Rural Elderly Population Research Articles

Prevalence of depression and anxiety among older persons residing in Thoubal district, Manipur

ABSTRACT Background: Among the elderly population, the most common psychiatric conditions include depression and anxiety, which often go untreated or unrecognized, owing to the lack of knowledge and misperceptions about these conditions. Timely identification and treatment improve the quality of life of the elderly. As community studies were scarce in Manipur, the present study was undertaken. Aim of the Study: This study aims to assess the prevalence of depression and anxiety among older persons residing in Thoubal district, Manipur. Materials and Methods: A descriptive cross-sectional study was conducted among 352 older persons, aged 60 years and above residing in a rural area of Thoubal district of Manipur in India for 1 year. The elderly subjects were selected randomly by lottery method. The validated Manipuri translation of the Geriatric Depression Scale-15 short version and the Geriatric Anxiety Scale-10 were used to assess depression and anxiety. Data analysis was done using SPSS version 26 for Windows. Results: The overall prevalence of depression was 102 (29.0%), of which 65 (18.5%), 31 (8.8%), and 6 (1.7%) had mild, moderate, and severe depression, respectively. Gender, age, marital status, no income, presence of chronic illnesses, and substance use were significantly associated with depression. The overall presence of anxiety among respondents was 91 (25.9%), out of which 59 (16.8%), 27 (7.7%), and 5 (1.4%) were mild, moderate, and severe, respectively. No income, presence of chronic illnesses, and substance use were significantly associated with anxiety. During binary logistic analysis, a higher risk of developing depression was found in females, widows/widowers, unemployed, no income, and elderly with diabetes and alcohol use, whereas the elderly with hypertension, both hypertension and diabetes, and tobacco use had a higher risk of developing anxiety. Conclusion: The results confirmed that there is a high prevalence of depression and anxiety among the rural elderly population. There is a need to improve geriatric mental health-care services including timely screening, monitoring, and implementing preventive programs at the primary health-care level.

Rural Population Aging and Rural Revitalization Interaction —Challenges, Opportunities, and Strategy Analysis

Rural Population Aging and Rural Revitalization Interaction —Challenges, Opportunities, and Strategy Analysis

The Relationship Between the Economic Status and Suicidal Behavior of Rural Elderly Population: Focused on the mediating effects of depression

The purpose of this study is to examine the mediating effect of depression in the relationship between the economic status and suicidal behavior of rural elderly individuals. To achieve the purpose of the research, the raw data from the Elderly Welfare Center Survey Report conducted at Jindo-gun county Elderly Welfare Center was used. The subject of the investigation is 1,088 elderly residents of Jindo-gun county, and the data collection period was from July to November 2019. The data analysis was conducted using SPSS version 27.0. The research findings revealed a partial mediating effect of depression in the relationship between the economic status and suicidal behavior of rural elderly individuals. Based on these findings, practical and policy recommendations have been proposed to reduce suicidal behavior among rural elderly individuals.

Assessing the Impact of Rural Population Aging on China's AGTFP: A Mediation and Threshold Effect Analysis

Assessing the Impact of Rural Population Aging on China's AGTFP: A Mediation and Threshold Effect Analysis

Late-life depression: assessment of validity and performance of depression scales in patients attending outpatient clinic at the institute of mental health

Background: Ageing and depression often coexist, with older individuals experiencing increased depressive symptoms. Factors include substance use, diabetes, cardiovascular disease, and rural elderly populations. This study aimed to assess the validity and performance of depression scales for late-life depression among patients attending the outpatient clinic at the Institute of Mental Health, Chennai. Methods: This prospective study was conducted on 358 patients aged >50 years who reported to the OPD and were diagnosed with depression at the institute of mental health, Chennai. Baseline assessments were done at the time of recruitment into the study, and assessments were done (visit 1) for depression as in assessment tools. Scheduled visits were performed every six months for two years (visits 2-5). Adverse events were monitored and recorded periodically. Results: The study found a significant positive correlation between CSDD, MADRS, and PHQ9 scores with HAMD, MADRS, and GDS. The HAMD had a higher correlation with all depression scales except the Geriatric Depression Scale (GDS). The GDS had a distinct dimensionality and varied items, while MADRS showed a good correlation with all depression scales except GDS. The PHQ9 and MADRS are more valid and accurate among the participants, with higher accuracy, sensitivity, and specificity values. After these two scales, the HAMD was better with higher values than all the other scales. Conclusions: Various depression scales were found to have a strong correlation with each other in measuring late-life depression at a tertiary care psychiatric institution.

Socioeconomic, Health Services, and Multimorbidity Disparities in Chinese Older Adults

IntroductionAs one of the world's most populous countries, China persistently confronts a significant multimorbidity burden. This study aimed to elucidate the multimorbidity burden experienced by Chinese older adults, explore its interplay with socioeconomic disparity, and investigate potential correlations between these provincial disparities and health services availability. MethodsThe fourth wave of China's national Urban and Rural Elderly Population study, conducted in 2015, was used to construct a multimorbidity index (MHI) and elucidate the geographical differences in the multimorbidity burden. Incorporating macro-level indicators about socioeconomic and health services availability, quantile regression and spearman correlation analyses were employed to investigate the relationship between multimorbidity and socioeconomic disparities, and examine the potential linkages between these provincial disparities and health services availability. Analyses were performed in 2023. ResultsFinal analysis included a total of 213,857 older adults. At the provincial level, significant geographic disparities in multimorbidity burden were identified. After adjusting for individual social determinants of health, an independent association was found between the human development index (HDI) and a higher MHI [coefficient = -0.22; 95% CI: (-0.24, -0.19)]. Furthermore, a significant positive correlation emerged between HDI and both population and geographic densities of health services availability. Notably, geographic density displayed greater inequality (Gini coefficients of 0.45 to 0.48) compared to population density (Gini coefficients of 0.03 to 0.10). ConclusionsThis study demonstrates that multimorbidity burden in China is linked to provincial socioeconomic disparities, and inequality in health services availability may account for this, which would advocate for a need to reduce disparities in health services availability.

Leisure and Rural Elders: China’s Leisure Education Programmes Under the Rural Revitalization Strategy

The World Leisure Organisation’s Charter for Leisure outlines the right to adequate time for rest and for the pursuit of leisure activity. The right to leisure time and to participate in the cultural life of the community are significant for the wellbeing of a person. Leisure time refers to the remaining disposable time after completing various social responsibilities such as labour and professional activities, mainly used for entertainment, rest, and to meet spiritual and cultural needs. For older adults, mastering their leisure time is an important component of their lifestyle. However, the current situation is that doing household chores and helping the next generation take care of their children occupy a large part of their leisure time. Older adults’ decline in leisure activity participation is related to occurrence of diseases such as Alzheimer’s disease. Therefore, with the acceleration of the aging population in the world, monitoring the participation level of older adults in leisure activities and timely intervention has become an urgent task. China has an aging population, with the rural elderly population growing faster than the urban one. Data from the seventh national census in 2021 show that the proportion of people aged 60 and 65 and above in rural areas has reached 23.81 percent and 17.72 percent respectively, which are 7.99 and 6.61 percentage higher than the corresponding figure in urban areas. With the migration of young people to urban areas, rural older adults are left alone causing serious social concerns. Through the Healthy China initiative, many proactive policy initiatives are formulated for the older adults. Initiation of policies to improve the mental and physical well-being of older adults especially in the rural areas show the significance China attaches to solve the challenges faced by rural elders. Since leisure directly determines the happiness of the people, the Chinese government is increasingly attaching importance to leisure education for the people, and paying attention to adult leisure education in rural areas has become an important part of the rural revitalization strategy. Promoting rural adults’ leisure is significant for creating an environment for them to live happily in their later years. This complements the rural revitalization strategy to construct a beautiful countryside. In this backdrop, this paper discusses the various aspects of aging and leisure of rural elders and how it is integrated into the rural revitalization strategy of China. Even though China has rightly identified the problem of rural elder adults’ need for leisure activities, the paper argues that integrating rural elderly leisure with rural revitalization strategy has opened a new path of development for rural China.

Comparative analysis of health status and health service utilization patterns among rural and urban elderly populations in Hungary: a study on the challenges of unhealthy aging

The demographic transition poses a significant challenge for health systems, especially in Central and Eastern European (CEE) countries, where the healthcare needs of aging populations are on the rise. This study aimed to describe and compare the health status and utilization of health services among the elderly residing in urban and rural areas of the most deprived region in Hungary. A comprehensive health survey was conducted in 2022, involving a randomly selected sample of 443 older adults (≥ 65 years) in Northeast Hungary. Multivariable logistic regression models adjusting for age, sex, education, financial status, chronic diseases, and activity limitations were used to investigate the association between type of residence and health service use. Among the study participants, 62.3% were female, 38.3% attained primary education, 12.5% reported a bad or very bad financial situation and 52.6% lived in urban areas. Overall, 24% of the elderly rated their health as very good or good (27.8% in urban and 19.7% in rural areas), while 57.8% (52.6% and 63.5% in urban and rural areas) reported limitations in daily activities. Compared to urban residents, rural residents reported lower rates of dentist visits (p = 0.006), specialist visits (p = 0.028), faecal occult blood testing (p < 0.001), colorectal cancer screening with colonoscopy (p = 0.014), and breast cancer screening (p = 0.035), and a higher rate of blood pressure measurement (p = 0.042). Multivariable models indicated that urban residence was positively associated with faecal occult blood testing (OR = 2.32, p = 0.014), but negatively associated with blood pressure (OR = 0.42, p = 0.017) and blood glucose measurements (OR = 0.48, p = 0.009). These findings highlight the influence of residence on health service utilization among older adults in Hungary. Further comprehensive studies are needed to better understand the health needs of the elderly population and to develop policies aimed at promoting healthy aging in CEE countries.

Trend of hypertension death and its impact on life expectancy in 6 northwestern provinces of China, 2013-2021

Objective: To analyze the mortality trend of hypertension in Xinjiang Uygur Autonomous Region, Qinghai Province, Shaanxi Province, Gansu Province, Ningxia Hui Autonomous Region and Inner Mongolia Autonomous Region (6 provinces) in northwestern China, from 2013 to 2021, and evaluate the influence of hypertension on people's life expectancy. Methods: Based on national death surveillance data and demographic data in the 6 provinces from 2013 to 2021, the mortality rate, standardized mortality rate, life expectancy, cause eliminated life expectancy (CELE), potential gains in life expectancy (PGLEs) and life loss rate of hypertension were calculated. Software Joinpoint was used to analyze the mortality trends and calculate average annual percentage change (AAPC) and annual percentage change (APC) in hypertension deaths. Results: From 2013 to 2021, the overall standardized mortality rate of hypertension in the 6 provinces showed a downward trend (AAPC=-1.82%, P=0.050). The mortality rate in rural area was always higher than that in urban area, and showed an increasing trend after 2016 (APC=4.74%, P=0.003), and the mortality rate in men was always higher than that in women. The incidence trend of deaths of different types of hypertension were different, and the deaths caused by hypertensive heart disease accounted for the highest proportion (72.69%). In 2021, the life expectancy of the population in the 6 provinces increased by 1.01 years, the CELE increased by 0.93 years, the PGLEs decreased by 0.08 years, and the life loss rate decreased by 0.11% compared with 2013. Conclusions: The overall standardized mortality rate of hypertension showed a decreasing trend in the 6 northwestern provinces from 2013 to 2021, but it showed an increasing trend in rural area after 2016. Prevention of hypertension should be further strengthened in rural area, men and elderly population.

Analysis of differences in health awareness among urban and rural elderly population under the background of aging

Objective: To explore the status quo, differences and influencing factors of health concern among the elderly in urban and rural areas. Methods: The data of China Health and Retirement Tracking Survey (CHARLS) in 2018 were used to describe the health concerns of the elderly in urban and rural areas by selecting relevant indicators. The differences of health concerns of the elderly in urban and rural areas were compared from two aspects of social demographic characteristics and health status. Multivariate logistic regression model was used to analyze the factors affecting the health concern of the elderly in urban and rural areas. Results: A total of 7 758 urban and rural elderly were included, including 1 913 urban elderly and 5 845 rural elderly. Half (3 899, 50.3%) of the elderly are at the average level of health concern, and there is a difference between urban and rural elderly (χ2=186.61,P<0.05). The rural and urban elderly with different characteristics had different health concerns. The rural elderly with more than two diseases had higher health concerns (χ2=13.71, P=0.001), and different living types of urban elderly people have different health concerns (χ2=28.96, P<0.001). Regression analysis showed that the health concern of the elderly in urban and rural areas was affected by many factors, gender (OR=1.51, P<0.001), health status (OR=2.18, P<0.001), cognitive function impairment (OR=2.93, P<0.001), depression (OR=0.49, P<0.001) is the main factor affecting the difference of health attention of the elderly in urban and rural areas. Whether to receive pension was the influential factor of health concern of the rural elderly (OR=0.63, P<0.05); Disability was an influential factor in the health concern of the urban elderly (OR=2.11, P<0.05). Conclusion: There is much room to improve the health attention of the elderly in urban and rural areas. It is suggested to increase the economic security of the elderly in rural areas and pay special attention to the disabled elderly in urban areas, so as to further improve the health status of the elderly groups.

The Influence of Aging Population in Rural Families on Farmers’ Willingness to Withdraw from Homesteads in Shenyang, Liaoning Province, China

Population aging presents a significant global challenge. In China, the aging of the rural population coincides with inefficient rural homestead utilization. While the Chinese government has enacted policies to address this, their impact remains limited. Utilizing survey data from 403 rural families in Shenyang, Liaoning Province, China, this study applies the binary Logit and mediating effect models to analyze the impact of rural family population aging on farmers’ willingness to withdraw from homesteads with compensation and their compensation preference. Key findings include: (1) Family population aging intensifies farmers’ willingness to withdraw from homesteads, with a stronger preference for non-monetary compensation as aging increases. (2) Regarding the willingness to withdraw with compensation, farmers’ cognition of homestead security value masks the effect by 4.71%, while asset value cognition has no mediating effect. (3) With regard to promoting non-monetary compensation choices, farmers’ homestead asset value cognition fully mediates at 16.01%, but security value cognition is without mediating effect. Based on these findings, it is recommended that the government crafts tailored homestead withdrawal policies considering farmers’ family age structure. Further, efforts should aim at refining farmers’ understanding of homestead values, promoting a blend of non-monetary and monetary compensations.

Gender-specific effects of soybean consumption on cardiovascular events in elderly individuals from rural Northeast China – a prospective cohort study

BackgroundThe impact of consuming soybean and its products on cardiovascular events (CVEs), cardiovascular mortality, and all-cause mortality remains unclear. This study aimed to examine the prospective association of soybean consumption with CVEs, cardiovascular mortality, and all-cause mortality among the elderly population in rural China.MethodsThe Northeast China Rural Cardiovascular Health Study included 2477 elderly individuals (mean age 67 ± 6 years, 49.97% men) in the initial phase of the study from 2012 to 2013, with a follow-up period between 2015 and 2017. Soybean consumption was categorized as follows: low-frequency consumption: rare consumption; moderate-frequency consumption: two to three times/week; high-frequency consumption: ≥ four times/week. Cox proportional hazard analysis assessed the potential relationship of soybean consumption with CVEs, cardiovascular mortality, and all-cause mortality.ResultsThe prevalence of soybean and its product consumption was as follows: 38.3% for low-frequency consumption (43.8% for women; 32.8% for men), 49.7% for moderate-frequency consumption (45.8% for women; 53.7% for men), and 11.9% for high-frequency consumption (10.4% for women; 13.5% for men). After adjusting for possible confounders, Cox proportional hazard analysis revealed that the frequency of soybean consumption was an effective predictor of CVEs [Hazard ratio (HR) high (95% CI): 0.555 (0.348, 0.883)], stroke [HR moderate (95% CI): 0.672 (0.494, 0.913); HR high (95% CI): 0.483 (0.276, 0.842)], and all-cause mortality [HR high (95% CI): 0.540 (0.310, 0.942)] in the overall older population. High-frequency consumption of soybean [HR (95% CI): 0.467 (0.225, 0.968)] and moderate-frequency consumption [HR (95% CI): 0.458 (0.270, 0.779)] were associated with stroke events in older men and women, respectively. In addition, high-frequency consumption of soybean [HR (95% CI): 0.437 (0.197, 0.968)] decreased the risk of CVEs in older women.ConclusionSoybean consumption is closely associated with CVEs and all-cause mortality in older individuals residing in rural areas, with a significant gender discrepancy in this relationship. These findings provide new insights into the impact of soybean consumption on cardiovascular well-being in the elderly rural population, thus enhancing our understanding of this field of interest.

What Sustains Mask-Wearing Behavior among Elders in a Rural Community in the Post-COVID-19 Era: An Exploratory Mixed-Methods Study.

The current study investigates the factors influencing face-mask-wearing practices among elderly individuals in rural Thailand. A mixed-methods approach was employed, involving qualitative interviews with 15 elderly participants and a subsequent survey of 201 elders. Seven subthemes were identified, including the perceived benefits of mask-wearing, the perceived threat of COVID-19, mask-wearing enhancing attractiveness and self-confidence, social norms, misconceptions about COVID-19 prevention tools, perceived barriers to mask-wearing, and resources to afford face masks. The developed themes, codes, and quotes were utilized for creating a questionnaire. The survey revealed the adherence of 81.1% of the participants to mask-wearing. Structural equation modeling (SEM) analysis demonstrated that motivation, comprising (1) the perceived threat of COVID-19, (2) alternative threats aside from COVID-19, and (3) the perceived benefits of a face mask strongly affected mask-wearing practices (β = 0.68, p < 0.001) and the willingness to wear a face mask (β = 0.61, p < 0.001). Social norms had a negative direct effect on the perceived barrier (β = -0.48, p < 0.001) and a positive direct effect on mask-wearing practices (β = 0.25, p = 0.001). This study highlights that motivation and social norms play pivotal roles in sustaining mask-wearing behavior among rural elderly populations. Encouraging local cooperative actions through community rules could initiate behavioral changes within the community. These findings contribute to the understanding of factors influencing mask-wearing and provide insights into designing effective interventions to promote mask-wearing among elderly individuals in rural areas.

Future temperature-related hospitalizations from cardiovascular diseases among rural residents in southeastern China considering population aging

Future climate changes are projected to adversely affect mortality risk of cardiovascular disease (CVD) in urbanized regions. However, future temperature-related excess CVD hospitalizations in rural residents with poorer socioeconomic status is not well understood. Moreover, influence of aging and declining rural population are rarely considered. Using CVD hospitalizations in rural residents during 2010–2016 in eight regions in southeastern China, the region-specific temperature-CVD associations were estimated by generalized additive models, which were combined by a meta-regression. We projected excess CVD hospitalizations due to temperature using regional associations for 27 climate models under scenarios of climate change for 2010–2099. To reveal the influences of aging and declining rural population, age-specific associations and future population change ratio were used to estimate age-specific number of temperature-related hospitalizations. We found that heat-related hospitalizations in rural residents from ischemic stroke, ischemic heart disease and cerebrovascular disease are projected to increase in the 2090 s, although the excess CVD hospitalizations associated with future temperature in rural residents will reduce in the 2090 s. Rural population aging amplifies temperature-related CVD burden by >2.34-fold under SSPs in the 2050 s compared to scenarios with only population declining, although rural population reduction will reduce the temperature-related CVD hospitalizations in the 2090 s. The elderly, male and those lived in Longyan and Sanming could be more affected. These findings suggest that future heat is projected to increase hospitalizations of some CVD subcategories. Policies are needed to mitigate increasing temperature and baseline hospitalization rate. The impact of population aging is noteworthy.

HIV/AIDS Knowledge, Depression, and HIV-Related Stigma Among Elderly Men in Rural China: A Hierarchical Regression Analysis.

This study explored the current status and influencing factors of HIV-related stigma among elderly men (≥50 years old) in rural Chengdu, China. A structured face-to-face interview survey was conducted among 286 elderly males from three towns in Chengdu using convenience sampling, 240 men (83.9%) who had heard of HIV/AIDS were included in the analysis. Hierarchical regression was used to examine the associated factors of HIV-related stigma, including demographic variables, HIV/AIDS knowledge level, receiving HIV/AIDS-related health education in the past year, depression, and anxiety, and to examine the moderating effect of educational level on HIV/AIDS knowledge and HIV-related stigma. Hierarchical regression analysis showed that men with lower HIV/AIDS knowledge scores, primary school or below educated, and depression had higher HIV-related stigma total score and social stigma dimensional scores than their counterparts. In addition, living alone was associated with higher HIV-related stigma, and elderly men with lower monthly income and those without HIV/AIDS-related health education in the past year had higher levels of social stigma. Higher HIV/AIDS knowledge score was significantly associated with lower HIV-related stigma level among those with middle school or above education level, but no such effect in those with primary school or below. In conclusion, the HIV-related stigma level among elderly men in rural Chengdu was high and positively associated with depression. HIV/AIDS education should target elderly men with low education, living alone, and low income, and interventions to promote mental health may work together to reduce HIV-related stigma in the rural elderly population.

Can Land Circulation Improve the Health of Middle-Aged and Older Farmers in China?

Compared with the urban aging population, the rural aging population in China is larger, and is subject to a lower per capita income, lower social security coverage, and insufficient security capacity. Therefore, ensuring the health of middle-aged and older farmers is an inevitable requirement for maintaining the stability of rural areas and society. This study uses data from the China Health and Retirement Longitudinal Survey (CHARLS) 2018, an ordered probit model and instrumental variable approach to empirically analyze the effect of land circulation out on the physical health of middle-aged and older farmers over 45. The results indicate that land circulation out positively and significantly affects farmers’ health. Again, farmer’s non-agricultural work and household income play a significant role in this positive relationship between land circulation out and farmers’ health. Thus, the promotion of non-agricultural work for farmers and household income enhancement could alleviate household budget constraints while increasing health investment. The findings provide policies advocating for rural health development from land circulation perspectives.

Rural Population Aging, Capital Deepening, and Agricultural Labor Productivity

Whether the aging of rural population will affect the high-quality development of China’s agriculture is an important issue facing the construction of China’s characteristic modern agriculture. Using panel data from 30 provinces in China from 1999 to 2020, this paper used fixed effects models and mediation models for econometric regressions to explore the relationship between rural population aging and agricultural development, as well as the intermediate mechanisms involved. The study found that there was a positive relationship between rural population aging and agricultural labor productivity, and aging can stimulate agricultural development. Mechanism analysis revealed that rural population aging can promote the adjustment of the structure of agricultural factors, drive the deepening accumulation of capital and other factors, promote the modernization of agricultural production methods, and ultimately achieve an increase in agricultural labor productivity. Further examination showed that the positive relationship between rural population aging and agricultural productivity gradually weakened as the degree of rural population aging deepened. The study provides empirical evidence for sustainable agricultural development in the context of population aging.

Effects of Rural Population Aging on Agricultural Carbon Emissions in China

The “double carbon” goal (China aims to achieve carbon peak by 2030 and carbon neutrality by 2060) puts forward new requirements for the low-carbon development of agriculture. However, with the increasing aging of the rural population and the gradual aging of the agricultural labor force, determining the best means of achieving the target of reducing agricultural carbon emissions is particularly urgent. Based on the IPAT identity relationship (method of decomposing environmental impact (I) into socio-economic variables: population (P), affluence (A), and technology (T)), aging of the rural population, rural residents’ income, and agricultural technology innovation were selected as threshold variables. Using provincial panel data from 2003 to 2020 in China, this study empirically analyzed the impact of rural population aging on agricultural carbon emissions through a threshold–STIRPAT expansion model. The results showed that agricultural carbon emissions showed an inverted U-shaped growth trend from 2003 to 2020 and reached a peak in 2016. Baseline regression found that rural population aging has a significant emission reduction effect on agricultural carbon emissions. In addition, rural residents’ income and agricultural technology innovation have significant positive and negative impacts on agricultural carbon emissions, respectively. Using the three environmental factors as threshold variables, it was found that there is a significant threshold effect. The emission reduction effect of rural population aging weakens with the deepening of the aging degree but is enhanced with the improvement of rural residents’ income and agricultural technology innovation. In view of these findings, policy suggestions are put forward for agricultural low-carbon development that alleviates the effects of rural population aging, increases rural residents’ income, and strengthens agricultural technological innovation.

Long-term exposure to PM2.5 and O3 with cardiometabolic multimorbidity: Evidence among Chinese elderly population from 462 cities

Cardiometabolic multimorbidity (CMM) refers to the presence of multiple cardiovascular and metabolic diseases (CMDs), such as hypertension, diabetes, and cardio-cerebrovascular diseases (CCVD), in the same individual, and has emerge as a significant global health concern due to population aging. Although previous research has demonstrated the association between cardiovascular and metabolic diseases and air pollutants, evidence on the link between CMM and air pollution exposure among Chinese older adults is limited. To address this research gap, we conducted a national representative survey of 222,179 adults aged 60 and older to investigate the epidemiology of CMM and its association with long-term exposure to PM2.5 and O3 in China's elderly population. We found that the prevalence of CMM among Chinese older adults was 16.9%, and hypertension and CCVD were the most common CMM cluster (10.8%). After adjusting for confounding variables, we observed a significant positive association between PM2.5 exposure and the prevalence of hypertension, diabetes, and CCVD, with a respective excess risk increase of 3.2%, 3.6%, and 5.5% for every 10-unit increase. Moreover, every 10-unit increase in PM2.5 was linked to a higher risk of hypertension and diabetes (2.2%), hypertension and CCVD (5.4%), diabetes and CCVD (5.6%), and hypertension, diabetes, and CCVD combined (7.6%). We also found a U-shaped curve relationship between O3 exposure and the occurrence of hypertension, diabetes, and CCVD, as well as different subtypes of CMM, with the lowest risk of O3 exposure was observed near 75–80 μg/m3. Furthermore, we identified that female and rural residents are more vulnerable to the health risks of air pollution than male and urban residents. Given the increasing aging of the population and rising prevalence of multimorbidity, policymakers should focus more attention on the female and rural elderly population to prevent and control CMM. This study provides compelling evidence that reducing air pollution levels can be an effective strategy to prevent and manage CMM among older adults.

Ageing threatens sustainability of smallholder farming in China.

Rapid demographic ageing substantially affects socioeconomic development1-4 and presents considerable challenges for food security and agricultural sustainability5-8, which have so far not been well understood. Here, by using data from more than 15,000 rural households with crops but no livestock across China, we show that rural population ageing reduced farm size by 4% through transferring cropland ownership and land abandonment (approximately 4 million hectares) in 2019, taking the population age structure in 1990 as a benchmark. These changes led to a reduction of agricultural inputs, including chemical fertilizers, manure and machinery, which decreased agricultural output and labour productivity by 5% and 4%, respectively, further lowering farmers' income by 15%. Meanwhile, fertilizer loss increased by 3%, resulting in higher pollutant emissions to the environment. In new farming models, such as cooperative farming, farms tend to be larger and operated by younger farmers, who have a higher average education level, hence improving agricultural management. By encouraging the transition to new farming models, the negative consequences of ageing can be reversed. Agricultural input, farm size and farmer's income would grow by approximately 14%, 20% and 26%, respectively, and fertilizer loss would reduce by 4% in 2100 compared with that in 2020. This suggests that management of rural ageing will contribute to a comprehensive transformation of smallholder farming to sustainable agriculture in China.