Health Longitudinal Study Research Articles

Can long-term care insurance prevent worsening of frailty among older Chinese adults? A difference-in-differences study based on CHARLS data

Frailty, which is accompanied by negative health outcomes associated with aging, is an increasingly serious public health problem. Long-term care insurance (LTCI) is an effective intervention for frailty in older adults, but few studies have linked LTCI to frailty prevention. This study aimed to determine the role of LTCI in preventing worsening of frailty in older adults. This study used five-wave panel data from the China Health and Retirement Longitudinal Study (CHARLS) 2011 to 2020 to construct an indicator system to assess the frailty index (FI) of surveyed older adults and used a difference-in-differences (DID) method to assess the policy effect of LTCI on frailty among older adults. We found that the full-sample mean of the FI of older adults in China was 0.196, and the implementation of LTCI had a significant negative effect on the FI of older adults. The effect was heterogeneous across sex, age, education and medical insurance groups. LTCI had a more significant negative effect on male group, the middle-aged group, the less educated group, and the URRBMI group, while the effect was less significant for the female and the UEBMI group, and not significant for the more educated and other age groups. That is to say, older Chinese adults are generally frail to different degrees, and the implementation of a LTCI system can prevent worsening of frailty among them, but the effect is not equal across populations. The institutional coverage of LTCI should be further strengthened in the future to slow down the frailty process of the enrollees, so as to promote healthy aging.

Abstract P135: Evaluating the Impact of Cumulative Blood Pressure and Metabolic Indicators on Long-Term Cardiovascular Risk: Insights from a 9-year Nationwide Prospective Cohort Study

Background: Cardiovascular diseases (CVD) are a global health challenge, particularly for older adults. Blood pressure and the Triglyceride-Glucose (TyG) index, an insulin resistance indicator, are key predictors of cardiometabolic risks. Methods: Using data from the China Health and Retirement Longitudinal Study (CHARLS), this study followed participants without baseline CVD over 9 years. We stratified subjects by cumulative TyG and TyG-BMI indices, applying Cox proportional hazards adjusted by age and gender, and restricted cubic spline regression for CVD risk evaluation. Results: From 11,847 participants, 4,751 were analyzed, mainly females (55.25%), with a median age of 57. BMI, TyG, and TyG-BMI indices increased significantly (23.16 to 23.51 for BMI; 8.59 to 8.62 for TyG, 199.14 to 204.22 for TyG-BMI) over 4 years. Participants were categorized based on cumulative TyG and TyG-BMI medians at 25.84 and 606.43, respectively. In the lower TyG group, each SBP unit increment raised CVD risk by 0.5% at 4 years (HR = 1.005, 95% CI 1.003–1.007, p<0.001) and 9 years (HR = 1.005, 95% CI 1.004–1.006, p<0.001). Each 10-unit rise in cumulative DBP corresponded to an 8-9% higher CVD risk at the 4 and 9-year follow-ups. In the higher TyG group, SBP increases were significantly associated with CVD risk changes. Each 10-unit DBP rise corresponded to a non-significant 2% risk elevation at 4 years, but a significant 3% risk increase at 9 years (HR = 1.003, 95% CI 1.000–1.005, p=0.023). For those with a TyG-BMI below 606.43, minor SBP increases significantly impacted CVD risk at both 4 and 9 years. Meanwhile, each 10-unit DBP increment resulted in a 6-8% risk increase, which grew over time. Above a TyG-BMI of 606.43, SBP changes resulted in a notable 2% risk rise by 9 years, and 10-unit DBP increases resulted in a 2-3% risk rise by 9 years. Restricted cubic spline regression showed the 4 and 9-year CVD risk increased with each rise in cumulative SBP and DBP when cumulative TyG was <25.84 or cumulative TyG-BMI <606.43, and DBP had a more profound impact. In contrast, trends were unclear when cumulative TyG ≥25.84 or cumulative TyG-BMI ≥606.43. Conclusion: Cumulative SBP and DBP increases are linked to higher CVD risks, especially in individuals with lower cumulative TyG or TyG-BMI indices. DBP effects were more substantial, particularly noticeable over 9 years. This study underscores the nuanced impacts of blood pressure and metabolic indicators on long-term cardiovascular health.

Effects of educational attainment on comorbidity of pain and depression in Chinese older adults

Pain and depression comorbidity (PD) among older adults in China is common and significantly affects their physical and mental health. The psychosocial factors may affect people's feelings, understanding and expression of pain and depression, leading to inaccurate assessment of this condition. Educational attainment is thought to be associated with either pain or depression. However, we do not yet know the relationship between educational attainment and PD. Using data from the 2018 China Health and Retirement Longitudinal Study in 2018, we analyzed various variables in 7742 individuals aged 60 years and older. Our results indicate significant differences between the PD and non-PD populations in terms of social, lifestyle, and behavioral factors. We observed a significant decrease in the incidence of PD among older adults with higher levels of education (p < 0.001). This association appears to be partially mediated by cognitive ability, suggesting that educational attainment may mitigate the risk of PD through cognitive enhancement. In addition, our analysis shows that the effect of educational attainment on PD is moderated by additional psychosocial factors, including living environment and alcohol consumption patterns. Older adults with higher levels of education tend to live in urban areas and have better control over alcohol consumption, which may contribute to a lower incidence of PD. Therefore, interventions aimed at enhancing cognitive abilities, improving living environments, and promoting healthier lifestyles and habits among older adults could potentially reduce their burden of PD.

Abstract P115: Hypothetical Blood Pressure Lowering Interventions and Risk of Mortality in Middle-Aged and Older Chinese Adults: A Population-Based Modelling Study

Background: Improving hypertension control is an important global health priority. We aimed to study the effects of hypothetical interventions on systolic blood pressure (SBP) on mortality risk at the population level. Methods: We estimated the relationship between SBP and all-cause mortality in adults aged 45 years and older from the China Health and Retirement Longitudinal Study and compared the mortality reductions associated with lowering SBP to different hypothetical targets (120, 130, 140, 150 mm Hg). Using the parametric g-computation modeling technique, we estimated the mean blood pressure reduction required to achieve each target, the share of the population in need of management, and the number needed to treat (NNT) to avert one death under different hypothetical population-wide scale-up scenarios. Results: Among 12355 participants, 1203 died over 7-year follow-up. We found a weak, non-linear relationship between SBP and mortality, with larger incremental mortality benefits at higher SBP values: reducing SBP from 160 mm Hg to 120 mm Hg was associated with a relative risk of mortality of 0.75 (95% CI 0.65 to 0.86). At the population level, reducing SBP to 120 mm Hg among all those with a starting SBP of more than 120 mm Hg (120 mm Hg scenario) was associated with 13.7 deaths averted per 1000 population (95% CI -19.3 to -8.1), compared with 3.8 deaths averted per 1000 population (95% CI -6.0 to -1.6) associated with reducing SBP to 150 mm Hg among all those with a starting SBP of more than 150 mm Hg (150 mm Hg scenario). However, there were large differences between scenarios in the proportion of the population that would require treatment, ranging from 64.3% (95% CI 63.4 to 65.1) in the 120 mm Hg scenario to 16.7% (6.0 to 17.3) in the 150 mm Hg scenario. To achieve the target, the 120 mm Hg scenario required a mean shift of -14.4 mm Hg in SBP (95% CI -14.7 to -14.1) compared with a -2.9 mm Hg mean change (-3.0 to -2.7) for the 150 mm Hg scenario. Based on the ratio of number of deaths averted to the proportion requiring treatment, the 150 mm Hg scenario had the smallest NNT (n=44), followed by the 120 mm Hg scenario (n=47), the 140 mm Hg scenario (n=49), and the 130 mm Hg scenario (n=51). Conclusions: These findings highlight the possible substantial benefits of reducing blood pressure. We find that scaling up management based on a 150 mm Hg target is more efficient in terms of the NNT compared with strategies to reduce SBP to lower levels.

Intergenerational Educational Mobility and Cognitive Trajectories Among Middle-Aged and Older Chinese People: An Application of Growth Mixture and Mobility Contrast Models in Longitudinal Analysis.

Due to statistical challenges in disentangling the mobility effect (i.e., intergenerational educational mobility) from the position effect (i.e., parental and person's own education), the impact of intergenerational educational mobility on cognitive function remains unclear. We employed a novel approach to identify the mobility effect and investigate the net impact of intergenerational educational mobility on heterogeneous patterns of cognition among middle-aged and older adults in China. Participants aged 45 and older were recruited from the China Health and Retirement Longitudinal Study, a population-based prospective cohort study between 2011 and 2018. We identified cognitive trajectories using the growth mixture model (GMM) and subsequently employed the mobility contrast model (MCM) to examine the effects of intergenerational educational mobility on cognitive patterns stratified by gender. Almost two thirds of respondents experienced intergenerational educational mobility, and 55% experienced upward mobility. Men had a higher rate of upward mobility than women. Three population-based cognitive patterns were identified: the low cognitive function with decline group (28%), the moderate cognitive function group (47%), and the high cognitive function group (26%). MCM analysis revealed that both upward and downward intergenerational educational mobility negatively affected cognitive trajectory patterns, extending beyond the influence of individuals' current and parental education. In future research, the impact of mobility can be studied in longitudinal data sets by combining the GMM and MCM approaches. The net negative effect of intergenerational educational mobility on cognitive trajectory patterns indicates that it should be recognized as an independent predictor of cognitive decline.

Levels and outcomes of 12-step participation among sexual and gender minority subgroups

IntroductionSexual minority (e.g., bisexual, gay, lesbian, queer) and gender minority (e.g., transgender, non-binary, gender expansive) individuals (SGMI) experience higher rates of alcohol and other substance use disorders than their heterosexual and cisgender (i.e., non-transgender) counterparts. 12-Step programs are currently the most common source of support for alcohol and other substance use-related problems in the United States. Little is known about rates and levels of participation and outcomes of SGMI in 12-Step programs. Examining SGMI with a lifetime alcohol or other substance use disorder, this study aims to: 1) describe lifetime attendance rates (any vs. none) and levels of participation (number of program activities) in 12-Step groups among SGMI overall and compare rates of attendance and levels of participation across sexual and gender minority identities and 2) determine how lifetime level of participation in 12-Step programs relates to past-year alcohol and other substance use outcomes. MethodsWe used data collected through The PRIDE Study, a national, large-scale, longitudinal health study of adult SGMI, administering supplemental questions to assess alcohol and other substance use disorders and 12-step participation. Zero-Inflated Negative Binomial models (N = 1353) run with sexual and gender identities as predictors of lifetime 12-step attendance (yes/no) and level of 12-Step participation determine if greater levels of 12-Step participation were associated with lower levels of past-year Alcohol and Substance Use Disorder (AUD & SUD) symptoms. The study ran models for those with lifetime AUD (n = 1074) and SUD (n = 659) separately. ResultsParticipants who engaged in greater levels of 12-Step participation had lower levels of past-year AUD and SUD symptoms. Gay and queer respondents with AUD were more likely and lesbian respondents with SUD were less likely than other participants to have ever participated in 12-Step programs. All other associations between sexual/gender identities and 12-Step participation disappeared when age was added to the model. ConclusionsThis study provides preliminary evidence that 12-Step participation may be an effective resource for reducing AUD and SUD symptoms among SGMI. Younger SGMI and SGMI holding sexual/gender identities other than gay and queer may require additional support to initiate participation in 12-Step programs.

Using machine learning models to identify the risk of depression in middle-aged and older adults with frequent and infrequent nicotine use: A cross-sectional study

BackgroundDepression is very prevalent in middle-aged and older smokers. Therefore, we aimed to identify the risk of depression among middle-aged and older adults with frequent and infrequent nicotine use, as this is quite necessary for supporting their well-being. MethodsThis study included a total of 10,821 participants, which were derived from the China Health and Retirement Longitudinal Study Wave 5, 2020 (CHARLS-5). Five machine learning (ML) algorithms were employed. Some metrics were used to evaluate the performance of models, including area under the receiver operating characteristic curve (AUC), positive predictive value (PPV), specificity, accuracy. Results10,821 participants (6472 males, 4349 females) had a mean age of 60.47 ± 8.98, with a score of 8.90 ± 6.53 on depression scale. For middle-aged and older adults with frequent nicotine use, random forest (RF) achieved the highest AUC value, PPV and specificity (0.75, 0.74 and 0.88, respectively). For the other group, support vector machines (SVM) showed the highest PPV (0.74), and relatively high accuracy and specificity (0.72 and 0.87, respectively). Feature importance analysis indicated that “dissatisfaction with life” was the most important variable of identifying the risk of depression in the SVM model, while “attitude towards expected life span” was the most important one in the RF model. LimitationsCHARLS-5 was collected during the COVID-19, so our results may be influenced by the pandemic. ConclusionsThis study indicated that certain ML models can ideally identify the risk of depression in middle-aged and older adults, which holds significant value for their health management.

The impact of land-use policy on household energy transition: Evidence from China's conversion of cropland to forestland program

The implementation of the Conversion of Cropland to Forestland Program (CCFP) has affected land-use patterns and biomass availability in China, consequently reshaping household energy consumption patterns. Utilizing data from the China Health and Retirement Longitudinal Study, this study employs a multinomial logit model to examine the impact of CCFP subsidies on household energy transitions, analyzed through the lenses of the energy ladder and energy types. Additionally, this study differentiates the effects of CCFP subsidies across households with varying characteristics. The empirical results reveal that, from the energy ladder perspective, CCFP subsidies hinder household energy transitions from biomass to both traditional and advanced commercial energy sources. From the energy type perspective, the subsidies impede transitions from biomass energy to coal, electricity, and LPG/LNG. These adverse effects may be attributed to the CCFP subsidy's role in increasing biomass supply and encouraging the use of biomass energy equipment. Moreover, the impacts of CCFP subsidies differ among households based on education level, location, and degree of engagement in farming. Overall, this study highlights the importance of considering land use policies and patterns in the formulation of energy policies aimed at promoting energy transition and alleviating energy poverty.

Inequalities in health care use among patients with arthritis in China: using Andersen’s Behavioral Model

BackgroundThis study sought to assess socioeconomic-related inequalities in health care use among arthritis patients in China and to analyze factors associated with this disparity.MethodsThis study used data from the 2018 China Health and Retirement Longitudinal Study. 3255 arthritis patients were included. The annual per capita household expenditure was used to divide individuals into five categories. We calculated actual, need-predicted, and need-standardized distributions of health care use by socioeconomic groups among people with arthritis. The concentration index (Cl) was used to assess inequalities in health service use. Influencing factors of inequalities were measured with the decomposition method.ResultsThe outpatient and inpatient service use rates among 3255 arthritis patients were 23.13% and 21.41%, respectively. The CIs for actual outpatient and inpatient services use were 0.0449 and 0.0985, respectively. The standardized CIs for both outpatient and inpatient services use increase (CI for outpatient services use = 0.0537; CI for inpatient services use = 0.1260), indicating the emergence of a significant pro-rich inequity. Annual per capita household expenditure was the chief positive contributor to inequity for both outpatient (104.45%) and inpatient services use (105.74%), followed by infrequently social interaction (22.60% for outpatient services use) and Urban Employee Basic Medical Insurance (UEBMI) (11.90% for inpatient services use). By contrast, UEBMI also provided a high negative contribution to outpatient services use (-15.99%).ConclusionsThere are significant pro-rich inequalities in outpatient and inpatient services use among patients with arthritis, which are exacerbated by widening economic gaps. Interventions to address inequalities should start by improving the economic situation of lower socioeconomic households.

Estimating the impact of metabolic syndrome on low back pain and the joint effects of metabolic syndrome and depressive symptoms on low back pain: insights from the China Health and Retirement Longitudinal Study

BackgroundAlthough metabolic syndrome (MetS) and depressive symptoms (DS) are predictors of low back pain (LBP), their combined effects and relative contributions to LBP have not been well studied. Using the nationally representative data from the China Health and Retirement Longitudinal Study (CHARLS), this study conducted cross-sectional and longitudinal analyses to investigate the impact of MetS on LBP, and the joint effects of MetS and DS on LBP.MethodsThis study included a cross-sectional analysis of 8957 participants aged at least 45 years from the CHARLS 2011 dataset and a longitudinal follow-up of 3468 participants without LBP from the CHARLS 2011, tracked over 9.25 years (from June 2011 to September 2020) with 4 times LBP assessment in CHARLS 2013, 2015, 2018, and 2020. To explore the association between MetS on LBP and the joint effects of MetS and DS on LBP, multivariable-adjusted multinomial logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs). Multivariable-adjusted COX proportional hazards regression models were applied to estimate hazard ratios (HRs) and 95% CIs. All statistical analyses were conducted using STATA (version SE16).ResultsIn the cross-sectional analysis, MetS was associated with a lower risk of LBP (adjusted OR = 0.85, 95% CI = 0.74–0.97), while there was no significance for this association in the longitudinal analysis. In the joint association of MetS and DS with LBP, participants with NoMetS + DS (adjusted OR = 2.31, 95% CI = 1.94–2.75), and MetS + DS (adjusted OR = 2.16, 95% CI = 1.81–2.59) were risk factors for LBP events, while those with MetS + NoDS (adjusted OR = 0.75, 95% CI = 0.62–0.90) was a protective factor for LBP events than those with NoMetS + NoDS. During the 9.25 years of follow-up, 1708 cases (49.25%) experienced incident LBP events. In the longitudinal analysis, a significantly negative association was not found in MetS + NoDS for LBP events. Three sensitivity analyses identified the robustness of the associations. Moreover, the nature of cross-sectional associations differed by age (45–64 and 65 + years).ConclusionsOur study found that MetS was linked to a lower incidence of LBP, but this effect does not persist over time. Importantly, the combination of MetS and DS significantly increased LBP risk, a joint effect not extensively studied before. These findings underscore the novel contribution of our research, advocating for the joint assessment of MetS and DS to enhance LBP risk stratification and inform prevention strategies.

How does chronic disease influence subjective life expectancy among middle-aged and older adults? Evidence from the China Health and Retirement Longitudinal Study (CHARLS) 2018 cross-sectional data.

Chronic diseases have become one of the most important factors threatening human health. Subjective life expectancy (SLE) describes an individual's expectation or subjective perception of lifespan. This article aims to explore the relationship between chronic diseases and SLE, as well as the differences among different age groups and different types of chronic diseases in this relationship. China Health and Retirement Longitudinal Study (CHARLS) is a nationwide longitudinal study that evaluates the social, economic, and health conditions of middle-aged and older adult families and individuals aged 45 and above in China. In this study, CHARLS used probability proportional to size sampling (PPS sampling) to ensure the breadth and representativeness of the sample. This study selected cross-sectional data from CHARLS 2018, removed missing values, and obtained a valid sample of 10,658 middle-aged and older individuals, of whom 8564 had chronic diseases. After controlling demographic, health behavior, socioeconomic, psychological, and social security factors, an ordered logistic regression was performed to explore the relationship between chronic disease and SLE in middle-aged and older adults. The results show that chronic diseases negatively correlate with SLE in middle-aged and older adults. Middle-aged and older adults with chronic diseases are 36.2% less likely to have high life expectancy than those without chronic diseases. Many different types of chronic diseases are negatively correlated with SLE. Cancer is most negatively correlated with SLE, far exceeding other chronic diseases. Chronic disease and SLE of middle-aged and older adults have age-heterogeneous differences. For middle-aged people aged 45-59 and young older adults aged 60-79, there is a significant correlation between chronic diseases and SLE. However, there is no correlation between chronic diseases and subjective life expectancy in the older population aged 80 and above. The government and society should pay close attention to the prevention and treatment of chronic diseases among middle-aged and older adults and adjust policies and measures according to the population's age structure. In addition, the government and society should pay attention to the spiritual needs of middle-aged and older adults. The government and society should pay more attention to cancer patients. Finally, the scientific research team should also strengthen research on chronic diseases, research and development of specific drugs and vaccines, improve the cure rate of chronic diseases, promote people's health, and make people no longer afraid of diseases.

The effect of age on the relationship between negative life events and current and new depressive episodes: results from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)

BackgroundThere is scarce data concerning the relationship between negative life events (NLEs)* and current and new depressive episodes by age. MethodsCross-sectional (baseline) and prospective analyses (4-year/8-year follow-ups) were performed in 15,105 civil servants in 6 cities in Brazil classified according to age strata at baseline: 1st(35–44), 2nd(45–54), 3rd(55–64), and 4th(65–74) years. The independent variable was NLEs in the last year (robbery, hospitalization, death of a relative, financial hardship, and rupture of a love relationship) collected at baseline. The dependent variable was depressive episodes assessed at baseline (current), and 4-year/8-year follow-ups (new). We built logistic (Odds Ratio[OR];95 % Confidence Interval[CI]) in the cross-sectional analysis and Poisson regression models (Relative Risk[RR], [CI]) in the prospective analysis. ResultsRobbery, hospitalization, financial hardship, rupture of a relationship were associated with current depressive episodes concentrated in the 35–44 age range, while for new depressive episodes, the association of hospitalization, death of a relative, and financial hardship were concentrated in the 45–54 age stratum. Financial hardship was associated with current depressive episodes in all age-strata: 1st: OR, 2.77(CI, 1.83–4.19); 2nd: OR, 1.71(CI, 1.26–2.34); 3rd: OR, 1.68(CI,1.15–2.46); 4th, OR, 4.07(CI, 1.24–13.34), and new depressive episodes: 1st: RR, 1.45(CI, 1.09–1.93); 2nd RR, 1.46(CI: 1.15–1.84); 3rd: RR, 1.97(CI, 1.38–2.82). Rupture of a relationship was associated only with current depressive episode, while death of a relative only with new depressive episode. LimitationWe cannot rule out the possibility of recall bias, since NLEs` information was self-reported. ConclusionThe association between NLEs with depressive episodes was concentrated in youngers.

Association of handgrip strength with health care utilisation among older adults: A longitudinal study in China.

Evidence on the association between handgrip strength (HGS) and health care utilisation among Chinese older adults is scarce. In this study, we aimed to investigate the association of HGS with health care utilisation and to identify whether these associations varied by gender. The analytic sample of this prospective cohort study included 6007 Chinese older adults (≥60 years) from 2011 to 2018 waves of the China Health and Retirement Longitudinal Study. A handgrip dynamometer was used to measure HGS. We measured health care utilisation by outpatient visits, inpatient visits, and unmet hospitalisation needs. We used covariates-adjusted general estimating equations for the analyses. Longitudinal results showed that participants with weakness increased the likelihood of outpatient visits (odds ratio (OR) = 1.13; 95% confidence interval (CI) = 1.01-1.27), inpatient visits (OR = 1.51; 95% CI = 1.32-1.73), and unmet hospitalisation needs (OR = 1.44; 95% CI = 1.19-1.79) than their counterparts. Participants with weakness increased the number of outpatient visits (incidence rate ratio (IRR) = 1.29; 95% CI = 1.11-1.51) and the number of inpatient visits (IRR = 1.39; 95% CI = 1.10-1.61). Participants with HGS asymmetry increased the likelihood of unmet hospitalisation needs (OR = 1.19; 95% CI = 1.03-1.43) than their counterparts. The results of the impact of every one-kilogramme (kg) increase in HGS on health care utilisation indicated consistent results. The associations were similarly observed irrespective of gender. Chinese older adults with weakness or HGS asymmetry used more health care. Interventions for improving muscle strength and correcting strength asymmetry are highly recommended, with the potential to considerably save households and health care systems.

Gender Disparities in Frailty and Its Decomposition Among Chinese Older Adults.

To identify the evidence of gender disparities in frailty and explore the factors contributing to male-female differences. A longitudinal study. A total of 24,429 older adults (60+) were enrolled. Frailty was assessed by frailty index and frailty risk based on Rockwood's cumulative deficit frailty index. OLS and logistic regression models were conducted, with Oaxaca-Blinder and Fairlie decomposition methods to further analyse the factors contributing to gender disparities in frailty. The paper used four waves of the China Health and Retirement Longitudinal Study from 2011 to 2018, a nationwide survey organised by the National Development Institute of Peking University. Women had higher frailty status than men, with more pronounced increases. Among the factors, education has the most significant association with frailty gender disparities. The contribution of individual characteristics, particularly education, to gender disparities in frailty appeared to diminish over time, while the contribution of family and regional factors remained relatively stable, and the contribution of institutions was deemed inadequate. The frailty in Chinese older adults is generally on the rise with continuously expanded gender disparities. It is crucial to consider the contributing factors to frailty in older adults for effective prevention and intervention strategies. Additional gender-specific geriatric care policies are needed in order to address gender inequality in health. The findings of this study highlight the prevalence of increasing gender disparities in frailty and identify that the level of education, per capita annual household income as well as marital status are the most significant factors contributing to the gender gap. Those findings provide policy implications for healthcare nursing service from a gender-specific perspective in order to achieve health equity. This study has adhered to the STROBE guideline. No Patient or Public Contribution. WHAT DOES THIS PAPER CONTRIBUTE TO THE WIDER GLOBAL CLINICAL COMMUNITY: This study provided implications on gender-specific geriatric care nursing services. The study highlighted the importance of focusing on frailty and its gender disparities in geriatric clinical nursing.

Predicting all-cause mortality and premature death using interpretable machine learning among a middle-aged and elderly Chinese population

ObjectiveTo develop machine learning-based prediction models for all-cause and premature mortality among the middle-aged and elderly population in China. MethodAdults aged 45 years or older at baseline of 2011 from the China Health and Retirement Longitudinal Study (CHARLS) were included. The stacked ensemble model was built utilizing five selected machine learning algorithms. These models underwent training and testing using the CHARLS 2011–2015 cohort (derivation cohort) and subsequently underwent external validation using the CHARLS 2015–2018 cohort (validation cohort). SHapley Additive exPlanations (SHAP) was introduced to quantify the importance of risk factors and explain machine learning algorithms. ResultIn derivation cohort, a total of 10,677 subjects were included, 478 died during the follow-up. The stacked ensemble model demonstrated the highest efficacy in terms of its discrimination capability for predicting all-cause mortality and premature death, with an AUC[95 % CI] of 0.826[0.792–0.859] and 0.773[0.725–0.821], respectively. In validation cohort, the corresponding AUC[95 % CI] were 0.803[0.743–0.864] and 0.791[0.719–0.863], respectively. Risk factors including age, sex, self-reported health, activities of daily living, cognitive function, ever smoker, levels of systolic blood pressure, Cystatin C and low density lipoprotein were strong predictors for both all-cause mortality and premature death. ConclusionStacked ensemble models performed well in predicting all-cause and premature death in this Chinese cohort. Interpretable techniques can aid in identifying significant risk factors and non-linear relationships between predictors and mortality.

The impact of chronic diseases on the health-related quality of life of middle-aged and older adults: the role of physical activity and degree of digitization

BackgroundThe incidence of chronic diseases is on the rise worldwide, with a high mortality rate in China, posing a serious threat to the health-related quality of life (HRQoL) of middle-aged and older adults. This study explores the association between chronic diseases and the HRQoL of middle-aged and older adults, as well as the role of physical activity (PA) and degree of digitization in this relationship.MethodsThe data used in this study was obtained from the 2018 China Health and Retirement Longitudinal Study (CHARLS), which included 13,620 middle-aged and older Chinese adults (≥ 45 years). The study utilized correlation analysis, and bootstrapping to investigate the mediating role of PA and the moderating influence of the degree of digitization. Data analysis was conducted using SPSS 26.0.ResultsThe study findings indicate that the severity of chronic disease has a significant negative predictive effect on HRQoL (PCS, physical component summary; MCS, mental component summary) (PCS: β = -2.515, p < 0.01, MCS: β = -0.735, p < 0.01). Further analysis revealed that PA plays a mediating and masking role in the impact of chronic disease on PCS and MCS. Additionally, the degree of digitization moderates the relationship between chronic disease and PA, chronic disease and PCS, and PA and PCS.ConclusionFor middle-aged and older persons, chronic diseases have a detrimental effect on their HRQoL; nevertheless, PA can help. Furthermore, proper internet usage can help older individuals to some extent in mitigating the negative impact of chronic diseases. Therefore, it is encouraged to promote PA among the elderly with chronic diseases to improve their physical health, as well as to guide them in the proper use of the Internet to establish healthy behaviors.

Post-COVID social engagement and depression among Chinese older adults: exploring rural/urban and gender differences.

This study investigates the impact of post-COVID social engagement on depression levels among Chinese older adults, with a focus on rural/urban and gender differences. Using the year 2018 and year 2020 data from the China Health and Retirement Longitudinal Study (CHARLS), this study analyzed pre- and post-COVID depression levels and social engagement indicators, including going-out, activities and networking among Chinese older adults (N = 8,793). Results showed a significant increase in depression levels across all demographic groups post-COVID, with rural females exhibiting the highest levels of depression. Reduced social engagement was associated with increased depression, particularly among rural males and females. Subgroup analyses highlighted nuanced patterns: rural males suffered from decreased intense activities and online contacts, while urban males experienced heightened depression with reduced visiting and light activities. Rural females reported increased depression with decreased moderate activities and dancing outdoors but decreased levels with reduced online contacts. Conversely, urban females experience decreased depression with reduced social engagements, suggesting areevaluation of priorities amidst pandemic challenges. This study has underscored the importance of considering individual, cultural, and contextual factors in understanding mental health outcomes among Chinese older adults. Findings inform targeted interventions aimed at promoting psychological well-being and resilience among Chinese older adults in the post-COVID era, including community-based programs and mental health screenings, to foster social connection and emotional support.

Association of Handgrip Strength Weakness and Asymmetry With Incidence of Motoric Cognitive Risk Syndrome in the China Health and Retirement Longitudinal Study.

Association of Handgrip Strength Weakness and Asymmetry With Incidence of Motoric Cognitive Risk Syndrome in the China Health and Retirement Longitudinal Study.

Is subjective life expectancy stronger in older adults with more physical activity? Evidence from China

To explore the relationship between physical activity and subjective life expectancy in an older population. Repeated-measures ANOVA, as well as construction of a cross-lagged model, was conducted with a sample of 4969 older adults from the China Health and Retirement Longitudinal Study data in 2018 and 2020. It was found that T1 subjective life expectancy significantly predicted T2 physical activity (β=0.03, P < 0.01) and T1 physical activity significantly predicted T2 subjective life expectancy (β=0.05, P < 0.05). There was a significant bidirectional predictive relationship between physical activity and subjective life expectancy in older adults, and physical activity is a causal variable for subjective life expectancy.

Social capital, health risk avoidance, and the enrollment of health insurance: The case of rural middle-aged and elderly in China

Low enrollment intention threatens the funding pools of rural insurance schemes in developing countries. The purpose of this study is to investigate how social capital enhances the enrollment of health insurance among rural middle-aged and elderly. We propose that social capital directly increases health insurance enrollment, while indirectly influences health insurance through health risk avoidance. We used data from the China Health and Retirement Longitudinal Study (wave 4) dating the year of 2018, instrumental variable estimation was introduced to deal with the endogeneity problem, and the mediation analysis was used to examine the mechanism of social capital on insurance enrollment. The results show that social capital is positively related to social health insurance enrollment, and the relationship between social capital and social health insurance enrollment is mediated by health risk avoidance.