duration: short (≤6 hours per day), middle (>6 but <10 hours per day) and long (≥10 hours per day). Frailty was measured according to the accumulation of health deficits by the construction of a frailty index of 38 items with 0.25 as the cutoff. A Cox proportional hazard model, a competing risk model and a generalized estimating equation (GEE) model with multiple adjustments were performed to evaluate the association between sleep duration and frailty risk. RESULTS During a median follow-up period of 4.4 years (IQR 2.9-9.0), 2531 (33.2%) individuals developed frailty. Compared with participants with middle sleep duration, the risk of frailty was increased among participants with long sleep duration (HR 1.26, 95% CI 1.14-1.38) in the fully adjusted Cox proportional hazard model. However, short sleep duration was insignificantly associated with frailty risk. The competing risk model and the GEE model yielded similar results. CONCLUSION Long sleep duration is significantly associated with frailty incidence among older adults even after adjustment for confounding factors. This study provides reinforcing longitudinal evidence for the need to design sleep quality improvement interventions in health care programs to prevent frailty among older adults.
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Affiliation(s)
- S Chen
- Qi Lu, MD, School of Nursing, Tianjin Medical University, Tianjin, 300070, China. Tel:86-23542855. Email address: ; Yue Zhao, PhD, Professor, School of Nursing, Tianjin Medical University, Tianjin, 300070, China. Tel:86-23542855. Email address:
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Yang R, Ren F, Ma X, Zhang H, Xu W, Jia P. Explaining the longevity characteristics in China from a geographical perspective: A multi-scale geographically weighted regression analysis. GEOSPATIAL HEALTH 2021; 16. [PMID: 34763415 DOI: 10.4081/gh.2021.1024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 11/05/2021] [Indexed: 06/13/2023]
Abstract
Longevity is a near-universal human aspiration that can affect moral progress and economic development at the social level. In rapidly developing China, questions about the geographical distribution and environmental factors of longevity phenomenon need to be answered more clearly. This study calculated the longevity index (LI), longevity index for females (LIF) and longevity index for males (LIM) based on the percentage of the long-lived population among the total number of elderly people to investigate regional and gender characteristics at the county level in China. A new multi-scale geographically weighted regression (MGWR) model and four possible geographical environmental factors were applied to explore environmental effects. The results indicate that the LIs of 2838 counties ranged from 1.3% to 16.3%, and the distribution showed obvious regional and gender differences. In general, the LI was high in the East and low in the West, and the LIF was higher than the LIM in 2614 counties (92.1%). The MGWR model performed well explaining that geographical environmental factors, including topographic features, vegetation conditions, human social activity and air pollution factors have a variable influence on longevity at different spatial scales and in different regions. These findings enrich our understanding of the spatial distribution, gender differences and geographical environmental effects on longevity in China, which provides an important reference for people interested in the variations in the associations between different geographical factors.
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Affiliation(s)
- Renfei Yang
- School of Resource and Environmental Science, Wuhan University, Wuhan.
| | - Fu Ren
- School of Resource and Environmental Science, Wuhan University, Wuhan; Key Laboratory of GIS, Ministry of Education, Wuhan University, Wuhan.
| | - Xiangyuan Ma
- School of Resource and Environmental Science, Wuhan University, Wuhan.
| | - Hongwei Zhang
- Electronic Information School, Wuhan University, Wuhan.
| | - Wenxuan Xu
- School of Geographic and Oceanographic Sciences, Nanjing University, Nanjing.
| | - Peng Jia
- School of Resource and Environmental Science, Wuhan University, Wuhan; International Institute of Spatial Lifecourse Epidemiology (ISLE), Wuhan University, Wuhan.
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