Association between red cell distribution width-albumin ratio and osteoarthritis in middle-aged and older adults: Analysis of NHANES data (1999-2018).

Dietary inflammatory potential and depression in middle-aged and older adults: A population-based study of associations and comorbid disease network.

To explore the geographical and risk factor trends associated with type 2 diabetes mellitus using Global Burden of Disease (GBD) data (1990-2021). Age-standardized T2DM incidence, prevalence, mortality and disability-adjusted life years (DALYs) were extracted from the GBD for 204 countries stratified by sociodemographic index (SDI). Trends were analysed using joinpoint regression to compute average annual percentage changes (AAPCs) and mapping. Age-standardized burden estimates were calculated across 5-year age groups. Risk factor attribution was performed using Bayesian meta-regression and spatiotemporal analysis, illustrating the relative importance of each risk factor by bubble plots. From 1990 to 2021, the global age-standardized incidence rate of T2DM increased (AAPC = 1.83%), with the most pronounced rises in low-middle SDI regions. Mortality slightly increased globally (AAPC = 0.30%) but declined in high-SDI regions. The burden was highest in middle-aged and elderly populations, with a concerning increase in adolescent cases. High body mass index (BMI) was the leading risk factor, estimated to account for 44.5% (95% UI: 19.0%-65.2%) of deaths and 51.9% (95% UI: 24.7%-71.5%) of DALYs in 2021, followed by ambient particulate matter pollution and physical inactivity. The contribution of dietary risks and air pollution varied significantly across SDI regions. Our analysis identifies high BMI, ambient air pollution and physical inactivity as the primary risk drivers of the global T2DM burden. All indicators increased most markedly in low-middle SDI regions, with substantial disparities across age and sex groups. These findings underscore the need for risk-specific and region-tailored preventive strategies.

Mental disorders constitute a major global public health concern, particularly among the working-age population. Their impact extends beyond reduced productivity and long-term economic loss. This study presents a comprehensive assessment of the global burden of mental disorders among working-age adults and compares trends in the three most populous countries, India, China, and the United States, from 1990 to 2021, with projections through 2045. To evaluate age-, sex-, and country-specific trends in the prevalence, incidence, and disability-adjusted life years (DALYs) of mental disorders among working-age adults, and to forecast future disease burden using advanced modeling techniques. Data for individuals aged 15-64years were derived from the Global Burden of Disease Study 2021. The analysis was stratified by sex, age, country, and type of disorder. Age-standardized prevalence and incidence rates were calculated and temporal trends were quantified using the estimated annual percentage change. Significant inflection points were detected using the Joinpoint regression. Future DALYs (2022-2045) were projected using the Nordpred age-period-cohort model based on historical trends and population forecasts. All analyses were conducted using the R software (version 4.4.3). Globally, the overall burden of mental disorders remained relatively stable from 1990 to 2021; however, substantial heterogeneity was observed across sex, age groups and countries. Females consistently demonstrated a higher prevalence of depressive and anxiety disorders, whereas males exhibited higher rates of schizophrenia, attention deficit/hyperactivity disorder, and autism spectrum disorders. In the United States, both the prevalence and incidence increased markedly for most mental disorders, whereas China and India showed overall declining trends. Age-stratified analyses revealed a high disease burden among adolescents and young adults, alongside a pronounced and continuing increase in the middle-aged and older populations. Projections through 2045 suggest a further rise in DALYs, particularly among females and individuals aged 50-54years, indicating a worsening global burden of mental disorders. This study provides the most detailed, age-stratified evaluation of mental disorder burden among working-age populations to date. The findings highlight persistent gender and regional disparities and demonstrate the urgent need for scalable, culturally sensitive mental health interventions, workforce-based support systems, and the integration of mental health care into primary and occupational health frameworks.

Recent decades have seen an increase in the incidence and mortality rates of early-onset cancers in adolescents and adults aged 15 to 49 years. The incidence and mortality rates of liver cancer caused by NAFLD have been increasing on an annual basis; however, the most recent global data on liver cancer caused by NAFLD has not been reported. A detailed analysis of trends in early-onset hepatocellular carcinoma attributable to NASH (EO-NRLC) from 1990 to 2021 was conducted using data from the global burden of disease study for 204 countries, 21 regions, and 5 sociodemographic indices (SDI) regions, with separate analysis conducted for each category. Prevalence rates, mortality rates, YLLs, YLDs, and disability-adjusted life years (DALYs) were calculated based on vital registration data, adjusted for age and reporting per 1,00,000 population, with a UI of 95%. Subsequently, we performed SDI analysis, as well as trend analysis based on age groups. In addition to this, decomposition analysis, age-period-cohort analysis, and Bayesian age-period-cohort projection and frontier analysis were also conducted. The prevalence (0.61 [0.49, 0.73]), mortality (0.48 [0.39, 0.58]), rate of DALYs (11.50 [9.39, 13.84]), and morbidity (0.49 [0.40, 0.60]) of EO-NRLCs in 2021 compared with 1990 were increasing. The analysis indicates that age-standardized indicators, encompassing prevalence, morbidity, mortality, and DALYs, have exhibited an accelerated increase in regions characterized by higher SDIs and more economically developed economies, particularly in Australia, Europe, and North America. Conversely, numerous low SDI countries and less developed economies continue to exhibit comparatively elevated age-standardized rates for these 4 indicators. It is also noteworthy that all indicators are higher for men than for women as a whole. Subsequent Bayesian age-period-cohort projection analyses suggest that the indicators will remain high and increasing through 2040. The substantial increase in the incidence, prevalence, mortality, and DALYs of EO-NRLC across multiple regions from 1990 to 2021 is projected to impose a considerable socioeconomic burden on governments and health systems in the coming years. The findings of this study may inform policymakers in developing strategies to address EO-NRLC, with particular emphasis on strengthening professional training to mitigate the burden of this complex disease.

Study design/settingRetrospective longitudinal study.PurposeOsteoporotic vertebral fractures (OVF) are common in middle-aged and elderly populations. However, few studies have predicted the risk of OVF from the perspective of the bone heterogeneity. This study conducted a longitudinal study to predict the risk of OVF in individuals over 50years old based on habitat radiomics which can quantify heterogeneity of vertebral trabecular bone.MethodsIndividuals aged over 50years who had not experienced OVF and underwent CT scans between 2016 and 2023 were enrolled and followed up until 2024. During the follow-up period, 107 cases developed new OVF, and 270 individuals without fractures were selected as the control group. Radiomic features of each pixel within the vertebra were extracted, and the optimal segmentation of vertebral sub-regions was determined using the K-means unsupervised clustering method.ResultsThe habitat radiomics model significantly outperformed the CT value model (AUC = 0.702, DeLong test P-value = 0.001) and also surpassed the traditional radiomics model. The Cox proportional hazards analysis showed that the habitat radiomics risk score could serve as an independent predictor of vertebral fractures (hazards ratio = 1.092, 95% confidence interval (CI): 1.074 - 1.111, P < 0.001). The C-index of the habitat radiomics nomogram model was 0.803 in the training set (95% CI: 0.752 - 0.854) and 0.748 in the validation set (95% CI: 0.667 - 0.829).ConclusionThe habitat radiomics model can predict vertebral fractures based on vertebral heterogeneity, with better performance than traditional bone density prediction methods.

Non-Hodgkin lymphoma (NHL) is increasingly prevalent in middle-aged and elderly populations, contributing to the rising global health burden, particularly in high-income countries. This retrospective analysis utilized data from the Global Burden of Disease (GBD) study (1990-2021) to examine temporal trends in age-standardized incidence, mortality, and disability-adjusted life year (DALY) rates of NHL among middle-aged and older adult populations, incorporating age- and sex-stratified comparisons. Furthermore, projections for the subsequent 30 years were generated using Bayesian age-period-cohort (BAPC) modeling. From 1990 to 2021, the number of cases, deaths, and DALYs in middle-aged and older people with NHL had significant increases. Age-standardized incidence rates exhibited an increasing trend (estimated annual percentage change [EAPC] = 0.53), whereas mortality (EAPC = -0.33) and DALY rates (EAPC = -0.52) demonstrated a decreasing trend. The Western European region and high SDI countries are the core burden areas for middle-aged and elderly populations with NHL globally. Lower-middle SDI countries experienced the fastest increase in mortality (EAPC = 0.38) and DALY rates (EAPC = 0.22), while high-SDI countries experienced the steepest decline in all metrics. The DALY burden showed its peak value at 65-69 years among middle-aged and aged adults with NHL, while the morbidity and mortality burden reached their highest point at 70-74 years. When stratified by gender, the overall burden was higher in males than in females. High BMI causes the burden of NHL DALY to rise with increasing SDI, up to 39.14% in High-income North America. By 2050, global NHL incidence is projected to increase modestly by 0.28%, whereas mortality and DALY burdens are expected to decline markedly by 30.67% and 23.02%, respectively. NHL in middle-aged and older adults represents a significant global public health burden, necessitating context-specific interventions due to variations across regions, genders, and age groups.

Modulating bone remodeling through magnetic field: Approach targeting metabolic dysregulation in diabetic osteoporosis.

Periplogenin alleviates osteoarthritis by suppressing NF-κB-mediated inflammation and apoptosis in chondrocytes.

To analyse the relationship between the ratio of non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol (NHHR) and osteoporosis, and explore the mediating role of 25-hydroxyvitamin D (25(OH)D) and the moderating effect of body mass index (BMI). Four hundred forty-eight residents selected from 'REACTION' cohort study. BMD was measured by dual-energy X-ray absorptiometry. Logistic/linear regression and Process models were used to analyse the relationship of NHHR with osteoporosis, 25(OH)D's mediating effect and BMI's moderating effect. Logistic regression showed a 42.3% increased osteoporosis risk per 1 unit increase in NHHR (OR=1.423, p<0.001) and a 7.6% risk reduction per 1 unit increase in 25(OH)D (OR=0.924, p<0.001). Linear regression showed that BMD negatively correlated with NHHR (β=-0.043, p<0.001) and positively with 25(OH)D (β=0.014, p<0.001). In addition, 25(OH)D significantly decreased with elevated NHHR (β=-1.145, p=0.004). Stratified analysis showed NHHR negatively associated with BMD in all individuals (p<0.05), but negatively associated with 25(OH)D only in the overweight and obese. Mediating effect analysis indicated direct (-0.028) and indirect effect (-0.031) effects of NHHR on BMD via 25(OH)D (p<0.05). Moderating effect analysis showed a significant negative moderating effect of BMI on the indirect effect of mediation (p<0.01). NHHR can be used as an early predictor of osteoporosis in middle-aged and elderly populations. In addition, with increasing BMI, the effect of NHHR on BMD via 25(OH)D diminishes. Therefore, early prevention of osteoporosis should focus not only on lipids but also on vitamin D levels and be stratified according to different BMI levels.

Traditional cardiovascular disease (CVD) risk models may fail to adequately capture the interactions among metabolic factors. We evaluated the combined and mediating associations of the triglyceride-glucose (TyG) index and uric acid (UA) with incident CVD in Chinese adults. Using data from the nationally representative China Health and Retirement Longitudinal Study, we included 9,353 participants aged ≥ 45 years without baseline CVD or cancer, whose fasting triglycerides, glucose, and UA were measured in 2011, and who were followed up through 2020. TyG was calculated as ln [triglycerides (mg/dL) × glucose (mg/dL)/2]. Incident CVD (including myocardial infarction, coronary heart disease, angina pectoris, congestive heart failure, or stroke) was ascertained via standardized self-reported questionnaires. Cox proportional hazards models were used to quantify the relationship between TyG index/UA level, their combination categories and CVD events. Kaplan-Meier curves were used to illustrate the time-dependent association and synergistic effect of TyG index and UA on CVD-related outcomes. Age subgroup classification was used to analyze the effects of two biomarkers on CVD at different ages. Mediation analysis was conducted to assess the direct and indirect associations between two biomarkers and CVD events. During the 9-year follow-up, 2505 (26.8%) individuals developed CVD, including 1745 (18.7%) cases of CHD and760 (8.1%) cases of stroke. Compared with TyG < median (8.59) and UA 4-5 mg/dL, higher TyG and higher UA were each associated with greater CVD risk (fully adjusted HR = 1.146 for TyG ≥ median and HR = 1.167 for UA > 6 mg/dL, all P < 0.05). The joint category of TyG ≥ median and UA > 6 mg/dL showed the strongest association, especially for stroke (fully adjusted HR = 2.193). Elevated TyG and UA levels jointly increased the cumulative incidence of CVD (41.1%), coronary heart disease (31.5%), and stroke (119.3%) relative to the reference group. Synergy was most evident at ages 45-59 and was not significant at ≥ 70 years. Mediation analyses supported a bidirectional pathway: TyG affected CVD via UA and UA affected CVD via TyG. The TyG index and UA levels independently and synergistically increase CVD risk in middle-aged and elderly Chinese adults, with the strongest synergistic effect observed in middle-aged individuals (45-59 years). A bidirectional mediating relationship exists between the TyG index and UA in their effects on CVD. Combined assessment of the TyG index and UA may improve CVD risk stratification, supporting more refined clinical and public health interventions for CVD prevention.

This study outlines the changes in the age- and sex-specific burden of motor neuron disease (MND) in China from 1990 to 2021, focusing on the prevalence, incidence, number of disability-adjusted life years and mortality. Additionally, these trends are evaluated in comparison to the Global Burden of Disease data. Public data from the Global Burden of Disease database covering the period from 1990 to 2021 were analyzed to explore the burden of motor neuron disease in China and worldwide. Trends in prevalence, incidence, disability-adjusted life years (DALYs) and mortality were examined in the analysis. The average annual percentage change was calculated using Joinpoint, and the relevant 95% confidence intervals (95% CIs) were examined to identify changes in the MND burden over time. Additionally, a thorough comparative analysis was performed to investigate the differences in the MND burden between China and other regions worldwide, considering factors such as age, sex, and time periods. From 1990 to 2021, the age-standardized incidence rate (ASIR) of motor neuron disease (MND) in China declined from 0.65 per 100,000 to 0.46 per 100,000, whereas the global ASIR decreased slightly from 0.81 per 100,000 to 0.77 per 100,000. In contrast, the age-standardized prevalence rate (ASPR) in China increased from 2.131 per 100,000 to 2.298 per 100,000, whereas the global ASPR decreased slightly from 3.356 per 100,000 to 3.31 per 100,000. The age-standardized mortality rate (ASMR) in China increased from 0.151 per 100,000 to 0.181 per 100,000; the global ASMR also increased from 0.38 per 100,000 to 0.46 per 100,000 during this period. Moreover, the age-standardized disability-adjusted life year (ASDR) rate in China decreased slightly from 7.995 per 100,000 to 7.672 per 100,000, whereas the global ASDR increased from 11.221 per 100,000 to 12.167 per 100,000. The average annual percentage changes (AAPCs) for the ASPR, ASIR, ASDR, and ASMR in China were -1.10%, 0.25%, 0.57%, and -0.14%, respectively. In contrast, the global AAPCs were -0.16%, -0.04%, 0.58%, and 0.26%, respectively. Age and sex played distinct roles in shaping MND burden. The ASIR of MND decreased but then increased for both sexes, remaining higher for males. Its ASPR trends differed: a slight increase in males versus an increase then decrease in females. While the ASMR was consistently higher for males, the DALYs for males started to decrease but surpassed those for females. Global MND rates have remained stable. The prevalence, incidence, DALYs and mortality of motor neuron disease in China decreased between 1990 and 2021, suggesting a relative decrease in the total burden of MND in the country. Age influences the burden of MND, with a higher occurrence incidence in children and middle-aged individuals; the prevalence of MND is highest in the younger population, whereas MND-related mortality is the highest within the middle-aged and senior populations. Compared with females, males are more likely to be affected by MND and have a greater likelihood of death. Given the rapid population aging in China, MND is expected to remain a significant public health issue.

Plant-based diets have been demonstrated to be associated with lower risk of several chronic diseases. However, a comprehensive assessment of plant-based diet quality and its association with heart failure (HF) is limited. This study aimed to investigate whether healthful and unhealthful plant-based dietary patterns are associated with overall HF risk among middle-aged and older adults in the United Kingdom. We included a total of 190,092 UK Biobank participants without HF at baseline. Three plant-based diet indices were calculated using 24-h dietary recalls based on 17 food groups: the overall plant-based diet index (PDI), healthful plant-based diet index (hPDI), and unhealthful plant-based diet index (uPDI). Multivariable Cox regression models were applied to assess the association between these indices and incident HF. Over a median follow-up of 13.04 years, 4,351 cases of new-onset HF were recorded. Compared to the lowest tertile, the multivariable-adjusted hazard ratios (HRs) with 95% confidence interval (CI) for HF in the highest tertile were 0.94 (0.88-1.02) for overall PDI, 0.84 (0.78-0.91) for hPDI, and 1.11 (1.03-1.19) for uPDI. A higher intake of healthful plant-based diets was associated with a lower risk of HF, while follow unhealthful plant-based diet was linked to a higher overall HF risk. Adhering to a high-quality diet primarily based on healthy plant-based foods may be helpful prevent HF.

Association between non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) and cognitive impairment in middle-aged and elderly Chinese population.

Healthy worker survivor bias (HWSB) skews health outcome studies by favouring healthier employed individuals. While advanced statistical methods exist, their application in Korea has been limited due to insufficient occupational and mortality data. This study quantifies HWSB due to employment status changes (HWSB-ES) using Korea's National Health Insurance Service (NHIS) database. This retrospective cohort study analysed NHIS data to assess HWSB-ES in individuals aged 30-59 years who maintained consistent insurance types from 2008 to 2010. The primary outcome, all-cause mortality, was tracked until December 2022. Insurance type determined employment status, with industry details collected for employees. Landmark analysis (origin: 2011; current: 2012-21) estimated HWSB-ES by assessing mortality risk attenuation in fixed and dynamic cohorts, stratified by age, sex, and landmark periods (1-10 years for short-term; 1-7 years for long-term). After exclusions, 18 192 989 participants were included (median age: 44 years; 49.05% male). HWSB-ES was more pronounced in female, dynamic cohorts, and longer landmark periods. Importantly, the effect of HWSB-ES intensified with age but showed a smaller long-term attenuation compared to the short-term effect. Short-term HWSB-ES attenuated mortality risk by 25%-30% in male and 36%-39% in female. Long-term attenuation was lower, at 7%-15% in male and 12%-18% in female. The quantified HWSB-ES results provide critical national-level estimates for adjustment, especially in female and older cohorts, to prevent the underestimation of adverse health effects in occupational research.

Background: Xerostomia, or the subjective sensation of dry mouth, is a prevalent side effect of medications. While its impact on oral function is well documented, limited research has examined how xerostomia influences beverage consumption and the timing of food intake, especially in non-cancer, middle-aged populations. Objectives: To examine associations between beverage intake, meal timing, and subjective and objective measures of salivary gland function in individuals with medication-induced xerostomia. Methods: This cross-sectional pilot study included 90 adults aged 45-66 taking anticholinergic medications. Salivary function was assessed via unstimulated whole saliva (UWS), minor salivary flow (MSF), and the Xerostomia Inventory (XI). Validated questionnaires evaluated habitual water and beverage intake, and meal timing. Multivariable models were adjusted for demographics, medication use, and comorbidities. Results: Hyposalivation (UWS ≤ 0.3 mL/min) was associated with higher XI scores (p = 0.033) and greater anticholinergic medication burden (p = 0.024). The later timing of last intake and last snack was independently associated with greater xerostomia severity. Total beverage and water intake were not associated with salivary flow or XI scores. Nighttime eating was correlated with higher anticholinergic burden. Conclusions: The timing of intake, rather than fluid volume, may better reflect symptom burden in medication-induced xerostomia, underscoring the behavioral adaptations to oral dryness.

Differences in the association between metabolic syndrome (MetS) and cardiovascular disease (CVD) across definitions and subtypes are unknown. The aim of this study was to investigate the differences between the associations of MetS defined by the Chinese Diabetes Society (CDS) and the Writing Group of 2024 Chinese Guidelines for the Management of Hypertension (WCGH) with CVD. This cohort study included participants aged ≥ 40 years without cardiovascular disease from the 2011 survey of the China Health and Retirement Longitudinal Study. Individuals meeting different definitions of MetS based on criteria from the CDS and the WCGH were identified and followed up until 2020. Cox proportional risk models were used to analyze the association between different definitions and subtypes of MetS with CVD, and the predictive performance of the models was compared using the area under the curve (AUC) of the time-dependent receiver operating characteristic curve, integrated discrimination improvement (IDI), and net reclassification improvement (NRI). Both CDS and WCGH based MetS were significantly associated with increased CVD risk, with hazard ratios (HRs) and 95% confidence intervals (CIs) of 1.51 (1.38 ~ 1.66) and 1.81 (1.66 ~ 1.99), respectively, both P < 0.001. 7 of the 16 subtypes of MetS based on CDS were not associated with CVD; all 5 subtypes of MetS based on WCGH were significantly associated with an increased risk of CVD. When participants were grouped based on meeting two definitions, compared with the CDS-WCGH- group, CVD risk increased most significantly in the CDS-WCGH + group (HR and 95%CI: 2.57 [1.94 ~ 3.39], P < 0.001), showed a significant increase in the CDS + WCGH + group (HR and 95%CI: 1.66 [1.51 ~ 1.83], P < 0.001), and showed no significant increase in the CDS + WCGH- group (HR and 95%CI: 0.93 [0.7 ~ 1.23], P = 0.606). The AUC of WCGH was higher than that of CDS at all time points. IDI and NRI analyses showed that the WCGH standard demonstrated significant improvements in risk reclassification and identification compared to CDS. The association between MetS and CVD depends on the definition criteria and specific component combinations employed. The WCGH definition, which integrates diagnostic criteria for dyslipidemia, has been demonstrated to be more robust than the CDS.

Atherosclerotic cardiovascular and cerebrovascular diseases are still the main cause of global incidence rate and mortality. The LDL-C/HDL-C ratio (LHR) has been identified as a potential biomarker for cardiovascular risk. However, the relationship between it and the long-term risk of carotid plaques is not yet clear, especially in low-income populations in China. This prospective cohort study included adults aged ≥45 years without carotid plaque at baseline from low-income rural areas of Tianjin, China. Baseline characteristics were collected in 2014, and follow-up data were obtained in 2019. The primary outcome was the development of new carotid plaques, assessed using carotid ultrasound. The relationship between the LDL-C/HDL-C ratio (LHR) and new carotid plaques was analyzed using multifactorial logistic regression, with the presence or absence of new-onset plaques as the dependent variable. Additionally, we utilized restricted cubic spline (RCS) regression to visually present the potential nonlinear relationship between LHR and the risk of carotid plaque. Over the six-year follow-up period, 606 participants (38.3%) developed new carotid plaques. Higher LHR was significantly associated with an increased risk of new carotid plaques, with each unit increase in LHR corresponding to a 35.9% higher risk (OR = 1.359, 95% CI: 1.180-1.566, p < 0.001). The RCS curve indicated a non-linear positive association between LHR and the likelihood of carotid plaques (p for non-linearity = 0.019), with an optimal cut-off at 1.257. Logistic regression analysis confirmed that LHR > 1.257 was linked to increased odds of carotid plaques in both unadjusted (OR: 1.80, p < 0.001) and adjusted models (OR: 1.835, p < 0.001), with LHR ≤ 1.257 serving as the reference. In subgroup analysis, all subgroups consistently demonstrated a significant association between increased LHR (all OR > 1). The research results indicate that there is a non-linear positive correlation between LHR and the long-term risk of carotid plaques in middle-aged and elderly populations, suggesting that LHR may be an effective indicator for screening carotid plaques in grassroots middle-aged and elderly populations.

Cardiometabolic multimorbidity (CMM) is increasingly common among middle-aged and older adults, but there remains a lack of simple risk indicators that can simultaneously reflect inflammatory and metabolic burden. The C-reactive protein-triglyceride-glucose index (CTI) has been proposed as a novel biomarker that integrates insulin resistance and inflammatory status. This study aimed to assess the association of CTI and its cumulative exposure with CMM. This study conducted the primary analyses using the 2011 baseline cross-sectional data and the 2011-2020 prospective follow-up data from the China Health and Retirement Longitudinal Study (CHARLS), and additionally performed longitudinal supplementary analyses by calculating cumulative CTI over 2011-2015 within CHARLS. An external longitudinal validation was conducted using the 2002-2012 cohort from the UK English Longitudinal Study of Ageing (ELSA), and cross-population cross-sectional replication was further performed using the 2001-2010 data from the US National Health and Nutrition Examination Survey (NHANES). Multivariable logistic regression, Cox proportional hazards models, Kaplan-Meier curves, and restricted cubic spline analyses were used to examine the associations of CTI with the prevalence and incident risk of CMM, and cumulative CTI from 2011 to 2015 was calculated in CHARLS for supplementary analyses; meanwhile, receiver operating characteristic (ROC) curves were used to evaluate the predictive performance of CTI for 4-year CMM occurrence, and prespecified subgroup analyses were conducted to test the robustness of the findings. In the CHARLS prospective cohort, among 10,863 participants free of CMM at baseline, 1698 incident CMM cases (15.6%) occurred during approximately 9years of follow-up. In the primary model, each 1-unit increase in baseline CTI was associated with a 71% higher risk of CMM (HR = 1.71, 95% CI 1.39-2.11), and the hazard ratio comparing the highest with the lowest quartile of CTI was 1.33 (95% CI 0.94-1.88); in the 2015 baseline subcohort, each 1-unit increase in cumulative CTI was associated with an HR of 1.02 (95% CI 1.00-1.05). Cross-sectional analyses in CHARLS and NHANES both showed a significant positive association between CTI and CMM prevalence, with a dose-response relationship. After adding CTI to a model containing traditional risk factors, the area under the receiver operating characteristic curve (AUC) for 4-year CMM prediction increased from 0.753 to 0.778. In the external longitudinal validation, 3129 participants from the ELSA cohort were included, among whom 406 incident CMM cases occurred during follow-up (13.0%). In the primary model, each 1-unit increase in CTI was associated with an HR of 1.59 (95% CI 0.99-2.55), and participants in the highest quartile had a higher risk than those in the lowest quartile (HR = 2.22, 95% CI 1.06-4.62), with a significant trend test (P for trend = 0.027), indicating that the direction of the association was consistent with that observed in CHARLS. CTI and its cumulative exposure level are closely associated with both the prevalence and incidence risk of CMM, and these findings were further supported by validation in the independent longitudinal ELSA cohort. As a simple composite index derived from routinely measured indicators, CTI may help identify individuals at high risk of CMM and provide a reference for early risk stratification and intervention in middle-aged and older populations.

Post-stroke depression is a psychological complication among stroke survivors, associated with adverse outcomes. In recent years, social activity engagement has been proposed as a potential intervention to alleviate depression, yet evidence remains limited for middle-aged and older stroke populations in China. To examine the association of participation and diversity of social activities with depression among middle-aged and older Chinese stroke patients. Using data from the China Health and Retirement Longitudinal Study (CHARLS) 2018 and 2020, we included 731 stroke patients for cross-sectional analysis, with 365 stroke patients without baseline depression used for longitudinal analysis. Weighted logistic regression assessed social activities-depression associations. Unweighted analyses tested robustness, and subgroup analyses explored sex and age differences. Cross-sectional analysis showed that in the fully adjusted model, interacting with friends (OR = 0.66, 95% CI: 0.45-0.98) and helping others (OR = 0.50, 95% CI: 0.28-0.90) were linked to lower depression likelihood. Longitudinal analysis demonstrated that, in the fully adjusted model, interacting with friends (OR = 0.49, 95% CI: 0.27-0.91), helping others (OR = 0.38, 95% CI: 0.18-0.79), and internet use (OR = 0.36, 95% CI: 0.14-0.91) significantly reduced two-year incident depression likelihood. Compared to non-participants, engagement in multiple social activities was linked to markedly lower odds of depression (OR = 0.48, 95% CI: 0.28-0.81) and two-year incident depression (OR = 0.36, 95% CI: 0.16-0.77). These associations were more prominent in males, those who take care of grandchildren, or those with frequent children visit (once a week or more). Participation in social activities, particularly diverse engagements, is significantly associated with reduced depression likelihood among middle-aged and older Chinese stroke patients, with a stronger effect in males. Based on the above findings, clinical practice should attach importance to integrating social activities into post-stroke rehabilitation and public mental health programs.