Trajectories network analysis of chronic diseases among middle-aged and older adults: evidence from the China Health and Retirement Longitudinal Study (CHARLS).

BACKGROUND: Given the increased risk of chronic diseases and comorbidity among middle-aged and older adults in China, it is pivotal to identify the disease trajectory of developing chronic multimorbidity and address the temporal correlation among chronic diseases. METHOD: The data of 15895 participants from the China Health and Retirement Longitudinal Study (CHARLS 2011 - 2018) were analyzed in the current study. Binomial tests and the conditional logistic regression model were conducted to estimate the associations among 14 chronic diseases, and the disease trajectory network analysis was adopted to visualize the relationships. RESULTS: The analysis showed that hypertension is the most prevalent disease among the 14 chronic conditions, with the highest cumulative incidence among all chronic diseases. In the disease trajectory network, arthritis was found to be the starting point, and digestive diseases, hypertension, heart diseases, and dyslipidemia were at the center, while memory-related disease (MRD), stroke, and diabetes were at the periphery of the network. CONCLUSIONS: With the chronic disease trajectory network analysis, we found that arthritis was prone to the occurrence and development of various other diseases. In addition, patients of heart diseases/hypertension/digestive disease/dyslipidemia were under higher risk of developing other chronic conditions. For patients with multimorbidity, early prevention can preclude them from developing into poorer conditions, such as stroke, MRD, and diabetes. By identifying the trajectory network of chronic disease, the results provided critical insights for developing early prevention and individualized support services to reduce disease burden and improve patients' quality of life.

Assessment of groundwater hydrochemistry, water quality, and health risk in Hainan Island, China.

Groundwater is an important source of water for human sustenance. The determination of groundwater quality at island sites is an urgent priority in China, but there are lacking systematic reports relating to them. Here, 63 groups of groundwater samples were collected and analyzed of Hainan Island. The groundwater in the study area is weakly alkaline, mainly comprising hard and soft freshwater. The predominant anions and cations are HCO3-, and Ca2+ and Na+, respectively, and the main water chemistry types are HCO3-Cl-Na and HCO3-Cl-Na-Ca. The chemical evolution of groundwater is mainly affected by water-rock interactions, cation exchange, and human activity. The groundwater is mostly of high quality and, in most areas, is suitable for drinking and irrigation. Contrastingly, the water quality in the west of the island is relatively poor. The spatial distribution of the risk coefficient (HQ) is consistent with the spatial variation in the NO3- concentrations in the groundwater. Notably, there are unacceptable health risks for different groups of people, with infants having the greatest level of impact, followed by children, teenagers, and adults. This study provides a valuable reference for the development and utilization of groundwater resources, as well as the improvement of aquatic ecological conditions on Hainan Island and other island areas worldwide.

Priority control factors for heavy metal groundwater contamination in peninsula regions based on source-oriented health risk assessment.

Peninsula regions in China face serious environmental issues, such as heavy metal (HM) groundwater contamination. However, attempts to investigate the pollution sources and health risks of HM contamination in such regions require considerable resources and costs. Moreover, the priority control factors for groundwater HMs remain unclear. In this study, absolute principal component score/multiple linear regression (APCS/MLR) was used to quantify the groundwater pollution sources of typical peninsular areas in China, and a health risk assessment (HRA) was performed to assess the health risks caused by different sources. The results showed that the concentrations of Mn and Fe were higher than those of other HMs, and HM pollution was high in shallow groundwater. The dominant source of HMs in groundwater was agricultural activities (31.12 %), followed by natural sources (26.33 %), industrial activities (22.47 %), and atmospheric deposition (20.09 %). The non-carcinogenic risks to residents were acceptable, whereas the carcinogenic risks were high. Agricultural sources, atmospheric deposition sources, and Cr and As were identified as the priority control factors for HM groundwater contamination. This study has implications for improving the control of groundwater HM contamination in peninsula regions and ensuring sustainable groundwater development.

Health Risk Assessment of Heavy Metals in Groundwater of Hainan Island Using the Monte Carlo Simulation Coupled with the APCS/MLR Model.

Groundwater is a significant component of water resources, but drinking groundwater with excessive heavy metals (HMs) is harmful to human health. Currently, quantitative source apportionment and probabilistic health risk assessment of HMs in groundwater are relatively limited. In this study, 60 groundwater samples containing seven HMs were collected from Hainan Island and analyzed by the coupled absolute principal component scores/multiple linear regression (APCS/MLR), the health risk assessment (HRA) and the Monte Carlo simulation (MCS) to quantify the pollution sources of HMs and the health risks. The results show that the high-pollution-value areas of HMs are mainly located in the industry-oriented western region, but the pollution level by HMs in the groundwater in the study area is generally low. The main sources of HMs in the groundwater are found to be the mixed sources of agricultural activities and traffic emissions (39.16%), industrial activities (25.57%) and natural sources (35.27%). Although the non-carcinogenic risks for adults and children are negligible, the carcinogenic risks are at a high level. Through analyzing the relationship between HMs, pollution sources, and health risks, natural sources contribute the most to the health risks, and Cr is determined as the priority control HM. This study emphasizes the importance of quantitative evaluation of the HM pollution sources and probabilistic health risk assessment, which provides an essential basis for water pollution prevention and control in Hainan Island.

Relationship between physical activity and mental health in a national representative cross-section study: Its variations according to obesity and comorbidity.

BACKGROUND: Physical activity is positively associated with mental health in obese people with chronic comorbidities. However, how physical activity types (PATs), physical activity frequency (PAF), and physical activity duration (PAD) are associated with mental health need to be further clarified. The current study investigated and compared the effectiveness of PATs, physical activity frequency PAF and PAD for mental health in obese people with various chronic comorbid conditions. METHODS: This cross-sectional study included 871,919 adults who participated in the Behavioral Risk Factor Surveillance System (BRFSS). They were divided into four groups: healthy people, obese people with 0, 1, and 2+ chronic comorbid conditions. The zero-inflated negative binomial (ZINB) regression model and the generalized additive model were used to explore the association between physical activity and mental health burden in the four groups, respectively. RESULTS: Jogging (30.00%), hiking (28.36%) and bicycling (28.32%) have greater improvement in mental health of healthy people; jogging (19.25%), golf (19.95%) and bicycling machine exercise (19.13%) showed a greater improvement in mental health of obese people with no chronic comorbid condition; and aerobic exercise videos or class showed a greater improvement in mental health of obese people with one chronic comorbid condition (22.14%) and obese people with two or more chronic comorbid conditions (19.60%). Non-linear relationships were observed between PAF, PAD, and energy expenditure and mental health. The healthy participants who exercised about 10-15 times a month and 40-50 min per session or about 400-600 METs-min per week had greater benefits for mental health. However, the lowest point of the smooth curve moved to the left with an increasing number of chronic comorbid conditions in obese people. CONCLUSIONS: Almost all PATs were associated with better mental health, but their benefits decreased with increasing number of chronic comorbid conditions in obese people. There were U-shaped relationships between mental health and weekly physical activity frequency, duration, and METs-min.

[Hydrochemical Characteristics and Controlling Factors of Groundwater in the Leizhou Peninsula].

Groundwater resources in the Leizhou Peninsula provide a strong support for the economic and social development. Therefore, understanding the chemical characteristics and formation mechanism of groundwater in this area is necessary for the rational exploitation and sustainable utilization of water resources. In this study, 43 groundwater samples were collected, and the hydrochemical characteristics and controlling factors were analyzed by descriptive statistical analysis, Piper triangular diagrams, ArcGIS spatial interpolation, Gibbs diagram, and ion ratios. The results showed that:① The anions and cations of the groundwater in the study area were mainly HCO3-, Ca2+, and Na+, and the hydrochemical types were mainly HCO3-Cl-Na-Ca, HCO3-Cl-Na-Ca-Mg, HCO3-Cl-Na-Mg, and HCO3-Na. The contents of Cl-, SO42-, and Na+were higher in the west of Leizhou City compared to other areas. The sites with higher contents of HCO3-, NO3-, Ca2+, Mg2+, and K+ were mainly concentrated in the southwest and eastern coastal areas. ② The chemical evolution of groundwater was mainly affected by water-rock interaction, cation alternating adsorption, and anthropogenic activities. The sources of Na+ and K+ were mainly from evaporative and silicate rocks, Ca2+ and Mg2+ were mainly from carbonate karstification, while NO3- originated from anthropogenic activities.

[Source Analysis and Health Risk Assessment of Heavy Metals in Groundwater of Leizhou Peninsula].

Source identification and health risk assessment of heavy metals in groundwater is one of the key issues in China's new era of environmental management. In order to reveal the status, sources, and health risk of pollutants in groundwater of the Leizhou Peninsula, 44 groundwater samples were collected, and the concentrations and spatial distribution of Cr, Mn, Cu, Zn, As, Cd, Hg, and Pb were measured and analyzed. The sources of heavy metals in groundwater were then determined through correlation coefficient and principal component analysis. Finally, the health risk model was used to evaluate the different health risks associated with these heavy metals. The results showed that the average value of heavy metal elements in groundwater of the Leizhou Peninsula does not inferior to the class Ⅱ water quality standard(GB/T 14848-2017). However, As, Mn, and Cd do not meet the standard. The overall spatial distribution indicated obvious spatial differences, with higher values in the south than in the north. Heavy metal sources can be identified as three principal components (PCs). PC1 (Cu, Zn, Cd, and Pb) metals mainly originate from industrial, agricultural, and traffic sources. PC2 (Cr, Mn, and As) sources can be both natural and man-made, and PC3 (Hg) sources are primarily man-made. For the groundwater of the Leizhou Peninsula, the health risks of 8 metals are with the acceptable range, the carcinogenic risk of adults is higher than that of children, and the risk of drinking exposure is higher than that of skin exposure. The study shows that the environmental protection department should encourage the rational exploitation of groundwater resources and control the sources of pollution to reduce health risks.