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OBJECTIVE: To investigate the interplay between individual nighttime and midday sleep duration and the number of new-onset chronic diseases and determine the optimal sleep duration associated with lowest number of new-onset chronic diseases. METHODS: We used data from the China Health and Retirement Longitudinal Study (CHARLS) covering a decade and involving 10,828 participants. A random intercept cross-lagged model was used to explore the interplay between nighttime/midday sleep durations and new-onset chronic diseases at both the within-individual and between-individual levels, followed by a dose-response analysis at the between-individual level to determine the optimal sleep duration. New-onset chronic diseases include 14 types of self-reported diseases diagnosed by doctors. RESULTS: Within-individual analysis revealed that increased nighttime/midday sleep duration led to a higher number of new-onset chronic diseases, and an increased number of new-onset chronic diseases resulted in decreased nighttime sleep duration. Between nighttime and midday sleep, one type of sleep duration increase was likely to lead to an increase in another type. Between-individual analysis found a nonlinear relationship between the number of new-onset chronic diseases and nighttime sleep duration, identifying the optimal nighttime sleep duration as 7.46 h. CONCLUSIONS: These findings elucidate the interplay between sleep duration and number of new-onset chronic diseases and underscore the need for public awareness and comprehensive interventions. Future studies should focus on refining sleep monitoring and exploring the sleep-chronic diseases nexus in greater depth.

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With the rapid urbanization and aging population, depression has become a severe public health issue globally, affecting millions of individuals and significantly impacting their quality of life and healthcare costs. Urban resilience refers to a city's ability to absorb, recover, and prepare for future shocks, ensuring sustainable development despite challenges. This study aims to explore the impact of urban resilience on depressive symptoms among middle-aged and elderly adults. Using data from the China Health and Retirement Longitudinal Study (CHARLS), we analyzed five dimensions of urban resilience: economic, social, ecological, institutional, and infrastructural resilience. The results of cox proportional hazards model indicate that high levels of urban resilience significantly reduce the risk of depressive symptoms (HR = 0.875, 95% CI: 0.832-0.920, P < 0.001). Specifically, economic resilience (HR = 0.883, 95% CI: 0.846-0.921, P < 0.001), social resilience (HR = 0.916, 95% CI: 0.876-0.958, P < 0.001), ecological resilience (HR = 0.670, 95% CI: 0.516-0.869, P = 0.003), institutional resilience (HR = 0.922, 95% CI: 0.886-0.960, P < 0.001), and infrastructural resilience (HR = 0.875, 95% CI: 0.826-0.926, P < 0.001) all show significant negative correlations with depressive symptoms. Furthermore, the mitigation of depressive symptoms risk resulting from improved urban resilience disproportionately benefits vulnerable groups and those with healthy living habits. These findings provide scientific evidence for urban planning and policy formulation, contributing to the promotion of mental health and healthy aging among middle-aged and elderly populations.

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Depresión , Resiliencia Psicológica , Población Urbana , Humanos , Masculino , Anciano , Femenino , Persona de Mediana Edad , Estudios Longitudinales , China/epidemiología , Depresión/epidemiología , Población Urbana/estadística & datos numéricos , Anciano de 80 o más Años , Longevidad

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OBJECTIVE: Insulin resistance (IR) imposes a significant burden on inflammatory diseases, and the triglyceride-glucose (TyG) index, which is an easily accessible indicator for detecting IR, holds great application potential in predicting the risk of arthritis. The aim of this study is to analyze the association between the TyG index and the risk of new-onset arthritis in the common population aged over 45 using a prospective cohort study design. METHOD: This population-based cohort study involved 4418 participants from the China Health and Retirement Longitudinal Study (from Wave 1 to Wave 4). Multivariate logistic regression models were employed to investigate the association between the TyG index and new-onset arthritis, and RCS analyses were used to investigate potential non-linear relationships. Moreover, decision trees were utilized to identify high-risk populations for incident arthritis. RESULT: Throughout a 7-year follow-up interval, it was found that 396 participants (8.96%) developed arthritis. The last TyG index quartile group (Q4) presented the highest risk of arthritis (OR, 1.39; 95% CI, 1.01, 1.91). No dose-response relationship between the TyG index and new-onset arthritis was identified (Poverall=0.068, Pnon-linear=0.203). In the stratified analysis, we observed BMI ranging from 18.5 to 24 exhibited a heightened susceptibility to the adverse effects of the TyG index on the risk of developing arthritis (P for interaction = 0.035). CONCLUSION: The TyG index can be used as an independent risk indicator for predicting the start of new-onset arthritis within individuals aged 45 and above within the general population. Improving glucose and lipid metabolism, along with insulin resistance, may play a big part in improving the primary prevention of arthritis.

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Artritis , Resistencia a la Insulina , Humanos , Estudios de Cohortes , Estudios Longitudinales , Estudios Prospectivos , Artritis/diagnóstico , Artritis/epidemiología , Glucosa , Factores de Riesgo , Triglicéridos , Glucemia , Biomarcadores

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Objective@#To investigate the association between self-rated health status and mortality risk, and to evaluate the predictive value of self-rated health status for mortality risk among the elderly.@*Methods@#Based on the China Health and Retirement Longitudinal Study (CHARLS) database, data of sociodemographic information, self-rated health status and mortality of the elderly aged 60 years and older were collected from 2011 to 2018. The association between self-rated health status and mortality risk among the elderly was analyzed using a multivariable Cox proportional risk regression model.@*Results@#Totally 4 850 individuals were included, with an median age of 65 (interquartile range, 8) years. There were 2 485 males (51.24%) and 2 365 females (48.76%). There were 877 individuals (18.08%) rated their health as good, 2 078 individuals (42.85%) as general, 1 895 individuals (39.07%) as poor. A total of 28 955 person-years were followed up, with an average follow-up of 5.97 years per person. There were 855 deaths by the end of follow-up in 2018, and the median survival time was 7 (interquartile range, 3) years. Multivariable Cox proportional risk regression analysis showed that there were interactive effects of age, sex and self-rated health status on mortality, respectively (both P<0.05). The results of gender-stratified analysis showed that there was no significant association between self-rated health status and mortality risk in old women (P>0.05). The mortality risk was higher in old men with poor self-rated health than with good self-rated health (<70 years, HR=5.382, 95%CI: 3.263-8.876; 70 to 79 years, HR=3.536, 95%CI: 1.070-11.686; ≥80 years, HR=3.043, 95%CI: 1.827-5.066).@*Conclusion@#There is an association between self-rated health status and mortality risk among the elderly, the old men with poor self-rated health had a higher mortality risk.

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Objective: Prior studies showed mixed results of the association between grandchild care and grandparents' health. This research focused on the mechanisms behind the above link by studying how internet use served as a mediator through which grandchild care has impacted grandparents' health. The study aimed to draw implications to improve health of grandparents who offer care to grandchildren. Methods: Using a sample of 16,829 grandparents aged 50 through 80 from the 2018 wave of China Health and Retirement Longitudinal Study (CHARLS), the study relied on the KHB method to conduct the analysis. Grandparental health was measured by self-rated health (SRH), instrumental activity of daily living (IADL), life satisfaction and depression. Results: Overall, grandchild care had a positive effect on grandparental health. Those who engaged in grandchild care were more likely to use internet. In addition, internet use mediated the ways in which grandchild care impacted grandparents' health. Interne use generally promoted the positive influence of grandparental caregiving on grandparents' health. Specifically, the mediating effects of watching videos and chatting through the internet were most pronounced among urban grandmothers. The mediating effects of watching news were most noticeable among both urban grandmothers and grandfathers. Conclusion: Internet use served as a mediator in the association between grandchild child care and grandparental health. Promoting internet usage may be an effective way reducing the negative impact of grandchild care on grandparents' mental health. It could also increase the positive effect of caregiving on grandparents' SRH and functional independence. The study also underscored the importance of taking rural-urban context and gender role into consideration when studying intergenerational caregiving and Chinese grandparents' health.

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Abuelos , Humanos , Uso de Internet , Estudios Longitudinales , Familia , Internet

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BACKGROUND: Stroke represents the second most prevalent contributor to global mortality. The Chinese Visceral Adiposity Index (CVAI) serves as an established metric for assessing visceral adiposity in the Chinese population, exhibiting prognostic capabilities. This investigation aimed to explore the association of CVAI and new-onset stroke among middle-aged and older Chinese populations. METHODS: The study employed data from the 2011 and 2018 China Health and Retirement Longitudinal Study (CHARLS) to assess the association of CVAI and the incidence of new-onset stroke. Utilizing a directed acyclic graph (DAG), 10 potential confounders were identified. Moreover, to explore the association between CVAI and new-onset stroke, three multifactor logistic regression models were constructed, accounting for the identified confounders and mitigating their influence on the findings. RESULTS: The study comprised 7070 participants, among whom 417 (5.9%) experienced new-onset strokes. After controlling for confounding variables, regression analysis suggested that the new-onset stroke's highest risk was linked to the fourth quartile (Q4) of the CVAI, with an odds ratio (OR) of 2.33 and a 95% confidence interval (CI) of 1.67-3.28. The decision tree analysis demonstrated a heightened probability of new-onset stroke among hypertensive individuals with a CVAI equal to or greater than 83, coupled with a C-reactive protein level no less than 1.1 mg/l. Age seemed to have a moderating influence on the CVAI and new-onset stroke association, exhibiting a more prominent interaction effect in participants under 60 years. CONCLUSIONS: In middle-aged and older Chinese populations, a linear relationship was discerned between CVAI and the probability of new-onset stroke. CVAI provides a predictive framework for stroke incidence in this demographic, laying the groundwork for more sophisticated risk prediction models that improve the precision and specificity of stroke risk evaluations.

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Adiposidad , Accidente Cerebrovascular , Humanos , Pueblos del Este de Asia , Estudios Longitudinales , Pueblo Asiatico , China/epidemiología , Accidente Cerebrovascular/epidemiología , Factores de Riesgo , Obesidad Abdominal/complicaciones

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Purpose: The aim of this study is to investigate the cross-sectional and longitudinal associations between sensory impairments (SIs) including single vision impairment (SVI), single hearing impairment (SHI), and dual sensory impairments (DSI) with social isolation in the middle-aged and older Chinese population. Methods: Data were obtained from the China Health and Retirement Longitudinal Survey (CHARLS). In total, 11,674 Chinese older adults aged over 45 were included at baseline 2011, and 6,859 participants who accomplished all four interviews from 2011 to 2018 were adapted for longitudinal analyses. Sensory status and social isolation measurements including social disconnectedness and self-perceived loneliness were collected. Assessment of social disconnectedness included the number of types of social activities in which they participated and the frequency of such participation. Loneliness referred to the subjective perception of loneliness. Other covariates included socio-demographic characteristics, medical conditions, and lifestyle-related factors. The impacts of baseline sensory status on social disconnectedness and loneliness were assessed using univariate and multivariate generalized linear models. A generalized linear model with generalized estimation equations (GEE) was used to assess the association between time-varying sensory statuses with social disconnectedness or loneliness over 8 years after being adjusted with multi-confounding factors. Results: Participants with SIs had significantly higher levels of social disconnectedness and self-perceived loneliness, compared to those who were free of SI. All kinds of SIs were significantly associated with loneliness according to both cross-sectional and longitudinal data. The correlations between DSI and social disconnectedness or loneliness at baseline and over 8 years were also noticed. SHI was found to be significantly associated with both frequency and types of social activities according to cross-sectional data and with the frequency of social activity participation in longitudinal analysis. SVI was only associated with the types of social activities at baseline (all p-values < 0.05). Conclusion: Sensory impairments, especially dual sensory impairments, have explicitly detrimental effects on social isolation among the older Chinese population. Over time, single hearing impairment specifically jeopardizes their frequency rather than types of social activities participation.

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Pueblos del Este de Asia , Soledad , Trastornos de la Sensación , Aislamiento Social , Anciano , Humanos , Persona de Mediana Edad , Estudios Transversales , Pueblos del Este de Asia/estadística & datos numéricos , Pérdida Auditiva/complicaciones , Pérdida Auditiva/epidemiología , Encuestas Epidemiológicas/estadística & datos numéricos , Trastornos de la Sensación/complicaciones , Trastornos de la Sensación/epidemiología , China/epidemiología , Estudios Longitudinales , Trastornos Sordoceguera/complicaciones , Trastornos Sordoceguera/epidemiología , Ceguera/complicaciones , Ceguera/epidemiología , Participación Social

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BACKGROUND: Few longitude cohort studies investigated the risk of the duration of nighttime sleep and naps to the new-onset common chronic disease conditions (CDCs) in middle-aged (45-60) and the elderly (age ≥ 60) populations using an age-stratified strategy. METHODS: The 7025 participants from The China Health and Retirement Longitudinal Study were screened as eligible subjects. Established 13 cohorts with CDCs, acquired their' sleep records in 2011, and obtained new-onset incidents of CDCs during follow-up in 2011-2018. Performed risk association analyses between sleep duration and 13 new-onset CDCs respectively. RESULTS: New-onset risk of four CDCs decreased with increasing nighttime sleep (p-nonlinear>0.05). The risk threshold was approximately 7 hours in middle-aged people and 6 hours in the elderly. For the middle-aged population, compared with 7-9hours sleep, <5hour and 5-7hours nighttime sleep were associated with 1.312∼1.675 times more risk of hypertension, kidney disease, diabetes or high blood sugar status, and multimorbidity; Compared with no nap, a 0-30 min nap was associated with 1.413(1.087∼1.837) times the heart disease risk. In the elderly, < 5 hours of night sleep was a significant risk factor for four CDCs including kidney disease and multimorbidity, etc. A long night's sleep (>9 hours) was connected with 61.2% reduction in risk of memory disease, a >90 min nap increased 62% risk of memory disease, and a 0-30 min nap was associated with higher risks of heart disease, hypertension, and a lower kidney disease risk. CONCLUSIONS: Nighttime sleep and daytime naps may have their own implications for the new-onset CDCs' risk in the aging process.

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Cardiopatías , Hipertensión , Persona de Mediana Edad , Humanos , Anciano , Estudios Longitudinales , Duración del Sueño , Sueño , Hipertensión/epidemiología , Enfermedad Crónica

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BACKGROUND: Fall is a major cause of mortality and cause a significant burden on the healthcare system and economic system. Weak grip strength signifies impaired function. Older people with weak grip strength are at a higher risk of death. China has the largest ageing population in the world today. This study aims to analyze the factors contributing to weak grip strength and fall among Chinese. METHODS: This study analyzed data from the 2011 baseline and 2015 follow-up survey of the China Health and Retirement Longitudinal Study (CHARLS). To identify the risk factors of fall and weak grip strength, we used a stepwise multivariable logistic regression model and a least absolute shrinkage and selection operator (LASSO) regression model. RESULTS: In the LASSO regression model, all the risk factors were not shrunken. In the stepwise logistic regression model, adjusted for gender, age, grip strength, depression, and chronic disease, we found that female (aOR = 1.376, 95% CI = 1.243-1.523; P < 0.001), history of ischemic stroke (aOR = 1.786, 95% CI = 1.263-2.524; P = 0.001), depression (aOR = 1.559, 95% CI = 1.396-1.742; P < 0.001), weak grip strength (aOR = 1.285, 95% CI = 1.105-1.494; P = 0.001), older age (aOR = 1.227, 95% CI = 1.163-1.294; P < 0.001), rheumatoid arthritis (aOR = 1.410, 95% CI = 1.270-1.560; P < 0.001), history of kidney disease (aOR = 1.383, 95% CI = 1.136-1.682; P = 0.001) were factors associated with fall significantly. After further adjusting, we found the risk factors of weak grip strength included symptomatic knee osteoarthritis (aOR = 1.755, 95% CI 1.158-2.661; P = 0.008), living in rural area (aOR = 2.056, 95% CI 1.290-3.277; P = 0.002), depression (aOR = 1.523, 95% CI 1.116-2.078; P = 0.008), older age (aOR = 2.116, 95% CI 1.801-2.486; P < 0.001). CONCLUSION: From the study, we found that older age and depression were risk factors of weak grip strength and fall. Weak grip strength was a risk factor of fall. Female, ischemic stroke, kidney disease, rheumatoid arthritis were risk factors of fall; living in rural area and symptomatic knee osteoarthritis were risk factors of weak grip strength.

Asunto(s)

Artritis Reumatoide , Accidente Cerebrovascular Isquémico , Osteoartritis de la Rodilla , Humanos , Femenino , Anciano , Jubilación , Estudios Longitudinales , Fuerza de la Mano , China/epidemiología , Debilidad Muscular

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Background: Currently, only a few studies have examined the link between dental health, cognitive impairment, and physical activity. The current study examined the relationship between denture use and physical activity in elderly patients with different cognitive abilities. Methods: The study data was sourced from the 2018 China Health and Retirement Longitudinal Study (CHARLS) database, which included information on denture use and amount of daily physical activity undertaken by older persons. Physical activity was categorized into three levels using the International Physical Activity General Questionnaire and the International Physical Activity Scale (IPAQ) rubric. The relationship between denture use and physical activity in middle-aged and older persons with varying degrees of cognitive functioning was studied using logistic regression models. Results: A total of 5,892 older people with varying cognitive abilities were included. Denture use was linked to physical activity in the cognitively healthy 60 + age group (p = 0.004). Denture use was positively related with moderate physical activity in the population (odds ratio, OR: 1.336, 95% confidence interval: 1.173-1.520, p < 0.001), according to a multivariate logistic regression analysis, a finding that was supported by the calibration curve. Furthermore, the moderate physical activity group was more likely to wear dentures than the mild physical activity group among age-adjusted cognitively unimpaired middle-aged and older persons (OR: 1.213, 95% CI: 1.053-1.397, p < 0.01). In a fully adjusted logistic regression model, moderate physical activity population had increased ORs of 1.163 (95% CI: 1.008-1.341, p < 0.05) of dentures and vigorous physical activity population had not increased ORs of 1.016 (95% CI: 0.853-1.210, p > 0.05), compared with mild physical activity population. Conclusion: This findings revealed that wearing dentures affects physical activity differently in older persons with different cognitive conditions. In cognitively unimpaired older adults, wearing dentures was associated with an active and appropriate physical activity status.

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BACKGROUND: Vision impairment (VI) and depression are highly prevalent among adults. However, few nationally representative studies from China on the self-reported VI and its association with depression symptoms. AIMS: This study re-estimated the relationship between self-reported VI and depression symptoms. METHODS: In this analysis, 62,525 respondents from the China Health and Retirement Longitudinal Study 2011-2018 were included. Based on self-reports, respondents with VI were allocated to distance VI (DVI), near VI (NVI), both distance and near VI (DNVI), or a blindness group. Multivariable pooled logistic regression models were used to evaluate the groups' odds ratios (ORs) for depression symptoms and self-reported VI. RESULTS: Overall, 35.9% of the respondents were self-reported VI. DVI (OR: 1.51, 95% confidence interval [95% CI]: 1.28-1.79) and DNVI (OR: 1.51, 95% CI: 1.21-1.88) showed the highest ORs for depression symptoms, followed by NVI (OR: 1.31, 95% CI: 1.11-1.54). Depression symptoms were associated with a significantly increased risk of DVI (OR: 1.49, 95% CI: 1.26-1.76), DNVI (OR: 1.49, 95% CI: 1.20-1.86), and NVI (OR: 1.29, 95% CI: 1.10-1.52), respectively. However, these associations between self-reported blindness and depression symptoms were not significant. All models provided similar results by excluding respondents aged 45-59 years. CONCLUSION: Self-reported DVI, NVI, and DNVI are associated with depression symptoms. A strong reverse association was found between depression and self-reported DVI, NVI, and DNVI, but not for blindness. Our findings emphasize the urgent need for depression screening for self-reported VI among Chinese adults.

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Personas con Daño Visual , Anciano , Ceguera , China/epidemiología , Estudios Transversales , Depresión/epidemiología , Humanos , Estudios Longitudinales , Persona de Mediana Edad , Autoinforme

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OBJECTIVES: Determinants of mortality may depend on the time and place where they are examined. China provides an important context in which to study the determinants of mortality at older ages because of its unique social, economic, and epidemiological circumstances. This study uses a nationally representative sample of persons in China to determine how socioeconomic characteristics, early-life conditions, biological and physical functioning, and disease burden predict 4-year mortality after age 60. METHODS: We used data from the China Health and Retirement Longitudinal Study. We employed a series of Cox proportional hazard models based on exact survival time to predict 4-year all-cause mortality between the 2011 baseline interview and the 2015 interview. RESULTS: We found that rural residence, poor physical functioning ability, uncontrolled hypertension, diabetes, cancer, a high level of systemic inflammation, and poor kidney functioning are strong predictors of mortality among older Chinese. DISCUSSION: The results show that the objectively measured indicators of physical functioning and biomarkers are independent and strong predictors of mortality risk after accounting for several additional self-reported health measures, confirming the value of incorporating biological and performance measurements in population health surveys to help understand health changes and aging processes that lead to mortality. This study also highlights the importance of social and historical context in the study of old-age mortality.

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Envejecimiento , Enfermedad Crónica , Costo de Enfermedad , Mortalidad , Rendimiento Físico Funcional , Anciano , Envejecimiento/etnología , Envejecimiento/fisiología , Envejecimiento/psicología , China/epidemiología , Enfermedad Crónica/clasificación , Enfermedad Crónica/epidemiología , Enfermedad Crónica/mortalidad , Femenino , Disparidades en el Estado de Salud , Humanos , Estudios Longitudinales , Masculino , Modelos de Riesgos Proporcionales , Factores de Riesgo , Factores Socioeconómicos

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BACKGROUND: Previous studies show that abnormal lipoprotein metabolism can increase the prevalence of chronic kidney disease (CKD). This study prospectively investigated the association of triglycerides to high-density lipoprotein cholesterol (TG/HDL-C) ratio and renal dysfunction in the Chinese population. METHODS: This longitudinal cohort research examined 7,316 participants (age range: 22-93) from the China Health and Retirement Longitudinal Study (CHARLS), including 6,560 individuals with estimated glomerular filtration rate (eGFR) ≥ 60 mL/min/1.73 m2 (normal renal function, NRF) group and 756 with eGFR < 60 mL/min/1.73 m2 (impaired renal function, IRF) group. In NRF group, reduction in renal function was defined as eGFR < 60 mL/min/1.73 m2 at exit visit and in IRF group, it was defined as decline in eGFR category, average eGFR decline > 5 mL/min/1.73 m2 per year or > 30 % decrease in eGFR from baseline. RESULTS: The study results showed that TG/HDL-C ratio was positively associated with the risk of renal function decline in the NRF group (OR 1.30, 95 %CI 1.03-1.65, P = 0.03) and the IRF group (OR 1.90, 95 %CI 1.21-3.23, P = 0.02) when adjusting for age, gender, obesity, diabetes, hypertension, waist circumference, drinking, smoking, history of heart disease and stroke, low-density lipoprotein cholesterol and eGFR category. Analysis of the IRF group indicated that relative to the group of TG/HDL-C < 1.60, the group of TG/HDL-C ≥ 2.97 had an increased risk for the decline of eGFR category (OR 1.89, 95 %CI 1.12-3.21, P = 0.02) and > 30 % decline in eGFR (OR 2.56, 95 %CI 1.05-6.38, P = 0.04). CONCLUSIONS: The high TG/HDL-C ratio was an independent risk factor for declining renal function in the Chinese population.

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HDL-Colesterol/sangre , Riñón/fisiopatología , Insuficiencia Renal Crónica/sangre , Triglicéridos/sangre , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Consumo de Bebidas Alcohólicas/sangre , Consumo de Bebidas Alcohólicas/epidemiología , Consumo de Bebidas Alcohólicas/fisiopatología , China/epidemiología , LDL-Colesterol/sangre , Diabetes Mellitus/sangre , Diabetes Mellitus/epidemiología , Diabetes Mellitus/fisiopatología , Femenino , Tasa de Filtración Glomerular , Cardiopatías/sangre , Cardiopatías/epidemiología , Cardiopatías/fisiopatología , Humanos , Hipertensión/sangre , Hipertensión/epidemiología , Hipertensión/fisiopatología , Riñón/metabolismo , Metabolismo de los Lípidos/fisiología , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Insuficiencia Renal Crónica/epidemiología , Insuficiencia Renal Crónica/fisiopatología , Factores Sexuales , Fumar/sangre , Fumar/epidemiología , Fumar/fisiopatología , Accidente Cerebrovascular/sangre , Accidente Cerebrovascular/epidemiología , Accidente Cerebrovascular/fisiopatología , Circunferencia de la Cintura

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BACKGROUND: Verbal autopsy is designed to ascertain causes of death that are not registered or certified. Verbal autopsy has been validated in multiple settings but has not been as widely evaluated for older populations as for younger age groups. OBJECTIVE: This study aims to provide empirical evidence of the value of verbal autopsy interviews in the context of population-based surveys of older adults by comparing the cause-of-death assignments derived from two methods of interpreting verbal autopsy data. METHODS: Data used in this study come from the China Health and Retirement Longitudinal Study, a nationally representative longitudinal survey of older Chinese. We compared 407 causes of death determined using InterVA, which is a computer-coded method, and causes of death as assigned by experts; then evaluated factors that affect the results of the two approaches. RESULTS: Among the 407 deaths, neoplasms, cardiac disease, and stroke are the leading causes of death according to both approaches. The consistency of the two approaches is about 45% at the individual level. The primary reason for the mismatch is that no cause of death could be assigned for more than 25% of the sample based on expert review. A higher likelihood of mismatch is associated with advanced age and a long period between death and verbal autopsy interview. CONCLUSION: Both approaches identify the same leading causes of death at the aggregate level, but consistency is relatively low at the individual level. InterVA works well when causes of death are characterized by distinctive signs and symptoms. Grouping the various causes of death with shared etiology or common risk factors may help improve the quality of the ascertainment of causes of death. Open-ended narratives are helpful because they provide information about the circumstances surrounding the death that are not available in the structured verbal autopsy interviews.

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Autopsia/métodos , Causas de Muerte , Anciano , Anciano de 80 o más Años , Algoritmos , China/epidemiología , Diagnóstico por Computador/mortalidad , Testimonio de Experto , Femenino , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Mortalidad

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A range of previous studies have suggested that early-life conditions (ELCs) are associated with various health problems throughout life in Western societies. The aim of this study was to investigate whether, and how, early-life conditions predicted the level and trajectory of cognitive function in middle- and old-aged Chinese adults. Data were obtained from China Health and Retirement Longitudinal Study which comprised 16,258 adults at baseline. Cognitive function was assessed using mental intactness and episodic memory and ELCs were measured by early parental death, childhood socioeconomic status (SES), food deprivation, and childhood health. Growth curve modeling was used to examine the trajectory of cognitive function (three waves in a 6-year period)with particular attention paid to the effects of ELCs on cognition. The results show that early maternal death is associated with the baseline cognitive level among middle- and old-aged Chinese adults (ß range between -0.44 and -0.35, p < 0.05), but that this association is also largely attenuated by adulthood education. Higher childhood SES predicts an enhanced level of baseline cognition in both age groups (ß range between 0.08 and 1.27, p < 0.001), but only protects against cognitive decline at baseline in middle-aged adults. Participants who were less healthy during childhood tended to have lower cognitive performance than those who had enjoyed good health (ß range between -0.36 and -0.14, p < 0.05). The results of this study highlight the detrimental impact of deleterious ELCs on cognitive function throughout later life.

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Cognición , Disfunción Cognitiva , Anciano , China , Femenino , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Jubilación

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BACKGROUND: The number of Chinese cancer survivors has increased bolstered by the combined trends of an aging population and improved cancer survival; however, related research on cancer survivorship remains limited. Therefore, this study aimed to provide an overview of the health status of middle-aged and older cancer survivors in China. METHODS: We used the cross-sectional self-reported survey data from wave 4 in the China Health and Retirement Longitudinal Study (CHARLS). A total of 354 cancer survivors and 16,664 participants without cancer were identified from CHARLS. Physical and mental health, health behavior, and health care information collected by questionnaire were compared between these two groups. RESULTS: Compared with the general middle-aged and older population, cancer survivors had more concomitant chronic diseases (2.75 vs. 2.00, P<0.001). In addition, cancer survivors were found to be more statistically likely to have difficulties with activity (3.53 vs. 2.39, P<0.001) and have depressive symptoms (10.07 vs. 8.01, P<0.001) compared with participants without cancer. Also, cancer survivors were less likely to drink compared to those without a cancer diagnosis (OR 0.49; 95% CI, 0.36-0.66, P<0.001), but smoking behavior and physical activity did not show a significant difference. Coexisting chronic diseases and smoking harmed the physical and mental health of middle-aged and older people. We also found that cancer survivors had higher medical care expenses when compared with participants without cancer. CONCLUSIONS: Cancer survivors older than 45 years in China have poorer outcomes in comorbidities and physical and mental health than their age-matched individual counterparts without cancer. Therefore, a higher quality and more cost-effective supportive care for these individuals is needed.