Higher triglyceride­glucose index is associated with increased risk of stroke among middle-aged and elderly Chinese: a national longitudinal study.

Stroke is a severe cerebrovascular disease. This study aimed to determine the association between triglyceride­glucose (TyG) index and stroke among middle-aged and elderly Chinese. Data was extracted from China Health and Retirement Longitudinal Study survey 2015 and survey 2018. Logistic regression, trend test and subgroup analysis were conducted to assess the association. Possible nonlinear relationships were explored with restricted cubic spline (RCS). Propensity score matching (PSM) was conducted to attenuate the effect of confounding factors. ORs of stroke was positively associated with TyG index. The ORs in RCS analysis also increased with the rising TyG, though p for non-linearity was bigger than 0.05. After PSM, the ORs in the full adjusted models were 1.28 (1.01, 1.62). TyG was suggested as an independent risk factor for stroke in the middle aged and elderly Chinese.

Development and validation of a novel sleep health score in the sleep heart health study.

BACKGROUND: There is a lack of consensus in evaluating multidimensional sleep health, especially concerning its implication for mortality. A validated multidimensional sleep health score is the foundation of effective interventions. METHODS: We obtained data from 5706 participants in the Sleep Heart Health Study. First, random forest-recursive feature elimination algorithm was used to select potential predictive variables. Second, a sleep composite score was developed based on the regression coefficients from a Cox proportional hazards model evaluating the associations between selected sleep-related variables and mortality. Last, we validated the score by constructing Cox proportional hazards models to assess its association with mortality. RESULTS: The mean age of participants was 63.2 years old, and 47.6% (2715/5706) were male. Six sleep variables, including average oxygen saturation (%), spindle density (C3), sleep efficiency (%), spindle density (C4), percentage of fast spindles (%) and percentage of rapid eye movement (%) were selected to construct this multidimensional sleep health score. The average sleep composite score in participants was 6.8 of 22 (lower is better). Participants with a one-point increase in sleep composite score had an 10% higher risk of death (hazard ratio = 1.10, 95% confidence interval: 1.08-1.12). CONCLUSIONS: This study constructed and validated a novel multidimensional sleep health score to better predict death based on sleep, with significant associations between sleep composite score and all-cause mortality. Integrating questionnaire information and sleep microstructures, our sleep composite score is more appropriately applied for mortality risk stratification.

Study on the Oral Health Status in Middle-aged and Elderly Population in Wuhan / 华中科技大学学报(医学版)

Objective To analyze the current oral health status of middle-aged and elderly people in Wuhan,and to provide clinical evidence for preventing and promoting oral health among middle-aged and elderly people.Methods The data was col-lected from the annual health examination data system of Wuhan,which included 1994 patients aged 45～95.According to the World Health Organization(WHO)"Basic Methods of Oral Health Survey"(5 th edition),the data of caries,periodontal disease,dentition defect,dentition loss and denture restoration was mainly studied.Statistical methods such as Chi-square test and vari-ance analysis were used for data analysis.Results Among the 1994 subjects,1613 people(80.89％)were male and 218 people(10.93％)were older than 75 years old.The average numbers of caries and teeth loss were 2.68 and 2.03,respectively.The mean number of caries and tooth loss increased with age.The mean numbers of caries and tooth loss in 45～,55～,65～,75～,and 85～95 years old groups were 0.98 and 0.54,1.82 and 1.39,3.21 and 2.48,7.65 and 6.04,12.65 and 9.91,respective-ly.The difference among different age groups was statistically significant(P＜0.01).The proportion of restoration of teeth loss was also elevated with the increase of age(P＜0.01),and the difference of community periodontal index(CPI)among different age groups was also statistically significant(P＜0.01).The proportion of people in CPI1 group(shallow periodontal pocket)was decreased with the increase of age,while the proportion of people in CPI2 group(deep periodontal pocket)was increased with the increase of age(P＜0.01).Conclusion The overall oral health examination results of middle-aged and elderly people in Wuhan shows that the oral health status is slightly better when compared with the result of urban area in the 4th National Oral Health Examination.But caries,periodontal disease,tooth loss and unrepaired dentures are still serious in the elderly population.It is necessary to improve the prevention awareness of oral diseases in the elderly through regular oral examination,timely detection and treatment.At the same time,attention should be paid to dental restoration in the elderly population to improve the quality of life.

Association between dietary inflammatory index and gallstone disease among middle-aged and elderly population / 预防医学

Objective@#To analyze the association between dietary inflammatory index (DII) and gallstone disease among middle-aged and elderly population, so as to provide the evidence for the prevention and control of gallstone disease.@*Methods@#Baseline survey data were collected from the Shanghai Women's Health Study (SWHS) and Shanghai Men's Health Study (SMHS), including demographic information, gallstone disease prevalence and dietary habits. DII was calculated using 29 kinds of food parameters associated with common inflammatory biomarkers and food intake data of residents. A multivariable logistic regression model was used to analyze the association between dietary inflammatory index and gallstone disease.@*Results@#A total of 132 312 individuals were included in the analysis. There were 59 627 males and 72 685 females. Among males, the median age was 53.07 (interquartile range, 9.73) years, 41 544 cases (69.67%) had an educational level of middle school, 4 463 cases (7.48%) had gallstone disease, and DII was -6.46 to 5.59. Among females, the median age was 50.27 (interquartile range, 9.05) years, 47 380 cases (65.19%) had an educational level of middle school, 8 090 cases (11.13%) had gallstone disease, and DII was -6.44 to 4.93. Multivariable logistic regression analysis showed that after adjusting for age, educational level, income level, smoking, alcohol consumption, tea consumption, physical activity and menopausal status (only for females), DII (OR=1.095, 95%CI: 1.002-1.196) was associated with an increased risk of gallston disease among males, but no statistically association was found among females (P>0.05).@*Conclusion@#DII might be associated with an increased risk of gallstone disease among middle-aged and elderly population.

Factors affecting balance ability among middle-aged and elderly peoplewith depressive symptoms / 预防医学

Objective@#To explore the factors affecting balance ability among middle-aged and elderly people with depressive symptoms, so as to provide the evidence for improving balance ability and prevention of falls.@*Methods@#Based on the 2015 database of China Health and Retirement Longitudinal Study (CHARLS), demographic information, lifestyle and health status were collected from people aged 45 years and older who scored 10 and more on the Self-rating Depression Scale or took antidepressants. The balance ability was assessed by semi-tandem and full-tandem stand tests, which was defined as meeting the standard when both tests were completed. Factors affecting the balance ability among middle-aged and elderly people with depressive symptoms were identified using a multivariable logistic regression model.@*Results@#Data were collected from 4 263 participants with an mean age of (60.73±8.53) years, including 1 748 males (41.00%) and 2 515 females (59.00%). There were 1 241 people failed to meet the standard of balance ability test, accounting for 29.11%. Multivariable logistic regression analysis showed that participants who were at ages of 65 years and older (OR=1.234, 95%CI: 1.071-1.421), were female (OR=1.422, 95%CI: 1.161-1.741), were physically disabled (OR=1.309, 95%CI: 1.127-1.521) and had physical pain (OR=1.170, 95%CI: 1.023-1.340) had higher risks of failing to meet the standard of balance ability test, while participants who took naps (OR=0.856, 95%CI: 0.748-0.980), never smoked (OR=0.641, 95%CI: 0.517-0.793) and had social activities (OR=0.864, 95%CI: 0.755-0.988) had lower risks of failing to meet the standard of balance ability test.@*Conclusion@#The balance ability among middle-aged and elderly people with depressive symptoms was associated with age, gender, napping, smoking, social activities, physical disability and physical pain.

Correlation between urinary protein levels and the incidence of chronic obstructive pulmonary disease in middle-aged and elderly population / 公共卫生与预防医学

Objective To explore the relationship between baseline urinary protein levels and the onset of chronic obstructive pulmonary disease (COPD). Methods A questionnaire survey, blood and urine sample collection, physical examination, and pulmonary function test were conducted among permanent residents over 40 years old in Pudong New Area, Shanghai. The subjects were divided into four groups based on the baseline urine albumin-to-creatinine ratio (ACR) quartiles (0~1.65 mg/g, 1.65~4.89 mg/g, 4.89~10.78 mg/g, and ≥10.78 mg/g). Cox regression analysis was used to explore the relationship between ACR levels and the incidence of COPD in middle-aged and elderly people. Results Among the 3 105 subjects, the median follow-up time was 3.212 years (P25~P75：3.102~3.473). 116 new cases of COPD were observed, with an incidence density of 10.423 per 1000 person-years. The incidence densities for COPD at four ACR levels were 7.922 per 1 000 person-years, 8.300 per 1 000 person-years , 11.419 per 1 000 person-years, and 13.843 per 1 000 person-years, respectively. Cox regression analysis revealed that as the ACR level increased, there was a rising trend in the incidence rate of COPD (χ2=4.396, P=0.036). After adjusting for gender, age, education level, occupational exposure to dust, history of childhood pneumonia, smoking, family history of COPD, central obesity, and hypertension, the risk of developing COPD was 2.499 times higher (95% CI: 1.460~4.276) for ACR levels ≥10.78 mg/g compared to the reference group with a baseline ACR level of 0~1.65 mg/g. Conclusion Elevated ACR levels in middle-aged and elderly population may increase the risk of COPD, and early monitoring of urine protein levels is beneficial for COPD prevention.

The Obesity Paradox: Effect of Body Mass Index and Waist Circumference on Post-Stroke Cognitive Impairment.

Background: Obesity is a risk factor for dementia within the old population however not within the middle-aged population, that is referred to the "obesity paradox". This study explored the association of body mass index (BMI) and waist circumference (WC) with post-stroke cognitive impairment (PSCI) in middle-aged (40-65 years) versus old population (≥ 65 years). Methods: The current study enrolled 1735 individuals over the age of 40 who had their first ischemic stroke from the Impairment of Cognition and Sleep (ICONS) subgroup of the China National Stroke Registry-3 (CNSR-3). BMI and WC were used for the diagnosis of obesity and central obesity, respectively. PSCI was diagnosed according to the Montreal Cognitive Assessment (MoCA). The main clinical outcome was the incidence of PSCI assessed at three months after stroke. Multivariable regression analysis was performed to evaluate the association between obesity and three-month PSCI. Stratified analysis was also performed to explore the effect of age on the relationship between obesity and PSCI. Results: In the general population, multivariable logistic regression found that the adjusted odds ratio (OR) with 95% confidence interval (CI) of general obesity was 1.45 (1.06-1.98) and that of central obesity was 1.54 (1.24-1.91) for the three-month incidence of PSCI. Stratified analysis by age showed that the adjusted OR with a 95% CI of general obesity was 1.84 (1.24-2.72) in middle-aged patients and 0.89 (0.52-1.54) in elderly patients (p-value for interaction = 0.05). Central obesity was associated with PSCI in all age groups: 1.57 (1.18-2.09) in middle-aged patients and 1.52 (1.08-2.15) in elderly patients (p-value for interaction= 0.93). Conclusion: General obesity was related to an increased risk of PSCI in middle-aged but not elderly patients, whereas central obesity was associated with an increased risk of PSCI in all age groups, suggesting that the obesity paradox arises only obesity is outlined by BMI.

Association between the triglyceride-glucose index and stroke in middle-aged and older non-diabetic population: A prospective cohort study.

BACKGROUND AND AIMS: Data regarding the association between insulin resistance (IR) and stroke among the non-diabetic population is still limited and inconsistent. This study aimed to investigate the association between IR measured by the triglyceride-glucose (TyG) index and the risk of stroke among the middle-aged and elderly Chinese without diabetes. METHODS AND RESULTS: A total of 17,708 middle-aged and elderly (main respondents≥45 years) individuals without diabetes were enrolled from the China Health and Retirement Longitudinal Study. Participants were divided into 4 categories according to quartiles of the TyG index. During a median follow-up of 7.00 years, a total of 305 (3.93%) incident strokes occurred. With the increase in the TyG index quartiles, stroke incidence increased substantially, compared with the Q1 group, the fully adjusted hazard ratios (HRs) were 1.64 (95% confidence interval [CI], 1.13-2.38), 1.65 (95% CI, 1.10-2.46), and 1.76 (95% CI, 1.21-2.57) for Q2, Q3, and Q4 groups, respectively. The cutoff value we determined for the TyG index was 8.28. Furthermore, the addition of the TyG index to a conventional risk model had an incremental effect on the predictive value for stroke (integrated discrimination improvement 0.17%, P = 0.0025; category-free net reclassification improvement 17.91%, P = 0.0025). CONCLUSION: TyG index was significantly associated with a higher risk of stroke among the middle-aged and elderly non-diabetic population. Our findings indicated that the TyG index may be a good tool in the prediction of stroke risk for clinical and public health fields.

Prediction of depression onset risk among middle-aged and elderly adults using machine learning and Canadian Longitudinal Study on Aging cohort.

BACKGROUND: Early identification of the middle-aged and elderly people with high risk of developing depression disorder in the future and the full characterization of the associated risk factors are crucial for early interventions to prevent depression among the aging population. METHODS: Canadian Longitudinal Study on Aging (CLSA) has collected comprehensive information, including psychological scales and other non-psychological measures, i.e., socioeconomic, environmental, health, lifestyle, cognitive function, personality, about its participants (30,097 subjects aged from 45 to 85) at baseline phase in 2012-2015. We applied machine learning models for the prediction of these participants' risk of depression onset approximately three years later using information collected at baseline phase. RESULTS: Individual-level risk for future depression onset among CLSA participants can be accurately predicted, with an area under receiver operating characteristic curve (AUC) 0.791 ± 0.016, using all baseline information. We also found the 10-item Center for Epidemiological Studies Depression Scale coupled with age and sex information could achieve similar performance (AUC 0.764 ± 0.016). Furthermore, we identified existing subthreshold depression symptoms, emotional instability, low levels of life satisfaction, perceived health, and social support, and nutrition risk as the most important predictors for depression onset independent from psychological scales. LIMITATIONS: Depression was based on self-reported doctor diagnosis and depression screening tool. CONCLUSIONS: The identified risk factors will further improve our understanding of the depression onset among middle-aged and elderly population and the early identification of high-risk subjects is the first step for successful early interventions.

Serum uric acid to creatinine ratio and metabolic syndrome in middle-aged and elderly population: Based on the 2015 CHARLS.

BACKGROUND AND AIMS: Serum uric acid to creatinine ratio (SUA/Cr) may be associated with metabolic syndrome (MS). Here, we investigated the correlation between SUA/Cr and MS in Chinese residents aged ≥ 45 years. METHODS AND RESULTS: Data were obtained from the 2015 China Health and Retirement Longitudinal Study (CHARLS) database. MS was diagnosed using the Chinese Diabetes Society 2017 criteria. We grouped the population according to SUA/Cr quartiles and compared the index differences between groups. We used spearman correlation analysis and binary logistic regression. The possible dose-response association of SUA/Cr with MS were analyzed using restricted cubic spline model. Of 12,946 included participants, 3370 (26.0%) had MS, and 1900 (56.4%) were female. After adjusting for multiple confounders, binary logistic regression analysis showed that compared with Quartile 1, the odds ratio (95% confidence interval) of the MS risk was 1.29 (1.09-1.52), 1.47 (1.25-1.74), and 1.80 (1.53-2.12) in Quartiles 2, 3, and 4, respectively. The restricted cubic spline model indicated a significant nonlinear dose-response association (Poverall < 0.001, Pnon-linearity = 0.029) between SUA/Cr and strength of MS prevalence association; MS risk began increasing when SUA/Cr > 6.22. CONCLUSIONS: A significant positive correlation existed between SUA/Cr and MS risk in Chinese individuals aged ≥ 45 years, which may be a new predictive marker for MS risk.

[Osteoporosis Screening Values of Osteoporosis Self-Assessment Tool for Asians Index and Body Mass Index in Middle-Aged and Elderly Tibetan Population in Tibet].

Objective: To analyze the screening value of osteoporosis self-screening tool for Asia (OSTA) and body mass index (BMI) for osteoporosis (OP) in middle-aged and elderly Tibetan population in the Tibetan region. Methods: Data on demographic information, bone mineral density (BMD), and other information of 627 middle-aged and elderly people were collected. Analysis of the correlation between OSTA index, BMI and BMD, and receiver operating characteristic (ROC) curve was performed to evaluate the OP screening effects. Results: OSTA index and BMI were correlated with BMD in both female and male populations ( P<0.05). In both male and female populations, OSTA index screening results for OP yielded higher area under the curve ( AUC) than BMI did, with the AUC for female OSTA index being 0.886 and that for female BMI being 0.785, while that for male OSTA index being 0.957 and that for male BMI being 0.834. When comparing the different age groups, the AUC of OSTA index and BMI of the middle-age group was higher than those of the quasi-elderly group and the elderly group, with the AUC of OSTA index and BMI of the middle-age being 0.939 and 0.858, those of the quasi-elderly group being 0.860 and 0.813, and those of the elderly group being 0.750 and 0.650, respectively. When the optimal cut-off value of diagnosis with OSTA index was －2.20, the sensitivity and specificity were both 100%. When the optimal cut-off value for diagnosis with BMI was 17.512 kg/m2, the sensitivity and specificity were both 100%. Conclusion: OSTA index and BMI have different OP screening effects in different middle-aged and elderly Tibetan populations, and OSTA index shows better effects for OP screening than BMI does.

Trends in prevalence of depression symptoms among middle-aged and elderly residents in China from 2011 to 2018 / 预防医学

Objective@#To investigate the trends in prevalence of depression symptoms among middle-aged and elderly residents at ages of 45 years and older in China from 2011 to 2018, so as to provide insights into depression prevention and control among middle-aged and elderly residents. @*Methods@#Demographic features and evaluation data of depressive symptoms were collected from middle-aged and elderly residents at ages of 45 years and older recorded during four follow-ups in the China Health and Retirement Longitudinal Study (CHARLS), and the depressive symptoms were screened using the Center for Epidemiological Studies Depression Scale (CES-D). Following sampling weights, non-response weights, and post-stratification weighting, the detection of depressive symptoms was analyzed among the middle-aged and elderly residents with different demographics, and the trends in prevalence of depressive symptoms were identified using annual percent change (APC). @*Results@#A total of 48 223 middle-aged and elderly residents were enrolled, including 12 624, 10 427, 12 144, and 13 028 residents in 2011, 2013, 2015 and 2018, with mean ages of (58.8±9.4), (58.9±9.2), (59.0±9.2), and (61.1±9.2) years, respectively. The prevalence of depressive symptoms was 34.5% (95%CI: 33.3%-35.8%), 29.6% (95%CI: 28.5%- 30.8%), 30.6% (95%CI: 29.4%-31.8%), and 35.0% (95%CI: 33.6%-36.4%) among middle-aged and elderly residents in 2011, 2013, 2015 and 2018, respectively, with no remarkable changing trends seen (APC=0.4%, t=0.188, P=0.868). Higher detection was seen among residents at advanced ages, among women than among men, among rural residents than among urban residents, among residents with lower educational levels, among widowed and unmarried residents than among married residents, among unemployed residents than among employees, and among residents that had lower per capita personal consumption expenditures than mean expenditures than among residents that had higher per capita personal consumption expenditures than mean expenditures (all P<0.05). @*Conclusions@#There were no obvious trends in prevalence of depressive symptoms among middle-aged and elderly residents in China from 2011 to 2018, and individuals with advanced ages, women, urban residents and those with low educational and economic levels should be given a high priority for depression control.

Long-term effect of submicronic particulate matter (PM1) and intermodal particulate matter (PM1-2.5) on incident dyslipidemia in China: A nationwide 5-year cohort study.

BACKGROUND: There is insufficient evidence of associations between incident dyslipidemia with PM1 (submicronic particulate matter) and PM1-2.5 (intermodal particulate matter) in the middle-aged and elderly. We aimed to determine the long-term effects of PM1 and PM1-2.5 on incident dyslipidemia respectively. METHODS: We studied 6976 individuals aged ≥45 from the China Health and Retirement Longitudinal Study from 2013 to 2018. The concentrations of particular matter (PM) for every individual's address were evaluated using a satellite-based spatiotemporal model. Dyslipidemia was evaluated by self-reported. The generalized linear mixed model was applied to quantify the correlations between PM and incident dyslipidemia. RESULTS: After a 5-year follow-up, 333 (4.77%) participants developed dyslipidemia. Per 10 µg/m³ uptick in four-year average concentrations of PMs (PM1 and PM1-2.5) corresponded to 1.11 [95% confidence interval (CI): 1.01-1.23)] and 1.23 (95% CI: 1.06-1.43) fold risks of incident dyslipidemia. Nonlinear exposure-response curves were observed between PM and incident dyslipidemia. The effect size of PM1 on incident dyslipidemia was slightly higher in males [1.14 (95% CI: 0.98-1.32) vs. 1.04 (95% CI: 0.89-1.21)], the elderly [1.23 (95% CI: 1.04-1.45) vs. 1.03 (95% CI: 0.91-1.17)], people with less than primary school education [1.12 (95% CI: 0.94-1.33) vs. 1.08 (95% CI: 0.94-1.23)], and solid cooking fuel users [1.17 (95% CI: 1.00-1.36) vs. 1.06 (95% CI: 0.93-1.21)], however, the difference was not statistically significant (Z = -0.82, P = 0.413; Z = -1.66, P = 0.097; Z = 0.32, P = 0.752; Z = -0.89, P = 0.372). CONCLUSIONS: Long-term exposure to PM1 and PM1-2.5 were linked with an increased morbidity of dyslipidemia in the middle-aged and elderly population. Males, the elderly, and solid cooking fuel users had higher risk. Further studies would be warranted to establish an accurate reference value of PM to mitigate growing dyslipidemia.

Association analysis of various obesity-related indices and vitamin D deficiency in middle-aged and elderly population in Lanzhou / 中华临床营养杂志

Objective:To analyze and compare the association between different obesity-related indices and vitamin D deficiency in middle-aged and elderly population dwelled in Lanzhou city.Methods:From May, 2011 to September, 2012, middle-aged and elderly individuals with complete baseline data were included via randomly cluster sampling from 3 communities in Lanzhou. The subjects were divided into 4 subgroups by vitamin D levels and various obesity-related indices were compared across subgroups with the same gender. The relationship between the obesity-related indices and the severity of vitamin D deficiency was analyzed using Spearman correlation analysis, and the effects of different obesity-related indices on the severity of vitamin D deficiency was analyzed using multivariate logistic regression analysis.Results:A total of 9 437 residents were included. The overall prevalence of vitamin D deficiency was 97.7%. Compared with the group with lower vitamin D level, participants in the group with higher vitamin D level showed evidently lower body mass index (BMI), waist circumference (WC), lipid accumulation product (LAP), visceral adiposity index (VAI) and triglyceride/ high density lipoprotein cholesterol (TG/HDL-C) ratio in the total population and females, while only WC, LAP, VAI and TG/HDL-C in the males (all P<0.05). Spearman correlation analysis showed that BMI, WC, LAP, VAI and TG/HDL-C were positively correlated with the severity of vitamin D deficiency in the total population and the females, while only LAP, VAI and TG/HDL-C in the males (all P<0.05) . Multivariate logistic regression analysis showed that higher levels of these obesity related indices were correlated with more severe vitamin D deficiency in the total population and the females, while only higher LAP, VAI and TG/HDL-C in the males (all P<0.05). The effects of higher LAP was the most prominant in the total population ,the females and the males. Conclusion:Various obesity phenotypes are closely related to vitamin D deficiency in middle-aged and elderly women, while only visceral obesity and abnormal lipid metabolism are related to vitamin D deficiency in middle-aged and elderly men, with LAP being the most important influencing factor.

Association of the depressive scores, depressive symptoms, and conversion patterns of depressive symptoms with the risk of new-onset chronic diseases and multimorbidity in the middle-aged and elderly Chinese population.

Background: The relationship between depressive symptoms (DS) and their conversion patterns over time and the new-onset risk of diseases in the middle-aged and elderly population has not been extensively studied. Methods: Based on The China Health and Retirement Longitudinal Study participants in 2013, we established 13 cohorts involving 12 types of chronic diseases and multimorbidity, who were identified by face-to-face questionnaires. We retrospectively assessed their DS during 2011 and 2013 through the 10-item Center for Epidemiological Studies Depression Scale (CES-D), which were classified into never, newly developed, relieved, and persistent DS, and these participants were followed from 2013 to 2018. Findings: CES-D scores were new-onset risk factors for 9 diseases. The new-onset risk of diseases increased with higher CES-D scores. When CES-D scores were higher than approximately 6, the hazard ratios (HRs) of emergent diseases were greater than 1. DS was independent new-onset risk factors for 8 diseases, with HRs (95% CI) ranging from 1.2635 (1.0061-1.5867) to 1.5231 (1.0717-2.165). Persistent DS was an independent risk factor for most diseases but might be an independent protective factor for new-onset cancer (HR, 95% CI: 0.276, 0.106-0.723). Interpretation: DS is closely associated with new-onset risk of chronic diseases and multimorbidity, and awareness of the risk associated with pre-DS status (6

Impact of migration status on incidence of depression in the middle-aged and elderly population in China: Exploring healthy migrant and salmon bias hypotheses from a mental health perspective.

BACKGROUND: The healthy migrant and salmon bias hypotheses stipulate that those who are healthier are more likely to migrate (a selection effect) and unhealthy migrants have a greater tendency to return to their origin communities than healthier migrants. It remains unclear whether the hypotheses are relevant for mental health, although they have robust evidence for physical health. The current study expands the theoretical foundation underlying these hypotheses by exploring the impact of migration status on depression among the middle-aged and older population in China. METHOD: Longitudinal data from the China Health and Retirement Longitudinal Study (CHARLS) in 2011, 2013, 2015 and 2018 were used. Participants were divided into three groups, non-migrants, permanent migrants, and return-migrants according to their migration status. The Chinese version of 10-item Center for Epidemiologic Studies Depression Scale was used to assess clinically relevant depressive symptoms. Incidence were estimated by each migration status and compared across strata using log-rank tests. Cox regression models were fit to assess the relationship between migration status and depression incidence. RESULTS: A total of 9264 middle-aged and elderly participants were included, of whom 7047 (76.1 %) were non-migrants, 1065 (11.5 %) were permanent migrants, and 1152 (12.4 %) were return-migrants, respectively. Incidence rates of depression by different migration statuses were 76.6/103 person-years (73.7/103-79.7/103) in non-migrants, 62.9/103 person-years (55.9/103-70.6/103) in permanent migrants, and 67.3/103 person-years (60.7/103-74.5/103) in return-migrants. After controlling for covariates, only permanent migrants had significantly lower incidence of depression than non-migrants (HR: 0.85 (0.75, 0.96)). After stratifying by current place of residence, urban-permanent-migrants had a lower risk of depression than both rural and urban non-migrants, and the HRs and 95%CIs were 0.62 (0.52-0.74) and 0.81 (0.68-0.97). LIMITATIONS: Migration statuses of participants may have changed over time, but due to the lack of raw data on migration status in 2013 and 2015, we used migration status at baseline. We were also not able to contextualize the migration experiences among those who migrated, and these trajectories may be heterogeneous. CONCLUSION: Using depression as an indicator of mental health, the healthy migrant hypothesis was supported among middle-aged and elderly permanent migrants living in urban areas while the salmon bias hypothesis was not. Significant urban-rural inequities in mental health existed among different types of migrants. Especially among permanent migrants who have migrated and converted Hukou from their original registration place to their current residence.

The Distribution and Potential Exposure Factors of Physical Activity Level Among Middle-Aged and Elderly Population - Six Communities, Beijing, China, October 2020 to January 2021.

What is already known about this topic?: Available evidence suggested that 31% of the world's population do not meet the minimum recommendations for physical activity. What is added by this report?: The latest findings showed that physical activity level (PAL), metabolic equivalents (MET) in min/week with <4,500 (low), 4,500-6,000 (moderate) and ≥6,000 (high) accounted for 45.72%, 25.62%, and 28.66% of middle-aged and elderly population in Changchunyuan Community, Weixiuyuan Community, Zhongguanyuan Community, Yanbeiyuan Community, Kangzeyuan Community, and Xima Community, respectively. The moderate and high PAL was associated with a decreased risk of hypertension, cardiovascular disease, dyslipidemia, and poor sleep. What are the implications for public health practice?: More attention should be given to the middle-aged population who may be at high risk of insufficient physical activity in urban environments as it is of public health significance for improving the community population health.

Nonlinear associations between environmental factors and lipid levels in middle-aged and elderly population in China: A national cross-sectional study.

BACKGROUND: Blood lipid is an important factor affecting cardiovascular disease in middle-aged and elderly people. At present, the associations between environmental factors and blood lipid level in elderly people has been controversial, and the nonlinear effect of their relationship is lack of research. METHODS: This study used data from a national cross-sectional survey of blood lipid levels in 13,354 subjects and data from environmental monitoring sites. Logistic regression was used to measure the relationship between the basic characteristics of the study population and blood lipid levels. After controlling the confounding factors, the nonlinear associations between environmental factors and blood lipid levels of middle-aged and elderly people in different geographical regions were studied by random forest model. RESULTS: The risk of dyslipidemia is significantly higher in middle-aged women, obese people, elderly people, and urban people. Smoking and alcohol consumption increase the risk. The associations between environmental factors and lipid levels of middle-aged and elderly people are nonlinear, the correlation effect between air pollutants and blood lipid level is mainly shown in northern China, and the correlation between meteorological factors and blood lipid level is more obvious in southern China. CONCLUSIONS: This study shows that the associations between environmental factors and lipid levels in middle-aged and elderly population are nonlinear and have regional differences. Therefore it should be considered in optimizing the allocation of public health resources and preventing and controlling environmental exposure of middle-aged and elderly population.

Sleep Patterns, Genetic Susceptibility, and Incident Chronic Kidney Disease: A Prospective Study of 370 671 Participants.

OBJECTIVES: Unhealthy sleep behaviors may be potential risk factors for chronic kidney disease (CKD). We aimed to examine the associations of combined sleep patterns and genetic susceptibility with incident CKD. METHODS: This large-scale prospective cohort study included 370,671 participants without CKD at baseline (2006-2010) in UK Biobank data. Five sleep behaviors were made up of sleep duration, insomnia, snoring, chronotype, and daytime sleepiness according to questionnaire. Overall sleep patterns by summing the five scores were created. Weighted genetic risk score of kidney function was calculated. Incident CKD was recorded from death register, primary care, and hospital inpatient records. A subset of 41,130 individuals who participated both the initial assessment visit and follow-up visit (2012+) was also used. RESULTS: During a median follow-up of 10.6 years (about 3.9 million person-years), we documented 6,365 patients with incident CKD. In five sleep behaviors, sleep 7-8 h/day, free of insomnia and no frequent daytime sleepiness were independently associated with incident CKD, with a 12% (95%CI 7-16), 9% (3-14), 13% (9-18) lower risk, respectively. Compared to those with a sleep score of 0-1, participants with a score of 5 had a 21% (10-31%) lower risk of CKD. 17.1% of CKD in this cohort could be attributed to total poor sleep pattern. Participants with high genetic risk and intermediate or poor sleep pattern showed the highest risk of CKD (OR = 2.58, 95%CI 2.24-2.96; OR = 2.59, 95%CI 2.02-3.32, respectively), although there was no significant interaction between sleep patterns and genetic risk categories. Among individuals who participated both the initial assessment visit and follow-up visit, we found that the association between amelioration of sleep pattern and risk of CKD was significant after fully adjustment (OR = 0.60, 95%CI 0.36-0.99), compared with group of stable sleep pattern. CONCLUSION: In this large prospective study, participants with a healthy sleep pattern was associated with a significant reduction of incident CKD risk no matter they had a high, intermediate, or low genetic risk.

Association between frailty and lifestyle factors among middle-aged and elderly populations / 预防医学

Objective@#To examine the correlation between frailty and lifestyle factors among middle-aged and elderly populations, so as to provide insights into the management of frailty among middle-aged and elderly populations.@*Methods @#Middle-aged and elderly residents at ages of 45 ot 69 years were recruited using the convenient sampling method from seven townships in Changxing County of Zhejiang Province from 2019 to 2020. The demographic characteristics and lifestyle factors were collected using questionnaires, and the frailty was measured using the Chinese version of Tilburg Frailty Indicator ( TFI ). Factors affecting frailty were identified among middle-aged and elderly populations using the multivariable logistic regression model.@*Results@#A total of 7 170 residents were surveyed, including 2 780 males ( 38.77% ) and 4 390 females ( 61.23% ), which had a median age of 56 (interquartile range, 10) years. The median frailty score was 2 (interquartile range, 3 ) among the study subjects, and the median frailty score was 2 ( interquartile range, 2 ) among residents at ages of 45 to 59 years, and 2 (interquartile range, 3) among residents at ages of 60 to 69 years. The overall detection of frailty was 16.07%, and the detection of frailty was 13.52% among subjects at ages of 45 to 59 years and 21.01% among subjects at ages of 60 to 69 years. Multivariable logistic regression analysis identified physical activity ( OR=0.826, 95%CI: 0.719-0.949 ) and sleep quality ( OR: 3.376-11.493, 95%CI: 2.907-15.808 ) as factors affecting frailty among middle-aged and elderly residents. Following age stratification, physical activity ( OR=0.817, 95%CI: 0.681-0.981 ) and sleep quality ( OR: 3.076-11.566, 95%CI: 2.518-18.216 ) as factors affecting frailty among subjects at ages of 45 to 59 years, while sleep quality ( OR: 3.777-11.827, 95%CI: 3.002-18.547 ) significantly correlated with frailty among residents at ages of 60 to 69 years.@*Conclusion@#Physical activity and sleep quality are associated with the risk of frailty among middle-aged and elderly populations.