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Background: Multimorbidity has become a major public health problem among Chinese middle-aged and older adults, and the most costly to the health care system. However, most previous population-based studies of multimorbidity have focused on a limited number of chronic diseases, and diagnosis was based on participants' self-report, which may oversimplify the problem. At the same time, there were few reports on the relationship between multimorbidity patterns and health care costs. This study analyzed the multimorbidity patterns and changes among middle-aged and older people in China over the past decade, and their association with medical costs, based on representative hospital electronic medical record data. Methods: Two cross-sectional surveys based on representative hospital data were used to obtain adults aged 45 years and older in Xiangyang in 2013 (n = 20,218) and 2023 (n = 63,517). Latent Class Analysis was used to analyze changes in the patterns of multimorbidity, gray correlation analysis and ordered logistics model were used to assess the association of multimorbidity patterns with medical expenses. The diagnosis and classification of chronic diseases were based on the International Classification of Diseases, Tenth Revision codes (ICD-10). Results: The detection rate of chronic disease multimorbidity has increased (70.74 vs. 76.63%, p < 0.001), and multimorbidity patterns have increased from 6 to 9 (2013: Malignant tumors pattern, non-specific multimorbidity pattern, ischemic heart disease + hypertension pattern, cerebral infarction + hypertension pattern, kidney disease + hypertension pattern, lens disease + hypertension pattern; new in 2023: Nutritional metabolism disorders + hypertension pattern, chronic lower respiratory diseases + malignant tumors pattern, and gastrointestinal diseases pattern) in China. The medical cost of all multimorbidity patients have been reduced between 2013 and 2023 (RMB: 8216.74 vs. 7247.96, IQR: 5802.28-15,737 vs. 5014.63-15434.06). The top three specific multimorbidity patterns in both surveys were malignancy tumor pattern, ischemic heart disease + hypertension pattern, and cerebral infarction + hypertension pattern. Hypertension and type 2 diabetes are important components of multimorbidity patterns. Compared with patients with a single disease, only lens disorders + hypertension pattern were at risk of higher medical costs in 2013 (aOR:1.23, 95% CI: 1.03, 1.47), whereas all multimorbidity patterns were significantly associated with increased medical costs in 2023, except for lens disorders + hypertension (aOR:0.35, 95% CI: 0.32, 0.39). Moreover, the odds of higher medical costs were not consistent across multimorbidity patterns. Among them, ischemic heart disease + hypertension pattern [adjusted odds ratio (aOR):4.66, 95%CI: 4.31, 5.05] and cerebral infarction + hypertension pattern (aOR: 3.63, 95% CI: 3.35, 3.92) were the two patterns with the highest risk. Meanwhile, men (aOR:1.12, 95CI:1.09, 1.16), no spouse (aOR:1.09, 95CI: 1.03, 1.16) had a positive effect on medical costs, while patients with total self-pay (aOR: 0.45, 95CI: 0.29, 0.70), no surgery (aOR: 0.05, 95CI: 0.05, 0.05), rural residence (aOR: 0.92, 95CI: 0.89, 0.95), hospitalization days 1-5 (aOR: 0.04, 95CI: 0.04, 0.04), and hospitalization days 6-9 (aOR: 0.15, 95CI: 0.15, 0.16) had a negative impact on medical costs. Conclusion: Multimorbidity patterns among middle-aged and older adults in China have diversified over the past decade and are associated with rising health care costs in China. Smart, decisive and comprehensive policy and care interventions are needed to effectively manage NCDS and their risk factors and to reduce the economic burden of multimorbidity on patients and the country.

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BACKGROUND: Data on the relationship between short-term exposure to air pollution and cardiovascular diseases (CVDs) and the potential modifying factors are limited and inconsistent. OBJECTIVE: To explore the relationship between short-term exposure to air pollution and CVD risk, and potential modification effect factors. METHOD: A time series study was conducted on 52,991 hospital admissions for CVD from 2015 to 2019 in Xiangyang City, China. Air pollution data from four national fixed monitoring stations were collected to estimate exposure level in Xiangyang City. A quasi-Poisson generalized additive model incorporating a distributed lag nonlinear model was applied to evaluate the association between air pollution and CVD risk. The potential modification effect of sex, age, and season on the above associations was also evaluated. RESULTS: CVD risk was positively associated with air pollution. Peak associations in single lag day structures were observed for particulate matter ≤10 µm in aerodynamic (PM10; RR: 1.040, 95 % CI: 0.996-1.087), PM2.5 (1.025, 1.004-1.045), nitrogen dioxide (NO2; 1.074, 1.039-1.111), and sulfur dioxide (SO2; 1.079, 1.019-1.141) at Lag 0 and ozone (O3; 1.018, 1.004-1.031) at Lag 4. In cumulative lag day structures, the highest RRs were 1.225 (1.079,1.392) for PM10 at Lag 06, 1.054 (1.013, 1.098) for PM2.5 at Lag 03, 1.200 (1.119, 1.287) for NO2 at Lag 04, and 1.135 (1.025, 1.257) for SO2 at Lag 02. Moreover, the association between air pollution and CVD risk was modified by sex and age (P < 0.05). Females and individuals aged ≤65 years were more vulnerable to NO2 and had a higher CVD risk. CONCLUSION: Short-term exposure to air pollution was positively associated with CVD risk. Moreover, sex and age could modify the effect of air pollution on CVD risk. Females and individuals aged ≤65 years had a higher NO2 exposure-induced CVD risk.

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TiO2 (P25) could significantly accelerate the degradation of carbon tetrachloride (CT) in the UV/K2 S2 O8 system by about 4 times, and 88.5% of the CT was dechlorinated. The presence of dissolved oxygen (DO) could delay the degradation process. The addition of P25 produced •O2 - through the transformation of DO, so as to prevent the inhibitory effect. In this work, it was proved that P25 could not enhance the persulfate (PS) activation. The presence of P25 delayed the CT degradation in the absence of DO. Furthermore, the results of electron paramagnetic resonance (EPR) and quenching experiments demonstrated that the presence of P25 could produce •O2 - , which could remove CT. Therefore, this work highlights the function of •O2 - during the reaction and excludes the possibility that the presence of P25 could activate PS under the UV illumination. Then, the pathway of the CT degradation is discussed. Heterogeneous photocatalysis could provide a new method to deal with the problems caused by DO. PRACTITIONER POINTS: The main reason of the improvement in P25-PS-UV-EtOH system is transformation of dissolved oxygen into superoxide radical in presence of P25. The addition of P25 could not accelerate PS activation in P25-PS-UV-EtOH system. Photo-induced electron, superoxide radical, alcohol radical and •SO4 - could all contribute to CT degradation, and the pathway is discussed.

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It still remains challenge for expanding the photo-response range of TiO2 with dominant {0 0 1} facets due to the hardly achieving modification of the electronic structure without destroying the formation of TiO2 high energy facets. Herein, we report the construction of carboxylate species modified TiO2 nanosheets with dominant {0 0 1} facets by employing ethanol as a carbon source through a low-temperature (300 °C) carbonization method. The as-obtained samples were investigated in detail by using various characterization techniques. The results indicate that the carboxylate species derived from the oxidation and carbonization of ethanol are coordinated to the {0 0 1} facets in a bidentate bridging mode. The electron-withdrawing carboxylate species induce TiO2 to form a lower valence band edge and a narrower bandgap, which enhances the oxidation ability of photogenerated holes and expands the photo-response range. The partially carbonized carboxylate species can also act as a photosensitizer to induce visible-light photocatalytic activity of TiO2 nanosheets. In addition, the carboxylate species can further promote the separation of photogenerated charge carriers. The findings of this work may provide a new perspective for tuning the band structure of TiO2 with dominant {0 0 1} facets and improving its photocatalytic performance.

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Nano-TiO2 is a type of environment-friendly and inexpensive substance that could be used for photocatalytic degradation processes. In this study, the multi-type carbon species doped and modified anatase nano-TiO2 was innovatively synthesized and developed to overcome the deficiency of common nano-TiO2 photocatalysts. The multi-type carbon species were derived from tetrabutyl titanate and ethanol as the internal and external carbon sources, respectively. Meanwhile, diverse characterization methods were applied to investigate the morphology and surface properties of the photocatalyst. Finally, the visible-light photocatalytic degradation activity of the collected samples was evaluated by using methyl orange as a model pollutant. The promotion mechanism of multi-type carbon species in the photocatalytic process was also discussed and reported. The results in this work show that the doping and modification of multi-type carbon species successfully narrows the bandgap of nano-TiO2 to expand the light absorption range, reduces the valence band position to improve the oxidation ability of photogenerated holes, and promotes the separation of photogenerated charge carriers to improve quantum efficiency. In addition, the further modification of the external carbon source can promote the surface adsorption of MO and stabilize the multi-type carbon species on the surface of nano-TiO2.

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Here we report a low-cost and facile synthesis approach for carbon-doped mesoporous anatase TiO2 by using Ti(BuO)4 as a source for both Ti and carbon through xerogel carbonization in a hypoxic atmosphere. The resultant mesoporous C-TiO2 with high crystallinity exhibits excellent photocatalytic activities for degradation of methyl orange (MO) and phenol under visible light irradiation.

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