Four-years change of BMI and waist circumference are associated with metabolic syndrome in middle-aged and elderly Chinese

The purpose of the study was to determine whether changes in body mass index (BMI) and waist circumference (WC) in middle-aged and elderly Chinese are associated with metabolic syndrome. In this cohort investigation, 3697 middle-aged and elderly people aged 45 or over were recruited from the China Health and Retirement Longitudinal Study (CHARLS). The National Cholesterol Education Program Adult Treatment Panel III (2005) defined metabolic syndrome (MetS). With Cox regression analysis, we calculated hazard ratio (HR) and 95% confidence intervals (CIs) for MetS based on BMI-WC change categories. To assess the prevalence of MetS, the changes in BMI and WC levels were classified into four quartiles based on their relative and absolute changes. In subjects whose BMI and WC decreased (HR = 0.338; 95% CIs 0.264, 0.433) as well as those whose BMI increased and their WC decreased (HR = 0.375; 95% CIs 0.228, 0.499), metabolic syndrome risk was significantly lower compared with those with increases in both BMI and WC. Regarding the absolute changes in BMI, the lowest percentile of BMI was significantly lower in both males (HR = 0.302; 95% CIs 0.204, 0.448) and females (HR = 0.486; 95% CIs 0.354, 0.667) for the risk of metabolic syndrome. Similar results were observed in the absolute changes in WC, with the lowest quantile of WC having a significant impact on MetS risk in males (HR = 0.170; 95% CIs 0.107, 0.270) and females (HR = 0.303; 95% CIs 0.217, 0.424). The risk of metabolic syndrome was significantly associated with changes in BMI and WC in middle-aged and elderly Chinese. A reduced BMI and WC are associated with lower metabolic syndrome risks in middle-aged and elderly people.

Decomposition analysis on the equity of health examination utilization for the middle-aged and elderly people in China: based on longitudinal CHARLS data from 2011 to 2018

BACKGROUND

This study aimed to investigate the utilization rate and equity of health examination service among the middle-aged and elderly population in China from 2011 to 2018. The contribution of various determinants to the inequity in health examination service utilization was also examined.

METHODS

Data from the China Health and Retirement Longitudinal Survey (CHARLS) were analyzed to assess the health examination service utilization rate among the middle-aged and elderly population. A concentration curve and concentration index were employed to measure the equity of health examination service utilization and decomposed into its determining factors. Horizontal inequity index was applied to evaluate the trends in equity of health examination service.

RESULTS

The health examination service utilization rates among the middle-aged and elderly population were 29.45%, 20.69%, 25.40%, and 32.05% in 2011, 2013, 2015, and 2018, respectively. The concentration indexes for health examination service utilization were 0.0080 (95% CI: - 0.0084, 0.0244), 0.0155 (95% CI: - 0.0054, 0.0363), 0.0095 (95% CI: - 0.0088, 0.0277), and - 0.0100 (95% CI: - 0.0254, 0.0054) from 2011 to 2018, respectively. The horizontal inequity index was positive from 2011 to 2018, evidencing a pro-rich inequity trend. Age, residence, education, region, and economic status were the major identified contributors influencing the equity of health examination service utilization.

CONCLUSIONS

A pro-rich inequity existed in health examination service utilization among the middle-aged and elderly population in China. Reducing the wealth and regional gap, providing equal educational opportunities, and strengthening the capacity for chronic disease prevention and control are crucial for reducing the inequity in health examination service utilization.

Analysis of related factors for sarco-osteoporosis in middle-aged and elderly inpatients and development and validation of a nomogram

BACKGROUND

Sarco-osteoporosis is a skeletal muscle disease associated with aging and complex pathological factors. At present, there are few studies on the analysis of its related factors, and a nomogram to estimate the risk of sarco-osteoporosis in middle-aged and elderly patients is not available.

METHODS

A total of 386 patients admitted to our hospital from October 2021 to October 2022 were collected, and the general demographic data and clinical data of the patients were collected.386 subjects were enrolled in the study and randomly divided into training set and validation set at a ratio of 7:3. In the training set, the Least absolute shrinkage and selection operator(LASSO)regression technique was used to select the optimal predictive features, and multivariate logistic regression was used to screen the factors associated with sarco-osteoporosis, and a nomogram was constructed using meaningful variables from multivariate analysis. The performance of the nomograms was assessed and validated by Area Under Curve (AUC) and calibration curves.

RESULTS

There were no significant differences in baseline characteristic of individuals in training set and validation set, six variables with non-zero coefficients were screened based on LASSO regression in the training set. Multivariate logistic regression analysis showed that the related factors for sarco-osteoporosis in middle-aged and elderly inpatients included age (OR = 1.08, 95%CI 1.03 ∼ 1.14), regular exercise (OR = 0.29, 95%CI 0.15 ∼ 0.56), albumin (OR = 0.9, 95%CI 0.82 ∼ 0.98), height (OR = 0.93, 95%CI 0.88 ∼ 0.99) and lean mass index (OR = 0.66, 95%CI 0.52 ∼ 0.85), and a nomogram was constructed based on the above factors. AUC of nomogram were 0.868(95%CI 0.825 ∼ 0.912) in the training set and 0.737(95%CI 0.646 ∼ 0.828) in the validation set. Calibration curve analysis showed that the predicted probability of sarco-osteoporosis had high consistency with the actual probability, and the absolute error of the training set and verification set was 0.018 and 0.03, respectively.

CONCLUSIONS

Our research showed that the occurrence of sarco-osteoporosis was associated with age, regular exercise, albumin, height and lean mass index, and we have developed a nomogram that can be effectively used in the preliminary and in-depth risk prediction of sarco-osteoporosis in middle-aged and elderly hospitalized patients.

Associations of muscle mass and strength with new-onset diabetes among middle-aged and older adults: evidence from the China health and retirement longitudinal study (CHARLS)

BACKGROUND

The associations of muscle mass and strength with new-onset Type 2 diabetes mellitus (T2DM) remain controversial. We aimed to longitudinally evaluate muscle mass and strength in predicting T2DM among Chinese middle-aged and older adults.

METHODS

We enrolled 6033 participants aged ≥ 45 years from the China Health and Retirement Longitudinal Study (CHARLS), a cohort survey, between 2011 and 2012. The appendicular skeletal muscle mass (normalized by weight, ASM/BW%), relative hand grip strength (normalized by weight, HGS/BW), and five-repetition chair stand test (5CST). were all categorized into tertiles (lowest, middle, and highest groups) at baseline, respectively. Individuals were followed up until the occurrence of diabetes or the end of CHARLS 2018, whichever happened first. Cox proportional hazards models to calculate hazard ratios with 95% confidence intervals (CI) and mediation analysis were used.

RESULTS

During follow-up, 815 (13.5%) participants developed T2DM. After adjusting for covariates, lower ASW/BW% was not associated with a higher risk of diabetes. Compared with individuals in the highest tertile of HGS/BW, those in the lowest tertile had 1.296 (95%CI 1.073-1.567) higher risk of diabetes. Compared with individuals in the lowest tertile of 5CST, those in the highest tertile had 1.329 times (95%CI 1.106-1.596) higher risk of diabetes. By subgroup, both the lowest HGS/BW and highest 5CST were risk factors for diabetes among obesity. The mediation analysis revealed that the effect of HGS/BW on the risk of diabetes is mainly mediated by insulin resistance.

CONCLUSIONS

Lower muscle strength is associated with an increased risk of diabetes, especially in obese populations.

Analysis of depression incidence and influence factors among middle-aged and elderly diabetic patients in China: based on CHARLS data

BACKGROUND

To investigate the incidence of depression in middle-aged and elderly patients with diabetes in China and the influencing factors to provide a theoretical basis to improve the mental health of middle-aged and elderly patients with diabetes and formulate prevention, control, and intervention strategies.

METHODS

The sample of this study was obtained from the China Health and Aging Tracking Survey (CHARLS) 2018 survey data, and middle-aged and older patients with diabetes(responding "Yes" to the questionnaire: "Have you ever been told by a doctor that you have diabetes or elevated blood glucose [including abnormal glucose tolerance and elevated fasting glucose]?") aged ≥ 45 years were selected as study subjects (n = 2,613 ). Depressive symptoms of the study subjects were determined using the simplified version of the Depression Scale for Epidemiological Surveys scores(a score ≥ 10 was defined as depression), influence factors were analyzed using binary logistic regression, and proportion of depressive symptoms was standardized using the sex ratio of the seventh census.

RESULTS

Among the 2,613 middle-aged and elderly patients with diabetes, 1782 (68.2%) had depressive symptoms and 831 (31.8%) had no depressive symptoms. There were 481 (27.0%) patients aged 45-59 years, 978 (54.9%) aged 60-74 years, and 323 (18.1%) aged ≥ 75 years. The depression rate among middle-aged and elderly Chinese patients with diabetes after standardization correction was 67.5%. Binary logistic regression results showed that age, education level, life satisfaction, marital satisfaction, self-rated health grade, somatic pain, visual impairment, physical disability, and the presence of comorbid chronic diseases were factors that influenced the onset of depression in middle-aged and elderly Chinese patients with diabetes (P < 0.05).

CONCLUSION

According to a survey analysis of the CHARLS 2018 data, depression is influenced by a combination of factors among middle-aged and elderly patients with diabetes in China. Therefore, for this population, targeted prevention and control should be carried out for key populations, such as middle-aged and elderly people, poor physical health, and low life satisfaction and marital satisfaction, from various dimensions (e.g., demographic and sociological factors, physical health status, and life satisfaction and marital satisfaction).

Effect of Helicobacter pylori infection on body fat percentage in middle-aged and elderly populations

Obesity, which is associated with excessive accumulation of body fat, is emerging as a new public health problem. Bioelectrical impedance analysis (BIA) is a non-invasive and straightforward method to analyze body composition, providing a more accurate estimate of obesity than the commonly used body mass index. The primary objective of this study was to examine the potential impact of Helicobacter pylori (H. pylori) infection on body fat percentage in a population using cross-sectional and cohort studies.

METHODS

A population of people who underwent physical examinations at Taizhou Hospital between 2017 and 2022 was included. The participants underwent various tests, including urea breath test, hematological examination, and anthropometric measurement, in addition, their body fat percentage was determined through the use of BIA. Univariate and multifactorial regression analyses were conducted to identify factors associated with excess body fat.

RESULTS

There was a difference in body fat percentage between H. pylori positive and negative populations. The population was divided into young and middle-aged and elderly according to age, and H. pylori infection was found to differ only in the middle-aged and elderly population. Multifactorial logistic regression showed that H. pylori infection remained associated with excess body fat in the middle-aged and elderly population. A subsequent cohort study confirmed the association of persistent H. pylori infection with excess body fat in the population.

CONCLUSION

H. pylori was negatively associated with excess body fat in middle-aged and elderly populations, and long-term H. pylori infection has a negative effect on body fat in people.

Effect of different types of Tai Chi exercise programs on the rate of change in bone mineral density in middle-aged adults at risk of osteoporosis: a randomized controlled trial

OBJECTIVE

To evaluate three Tai Chi (TC) exercise programs as intervention measures to compare their effects on improving rate of change in bone mineral density (BMD) in elderly individuals with osteoporosis (OP) and to propose the optimal exercise duration.

METHODS

A randomized controlled trial (RCT) was conducted to identify study participants based on inclusion and exclusion criteria. Due to subject attrition, the number of participants analyzed decreased from 60 to 49. These participants were divided into four groups: 24-style TC Chuan group (24TCCG) (n = 13, 7 males/6 females), TC Kung Fu Fan group (TCKFFG) (n = 12, 5 males/7 females), TC Softball group (TCSBG) (n = 11, 6 males/5 females), and a control group (CG) (n = 13, 6 males/7 females). Except for the control group, each group received different TC exercise programs four times a week for 60 min per session, lasting for 16 weeks. BMD was measured using dual-energy X-ray absorptiometry (DXA) at the L2-L4 lumbar vertebrae, Ward's triangle, femoral neck, and greater trochanter. The rate of change of BMD was calculated using the formula.

RESULTS

Compared with CG, all three TC groups showed significant improvements in BMD changes (P < 0.05), but their effects on the improvement of femoral neck and greater tuberosity BMD change rates were similar (P > 0.05). In addition, compared to the other exercise regimens, 24TCCG demonstrated more significant improvements in BMD at the L2-L4 lumbar vertebrae region and exhibited a more pronounced improvement in Ward's triangle BMD after only 8 weeks (P < 0.05). Short-term (≤ 4 weeks) TCKFFG was more effective than TCSBG in enhancing femoral neck BMD (P < 0.05). However, statistical significance was not found (P > 0.05) in all other cases.

CONCLUSION

These three TC exercise programs have similar positive effects on the BMD of the femoral neck and greater trochanter. However, compared with other exercise schemes, 24TCC showed a more significant improvement in BMD of the L2-L4 lumbar vertebrae region after just 8 weeks, as well as a more pronounced improvement in BMD of Ward's triangle. In terms of improving femoral neck BMD, TCKFF was found to be more effective than TCSB in less than 4 weeks. This study provides evidence for the effectiveness of TC exercise in improving BMD and preventing OP in the middle-aged and elderly high-risk population.

Comprehensive Insights into the Health Effects of Selenium Exposure and Supplementation Among the Chinese Community Middle-Aged and Elderly: a Combined Retrospective Cohort Study and Intervention Study

Selenium (Se) is an essential trace element for maintaining human health, for example, plays a crucial role in preventing aging-related diseases. However, most studies on the health effects of Se among the community middle-aged and elderly have been observational or the health indices were single, and the related study among the Chinese population is limited. Additionally, China is recognized as among the countries facing a significant deficiency in Se, and Se contents in the human body may decrease with age. Therefore, a two-step study was conducted to explore the health effects of Se exposure and supplementation among such populations in China. Firstly, a retrospective cohort study was conducted to compare the health outcomes between such populations residing in Se-rich regions and non-Se-rich regions, involving a total of 102 subjects, with 51 residing in Se-rich regions and 51 in non-Se-rich regions. The hair-Se (H-Se) contents, serum-Se (S-Se) contents, and total cholesterol of subjects from Se-rich regions were significantly higher than their counterparts. Notably, significant positive associations were observed between S-Se and lipids. Secondly, a before-after self-control Se supplementation study among subjects residing in non-Se-rich regions was conducted. A total of 40 subjects administered Se tablets orally for 30 days, with Se of 120 μg/day. The results showed significant increases in H-Se and S-Se. Se supplementation also exhibited positive effects on alanine aminotransferase, homocysteine, and fasting glucose; however, high-density lipoprotein cholesterol significantly decreased. Overall, the community middle-aged and elderly residing in Se-rich regions or receiving quantitative Se supplementation could effectively improve Se contents in bodies and certain health indices, excluding lipids. These improvements encompass liver function, cardiovascular health, and glucose metabolism. These findings enhance our understanding of how Se impacts the health of the middle-aged and elderly, emphasizing the significance of targeted interventions for such populations in non-Se-rich regions. Trial registration: ChiCTR2000040987 ( https://www.chictr.org.cn ).

Age-dependent association of high urinary iodine concentration with major depression in adults: NHANES 2007-2020

Excessive iodine exposure can have detrimental effects on thyroid function and overall health. This study aimed to investigate the age-dependent association between high urinary iodine concentration (UIC) and major depression symptoms in adults, using data from the National Health and Nutrition Examination Survey (NHANES) from 2007 to 2020. To perform stratified analysis by age, we utilized a rolling window method with a 15-year window width to examine the trend of the odds ratios (ORs) of UIC on depression symptoms with age. Full-factor and one-factor multinomial logistic regression models were employed to calculate the ORs, and violin plots were utilized to depict the ORs of UIC on major depression. The LASSO regression was applied to select variables for one-factor models. The bootstrap method was utilized to ensure the robustness of the results, and the Games-Howell test was applied to compare the differences in the bootstrapped ORs of different UIC groups. Our results indicate that, after age 46, the ORs of high UIC (≥ 300 μg/L) on major depression are significantly higher than those of normal UIC (100-199 μg/L). The bootstrapped ORs of high UIC on major depression calculated by the full-factor and one-factor multinomial logistic regression models are 1.9 (1.28, 2.82) and 1.42 (1.02, 1.93) among participants aged 46 and older, respectively. Based on these findings, we conclude that major depressive symptoms are significantly associated with high UIC among older individuals aged 46 and above.

Predicting hypertension by obesity- and lipid-related indices in mid-aged and elderly Chinese: a nationwide cohort study from the China Health and Retirement Longitudinal Study

BACKGROUND

Currently, the study outcomes of anthropometric markers to predict the risk of hypertension are still inconsistent due to the effect of racial disparities. This study aims to investigate the most effective predictors for screening and prediction of hypertension (HTN) in the Chinese middle-aged and more elderly adult population and to predict hypertension using obesity and lipid-related markers in Chinese middle-aged and older people.

METHODS

The data for the cohort study came from the China Health and Retirement Longitudinal Study (CHARLS), including 4423 middle-aged and elderly people aged 45 years or above. We examined 13 obesity- and lipid-related indices, including waist circumference (WC), body mass index (BMI), waist-height ratio (WHtR), visceral adiposity index (VAI), a body shape index (ABSI), body roundness index (BRI), lipid accumulation product index (LAP), conicity index (CI), Chinese visceral adiposity index (CVAI), triglyceride-glucose index (TyG-index) and their combined indices (TyG-BMI, TyG-WC, TyG-WHtR). To compare the capacity of each measure to forecast the probability of developing HTN, the receiver operating characteristic curve (ROC) was used to determine the usefulness of anthropometric indices for screening for HTN in the elderly and determining their cut-off value, sensitivity, specificity, and area under the curve (AUC). Association analysis of 13 obesity-related anthropometric indicators with HTN was performed using binary logistic regression analysis.

RESULTS

During the four years, the incident rates of HTN in middle-aged and elderly men and women in China were 22.08% and 17.82%, respectively. All the above 13 indicators show a modest predictive power (AUC > 0.5), which is significant for predicting HTN in adults (middle-aged and elderly people) in China (P < 0.05). In addition, when WHtR = 0.501 (with an AUC of 0.593, and sensitivity and specificity of 63.60% and 52.60% respectively) or TYg-WHtR = 4.335 (with an AUC of 0.601, and sensitivity and specificity of 58.20% and 59.30% respectively), the effect of predicting the incidence risk of men is the best. And when WHtR = 0.548 (with an AUC of 0.609, and sensitivity and specificity of 59.50% and 56.50% respectively) or TYg-WHtR = 4.781(with an AUC of 0.617, and sensitivity and specificity of 58.10% and 60.80% respectively), the effect of predicting the incidence risk of women is the best.

CONCLUSIONS

The 13 obesity- and lipid-related indices in this study have modest significance for predicting HTN in Chinese middle-aged and elderly patients. WHtR and Tyg-WHtR are the most cost-effective indicators with moderate predictive value of the development of HTN.

Assessing the causal effect of long-term exposure to air pollution on cognitive decline in middle-aged and older adults - Empirical evidence from a nationwide longitudinal cohort

Air pollution remains a risk factor for the global burden of disease. Middle-aged and older people are more susceptible to air pollution because of their declining physical function and are more likely to develop diseases from long-term air pollution exposure. Studies of the effects of air pollution on cognitive function in middle-aged and older adults have been inconsistent. More representative and definitive evidence is needed. This study analysed data from the Chinese Family Panel Study, an ongoing nationwide prospective cohort study, collected in waves 2014, 2016 and 2018. Rigorously tested instrument was selected for analysis and participants' PM_2.5 and instrument exposures were assessed using high-precision satellite data. The causal relationship between long-term exposure to air pollution and poor cognitive function in middle-aged and older adults was investigated using the Correlated Random Effects Control Function (CRE-CF) method within a quasi-experimental framework. This study included a total of 7042 participants aged 45 years or older. A comparison of CRE-CF with other models (OLS model, ordered probit model, and ordered probit-CRE model) demonstrated the necessity of using CRE-CF given the endogeneity of air pollution. The credibility and validity of the instrumental variable were verified. In the CRE-CF model, long-term exposure to PM_2.5 was found to accelerate cognitive decline in middle-aged and older adults (coefficients of -0.159, -0.336 and -0.244 for the total cognitive, verbal and mathematical scores, respectively). Taken together, these results suggest that chronic exposure to ambient air pollution is associated with cognitive decline in middle-aged and older adults, which highlights the need for appropriate protective policies.

Effects of air pollution and residential greenness on sleep disorder: A 8-year nationwide cohort study

BACKGROUND

Sleep disorder influencing the quality of life, however, its contributing factors have not been fully identified yet. Recently the potential effects of environmental exposures like air pollution and greenness on sleep disorder have attracted attention, but the evidence in China is limited, particularly in the middle-aged and elderly.

METHODS

We conducted a nationwide prospective study that included 21,878 Chinese citizens aged 45 years or above. For each participant, the 3-year averaged exposure concentrations of air pollutants (including PM₁₀, PM_2.5, PM₁, NO₂) and greenness (assessed by NDVI) were estimated based on residential address. We used mixed-effects logistic models to examine the associations of sustained air pollutants and greenness exposures with the occurrence of sleep disorder, and used linear mixed-effects models to assess the associations with sleep duration. Specifically, interaction effects models were employed to identify potential modificators of the above associations.

RESULTS

A total of 39,580 survey responses were received, with the overall occurrence rate of sleep disorder was 25.7%. A 10 μg/m³ increment in PM₁₀ and PM_2.5 were associated with increased occurrence of sleep disorder at 2% (aOR = 1.02, 95%CI:1.01, 1.04) and 7% (aOR = 1.07, 95%CI: 1.04, 1.11), and were associated with reduced sleep duration by 0.07 (95% CI: 0.08, 0.05) and 0.04 (95% CI: 0.05, 0.03) hours, respectively. Residential greenness appears to the potential protective factor for sleep disorder, that a 0.1 higher of the NDVI was associated a 9% (aOR = 0.91, 95%CI: 0.86, 0.96) decreased occurrence of sleep disorder and 0.09 h (95% CI: 0.05, 0.13) longer of sleep duration. Age and residence were identified as modificators of the above significant associations.

CONCLUSION

Sustained exposure to air pollutants can increase the occurrence of sleep disorder and can reduce sleep duration, while exposure to higher levels of greenness can protect sleep health from the side effects of air pollutants.

Long-term effect of intermediate particulate matter (PM1-2.5) on incident asthma among middle-aged and elderly adults: A national population-based longitudinal study

BACKGROUND

There is insufficient evidence about the long-term effects of intermediate particulate matter (PM_1-2.5) on asthma development in adults aged 45 years and above. This study aimed to investigate the relationship between long-term exposure to PM_1-2.5 and the incidence of asthma in adults aged 45 years and above.

METHODS

A cohort study based on the China Health and Retirement Longitudinal Study (CHARLS) database was conducted to investigate the long-term effects of PM_1-2.5 on self-reported asthma incidence in adults aged 45 years and above in China from 2011 to 2018. The PM concentrations were estimated using a high-resolution (1 km²) satellite-based spatiotemporal model. A covariate-adjusted generalized linear mixed model was used to analyze the relationship between long-term exposure to PM_1-2.5 and the incidence of asthma. Effect modifications and sensitivity analysis were conducted.

RESULTS

After a 7-year follow-up, 103 (1.61 %) of the 6400 participants developed asthma. Each 10 μg/m³ increment in the 1-, 2-, 3-, and 4-year moving average concentrations of PM_1-2.5 corresponded to a 1.82 [95 % confidence interval (CI):1.11-2.98], 1.95 (95 % CI: 1.24-3.07), 1.95 (95 % CI: 1.26-3.03) and 1.88 (95 % CI: 1.26-2.81) fold risk for incident asthma, respectively. A significant multiplicative interaction was observed between socioeconomic level and long-term exposure to PM_1-2.5. Stratified analysis showed that smokers and those with lower socioeconomic levels were at higher risk of incident asthma related to PM_1-2.5. Restricted cubic splines showed an increasing trend in asthma incidence with increasing PM_1-2.5. Sensitivity analyses showed that our model was robust.

CONCLUSION

Long-term exposure to PM_1-2.5 was positively associated with incident asthma in middle-aged and elderly individuals. Participants with a history of smoking and lower socioeconomic levels had a higher risk. More studies are warranted warrant to establish an accurate reference value of PM_1-2.5 to mitigate the growing asthma burden.

Hierarchical multiple regression investigating factors associated with depressive symptoms in the middle-aged and elderly undergoing haemodialysis

BACKGROUND

Depressive moods are commonly seen in patients who receive haemodialysis. This can cause a lack of compliance in their treatment procedures and increase the rate of hospitalization. This study aimed to investigate the relationship between social support and degree of depression in middle-aged and elderly patients undergoing haemodialysis and the predictors of depressive symptoms.

METHODS

A cross-sectional correlational study was designed with a structured questionnaire survey. Patients over 40 years of age were included from five haemodialysis centres. Measures embraced a demographic and clinical characteristics questionnaire, the Centre for Epidemiologic Studies Depression Scale, and the Personal Resource Questionnaire 2000. Statistical analysis was performed using hierarchical multiple regression analysis.

RESULTS

A total of 179 patients over 40 years of age were included from five haemodialysis centres in the analysis. The mean CES-D score was 19.0(12.3); the majority of participants (60.3%) had a CES-D score ≥ 15, indicating likely depressive status. The mean PRQ2000 score was 75.7(15.9). The proportional mean of the PRQ2000 was 72.11%, indicating moderate social support for participants in this study. Data disclosed that marital status, number of comorbidities, exercise behaviour, and social support could significantly predict depressive symptoms; total explanatory variance was 31.3%.

CONCLUSION

Health care professionals should identify those at high risk of depressive symptoms when they provide care to the middle-aged and elderly patients undergoing haemodialysis. These findings may lead to greater insights into the nursing and rehabilitative care of patients treated by chronic maintenance haemodialysis.

Inequality of opportunity in health service utilization among middle-aged and elderly community-dwelling adults in China

BACKGROUND

The inequality caused by circumstances is known as "inequality of opportunity" (IOp). Many scholars have studied IOp in the health field, but few studies have quantified contributors to the IOp of health service utilization among middle-aged and elderly people. This study measured the IOp of health service utilization and decomposed the contributors to IOp present among Chinese middle-aged and elderly people.

METHODS

Data were obtained from the China Health and Retirement Longitudinal Study (CHARLS) in 2013, 2015 and 2018. A mean-based regression method was adopted to measure the IOp of health service utilization. Shapley-Shorrocks decomposition was used to analyze the main contributors to IOp seen among the middle-aged and elderly.

RESULTS

Although the absolute IOp of health service utilization decreased over time, IOp still explains the total inequality to a large extent. The absolute IOp and relative IOp were greatest in the areas of self-treatment and inpatient care utilization, respectively. Shapley decomposition results showed that the out-of-pocket (OOP) ratio contributed most to the IOp of outpatient care utilization; and the residence area highly explains the IOp of inpatient service utilization. Meanwhile, social and economic factors such as work status and income contribute more to the IOp of inpatient care utilization than outpatient and self-treatment.

CONCLUSIONS

Strategies aimed at achieving equal opportunities remain necessary to ensure the fairness of health service utilization. Policies and measures should further adjust the medical insurance compensation policies, and pay more attention to the middle-aged and elderly residents in rural areas, optimize health resource allocation, improve the social security systems, and narrow the socioeconomic gap between urban and rural areas in China.

Effects and differences of sleep duration on the risk of new-onset chronic disease conditions in middle-aged and elderly populations

BACKGROUND

Few longitude cohort studies investigated the risk of the duration of nighttime sleep and naps to the new-onset common chronic disease conditions (CDCs) in middle-aged (45-60) and the elderly (age ≥ 60) populations using an age-stratified strategy.

METHODS

The 7025 participants from The China Health and Retirement Longitudinal Study were screened as eligible subjects. Established 13 cohorts with CDCs, acquired their' sleep records in 2011, and obtained new-onset incidents of CDCs during follow-up in 2011-2018. Performed risk association analyses between sleep duration and 13 new-onset CDCs respectively.

RESULTS

New-onset risk of four CDCs decreased with increasing nighttime sleep (p-nonlinear>0.05). The risk threshold was approximately 7 hours in middle-aged people and 6 hours in the elderly. For the middle-aged population, compared with 7-9hours sleep, <5hour and 5-7hours nighttime sleep were associated with 1.312∼1.675 times more risk of hypertension, kidney disease, diabetes or high blood sugar status, and multimorbidity; Compared with no nap, a 0-30 min nap was associated with 1.413(1.087∼1.837) times the heart disease risk. In the elderly, < 5 hours of night sleep was a significant risk factor for four CDCs including kidney disease and multimorbidity, etc. A long night's sleep (>9 hours) was connected with 61.2% reduction in risk of memory disease, a >90 min nap increased 62% risk of memory disease, and a 0-30 min nap was associated with higher risks of heart disease, hypertension, and a lower kidney disease risk.

CONCLUSIONS

Nighttime sleep and daytime naps may have their own implications for the new-onset CDCs' risk in the aging process.

Does direct settlement of intra-province medical reimbursements improve financial protection among middle-aged and elderly population in China? Evidence based on CHARLS data

In low- and middle-income countries, social health insurance schemes are the main focus of efforts to achieve universal health coverage (UHC) by promoting access to health care and financial protection. Problems with financial protection in China are caused mainly by health insurance fragmentation and a rapid rise in medical expenditure. In this context, China implemented a policy of direct settlement of intra-provincial medical reimbursement in 2014. We evaluated the impact of the policy on financial protection with a population aged 45 and above based on the China Health and Retirement Longitudinal Study from 2011 to 2018. We estimated the policy effects using the difference-in-differences method, based on coarsened exact matching. We found that the policy significantly reduced the catastrophic health expenditures (CHEs) rate by approximately 10% in the population, whether middle-aged or elderly. Subgroup analyses indicated that middle-aged and elderly people living in western China and with lower household incomes received greater protection from the policy. The CHEs rate for the two age groups in western China was reduced by 16.26% and 20.12%, respectively. The CHEs rate was reduced by 24.51% and 17.32% for middle-aged individuals in the lowest and second household income quartiles, respectively, and by 21.31% for older adults in the second household income quartile. The new rural cooperative medical scheme exerted a smaller protective effect than urban medical insurance among the participants aged 60 and older. We found that in addition to optimizing health insurance schemes, more health care reform measures, such as adopting more efficient payment methods and rationalizing medical expenditures, should be combined to help reduce health inequities and accelerate progress toward achieving UHC and the Sustainable Development Goals.

Gender differences in the association of depression trajectories with executive and memory functions: Evidence from the longitudinal study of the Survey of Health, Ageing and Retirement in Europe (2004-2017)

Gender differences in depression trajectories and their effects on cognitive function are poorly understood. This article aims to identify depression trajectories in both genders and further explore the association of depression trajectories with executive and memory functions by gender. A total 3990 participants aged 50 years or older with repeated measurements from waves 1 to 7 (wave 3 excluded) of the Study of the Survey of Health, Ageing and Retirement in Europe (SHARE) were included. Group-based trajectory modeling (GBTM) was conducted to identify the optimal number of depression trajectories. Generalized estimating equation (GEE) models were used to examine the relation of depression trajectories to cognitive function after stratification by gender. Three distinct depression trajectories were identified in both genders, but the patterns of trajectories among genders were nonidentical. The trajectories of depression in males were characterized by non-low, moderate, persistent-depressive symptoms but with an unstable trend, while in females, they were characterized by non-low, moderate, persistent-depressive symptoms and with a worsening trend. The prevalence of persistent high depression in women (20.08%) was higher than that in men (3.13%). Moderate and persistent high depression trajectories were negatively associated with episodic memory (β = -0.53 and -0.72, respectively, p < 0.001) and verbal fluency in females (β = -0.96 and -1.47, p=0.01 and < 0.001, respectively). Older women had a greater frequency of developing depression than older men. Gender differences in depression trajectories existed. Moderate and persistent high depression trajectories exerted a negative effect on some domains of cognitive impairment only in females.

The pupil constriction to light is associated with cognitive measures in middle-aged and older adults

AIMS

The evidence relating the pupil light reflex (PLR) and cognition have been inconsistent. In this cross-sectional study, we evaluated the association between the PLR and cognition in community-dwelling middle-aged and older individuals.

METHODS

Pupil reactivity was recorded in a subgroup of 403 participants (mean age 60.7 years, 57.3% females) in an epidemiologic study of aging. Ten pupil parameters were calculated to describe pupil constriction to light stimuli. A principal component analysis (PCA) score was used to calculate an overall performance over four cognitive testings. Linear regression was used to assess the association between pupil parameters and PCA scores, adjusting for age, sex, education, medications, health-related quality of life questionnaire, and systemic and ocular comorbidities.

RESULTS

The PCA scores decreased by 0.039 [95% CI (- 0.050, - 0.028)] per year increase in age and were lower in males than females by 0.76 [95% CI (- 0.96, - 0.55)] (p < 0.001). Pupil constriction amplitude in millimeters and the duration from stimulus onset to maximal constriction velocity were significantly associated with cognition after adjusting for (1) age and sex and (2) age, sex, and multiple covariates (p < 0.05).

CONCLUSIONS

In this study, we provided moderate evidence suggesting the association between PLR and neuropsychological cognitive measures. The findings suggest the potential of pupil reactivity to serve as a biomarker of brain aging and warrant further longitudinal study to assess if changes in the PLR can predict cognitive decline over time.

The network of psychosocial health in middle-aged and older adults during the first COVID-19 lockdown

PURPOSE

Psychosocial health problems, such as social isolation, loneliness, depression and anxiety, have gained attention during the COVID-19 pandemic and are commonly co-occurring. We investigated the network of psychosocial health constructs during the COVID-19 pandemic.

METHODS

This study included 4553 participants (mean age: 68.6 ± 11.2 years, 56% women) from the prospective Rotterdam Study, who filled out a questionnaire between April and July 2020, the time of the first COVID-19 wave in the Netherlands. Psychosocial health constructs included were depressive symptoms (Center for Epidemiological Studies Depression scale), anxiety symptoms (Hospital Anxiety and Depression scale), loneliness (University of California, Los Angeles loneliness scale), social connectedness (five items) and pandemic-related worry (five items). We estimated mixed graphical models to assess the network of items of these constructs and whether age and sex affected the network structure.

RESULTS

Within the network of psychosocial constructs, a higher depressive symptoms score was particularly associated with items of loneliness and social connectedness, whereas overall anxiety was particularly associated with items of pandemic-related worry. Between people from different sex and age, the network structure significantly altered.

CONCLUSION

This study demonstrates that within the same network of psychosocial health constructs, depressive symptom score is particularly associated with loneliness and social connectedness, whereas anxiety symptom score is associated with pandemic-related worry during the first COVID-19 lockdown. Our results support that psychosocial constructs should be considered in conjunction with one another in prevention and treatment efforts in clinical care, and that these efforts need to be tailored to specific demographic groups.

Using CatBoost algorithm to identify middle-aged and elderly depression, national health and nutrition examination survey 2011-2018

Depression is one of the most common mental health problems in middle-aged and elderly people. The establishment of risk factor-based depression risk assessment model is conducive to early detection and early treatment of high-risk groups of depression. Five machine learning models (logistic regression (LR); back propagation (BP); random forest (RF); support vector machines (SVM); category boosting (CatBoost) were used to evaluate the depression among 8374 middle-aged people and 4636 elderly people in the NHANES database from 2011 to 2018. In the 2011-2018 cycle, the estimated prevalence of depression was 8.97% in the middle-aged participants and 8.02% in the elderly participants. Among the middle-aged and elderly participants, CatBoost was the best model to identify depression, and its area under the working characteristic curve (AUC) reaches the highest. The second is LR model and SVM model, while the performance of BP and RF model was slightly worse. The primary influencing factor of depression in middle-aged male is alanine aminotransferase. All five machine learning models can identify the occurrence of depression in the NHANES data set through social demographics, lifestyle, laboratory data and other data of middle-aged and elderly people, and among five models, the CatBoost model performed best.

Hair Selenium Content in Middle-Aged and Elderly Chinese Population

Selenium (Se) is an essential nutrient element for human health, and middle-aged and elderly people (age ≥ 45 years old) are at higher risk of nutrient deficiency including Se due to their physiological characteristics. This study investigated the hair Se content of middle-aged and elderly people in China with the purpose of providing a reference for prescription of hair Se normal range in this population. In this study, the hair Se content of 2155 middle-aged and elderly people was detected with atomic fluorescence photometry. The participants were recruited from 15 provinces or municipalities spreading from south to north of China with a diverse Se content in soil. Additionally, the relationships between hair Se content with sex, age, and BMI were analyzed. The results found that the median and 95% quantile of hair Se content were 0.36 μg/g and 0.60 μg/g respectively, with a range of 0.08 to 20.04 μg/g in middle-aged and elderly Chinese. The hair Se content mostly concentrated at 0.23~0.48 μg/g in 81.11% of participants. The participants in Guangdong and Hunan provinces had the highest hair Se levels (medians were 0.51 and 0.50 μg/g, respectively), while Henan and Shaanxi provinces had the lowest levels (medians were 0.30 and 0.29 μg/g, respectively). In addition, the Se content of males was higher than that of females (p < 0.05), whereas there was no significant difference between different ages and BMI (p > 0.05). In conclusion, this study found that the hair Se content of middle-aged and elderly Chinese ranges from 0.08 to 20.04 μg/g, with median and 95% quantile of 0.36 μg/g and 0.60 μg/g, respectively. Our results provide a reference for the establishment of hair Se content in this population and suggest that the differences of region and sex should be considered when setting up the range.

Trends in equity of inpatient health service utilization for the middle-aged and elderly in China: based on longitudinal data from 2011 to 2018

BACKGROUND

The aim of this study was to assess the trends in equity of receiving inpatient health service utilization (IHSU) in China over the period 2011-2018.

METHODS

Longitudinal data obtained from China Health and Retirement Longitudinal Studies were used to determine trends in receiving IHSU. Concentration curves, concentration indices, and horizontal inequity indices were applied to evaluate the trends in equity of IHSU.

RESULTS

This study showed that the annual rate of IHSU gradually increased from 7.99% in 2011 to 18.63% in 2018. Logistic regression shows that the rates of annual IHSU in 2018 were nearly 3 times (OR = 2.86, 95%CL: 2.57, 3.19) higher for rural respondents and 2.5 times (OR = 2.49, 95%CL: 1.99, 3.11) higher for urban respondents than the rates in 2011 after adjusting for other variables. Concentration curves both in urban and rural respondents lay above the line of equality from 2011 to 2018. The concentration index remained negative and increased significantly from - 0.0147 (95% CL: - 0.0506, 0.0211) to - 0.0676 (95% CL: - 0.0894, - 0.458), the adjusted concentration index kept the same tendency. The horizontal inequity index was positive in 2011 but became negative from 2013 to 2018, evidencing a pro-low-economic inequity trend.

CONCLUSIONS

We find that the inequity of IHSU for the middle-aged and elderly increased over the past 10 years, becoming more focused on the lower-economic population. Economic status, lifestyle factors were the main contributors to the pro-low-economic inequity. Health policies to allocate resources and services are needed to satisfy the needs of the middle-aged and elderly.

The association between homocysteine levels and cardiovascular disease risk among middle-aged and elderly adults in Taiwan

BACKGROUND

Our study aimed to determine the association between homocysteine levels and cardiovascular disease (CVD) risk in middle-aged and elderly adults in a community in northern Taiwan.

METHODS

Participants in our study included adults aged 50 to 85 years old during community health examinations in 2019. A total of 396 people were enrolled, the ethnicity of all participants is Chinese. We divided participants according to tertiles of ln[homocysteine] level (low, middle and high groups). The CVD risk was calculated by the Framingham cardiovascular risk score (FRS). An FRS ≥ 20% indicated high CVD risk. Pearson correlation coefficients were calculated between homocysteine level and other cardio-metabolic risk factors while adjusting for age. Multivariate logistic regression analysis was used to determine the association of high and middle ln[homocysteine] groups with high CVD risk after adjusting age, sex, uric acid, creatinine, and body mass index (BMI). The Youden index and receiver operating characteristic (ROC) curves were performed to determine the optimized cut-off value.

RESULTS

There were 396 people enrolled for analysis; 41.4% of participants were male, and the average age was 64.79 (± 8.76). In our study, we showed a positive correlation of homocysteine with FRS. In the logistic regression models, higher ln[homocysteine] levels was associated with higher CVD risk with a odds ratio (OR) of 2.499 and 95% confidence interval (CI) of 1.214 to 5.142 in the high homocysteine level group compared with the low homocysteine group after adjusting for traditional CVD risk factors. The area under the ROC curve was 0.667, and a ln[homocysteine] cut-off value of 2.495 µmol/L was determined.

CONCLUSIONS

Middle-aged and elderly people with increased homocysteine levels were associated with higher FRSs in this Taiwan community. Furthermore, homocysteine was an independent risk factor for high CVD risk in this study.

The medical insurance system's weakness to provide economic protection for vulnerable citizens in China: A five-year longitudinal study

OBJECTIVES

Little is known about the magnitude of catastrophic health expenditure (CHE) attributable to critical disease, especially in the middle-aged and elderly population. This research aimed to exploring the key aspects of how the health insurance fails to protect the middle-aged and elderly against CHE in the past five years. And propose corresponding measures to improve.

METHODS

Data were obtained from the 2011 to 2015 China Health and Retirement Longitudinal Study. The method was adapted from WHO to calculate the catastrophic health expenditure (CHE) and impoverishment by medical expense (IME), and use Generalized Linear Mixed Models (GLMMs) to comprehensively analyze the risk factors that cause middle-aged and elderly people to fall into CHE.

RESULTS

The incidence of CHE of China's middle-aged and elderly population has been rose in the five years from 2011 (10.5 %) to 2013 (17.5 %) to 2015 (19.7 %). The CHE of richest families was almost 6 times from 2011 to 2015. Urban Employee Medical Insurance Scheme, the incidence of CHE was up 10 percentage from 2011 to 2015. According to the GLMMs, families have inpatient cares as the most important factor to CHE. The incidence of CHE increased by 2.25 times compared with those who did not use inpatient services.

CONCLUSIONS

The health system needs to control the irrational growth of health expenses and reduce residents' overuse of health services. Government should take supplementary measures to comprehensively strengthen the advantages of health insurance. Raise residents' awareness of health care, enhance citizens' physical fitness, and avoid unnecessary waste of health resources.

Impact of social participation on health among middle-aged and elderly adults: evidence from longitudinal survey data in China

BACKGROUND

Social participation (SP) is known to have a favourable impact on health. However, studies on this issue have been conducted mainly in advanced countries, and results in China have been mixed. This study examined the impact of SP on health outcomes of middle-aged and elderly adults in China, adjusted for simultaneity and heterogeneity biases.

METHODS

In total, 57,417 observations of 28,935 individuals obtained from the population-based, three-wave panel survey, Chinese Health and Retirement Longitudinal Study (CHARLS), conducted in 2011, 2013, and 2015 were used. The associations between one- or two-wave-lagged SP and health outcomes (mental health, self-rated health [SRH], activities of daily living [ADL], and diagnosed diseases) were examined by linear regression models. Individual-level heterogeneity was addressed by the random-effects estimation method.

RESULTS

SP was found to have a positive impact on mental health and ADL. Specifically, one-wave-lagged SP improved mental health measure (range: 10-70) by 0.820 (standard error [SE]: 0.199, p <  0.001), the basic ADL measure (range: 6-24) by 0.147 (SE: 0.043, p <  0.001), and the instrumental ADL measure (range: 5-20) by 0.159 (SE: 0.035, p <  0.001). In contrast, SP did not significantly affect SRH or diagnosed diseases. The impact of SP differed by SP type; playing Mah-jong (Chinese traditional game), chess, or cards, or going to the community club had the most favourable effect. The impact of SP on health was also greater for women than men and greater for individuals aged 60-69 years than those aged 45-59 years and aged 70 and older.

CONCLUSIONS

SP had a positive, albeit selective, impact on health outcomes among middle-aged and elderly adults in China. The results suggest that policy measures to encourage these individuals to engage in SP are needed to enhance their health.

Medical expenditure for middle-aged and elderly in Beijing

Background

High medical expenditures serve as a major obstacle for many people trying to access healthcare. Our goals are to provide an updated and comprehensive description of each category of medical expenditure in inpatient and outpatient treatment, and to identify factors associated with medical expenditures.

Methods

A survey of the middle-aged and elderly was conducted in August 2016 in Beijing, China. Data were collected from 808 random samples. Each participant had reported at least one inpatient or outpatient treatment episode and was 45 years old or older, were collected. Chi-squared tests, t-tests, multivariate analysis, and a linear regression were conducted in the data analysis.

Results

A total of 452 and 734 subjects had at least one inpatient and outpatient treatment, respectively. Even though insurance covered a significant amount of the total cost, the remaining out-of-pocket cost was still high, possibly resulting in financial difficulties for a number of the subjects. Demographic and socioeconomic factors were found to be associated with various costs.

Conclusions

Our findings suggest that the government may need to further adjust health care and health insurance systems to alleviate financial burdens caused by illness and improve the effective utilization of healthcare services.

[Association of ambient fine particulate matters with anxiety in middle-aged and elderly people]

Objective: To investigate the association of ambient fine particulate matters (PM(2.5)) exposure with anxiety in middle-aged and elderly people in China. Methods: Using a stratified random sampling method, 5 997 middle-aged and elderly people (aged 40-89) who resided in the region for more than 2 years and had no hearing or language impairment were selected from 32 districts/counties in the key areas for air pollution prevention and control in China from October 10(th), 2017 to February 7(th), 2018. Information about demographic characteristics, socioeconomic factors and health status were collected by questionnaire survey and physical examination. The anxiety symptoms were assessed by 7-item Generalized Anxiety Disorder Scales. Three-year moving average concentrations of PM(2.5) were calculated to estimate exposure level. The multivariate logistic regression model was conducted to assess the association between PM(2.5) exposure and anxiety. The interaction of age, gender, overweight, education, smoking, drinking and chronic diseases was also analyzed by likelihood ratio test. Results: There were 2 995 (49.94%) males subjects, 4 092 (68.23%) subjects with education of secondary school or above and 2 576 (42.95%) subjects with self-reported chronic diseases among the 5 997 middle-aged and elder participants. The prevalence of anxiety was 6.64% (n=398). The mean±SD of 3-year moving average concentrations of PM(2.5), O(3) and SO(2) were (53.50±13.38), (90.58±13.26) and (40.29±12.56) μg/m(3), respectively. PM(2.5) had significantly association with anxiety, and the corresponding OR value was 1.17 (95%CI: 1.05,1.31) with a 10 μg/m(3) increment of 3-year moving average concentrations of PM(2.5). Compared with female (OR (95%CI)=1.07 (0.93,1.23)), those with no chronic diseases (OR (95%CI)=1.06 (0.93,1.20)) and those with primary school degree or below (OR (95% CI)=0.90 (0.75,1.09)), the association between PM(2.5) and anxiety was stronger among male (OR (95%CI)=1.35 (1.12,1.63)) and those with chronic diseases (OR (95%CI)=1.77 (1.31,2.38)), middle school education (OR (95%CI)=1.43 (1.22,1.67)), college education and above (OR (95%CI)=1.68 (1.05, 2.67)), all the P interaction values were <0.05. Conclusion: PM(2.5) exposure has significantly positive association with anxiety. The associations are stronger in male, people with higher educational qualifications and patients with chronic diseases.

[Analysis of body composition and resting metabolic rate of 858 middle-aged and elderly people in urban area of Beijing]

Objective: To understand the overweight rate and obesity rate in middle-aged and elderly people in urban area of Beijing, and analyze the changes of body composition and resting metabolic rate with age. Methods: From November 2014 to December 2015, body composition measurement and resting metabolic rate detection were conducted among 858 people aged 51 to 99 years, including 760 men, 98 women, who received physical examination at Beijing Hospital. Results: The overweight rate was 51.4%, and the obesity rate was 16.9%. The overweight rate was 26.5% and the obesity rate was 14.3% in women, significantly lower than those in men (54.6% and 17.2%) (P<0.001). The distribution of skeletal muscle volume, muscle index, body fat percentage, visceral fat area and resting metabolic rate in different age groups were different (P<0.001). In the normal weight group, the skeletal muscle volume, muscle index and resting metabolic rate in age group ≥80 years decreased obviously (P<0.05). At the same time, the body fat percentage and visceral fat area increased obviously (P<0.05). However, the skeletal muscle volume, muscle index and resting metabolic rate of the overweight and obese groups began to decrease obviously in age group 70- years (P<0.05), and the decrease in age group ≥80 years was more obvious. At the same time, body fat percentage and visceral fat area increased significantly in age group 70- years (P<0.05). Conclusion: The overweight and obesity rates were high in the middle-aged and elderly people in the urban area of Beijing, and the rates were higher in men than in women. With the increase of age, the skeletal muscle volume, muscle index and resting metabolic rate gradually decreased, while the percentage of body fat and visceral fat area increased; Overweight and obese people had earlier changes in body composition and resting metabolic rate.

Healthcare underutilization in middle-aged and elderly adults in China

OBJECTIVES

This article investigates the prevalence of, illness conditions associated with, and reasons for healthcare underutilization among middle-aged and elderly adults in China. It also identifies participants' characteristics associated with healthcare underutilization.

STUDY DESIGN

A cross-sectional survey was conducted in Beijing and Henan in August 2016.

METHODS

The survey was questionnaire-based. It focused on middle-aged and elderly persons aged 45 years and older. A total of 1778 people were surveyed.

RESULTS

In the end, 243 participants (30.11%) and 312 participants (32.13%) displayed signs of healthcare underutilization in Beijing and Henan, respectively. The disease conditions and reasons for underutilization were different in these two areas. Age group, marital status, education level, occupation, and chronic disease were found to be associated with healthcare underutilization in Beijing, whereas gender, age group, marital status, education level, and chronic disease were associated with healthcare underutilization in Henan.

CONCLUSIONS

Illness conditions, reasons for underutilization, and risk factors associated with healthcare underutilization were different in developed areas compared with developing areas of China. Further reforms and interventions are needed to consider these problems.

Patterns of cognitive function in middle-aged and elderly Chinese adults-findings from the EMCOA study

Background

The principal aim of this study was to demonstrate the gender-specific cognitive patterns among middle-aged and elderly Chinese adults, investigate the risk factors on global and domain-specific cognitive performance in men and women, respectively, and report demographically adjusted norms for cognitive tests.

Methods

The Effects and Mechanism of Cholesterol and Oxysterol on Alzheimer’s disease (EMCOA) study enrolled 4573 participants aged 50–70 years in three Chinese cities. All participants underwent an extensive neuropsychological test battery. Composite scores for specific domains were derived from principal component analysis (PCA). Multivariate linear regression models were used to determine gender-specific risk factors and demographically adjusted normative data.

Results

Three cognitive domains of verbal memory, attention/processing speed/executive function, and cognitive flexibility were extracted. A female advantage in verbal memory was observed regardless of age, whereas men tended to outperform women in global cognition and attention/processing speed/executive function. The effects of education on women were more substantial than men for general cognition and attention/processing speed/executive function. For all the cognitive tests, regression-based and demographically adjusted normative data were calculated.

Conclusions

There is a need for gender-specific intervention strategies for operationalizing cognitive impairment.

Trial registration

EMCOA, ChiCTR-OOC-17011882. Retrospectively registered on 5 July 2017.

Electronic supplementary material

The online version of this article (10.1186/s13195-018-0421-8) contains supplementary material, which is available to authorized users.

Single-marker and multi-marker approaches to appraise the relationships between biomarkers and microalbuminuria in Chinese middle-aged and elderly from communities: a cross-sectional analysis

Background

Analyzing the relationships between biomarkers representing distinct pathophysiologic pathways and microalbuminuria (MA) can strengthen the identifying ability for renal damage and illuminate previously unrecognized pathways for the pathogenesis of renal damage. The current analysis was to clarify the associations between biomarkers, including N-terminal prohormone of brain natriuretic peptide (NT-proBNP), high-sensitivity C-reactive protein (hsCRP), homocysteine and uric acid (UA), and MA in Chinese middle-aged and elderly from communities.

Methods

All 839 residents had complete set of these biomarkers and full assessment of MA.

Results

Prevalence of participants with MA was 13.5% (113 participants). Levels of age, systolic blood pressure (SBP), fasting blood glucose (FBG), homocysteine and NT-proBNP and proportion of cigarette smoking in participants with MA significantly exceeded those in participants without MA (p < 0.05 for all). In single-marker and multi-marker models of linear and logistic regression analyses, homocysteine and NT-proBNP levels (p < 0.05 for all) rather than hsCRP and UA levels (p > 0.05 for all) were statistically significant in relation to MA. Additionally, no matter which biomarker was directed at, levels of age, SBP and FBG and proportion of cigarette smoking had significant associations with MA. Homocysteine and NT-proBNP levels (p < 0.05 for all) rather than hsCRP and UA levels (p > 0.05 for all) had significant abilities to identify MA.

Conclusion

Both single-marker and multi-marker analyses confirmed that homocysteine and NT-proBNP were associated with MA in Chinese middle-aged and elderly from communities after adjustment for multiple confounders.

[Characteristics and duration of hospitalization among middle-aged and elderly patients with community-acquired pneumonia]

Objective: To investigate the characteristics, underlying patterns of disease and treatments on middle-aged and elderly patients who suffered from community-acquired pneumonia (CAP) and factors related to the duration of hospitalization of this disease. Methods: Descriptive study was conducted to depict the characteristics, underlying disease patterns and treatments on patients who were older than 40 years of age. Data was collected through medical records of the patients, retrospectively. Multivariate logistic regression analysis was conducted to explore those factors that affecting the duration of hospitalization. Results: A total of 6 231 cases, with 3 583 (57.5%) males were involved. Mean age of the patients was 69.87±12.32. Underlying diseases would include hypertension (31.8%) and diabetes (16.6%), with most pathogens bacteria (25.4%) or fungus (14.9%) related. 97.7% of the patients received antibiotics. Factors as age (OR=1.005, 95%CI: 1.001-1.009), smoking habit (OR=1.292, 95% CI: 1.159-1.441), tumor (OR=1.217, 95% CI: 1.022-1.449), congestive heart failure (OR=1.323, 95% CI: 1.076-1.626), glucocorticoid treatment (OR=1.744, 95% CI: 1.545-1.969) and ICU admission (OR=2.724, 95%CI: 2.031-3.654) were significantly related to the duration of hospitalization. Conclusions: Patients above the age of 40 who suffered from community-acquired pneumonia were often accompanied by underlying diseases. Factors as age, smoking habit, tumor, congestive heart failure, glucocorticoid treatment and ICU admission would affect the duration of hospitalization.

Relationship between body mass index and depressive symptoms: the "fat and jolly" hypothesis for the middle-aged and elderly in China

Background

Obesity has been identified as a worldwide epidemic. In China, the highest prevalence of obesity is observed in adults aged ≥45 years old. This study aimed to describe the association between BMI and depressive symptoms among a large representative sample of middle-aged and elderly in China.

Method

A longitudinal sample of the middle-aged and elderly (6,224 males and 6,883 females) who were interviewed in the 2011 China Health and Retirement Longitudinal Study was used. A multivariate logistic regression analysis was used to examine the effects of socio-demographic characteristics, lifestyle, activity status, health status, physical exercise and body weight on depressive symptoms.

Results

Approximately 6.94% of the males were underweight, 25.48% were overweight and 8.16% were obese. A higher prevalence of obesity was found among women, with 6.89% being underweight, 31.98% overweight and 14.28% obese. The underweight subjects were more likely to be depressed (odds ratio; OR = 1.30 and 1.19) compared with the normal weight people, respectively, whereas overweight and obese men and women were less likely to be depressed (overweight: OR = 0.76 and 0.80; obesity: OR = 0.64 and 0.65, respectively) than people of normal weight.

Conclusion

Our data are consistent with the “fat and jolly” hypothesis being valid in both middle-aged and elderly men and women.

Spatial analysis of gender variation in the prevalence of hypertension among the middle-aged and elderly population in Zhejiang Province, China

Background

Previous studies have shown that there may be gender disparities in the prevalence of hypertension; however, these studies do not address the spatial information contained in the sample which may limit the analytical results. Our study extends the existing Shared Component Model (SCM) and compares its utility with a logistic regression model to evaluate the significance of spatial information for identifying risk factors for hypertension and other non-rare diseases.

Methods

A total of 1267 residents aged 45 years of age and over were included in our study, of which 48.1 % were males. The overall prevalence of hypertension was 33.2 %, with females experiencing a higher prevalence than males (35.5 % vs. 30.6 %). The research variables included body mass index (BMI), Waist -to-Height Ratio (WHtR), smoking status, alcohol consumption etc. The extended SCM is employed to investigate regional gender variations in the risk of hypertension and assess the gender variation in the middle-aged and elderly populations of Zhejiang Province in eastern China and then its performance is compared with that of a traditional multiple logistic regression model.

Results

Our SCM analysis determined that the spatial pattern of hypertension risk for the middle-aged and elderly populations of Zhejiang Province in eastern China is quite different for males and females. Furthermore, Waist -to-Height Ratio (WHtR) continues to be a simple and effective predictor of hypertension risk for males at the regional level.

Conclusions

We believe that the extended SCM spatial model is a useful tool for identifying risk factors at the regional level.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-016-3121-y) contains supplementary material, which is available to authorized users.

Utilization patterns of antidepressants between 1991 and 2011 in a population-based cohort of middle-aged and elderly

BACKGROUND

In middle-aged and older patients in whom antidepressant use increased in last decades, patterns of use might be of concern The objective of this study was to investigate the patterns of prevalence, incidence and duration of antidepressant use in an ageing population.

METHODS

All participants (aged>45 years) from the population-based Rotterdam Study were followed from January 1st 1991 until death, loss to follow-up, or end of the study period (December 31st 2011). Antidepressant drug dispensing, based on pharmacy records, were subdivided into Tricyclic Antidepressants (TCAs), Selective Serotonin Reuptake Inhibitors (SSRIs) and other antidepressants. One-year prevalence, 5-year incidence and duration of antidepressant use were calculated.

RESULTS

Yearly prevalence of antidepressant use increased from 3.9% in 1991 to 8.3% of the population in 2011. The increase in SSRI use was 5.8-fold, whereas use of other antidepressants doubled and TCA use remained stable over time. Incidence of all antidepressants decreased from 23.9 to 14.2 per 1000 person-years between 1992 and 2011. The duration of a first treatment episode increased over time.

CONCLUSION

Despite the prevalence of antidepressant use increased over time, incidence did not, which is most likely explained by a longer treatment duration and recurrent episodes.