Middle-aged Individuals Research Articles

Prevalence and risk factors associated with undiagnosed hypertension among adults aged 15–49 years in India: insights from the National Family Health Survey (NFHS-5)

ObjectivesTo estimate the prevalence and identify the factors associated with undiagnosed hypertension in India. Study designA secondary data analysis using the National Family Health Survey (NFHS-5) covering the period 2019–2021. MethodsInformation on hypertension among individuals aged 15–49 years was extracted from the survey dataset. We estimated the prevalence of undiagnosed hypertension using physical measurements along with self-reported data from the survey. A log-binomial model with survey-adjusted Poisson regression was used to estimate the prevalence ratio between undiagnosed and diagnosed hypertension. Multinomial logistic regression analysis examined the factors associated with diagnosed hypertension (vs healthy) and undiagnosed hypertension (vs healthy). All the analyses were survey-weight adjusted and stratified by gender. ResultsThe survey-adjusted prevalence of undiagnosed hypertension was 8.75% (8.62%–8.87%) and was higher among males [13.56% (13.03%–14.12%)] than in females [8.14% (8.03%–8.25%)]. The proportion of individuals with undiagnosed hypertension among total hypertension was 44.99% (44.44%–45.55%) and was higher in males [65.94% (64.25%–67.60%)] than in females [42.18% (41.66%–42.71%)]. ConclusionsOur findings revealed that age, higher body mass index, no access to health care, and having no comorbidities were risk factors for undiagnosed hypertension. One in twelve people had undiagnosed hypertension, and of those with hypertension, one in two were undiagnosed, with males being disproportionately affected. Targeted public health interventions are crucial to improve hypertension screening, particularly among middle-aged and obese individuals without comorbidities.

Cognitive decline in relation to later-life high temperature exposure in a Chinese nationwide cohort

Growing evidence has linked extreme temperature with neuropsychiatric disorders under climate warming with frequent extreme heat events over the past decades, while cognitive performance in relation to heat exposure remains largely unstudied, particularly in populations at high vulnerability to climate risks (e.g., China). Based on five survey waves of a nationwide dynamic cohort (2011–2020), we analyzed 47,825 cognitive test records from 14,729 respondents aged 45+ years across 126 Chinese cities. Global cognitive performance and its two dimensions (episodic memory and mental status) was measured using standardized questionnaires. Temperature exposure prior to cognitive tests was assessed using both average temperatures and heat days exceeding predefined temperature thresholds. Linear mixed-effects models were utilized to examine the relationship between high temperature exposure and cognitive function. This study revealed consistent evidence for heat-related declines in global cognitive performance and episodic memory across multiple exposure-window analyses, while robust associations were observed solely during prolonged exposure periods (more than 90 d) for mental status. For each 1-°C rise in annual mean temperature within 1 year prior to investigation, cognitive scores declined by 0.058 (95% CI: −0.079, −0.037) points for global performance, 0.033 (95% CI: −0.048, −0.018) points for episodic memory, and 0.025 (95% CI: −0.038, −0.013) points for mental status, respectively. Similar findings were seen in analyses using heat exposure days defined by multiple temperature percentiles, linking per 10-d increase in heat duration to reduced global cognitive scores ranging from −0.142 (95% CI: −0.214, −0.070) to −0.168 (95% CI: −0.254, −0.082). Despite varied evidence by heat exposure metrics and cognitive dimensions, stratified analyses suggested possibly higher susceptibility among females, less-educated, and urban-dwelling residents to heat-related cognitive impairment. These results provided suggestive evidence for the role of exposure to heat in triggering cognitive impairment in middle-aged and older individuals. This finding may be crucial in developing public health strategies for managing climate change risks of neurobehavioral disorders in a healthy aging society.

Exploring the Mechanism and Path of Financial Literacy's Impact on Consumption of Middle-aged and Elderly Rural Residents: Micro-evidence from CHFS Data

Based on the data from the three rounds of the China Household Finance Survey (CHFS) in 2015, 2017, and 2019, this study systematically explores the mechanism and path through which financial literacy influences the consumption patterns of middle-aged and elderly individuals in rural areas. The findings reveal that financial literacy plays a positive role in enhancing the consumption levels of this demographic group, while family satisfaction also significantly promotes their consumption growth. Furthermore, this research uncovers that Internet usage serves as a mediating factor between financial literacy and consumption among middle-aged and elderly rural dwellers, and risk preference significantly moderates the relationship between financial literacy and their consumption. It is noteworthy that the impact of financial literacy on the consumption habits of middle-aged and elderly rural populations varies across different regions. This study contributes novel insights to the theoretical understanding of the relationship between financial literacy and consumption among middle-aged and elderly rural residents, and offers empirical evidence and data-driven recommendations for elevating their consumption levels. It possesses both substantial theoretical value and practical implications for guiding policy and practice.

Are older adults perceived as morally better than middle-aged persons? Focus on the stereotype content model

Identifying and improving existing morality perceptions regarding older adults is crucial for fostering intergenerational cooperation and constructing an inclusive society. In this study, we conducted two online experiments with Japanese participants to investigate the degrees to which older adults are perceived as moral. We predicted that older adults are more likely to be perceived as morally good compared to middle-aged individuals (Hypothesis 1), and that regardless of the target person's age, individuals perceived as warm (Hypothesis 2) and competent (Hypothesis 3) are more likely to be regarded as morally good. In Study 1, participants were instructed to freely describe a typical older (aged 80 years) or middle-aged (aged 50 years) target individual. Contrary to expectations, the middle-aged target individual was perceived as morally better than the older counterpart. Meanwhile, regardless of the target individual's age, the target individuals perceived as warm and competent were more likely to be viewed as morally good. In Study 2, participants were presented with a simple vignette describing an older (aged 80 years) or middle-aged (aged 50 years) target individual, manipulating their warmth (warm/cold) and competence (competent/incompetent). The results indicated no effect of target age on moral perceptions, but warmer and/or more competent target individuals elicited higher moral perceptions. Thus, Hypothesis 1 was not supported in either study, whereas Hypotheses 2 and 3 were supported across both studies. These findings underscore the importance of enhancing moral perceptions, warmth, and competence regarding older adults to facilitate appropriate assistance from other generations.

How spousal cognitive functioning affects the level of depression in middle-aged and older adults: An instrumental variable study based on CHARLS in China.

A better understanding of the causal relationship between spousal cognitive functioning and depression levels among middle-aged and older adults is vital for effective health policymaking under the globally severe aging challenge. However, the related evidence is often limited by potential omitted-variable bias and reverse causation. This study uses an instrumental variables approach, namely the two-stage least squares (2SLS) method, to examine the impact of spousal cognitive functioning on depression levels among middle-aged and older adults in China. The data were sourced from the China Health and Retirement Longitudinal Study (CHARLS) of 2020, including a total of 3,710 couples aged 45 years and above. Depression levels were measured using the Center for Epidemiologic Studies Depression Scale (CES-D-10), while cognitive functioning was assessed using the Mini-Mental State Examination (MMSE). Spousal social participation was employed as the instrumental variable to address omitted-variable bias and reverse causation. Additionally, an interaction effect test between gender and spousal cognitive functioning was conducted. The results show that for each one-point increase in the spouse's MMSE score, the CES-D-10 score of middle-aged and older adults decreased by 17.1% to 68.2%. The OLS results indicated that women, rural residents, and middle-aged individuals were more sensitive to these changes. The interaction effect test results confirmed that women were more affected by changes in spousal cognitive functioning. However, after a more reliable 2SLS analysis, the results for age groups shifted, showing that middle-aged individuals were more sensitive to these changes, with a decrease in depression levels reaching 70.0%, compared to 60.2% for the elderly group. Nonetheless, given the prevalence of depression among the elderly, the impact of spousal cognitive decline on depression in this group should not be overlooked. Our findings highlight the importance of spousal cognitive health in managing depression among both middle-aged and older adults, with particular attention to women and rural populations.

A prospective study on etiology and clinical profile of chronic Cor pulmonale

Background: Cor pulmonale accounts for approximately 6% to 7% of all adult heart disease cases in the United States and is involved in 10% to 30% of hospital admissions for congestive heart failure nationwide. Materials and Methods: This prospective study was conducted at Al-Ameen Medical College and Hospital in Vijayapura, adhering to specific inclusion and exclusion criteria. The sample included 73 cases, with detailed medical histories and symptom analyses collected from each participant. A thorough clinical examination was also performed. Results: Among the 73 patients, 25 (34.3%) were aged 40 to 50 years, while another 25 (34.3%) were over 60 years. The majority were male (80.8%), and 50 patients (68.5%) had a history of smoking. All participants presented with symptoms of breathlessness, cough, and swelling of the feet. Physical examinations showed tachypnea, crepitations, and rhonchi in all individuals. Chronic bronchitis and emphysema were identified as the leading causes of chronic cor pulmonale in 44 patients (60.2%). Conclusion: This study found that chronic bronchitis and emphysema were common causes of chronic cor pulmonale, primarily affecting middle-aged and older individuals, with males affected more than females and smoking identified as a major contributing factor. Common symptoms included breathlessness, cough, and lower extremity swelling. Physical examinations frequently revealed tachypnea, crepitations, rhonchi, and notable signs such as epigastric pulsations, loud P2, pansystolic murmur of tricuspid regurgitation, and parasternal heave. Chronic cor pulmonale has a substantial impact on both pulmonary and cardiac function; 53.7% of patients are at risk of readmission within one year of discharge. The condition is generally associated with a poor prognosis. This highlights the importance of early detection of signs and symptoms to enhance management outcomes.

Relationship between white-coat hypertension and office isolated systolic or diastolic hypertension: an ambulatory blood pressure monitoring study.

This study investigated the prevalence of white-coat hypertension (WCH) among individuals with office isolated systolic hypertension (ISH), isolated diastolic hypertension (IDH), and systolic-diastolic hypertension (SDH). We evaluated 9122 individuals [57.0 ± 14.5 years, 51% men] with office blood pressure ≥140/90 mmHg who underwent ambulatory blood pressure monitoring (ABPM) and were categorized into younger (<40-years), middle-aged (≥40 and <60-years) and older (≥60-years) groups. The prevalence of WCH in SDH, ISH, and IDH was 18, 61, and 37% in younger, 16, 55, and 29% in middle-aged, and 23, 51, and 40% in older individuals. Multivariable logistic regression analysis showed a higher likelihood of WCH in ISH (4.1, 3.6, and 2.1-fold all p < 0.001) and IDH (1.9, 1.5, and 1.5-fold; all p < 0.001) compared to SDH among younger, middle-aged and older individuals, respectively. These data indicate that ISH and, to a minor extent, IDH are linked to a higher prevalence of WCH derived from ABPM exams.

Clinicopathological Features of Membranous Nephropathy Complicated by IgA Nephropathy: A Retrospective Analysis of Seven Cases.

Aims/Background Both membranous nephropathy (MN) and immunoglobulin A nephropathy (IgAN) are immune complex-mediated glomerular diseases, but the concurrent occurrence of these two conditions in the same patient is not common, a phenomenon that is currently not supported by clinical data in terms of treatment and prognosis. This study explores the clinical and pathological characteristics, as well as the treatment outcomes, of patients affected by MN and IgAN simultaneously. Methods The clinical data, pathological features, and diagnostic and therapeutic information of seven cases of MN complicated by IgAN, treated between December 2015 and December 2022, were retrospectively analyzed. Results Among the seven cases, there were two male and five female patients, with an average age of 57.3 ± 9.2 years. All patients presented with clinical manifestations of proteinuria and edema upon admission, with an average 24-hour urine protein of 3716.6 ± 1519.4 mg/24 h. Phospholipase A2 receptor (PLA2R) expression was detected in all seven cases, and nephrotic syndrome was clinically diagnosed in five cases. Additionally, all seven cases showed microscopic hematuria, with intermittent gross hematuria in two cases. All seven patients included in this study underwent renal biopsy. After disease staging, the patients had MN stages I-III and IgAN stages II-III. Pathological findings revealed abnormal glomerular basement membrane (GBM) and diffuse immunoglobulin G (IgG) deposition in the subepithelial space, predominantly of the IgG4 subtype. Simultaneously, there was diffuse mesangial zone deposition of immunoglobulin A (IgA) to varying degrees, co-localization of complement component C3 and IgA, and mesangial cell proliferation. Treatment strategies included angiotensin-converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB) in combination with steroids or immunosuppressive therapies such as tacrolimus, cyclophosphamide, and rituximab. After 2-6 months of treatment, all patients achieved complete remission with a favourable prognosis. Conclusion MN accompanied by IgAN tends to occur more frequently in middle-aged and elderly individuals, with a relatively low incidence. The latent feature of the comorbidities manifests as a form of IgAN superimposed on the background of MN. Utilizing ACEI or ARB in combination with steroids or various immunosuppressive therapies represents a potentially effective treatment strategy.

Effects of a Six-Month Physical Activity Program on Health Risk Factors and Body Composition Among Overweight and Obese Middle-Aged Adults.

Introduction. Physical activity is vital for preventing and managing lifestyle-related diseases, which pose significant health and socio-economic challenges. This study aimed to evaluate the effects of a six-month supervised physical activity program on health risk factors and body composition in middle-aged individuals with overweight or obesity. Methods. The study involved 166 men and women aged 30 to 65 years, with a body mass index (BMI) ranging from 26 to 35 and moderate to severe health risks. Participants of the study were engaged in a six-month physical activity training program designed in accordance with World Health Organization guidelines. Comprehensive assessments were performed at baseline and after the intervention, including measurements of various anthropometric and body composition parameters, as well as evaluations of functional performance. Fitness tests were also conducted to assess participants' physical capacity and to monitor improvements throughout the training period. Results. Baseline measures of body mass composition and age demonstrated a strong positive correlation with visceral fat rating (VFR) in both men (r = 0.364, p < 0.001) and women (r = 0.420, p = 0.002). Following the six-month training program, participants exhibited an average improvement of 30% (p < 0.001) in their Cooper endurance test results. The physical activity intervention positively impacted body mass index (BMI) and various body composition metrics, including fat mass, VFR, and muscle mass, across all participants and most subgroups (gender, BMI, and age). In males, training at higher maximum heart rate (HRmax) zones significantly contributed to a reduction in the percentage of fat mass (80-89% HRmax) and an increase in the percentage of muscle mass (70-79% and 80-89% HRmax). Conclusions. The study indicates that a six-month supervised physical activity program significantly improves health risk factors and body composition (visceral fat reduction and improvement in percent of fat and muscle mass) among middle-aged individuals with overweight or obesity. Therefore, we advocate for the integration of structured physical activity interventions into healthcare practices to effectively enhance health outcomes in this population.

Adherence to sports counselling in middle-aged individuals with myocarditis

Abstract Introduction Although current guidelines recommend abstaining from sports for a duration of a minimum of three months in patients with myocarditis, the implementation of this recommendation and its adherence to it are unknown. Objective Investigate counselling and adherence to sports behaviour in patients with myocarditis. Methods A cohort of patients diagnosed with myocarditis, based on the ESC criteria, received questionnaires three months post-diagnosis to assess their activity levels before and after the diagnosis as well as the adherence to sports counselling. Results In our study, 46 myocarditis patients (11; 25% women) with a mean age of 52±14.5years were analysed. At the time of diagnosis, 39 patients (84%) reported physical activity, with 7 (15%) engaging in competitive sports. Following myocarditis diagnosis, 27 (60%) were recommended to abstain from sports or reduce physical activity, with 92% adherence. Of those 11 (23%) were physically active without receiving recommendations continued physical activity (p&amp;lt; 0.001). After three months, less patients were physically active (i.e. 25; 54% patients) compared to 39 (84%) patients at baseline (p = 0.038), 13 of those being physically active but with reduced exercise intensity according to recommendations. Of those who continued exercise without changes (n=13, 28%), only 2 (4%) reported having received recommendations. All competitive athletes (7, 15%) received counselling, whereas significantly fewer recreational athletes 19 (41%) did (p = 0.039). Women received numerical non-significant fewer counselling (4, 36% of all women, compared to 23, 67% of all men; p = 0.186). Conclusion Middle-aged individuals with suspected myocarditis exhibit excellent adherence to recommendations regarding physical activity. However, a notable proportion did not recall receiving counselling on exercise and physical activity. This highlights the need for clinicians to provide comprehensive counselling to all patients with suspected myocarditis consistently.Illustrating the sports behaviourcomparing activity at 0 and 3 months

Electronic nudge letters to increase influenza vaccination uptake in younger and middle-aged individuals with diabetes: a prespecified analysis of the NUDGE-FLU-CHRONIC trial

Abstract Background Despite evidence demonstrating that influenza vaccination is associated with reduced risk of adverse cardiovascular events and all-cause mortality, influenza vaccine uptake remains suboptimal in persons with diabetes mellitus (DM). Purpose In this prespecified analysis of the NUDGE-FLU-CHRONIC trial we assessed the effectiveness of electronically delivered nudges on influenza vaccine uptake according to DM status. Methods NUDGE-FLU-CHRONIC was a nationwide, randomized, pragmatic implementation trial among younger and middle-aged (18-64 years) Danish citizens with chronic disease during the 2023/2024 influenza season. All trial participants were eligible for a free influenza vaccination through the Danish governmental vaccine program. Participants were randomized in a 2.45:1:1:1:1:1:1 ratio to usual care (no electronic letter) or one of 6 different electronic nudge letters delivered on Sep 26, 2023. Baseline and outcome data were obtained using the Danish nationwide registries. The endpoint was receipt of a seasonal influenza vaccine on or before Jan 1, 2024. Results Of 299,881 NUDGE-FLU-CHRONIC participants, 57,666 (19.2%) had DM at baseline. Participants with DM had a median age of 51.6 years, 43.0% were female, median Hba1c of 53 mmol/mol, median DM duration of 10.0 years, and 51.2% were insulin dependent. During follow-up, 43.0% of those with DM vs. 34.6% of those without DM received the seasonal influenza vaccine (p&amp;lt;0.001). Any electronic letter vs. usual care was highly effective in increasing vaccine uptake in participants with DM at baseline (45.6% vs. 36.5%, difference: +9.1 percentage points [99.29%CI: 7.9-10.3], relative risk ratio [RR]: 1.42, 99.29%CI: [1.39-1.44]). However, DM status modified the effect of any electronic letter such that participants without DM at baseline experienced a slightly greater effect than those with DM (37.3% vs. 25.9%, difference: +12.3 percentage points [11.7-12.8], RR: 1.47 [1.45-1.50]; p-interaction &amp;lt;0.001). For each individual electronic nudge letter, the effect of the intervention was slightly lower in participants with DM compared to those without (Figure 1; all p-interaction &amp;lt; 0.015). When assessing DM subgroups, the effect of any electronic letter vs. usual care was greater in participants with DM and concomitant cardiovascular disease than in those without, greater in non-insulin treated than in insulin-treated individuals, and greater in those with shorter diabetes duration. Effectiveness of nudges were consistent across all other DM subgroups including HbA1c level (Figure 2). Conclusions Electronic nudge letters significantly boosted vaccine uptake in a broad range of individuals with DM, but the effect was slightly lower compared to those without DM. Future studies should test whether behaviorally designed nudges may positively influence other health behaviors in people with diabetes.

Minimal extra-cardiac atherosclerosis in people &amp;lt;50 years with sudden cardiac death due to coronary disease

Abstract Background The association between severe coronary artery disease and widespread atherosclerosis in younger individuals remains uncertain. Purpose To characterise the association between severe (fatal) coronary disease and extra-cardiac atherosclerosis in a population of young and middle-aged individuals. Methods Individuals aged 1-50 years with sudden cardiac death (SCD) from 2019-23, autopsy-proven to be due to coronary artery disease, were identified using the state-wide EndUCD registry. The presence of extra-coronary atherosclerosis greater than modified American Heart Association class III was documented in five arterial beds (intra-cerebral vessels, carotid arteries, aorta, renal and femoral arteries). Results Of 3,044 individuals who experienced SCD, 372 were due to coronary artery disease and 71 of these (19.1%) had extra-coronary plaque. Plaque was identified in aorta (68/372 patients, 18.3%), carotid arteries (11/372, 3.0%), iliofemoral arteries (11/372, 3.0%), intracerebral arteries (4/157 patients who underwent examination of the brain, 2.6%) and renal arteries (7/372 patients, 1.9%). 51 patients (13.7%) had plaque in ≥2 arterial beds in addition to their coronary disease. Predictors of extra-coronary plaque were older age (median 47.7 vs 44.4 years, p&amp;lt;0.0001), hypertension (32.3% vs 18.9%, p=0.013), and previous percutaneous coronary intervention (9.9% vs 3.0%, p=0.01). Patients with extra-coronary plaque had higher rates of cardiomegaly (68.8% vs 51.1%, p=0.01), cardiac fibrosis indicative of previous myocardial infarction (49.3% vs 31.9%, p=0.006) and multi-vessel coronary disease (73.5% vs 55.6%, p=0.007). Conclusion Only 1 in 5 people aged 1-50 years experiencing SCD from a coronary cause exhibit extra-coronary plaque. This limits the utility of screening for carotid or aortic plaque to predict coronary atherosclerosis. Individuals with extra-coronary plaque had a higher burden of cardiovascular risk factors and more established coronary disease.

Suicide in young and middle-aged individuals: lessons from a psychosocial autopsy study

Abstract Background Sociodemographic characteristics of suicides are available from Statistics Netherlands. To improve suicide prevention, it is not only necessary to know who dies but also why people die. A psychosocial autopsy was conducted in the Netherlands to investigate differences in psychosocial characteristics and precipitating factors of suicides of young (&amp;lt;30) and middle-aged (40-70) suicide decedents. Methods Data were collected from bereaved individuals. A questionnaire detailed sociodemographic and psychosocial characteristics of the decedents. We reconstructed the suicidal process in the months preceding the suicide in an interview. Findings from the questionnaire and interview were integrated. An independent expert committee formulated recommendations for suicide prevention. Results 162 suicides were investigated. Young decedents showed high levels of substance use and academic pressure. Young adults with developmental disorders were vulnerable in the transition to adulthood. Young males reached out less to support and care. By contrast, suicides of young females were distinguished by comorbidity of psychiatric disorders, frequent suicidal behaviours, high levels of care use, wait lists and a loss of (treatment) perspective, harmful social media use and bullying. Work and financial problems were common in middle-aged decedents. Physical disability and pain were frequently mentioned for middle-aged females. Suicide in middle-aged males was characterized by financial distress, interpersonal conflicts such as divorce, high levels of binge drinking and addiction. Conclusions Our data provide a topology of the needs of individuals at risk for suicide. Suicide prevention strategies can be improved by better transition support and explicit suicide monitoring in young adults with a developmental disorder, active waitlist policies in mental healthcare, and improved collaboration between debt counsellors and mental care professionals based on shared accountability. Key messages • Bereaved individuals elucidated a wide range of psychosocial problems in suicide decedents. • Suicide prevention should adhere to a needs-based approach.

Long-term time-to-ventricular arrhythmic event prediction using a deep learning based model on the electrocardiogram signal

Abstract Background Ventricular arrhythmias (VA) risk stratification tools in individuals without known cardiovascular disease are still insufficient. Previous studies have used convolutional neural networks (CNN) to classify VA by the end of an established follow-up period using the electrocardiogram (ECG), showing a moderate performance (area under the curve [AUC] of 0.610). We hypothesised that the appearance of the VA substrate on the ECG signal depends on the proximity of the ECG acquisition to the VA event. Thus, the performance could improve if the CNN was trained to predict time-to-VA event instead, and if the presence of censored data was considered. Purpose We developed and tested a CNN to predict time-to-VA event in middle-aged individuals without known cardiovascular disease, and we compared its performance with that from ECG indices, such as QRS duration, QT interval and T-wave morphology variations (TMV), as well as sex and age. Methods A total of 69,283 individuals without known cardiovascular disease from the UK Biobank were used as the training set. We applied 10-fold cross validation to train a CNN, where the input was a 15-second ECG at rest (lead I), and the output was ‘occurrence of VA’, ‘censored’, or ‘survival’, up to 1, 2, 3, 4, 6, 8, 10 and 12 years after the ECG acquisition. We used 15-second ECG (lead I) from an independent cohort of 17,320 individuals without cardiovascular disease also from UK Biobank as a test set, where we set a follow-up of 10 years. The above ECG indices were derived from the median heartbeat from the ECG using in-house algorithms. We derived optimal cut-off thresholds from the training test, and we evaluated the AUC, sensitivity, specificity and Cox regression hazard ratios (HR) in the test set. Results In the test set, 9,206 individuals (53%) reached the 10-year follow-up, during which 60 (0.7%) had a VA event. The AUC, sensitivity and specificity values of the CNN were 0.715, 0.881 and 0.400, respectively. These values were 0.592, 0.686 and 0.383 for the QRS duration, 0.569, 0.156 and 0.717 for the QT interval and 0.552, 0.712 and 0.350 for TMV. The combination of sex and age alone showed performance values of 0.760, 0.694 and 0.683, respectively. Survival analyses showed a HR of 3.883 (P = 3.0 x 10-7) for individuals with a CNN prediction greater than the threshold derived in the training set after adjusting for age and gender. Conclusions A CNN that is trained to predict time-to-VA event and accounts for censored data outperforms previous classification proposed models and the predictive value of individual ECG indices of risk. Although the predictive value of the CNN does not show a better long-term VA predictive value than sex and age alone, it provides a significant contribution independently from these two risk factors. Our findings support the use of the ECG to improve long-term VA risk stratification, which might be particularly useful in age- and sex-stratified analyses.

The triglyceride-glucose index is a predictor for cardiovascular events and all-cause mortality in young and middle-aged patients with metabolic syndrome

Abstract Aims The association between the triglyceride-glucose (TyG) index and cardiovascular risk in young and middle-aged individuals with Metabolic syndrome (MetS) remains unclear. This study aimed to investigate the relationship between baseline TyG index and cardiovascular events and all-cause mortality in these patients among American adults. Methods This study enrolled 4937 young and middle-aged patients with MetS from the National Health and Nutrition Examination Survey (1999–2018). Mortality outcomes were determined by linking to National Death Index records up to December 31, 2019. Multivariate Cox proportional hazards models were constructed to analyze explore the associations between baseline TyG index and cardiovascular events or all-cause mortality. Non-linear correlations were explored using restricted cubic splines, and a two-piecewise Cox proportional hazards model for both sides of the inflection point was constructed. Results During the up to 9.3 years follow-up period, a total of 463 all-cause deaths and 143 cardiovascular events were recorded. The multivariate-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) escalate from the lowest to the highest TyG index quartile. Specifically, for cardiovascular events, the HRs range from 1.00 (reference) to 2.29 (1.22, 4.31) with a significant trend (P = 0.004). For all-cause mortality, the HRs vary from 1.00 (reference) to 1.59 (1.09, 2.32), also showing a significant trend (P = 0.003). The restricted cubic splines revealed a J-shaped association between the baseline TyG index with cardiovascular events and all-cause mortality in MetS patients. Conclusions The high TyG index was identified as an independent predictor of elevated rates of cardiovascular events among young and middle-aged patients with MetS. Additionally, a J-shaped curve pattern was observed in the association between these factors.

Different risk and protective factors predict change of planning ability in middle versus older age

Age-related cognitive decline has become an increasingly relevant public health issue. However, risk and protective factors of cognitive decline have yet to be investigated prospectively taking into account genetic, lifestyle, physical and mental health factors. Population-based data from middle-aged (40 to 59 years; N = 2,764) and older individuals (60 to 80 years; N = 1,254) were drawn from a prospective community cohort study using the Tower of London (TOL) planning task. Assessments were repeated at a 5-year interval to investigate age-related changes in planning performance and to determine the impact of risk and protective factors. Planning performance improved in middle-aged, but declined in older participants over 5 years. SNPs affecting the dopamine system (COMT, DRD2) and APOE polymorphisms differentially predicted cognitive performance in older vs. middle-aged individuals. For older individuals, high alcohol consumption, antidepressant medication and living without a partner had additional negative predictive power on cognition. In contrast, undiagnosed hypertension, no obstructive lung disease, and fewer years of education predicted cognitive decline in the middle-aged group. The results inform screening for individuals particularly vulnerable to cognitive decline and interventions (e.g., focusing on lifestyle factors) to help maintain cognitive performance into old age.

Impact of Delay of Retirement Age on Middle Age Employment Rate

Abstract: This paper examines the implications of delaying retirement on the labor market in China, focusing on its impact on the employment rates across different age groups. Over the past several decades, demographic shifts, such as the aging population and extended education durations, have necessitated adjustments to retirement policies. These adjustments pose significant questions about the optimal retirement age and the consequent effects on the labor market. Utilizing a combination of theoretical frameworks and empirical data, this study explores the correlation between delayed retirement and employment rates among middle-aged and older workers. The findings suggest a significant and positive correlation between these groups, indicating that a delayed retirement age could enhance employment opportunities for middle-aged individuals without adversely affecting the younger workforce. The study engages with data from the 2020 census in China and employs Ordinary Least Squares (OLS) regression models to analyze the relationship between age groups and employment rates. The results show a nuanced impact of delayed retirement on the labor market, with implications for policy-making. Specifically, the paper addresses the potential benefits of a flexible retirement age policy, considering economic, demographic, and social factors.

In utero and childhood exposure to the great Chinese famine and risk of aging in adulthood

Background Early-life exposure to famine may influence the occurrence of chronic diseases and aging in midlife among those exposed. This study aims to explore the relationship between exposure to the Chinese Great Famine and aging in middle-aged individuals. Methods Participants born in 1963–1965 (unexposed), 1959–1961 (in utero exposure), and 1955–1957 (childhood exposure) from the Kailuan Study were included. Their biological age at 2010, 2014, and 2018 was investigated, and age acceleration (biological age minus actual age) was calculated to assess aging. Logistic regression analysis was employed to describe the relationship between famine exposure and the aging risk. Subgroup and sensitivity analysis were conducted to explore differences and stability in this relationship among different groups. Results A total of 17,543 participants were included in this study. Among them, 12,762 (72.7%) were male, and 4,781 (27.3%) were female, with 2,543 participants experiencing aging events. Compared to unexposed participants, those exposed during childhood and in utero exhibited a 1.69-fold (OR = 1.69, 95%CI: 1.53–1.87) and 1.22-fold (OR = 1.22, 95%CI: 1.08–1.37) increased risk of aging. Subgroup analysis revealed an interaction with income (P for interaction = 0.008), and additional interaction analysis suggested that increasing income could partially mitigate the detrimental effects of early-life famine exposure. Furthermore, experiencing famine in severely affected regions exacerbated the risk of aging (OR = 1.41, 95%CI: 1.21–1.63). Conclusion Exposure to famine in utero or during childhood may elevate the risk of midlife aging among exposed individuals, and these relationships are influenced by the severity of famine exposure. Increasing income may also help mitigate these effects.Trial registration: Kailuan study, ChiCTRTNRC11001489. Registered July 19, 2015 Retrospectively registered, https//www.chictr.org.cn/showprojEN.html?proj=8050&u_atoken=af46a0dee8d73f320bb5459ab7bbcfa9&u_asig=1a0c381017255295896468605e00cf .

Evidence of the Long-Term Protective Effect of Moderate-Intensity Physical Activity on Cognitive Function in Middle-Aged and Elderly Individuals: A Predictive Analysis of Longitudinal Studies.

To investigate the effects of different intensities of physical activity (PA) on cognitive function in middle-aged and elderly individuals, and to predict future trends in cognitive ability using longitudinal data to assess the long-term role of PA in cognitive preservation. Data from the China Health and Retirement Longitudinal Study (CHARLS) were utilized. Mixed-effects models were employed to analyze the impacts of low-intensity PA (LPA), moderate-intensity PA (MPA), and vigorous-intensity PA (VPA) on overall cognition, episodic memory, and mental intactness. Random forest and XGBoost machine learning methods were employed to further validate the effects of PA. ARIMA models predicted future cognitive trends under the influence of PA. MPA demonstrated significant advantages in preserving cognitive function, particularly in overall cognition and episodic memory. While LPA had some protective effects, they were less significant than those of MPA, and VPA did not show advantages. Machine learning methods confirmed these findings. ARIMA model predictions indicated that the protective effects of MPA on cognitive function are likely to persist in the future. Moderate-intensity physical activity is associated with the preservation of cognitive ability in middle-aged and elderly individuals and may continue to provide this benefit in the future; however, further in-depth research is needed for confirmation.

Oral Function, Loneliness, Depression, and Social Participation Among Physically Disabled Middle-Aged and Older Adult Individuals: Insights from a Japanese Cross-Sectional Study.

Background/Objectives: In the context of an aging society, physical disability and its relationship with frailty is of growing concern. The aim of this study was to examine the associations between oral function, social participation, and loneliness among community-dwelling middle-aged and older adult physically disabled individuals. Methods: In this cross-sectional study, the participants were 140 individuals with certified physical disabilities living in the studied area. Demographic characteristics, outing activities, loneliness (Three-Item Loneliness (TIL) Scale), and frailty/ability to live independently (Kihon Checklist (KCL)) were assessed using a questionnaire survey. The participants were divided into two groups based on the presence or absence of oral dysfunction (OD), and statistical analyses were performed to compare the groups. Results: The group with OD had significantly higher TIL and KCL total scores and significantly lower mobility, confinement, cognitive function, greater levels of depression, and fewer outing activities (volunteering, movies, festivals, sports) compared to the group without OD. In a multivariate, age- and sex-adjusted binomial logistic regression analysis, outing activities (OR = 0.011, 95% CI: 0.000-0.529, p = 0.023) and loneliness (OR = 6.174, 95%CI: 1.292-29.502, p = 0.023) were identified as significant factors. Conclusions: An association was found between OD, loneliness, and social activities among middle-aged and older individuals with physical disabilities. The results suggest that future interventions should consider the relationship between oral function and factors such as depression, loneliness, social isolation, and social engagement as a means to mitigate frailty and other health and well-being concerns for physically disabled individuals.