Temporal Mortality Trends Attributable to Stroke in South Asia: An Age-Period-Cohort Analysis.

South Asia contributes the most to stroke mortality worldwide. This study aimed to determine the long-term trends in stroke mortality across four South Asian countries and its associations with age, period, and birth cohort. In 2019, nearly one million stroke deaths occurred across South Asia, and the associated age-standardized mortality rate (ASMR) was 80.2 per 100,000. Between 1990 and 2019, India had the largest decrease in the ASMR (-35.8%) across the four South Asian countries. While Pakistan had the smallest decrease in the ASMR (-7.6%), an increase was detected among males aged 15 to 34 years and females aged 15 to 19 years. Despite a 22.8% decrease in the ASMR, Bangladesh had the highest ASMR across the four South Asian countries. Nepal reported a witness increase in the stroke ASMR after 2006. Improved period and cohort effects on stroke mortality were generally indicated across the analyzed countries, except for recent-period effects in males from Nepal and cohort effects from those born after the 1970s in Pakistan. Stroke mortality has decreased in the four South Asian countries over the past 30 years, but potentially unfavorable period and cohort effects have emerged in males in Nepal and both sexes in Pakistan. Governmental and societal efforts are needed to maintain decreasing trends in stroke mortality.

The spatiotemporal associations between esophageal and gastric cancers provide evidence for its joint endoscopic screening in China: a population-based study.

BACKGROUND: The spatiotemporal epidemiological evidence supporting joint endoscopic screening for esophageal cancer (EC) and gastric cancer (GC) remains limited. This study aims to identify combined high-risk regions for EC and GC and determine optimal areas for joint and separate endoscopic screening. METHODS: We analyzed the association of incidence trends between EC and GC in cancer registry areas across China from 2006 to 2016 using spatiotemporal statistical methods. Based on these analyses, we divided different combined risk regions for EC and GC to implement joint endoscopic screening. RESULTS: From 2006 to 2016, national incidence trends for both EC and GC showed a decline, with an average annual percentage change of -3.15 (95% confidence interval [CI]: -5.33 to -0.92) for EC and -3.78 (95% CI: -4.98 to -2.56) for GC. A grey comprehensive correlation analysis revealed a strong temporal association between the incidence trends of EC and GC, with correlations of 79.00% (95% CI: 77.85 to 80.14) in males and 77.62% (95% CI: 76.50 to 78.73) in females. Geographic patterns of EC and GC varied, demonstrating both homogeneity and heterogeneity across different regions. The cancer registry areas were classified into seven distinct combined risk regions, with 33 areas identified as high-risk for both EC and GC, highlighting these regions as priorities for joint endoscopic screening. CONCLUSION: This study demonstrates a significant spatiotemporal association between EC and GC. The identified combined risk regions provide a valuable basis for optimizing joint endoscopic screening strategies for these cancers.

The stomach cancer epidemic in Chinese mainland: Current trends and future predictions.

BACKGROUND: China is one of the countries with the highest burdens of stomach cancer. The objective of this study was to analyze long-term trends in the incidence and mortality of stomach cancer in Chinese mainland from 1990 to 2019 and to make projections until 2030. METHODS: Data on stomach cancer were extracted from the Global Burden of Diseases Study 2019. Population data were extracted from the Global Burden of Diseases Study 2019 and World Population Prospects 2019. An age-period-cohort framework and decomposition analysis were used in this study. RESULTS: The net drift for the incidence of stomach cancer was 0.2% (95% confidence interval [CI]: 0.0%, 0.4%) per year for men and -1.8% (95% CI: -2.0%, -1.6%) for women. The net drift for mortality was -1.6% (95% CI: -1.8%, -1.3%) per year for men and -3.3% (95% CI: -3.5%, -3.1%) for women. In the last 10-15 years, the risk of stomach cancer occurrence and death has continued to decline for both sexes. Regarding birth cohorts, although the risk of stomach cancer death decreased in general among women and men born after 1920, the risk of occurrence increased in recent birth cohorts (men born after 1970 and women born after 1985). It is expected that the age-standardized incidence will increase among men and decrease among women, and age-standardized mortality will decrease for both sexes. The largest contributor to the projected increase in incident cases and deaths is population aging, and elderly individuals are projected to have an increased proportion of occurrence and death. CONCLUSIONS: In the past three decades, the incidence of stomach cancer among men has increased in Chinese mainland, and this trend is projected to continue. Aging will be the main contributor to future increased stomach cancer occurrence and deaths. To reduce the health impact of stomach cancer, more efforts are needed.

Global prevalence of violence against children and adolescents during COVID-19: A meta-analysis.

BACKGROUND: Recent studies suggest that children and adolescents are at an increased risk of experiencing violence during the COVID-19 pandemic. However, there is limited knowledge about the prevalence of violence against children and adolescents across different regions in the world. OBJECTIVE: To estimate the pooled prevalence of violence against children and adolescents during the COVID-19 pandemic and explore how geographical and methodological factors explain the variation across studies. METHODS: We conducted a systematic search of MEDLINE, Embase, and PsycInfo databases for articles published from January 1, 2020 to October 1, 2022. The study protocol was pre-registered with PROSPERO (CRD42022338181). We included published and unpublished studies available in English that reported the prevalence of violence (e.g., physical, emotional, or sexual violence, neglect, bullying) against children and adolescents (age <18 years) during the pandemic. Data extraction followed the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. A total of 2740 nonduplicate titles and abstracts were screened, and 217 full-text articles were reviewed for eligibility. RESULTS: Twenty-five studies with 66,637 participants met inclusion criteria. Based on random-effects meta-analysis, the pooled prevalence of violence against children and adolescents was 24 % (95%CI 18 %-30 %). The reported prevalence was higher in studies conducted in low- and middle-income countries compared to high-income countries. CONCLUSIONS: Over one in five children and adolescents globally reported ever experiencing violence during the COVID-19 pandemic. Our findings highlight the urgent need for effective child protection policies and interventions, as well as multisectoral collaboration, to reduce violence against children and adolescents.

Trends in mortality due to tracheal, bronchial, and lung cancer across the BRICS: An age-period-cohort analysis based on the Global Burden of Disease Study 1990-2019.

BACKGROUND: Tracheal, bronchus, and lung cancer (TBL) is a major cause of mortality and top contributor to productivity loss in large emerging economies such as the BRICS (Brazil, Russia, India, China, and South Africa). We examined the time trends of TBL mortality across the BRICS to better understand the disease burden in these countries and inform public health and healthcare resource allocation. METHODS: TBL mortality-related data between 1990 and 2019 were obtained from the Global Burden of Disease Study 2019 and analyzed using age-period-cohort models. Net drift (local drift) was used to describe the expected age-adjusted TBL mortality rate over time overall (each age group); the longitudinal age curve was used to reflect the age effect; the period rate ratios (RRs) were used to reflect the period effect; and the cohort RR was used to reflect the cohort effect. RESULTS: In 2019, there were 958.3 thousand TBL deaths across the BRICS, representing 46.9% of the global TBL deaths. From 1990 to 2019, the age-standardized mortality rate (ASMR) of TBL decreased in Russia, Brazil, and South Africa while increased in China and India, with the largest reduction reported in Russia (-29.6%) and the largest increase in China (+22.4%). India showed an overall increase (+15.7%) in TBL mortality but the mortality risk decreased among individuals born after 1990 (men) and 1995 (women). Although South Africa and Brazil experienced an overall decline in TBL mortality, their recent birth cohorts, such as Brazilian individuals born after 1985 (men) and 1980 (women), and South African men born after 1995, had an increasing TBL mortality risk. China has experienced an overall increase in TBL mortality, with the mortality risk rising among individuals born after 1995 for both men and women. Russia, which had the highest TBL mortality among the BRICS countries in 1990, has demonstrated significant improvement over the past three decades. CONCLUSIONS: Over the past 30 years, the BRICS accounted for an increasing proportion of global TBL mortality. TBL mortality increased in older women in all the BRICS countries except Russia. Among the recent birth cohort, the risk of TBL mortality increased in Brazil, China, and South Africa. More effective efforts are needed in the BRICS to reduce the burden of TBL and help achieve the United Nation's Sustainable Development Goals.

Temporal trends in disease burden and attributable risk factors for tracheal, bronchus, and lung cancer in Nepal, 1990-2019.

BACKGROUND: Tracheal, bronchus, and lung (TBL) cancer is one of the most common cancers in Nepal. The aim of this study was to analyze the changing disease burden and risk factors for TBL cancer in Nepal from 1990 to 2019. METHODS: TBL cancer burden data were obtained from the Global Burden of Disease Study 2019. A decomposition analysis was used to explore the impact of changes in population size, population age structure, age-specific prevalence, and disease severity on long-term trends of the TBL cancer burden in Nepal. RESULTS: In 2019, TBL cancer resulted in the loss of 45.2 thousand (95% uncertainty interval [UI]: 32.3-59.2 thousand) disability-adjusted life years (DALYs) in Nepal, with the age-standardized incidence and prevalence rates increasing by 12.7% (95% UI: -21.0 to 63.9%) and 12.8% (95% UI: -21.1 to 62.0%), respectively, compared with 1990. The proportion of DALYs due to TBL cancer increased significantly among people aged 70 years and older from 1990 to 2019. However, the proportion of DALYs due to TBL cancer still dominated among males and females aged 50-69 years. Population growth, population aging, and increased age-specific prevalence led to an increased disease burden of TBL cancer, while disease severity led to a decreased burden. In 2019, smoking remained the major risk factor for TBL cancer in Nepal, while ambient particulate matter pollution exhibited the most significant rise. CONCLUSIONS: The disease burden of TBL cancer in Nepal has continued to increase over the past three decades, and given the continuing population growth and aging process, TBL cancer is likely to have a considerable impact on health in Nepal in the future. There is a need to further establish effective TBL cancer prevention and control policies.

The application of simulation methods during the COVID-19 pandemic: A scoping review.

With the outbreak of COVID-19 pandemic, simulation modelling approaches have become effective tools to simulate the potential effects of different intervention measures and predict the dynamic COVID-19 trends. In this scoping review, Studies published between February 2020 and May 2022 that investigated the spread of COVID-19 using four common simulation modeling methods were systematically reported and summarized. Publication trend, characteristics, software, and code availability of included articles were analyzed. Among the included 340 studies, most articles used agent-based model (ABM; n = 258; 75.9 %), followed by the models of system dynamics (n = 42; 12.4 %), discrete event simulation (n = 25; 7.4 %), and hybrid simulation (n = 15; 4.4 %). Furthermore, our review emphasized the purposes and sample time period of included articles. We classified the purpose of the 340 included studies into five categories, most studies mainly analyzed the spread of COVID-19 under policy interventions. For the sample time period analysis, most included studies analyzed the COVID-19 spread in the second wave. Our findings play a crucial role for policymakers to make evidence-based decisions in preventing the spread of COVID-19 pandemic and help in providing scientific decision-makings resilient to similar events and infectious diseases in the future.

The relationship between intergenerational financial support and depressive symptoms among older adults: Evidence from China Health and Retirement Longitudinal Study, 2011-2018.

OBJECTIVE: Aimed to investigate the effect of intergenerational financial support on depressive symptoms among older adults over time. METHODS: Data were obtained from China Health and Retirement Longitudinal Study (CHARLS) 2011, 2013, 2015, and 2018. A finite distributed lag (FDL) model was employed, long-run cumulative effect was evaluated. 1426 respondents followed in four waves were included in FDL model. CES-D score was used to measure depressive symptoms, intergenerational financial support was defined as financial support received from older adults' children or grandchildren. Sociodemographic characteristics, health behaviors, social insurance, and social contact factors were controlled in the model. RESULTS: More than a third older adults in China had a CES-D score of 10 or higher. Intergenerational financial support has a significant long-run cumulative negative effect on older adults' depressive symptoms (CES-D scores: coef. = -0.674, P < 0.001; % with CES-D scores ≥10: Coef. = -0.154, P = 0.018). While, the intergenerational financial support in previous period exhibited a significant negative association with depressive symptoms, the 2, 3, and 4 periods did not reach statistical significance. CONCLUSIONS: Intergenerational financial support has a significant negative effect on older adults' depressive symptoms over time, while the effect may diminish. Programs need to be explored to support home-based eldercare to mitigate this diminished effect.

The epidemic of acute lymphoid leukemia in China: current trends and future prediction.

Background: China has experienced one of the fastest increases in the incidence of acute lymphoid leukemia (ALL). The aim of this study was to assess the long-term trends of the incidence and mortality of ALL in mainland China between 1990 and 2019 and to project these trends through 2028. Methods: Data on ALL were extracted from the Global Burden of Disease Study 2019; population data were extracted from World Population Prospects 2019. An age-period-cohort framework was used in the analysis. Results: The net drift for the incidence of ALL was 7.5% (95% confidence interval [CI]: 7.1%, 7.8%) per year in women and 7.1% (95% CI: 6.7%, 7.6%) in men, and local drift was found to be higher than 0 in every studied age group (p<0.05). The net drift for mortality was 1.2% (95% CI: 1.0%, 1.5%) in women and 2.0% (95% CI: 1.7%, 2.3%) in men. Local drift was lower than 0 in boys aged 0-4 years and girls aged 0-9 years and higher than 0 in men aged 10-84 years and women aged 15-84 years. The estimated period relative risks (RRs) for both incidence and mortality showed increasing trends in the recent period. The cohort RRs for incidence showed increasing trends in both sexes; however, the cohort RR for mortality was decreased in the recent birth cohort (women born after 1988-1992 and men born after 2003-2007). Compared with that in 2019, the incidence of ALL in 2028 is projected to increase by 64.1% in men and 75.0% in women, and the mortality is predicted to decrease by 11.1% in men and 14.3% in women. The proportion of older adult/adults individuals with incident ALL and ALL-related death was projected to increase. Conclusions: Over the last three decades, the incidence and mortality rates of ALL have generally increased. It is projected that the incidence rate of ALL in mainland China will continue to increase in the future, but the associated mortality rate will decline. The proportion of older adult/adults individuals with incident ALL and ALL-related death was projected to increase gradually among both sexes. More efforts are needed, especially for older adult/adults individuals.

Concentrations and association between exposure to mixed perfluoroalkyl and polyfluoroalkyl substances and glycometabolism among adolescents.

BACKGROUND: Perfluoroalkyl and polyfluoroalkyl substances (PFASs) are widely used for industrial and commercial purposes and have received increasing attention due to their adverse effects on health. OBJECTIVE: To examine the relationship of serum PFAS and glycometabolism among adolescents based on the US National Health and Nutrition Examination Survey. METHODS: General linear regression models were applied to estimate the relationship between exposure to single PFAS and glycometabolism. Weighted quantile sum (WQS) regression models and Bayesian kernel machine regressions (BKMR) were used to assess the associations between multiple PFASs mixture exposure and glycometabolism. RESULTS: A total of 757 adolescents were enrolled. Multivariable regression model showed that Me-PFOSA-AcOH exposure was negatively associated with fasting blood glucose. WQS index showed that there was marginal negative correlation between multiple PFASs joint exposure and the homeostasis model of assessment for insulin resistance index (HOMA-IR) (ß = -0.26, p < .068), and PFHxS had the largest weight. BKMR models showed that PFASs mixture exposure were associated with decreased INS and HOMA-IR, and the exposure-response relationship had curvilinear shape. CONCLUSIONS: The increase in serum PFASs were associated with a decrease in HOMA-IR among adolescents. Mixed exposure models could more accurately and effectively reveal true exposure.Key MessagesThe detection rates of different PFAS contents in adolescent serum remained diverse.Adolescent serum PFASs had negative curvilinear correlation with INS and HOMA-IR levels.PFHxS had the highest weight in the associations between multiple PFASs and adolescent glycometabolism.

Projections of future life expectancy in China up to 2035: a modelling study.

BACKGROUND: To plan social and health services, future life expectancy projections are needed. The aim of this study was to forecast the future life expectancy for mainland China and its provinces. METHODS: Following the same approach as the Global Burden of Disease Study, we used the largest compiled epidemiological and demographic datasets to estimate age-specific mortality and evaluate population data from 1990 to 2019. A total of 21 life expectancy forecasting models were combined by a probabilistic Bayesian model to forecast the life expectancy for mainland China and its provinces in 2035. FINDINGS: The projected life expectancy at birth in mainland China in 2035 is 81·3 years (95% credible interval 79·2-85·0), and there is a high probability that the national goals of improving life expectancy will be achieved (79 years in 2030, and over 80 years in 2035). At the provincial level, women in Beijing have the highest projected life expectancy in 2035 with an 81% probability of reaching 90 years, followed by Guangdong, Zhejiang, and Shanghai, which all have more than a 50% probability of surpassing 90 years. Men in Shanghai are projected to have the highest life expectancy at birth in 2035, with a 77% probability of life expectancy being over 83 years, the highest provincial life expectancy in mainland China in 2019. The projected gains in life expectancy are mainly derived from older individuals (aged ≥65 years), except those in Xinjiang, Tibet, and Qinghai (for men), in which the main contributions come from younger (0-29 years) or middle-aged (30-64 years) individuals. INTERPRETATION: Life expectancy in mainland China and its provinces has a high probability of continuing to increase through to 2035. Adequate policy planning of social and health services will be needed. FUNDING: China National Natural Science Foundation and Social Science Fund of Jiangsu Province.

The epidemic of thyroid cancer in China: Current trends and future prediction.

Background: Thyroid cancer (TC) is one of the most common cancers in China. The aim of this study was to identify the potential age, period, and cohort effect under the long-term trends in TC incidence and mortality, making projections up to 2030. Methods: Incidence and mortality data on TC were obtained from the Global Burden of Disease Study 2019. The population predictions were obtained from the United Nations World Population Prospects 2019. An age-period-cohort model was used for the analysis. Results: From 1990 to 2019, the net drift (the overall annual percentage change of TC over time adjusted for age groups) of the TC incidence was 5.01% (95% confidence interval [CI]: 4.72%, 5.29%) for men and 1.48% (95% CI: 1.14%, 1.82%) for women. The net drift of TC mortality was 1.64% (95% CI: 1.38%, 1.91%) for men and -2.51% (95% CI: -2.77%, -2.26%) for women. Regarding the incidence of TC, both the period and the cohort relative risks (RRs) in men and women showed an overall increasing trend. As to the mortality rate of TC, both the period and cohort RRs in women showed a monotonic declining trend. The period RRs for men decreased after 2015, but the cohort RRs revealed a fluctuating upward pattern. From 2019 to 2030, the TC incidence was projected to rise by 32.4% in men and 13.1% in women, the mortality declining by 13.0% in men and 17.3% in women. The elderly was projected to have an increasing proportion of TC occurrence and deaths. Conclusions: Over the past 30 years, the incidence rate of TC in China has continually increased, and this trend was projected to continue. Although male mortality has increased in the past, it is expected to decline in the future. The proportion of older people among TC occurrence and death was projected to gradually increase, and the difficulties elderly with TC lrequire more attention.

Incidence and mortality trends of nasopharynx cancer from 1990 to 2019 in China: an age-period-cohort analysis.

BACKGROUND: Nasopharynx cancer (NPC) is a great health burden in China. This study explored the long-term trends of NPC incidence and mortality in China. METHODS: We retrospectively analyzed data from the Global Burden of Disease Study 2019 using an age-period-cohort framework. RESULTS: The age-standardized incidence rate (ASIR) of NPC increased by 72.7% and age-standardized mortality rate (ASMR) of NPC decreased by 51.7% for both sexes between 1990 and 2019. For males, the local drift for incidence was higher than 0 (P < 0.05) in those aged 20 to 79 years. For females, the local drift was higher than 0 (P < 0.05) in those aged 30 to 59 years, and lower than 0 (P < 0.05) in those aged 65 to 84 years. The local drift for mortality rates were less than 0 (P < 0.05) in every age group for both sexes. The estimated period relative risks (RRs) for incidence of NPC were increased monotonically for males, and increased for females after 2000. The increasing trend of cohort RRs of incidence was ceased in recent birth cohorts. Both period and cohort effects of NPC mortality in China decreased monotonically. CONCLUSIONS: Over the last three decades, the ASMR and crude mortality rate (CMR) of NPC has decreased, but the ASIR and crude incidence rate (CIR) increased in China. Although the potential mortality risk of NPC decreased, the risk of NPC incidence was found to increase as the period move forward, and suggested that control and prevention efforts should be enhanced.

The Effectiveness of Plaza Dancing on Psychological Well-Being and Ill-Being: A Systematic Review and Meta-Analysis.

Evidence suggests that participation in plaza dancing may affect mental health. This study for the first time quantified the relationships between plaza dancing and psychological well-being and ill-being. We systematically searched PubMed, Web of Science, CNKI, Wanfang, and VIP to identify relevant studies published from the databases since their inception to July 25, 2021. The standardized mean differences (SMDs) of pre-to-post intervention data were calculated in the meta-analysis. Subgroup and meta-regression analyses were performed to test the potential moderating effects of age, outcome classification, measurement instruments, district, publication year, total sample size, and the duration, frequency, and length of the square dance intervention. A total of 25 original articles met all the eligibility criteria and were included in the review, and 17 studies were included in the meta-analysis. The meta-analysis revealed that plaza dancing improved psychological well-being (pooled SMD = 0.76; 95% CI: 0.58, 0.95; I 2 = 86.9%) and reduced psychological ill-being (pooled SMD = -0.84; 95% CI: -1.00, -0.68; I 2 = 64.8%). The study participants' age and district did not seem to affect the effectiveness of the plaza dancing intervention. The duration and frequency of plaza dancing affected the association between square dance and psychological well-being (duration, ß = -0.044; 95% CI: -0.085, -0.004; frequency, ß = 0.122; 95% CI: 0.024, 0.221) and psychological ill-being (duration, ß = -0.029; 95% CI: -0.040, -0.018; frequency, ß = 0.154; 95% CI: 0.030, 0.278). Plaza dancing has a significant positive effect on psychological well-being and psychological ill-being, and the effects are moderated by intervention modality. Generalizing plaza dancing interventions to promote psychological well-being and prevent or treat psychological ill-being is needed. Systematic Review Registration: [www.crd.york.ac.uk/prospero], identifier [CRD42021272016].

Low- and middle-income countries demonstrate rapid growth of type 2 diabetes: an analysis based on Global Burden of Disease 1990-2019 data.

AIMS/HYPOTHESIS: The study aims to quantify the global trend of the disease burden of type 2 diabetes caused by various risks factors by country income tiers. METHODS: Data on type 2 diabetes, including mortality and disability-adjusted life years (DALYs) during 1990-2019, were obtained from the Global Burden of Disease Study 2019. We analysed mortality and DALY rates and the population attributable fraction (PAF) in various risk factors of type 2 diabetes by country income tiers. RESULTS: Globally, the age-standardised death rate (ASDR) attributable to type 2 diabetes increased from 16.7 (15.7, 17.5)/100,000 person-years in 1990 to 18.5 (17.2, 19.7)/100,000 person-years in 2019. Similarly, age-standardised DALY rates increased from 628.3 (537.2, 730.9)/100,000 person-years to 801.5 (670.6, 954.4)/100,000 person-years during 1990-2019. Lower-middle-income countries reported the largest increase in the average annual growth of ASDR (1.3%) and an age-standardised DALY rate (1.6%) of type 2 diabetes. The key PAF attributing to type 2 diabetes deaths/DALYs was high BMI in countries of all income tiers. With the exception of BMI, while in low- and lower-middle-income countries, risk factors attributable to type 2 diabetes-related deaths and DALYs are mostly environment-related, the risk factors in high-income countries are mostly lifestyle-related. CONCLUSIONS/INTERPRETATION: Type 2 diabetes disease burden increased globally, but low- and middle-income countries showed the highest growth rate. A high BMI level remained the key contributing factor in all income tiers, but environmental and lifestyle-related factors contributed differently across income tiers. DATA AVAILABILITY: To download the data used in these analyses, please visit the Global Health Data Exchange at http://ghdx.healthdata.org/gbd-2019 .

Is Travel Time Associated with Health Service Utilization in Northwest China? Evidence from Shaanxi Province.

Purpose: Northwest China has a large area, low population density, and few health resources, which makes the utilization of health resources in this region difficult. The objective of this study was to assess utilization of health services and its association with travel time in Shaanxi Province. Patients and Methods: Data were obtained from the fifth Household Health Service Survey of Shaanxi Province conducted in 2013. Binary logistic regression was used to assess the relationship between travel time and health service utilization, and negative binomial regression was conducted to assess the relationship between travel time and the frequency of health service utilization. Results: A total of 42.6% of patients used health services, with a higher use rate among rural residents than among urban residents (47.0% and 27.4%, respectively). A total of 30.9% of patients traveled more than 15 min to the nearest medical facility (33.3% in rural areas and 22.6% in urban areas). A total of 12.4% of patients traveled more than 30 min to the nearest medical facility (15.1% in rural areas and 3.0% in urban areas). Urban residents living farthest from health care facilities (more than 30 min) had a 2.12-fold higher probability of health service utilization and expected to have a health service utilization rate 1.77 times greater than that of residents with a travel time of less than 5 min. Among the rural population, there was no significant correlation between travel time and health service utilization. Conclusion: Urban patients living farthest from hospitals were more likely to use health services and used health services more frequently. This suggests that more attention should be given to urban patients who live far away from health service providers in Shaanxi Province.

How Different Is the Annual Physical Examination of Older Migrants than That of Older Nonmigrants? A Coarsened Exact Matching Study from China.

It has become a top priority to ensure equal rights for older migrants in China. This study aims to explore how different the annual physical examination of older migrants is compared to that of older nonmigrants in China by using a coarsened exact matching method, and to explore the factors affecting annual physical examination among older migrants in China. Data were drawn from the China Migrants Dynamic Survey 2015 and China Health and Retirement Longitudinal Survey 2015. The coarsened exact matching method was used to analyse the difference in the annual physical examination of older migrants and nonmigrants. A logistic regression was used to analyse the factors affecting annual physical examination among older migrants. The annual physical examination of older migrants was 35.6%, which was significantly lower than that of older nonmigrants after matching (Odds ratios = 0.91, p < 0.05). It was affected by education, employment, hukou, household economic status, health, health insurance, main source of income, type of migration, range of migration, years of migration, having health records in local community and number of local friends among older migrants in China. Older migrants adopted negative strategies in annual physical examination compared to older nonmigrants. Active strategies should be made to improve the equity of annual physical examination for older migrants in China.

Prevalence of and Factors Associated With Nutritional Supplement Use Among Older Chinese Adults: A Nationwide Cross-Sectional Study in China.

Objective: This study identified the prevalence of nutritional supplement (NS) use among older Chinese adults and explored the factors associated with NS use in this population. Methods: We used data from 11,089 Chinese men and women aged ≥ 65 years from the 2018 Chinese Longitudinal Healthy Longevity Survey. The chi-square test was used to examine the differences in demographics, health status and lifestyles at different levels. Multivariate logistic regression was used to assess the association between NS use and demographic and lifestyle characteristics. Results: Twelve percent of Chinese adults aged 65 years and above used NS. In terms of the type of supplement used, the most commonly used was calcium (8.49%), followed by protein (2.73%) and multivitamins (2.40%). In terms of demographic characteristics, women, older people, urban residents with other marital status, higher educational level, better living conditions and better lifestyle habits showed a greater use of some kinds of NS to varying degrees. Factors associated with the use of any NS included female gender [OR = 1.71, 95% confidence intervals (95% CI): 1.09-1.44], age 85-94 (OR = 1.30, 95% CI: 1.08-1.58), urban household registration (hukou) (OR = 1.25, 95% CI:1.46-2.00), higher education (primary school and middle school: OR = 1.32, 95% CI:1.14-1.52; high school and above: OR = 1.56, 95% CI:1.25-1.94), average and poor living standard (average: OR = 0.64, 95% CI:0.56-0.73; poor: OR = 0.42, 95% CI:0.32-0.55), poor health status (OR = 1.36, 95% CI:1.13-1.63), former smoking (OR = 1.33, 95% CI:1.11-1.60), and having exercise habits (former exercise: OR = 2.24, 95% CI:1.83-2.74; current exercise: OR = 2.28, 95% CI:2.00-2.61). Women reported taking 2-3 kinds of NSs, and more than 50% of NS users reported taking supplements often. Conclusion: This study provides information on the current prevalence of NS use among older Chinese adults, and it clarifies the association of NS use with demographic, lifestyle and other factors. Providing scientifically based health guidance on NS use for older people is crucial to promoting their health.

Temporal Trends in the Incidence and Disability Adjusted Life Years of Schizophrenia in China Over 30 Years.

Background: Schizophrenia is an important public health problem in China. This study aims to assess the long-term trends in the incidence and disability-adjusted life years (DALYs) rate of schizophrenia in China between 1990 and 2019. Methods: The incidence and DALYs data were drawn from the Global Burden of Disease Study 2019, and an age-period-cohort model was used in the analysis. Results: The age-standardized incidence rate (ASIR) and age-standardized DALYs rate (ASDR) of schizophrenia increased by 0.3 and 3.7% for both sexes between 1990 and 2019. For males, the local drift for incidence was higher than 0 (P < 0.05) in those aged 10 to 29 years (local drifts, 0.01 to 0.26%) and lower than 0 (P < 0.05) in those aged 35 to 74 years (local drifts, -1.01 to -0.06%). For females, the local drift was higher than 0 (P < 0.05) in those aged 10 to 34 years (local drifts, 0.05 to 0.26%) and lower than 0 (P < 0.05) in those aged 40 to 74 years (local drifts, -0.86 to -0.11%). The local drift for DALYs rate was higher than 0 (P < 0.05) in the age group from 10 to 69 years (local drifts, 0.06 to 0.26% for males and 0.06 to 0.28% for females). The estimated period and cohort relative risks (RR) for DALYs rate of schizophrenia were found in monotonic upward patterns, and the cohort RR for the incidence increased as the birth cohort moved forward starting with those born in 1972. Conclusion: Although the crude incidence of schizophrenia has decreased in China, the ASIR, ASDR, and crude DALYs rate all showed a general increasing trend over the last three decades. The DALYs rate continue to increase as the birth cohort moved forward, and the increasing trend of incidence was also found in individuals born after 1972. More efforts are needed to promote mental health in China.