[Potential Ecological Risk Assessment of Soil Heavy Metals in Fengdong New District Based on Information Diffution Model].

The large-scale construction of new districts has led to severe soil heavy metal pollution. Therefore, taking Fengdong New District as the target research area, the descriptive statistics of heavy metal content characteristics and Kriging interpolation analysis have been conducted, and the potential ecological risk index and information diffusion theory were further combined to create an information diffusion model based on risk assessment. Finally, the pollution degree, ecological risk, and risk occurrence probability of Pb, Cu, Cd, and Hg were discussed. The findings revealed that the average concentrations of the four heavy metals far exceeded the background value of soil heavy metals by a factor of 1.943 (Pb), 1.419 (Cu), 3.074 (Cd), and 3.567 (Hg), respectively. Moreover, the distribution of soil heavy metals showed strong variability(CV>65%)owing to human interference. The distribution of Pb and Cu pollution were predominantly influenced by industrial production and land development for construction purposes, whereas industrial activities, agricultural practices, and transportation served as the primary sources of Cd contamination. On the other hand, industrial construction emerged as the major factor contributing to Hg pollution. The average values of individual potential ecological risk index for heavy metals of 9.716 (Pb), 7.095 (Cu), 92.292 (Cd), and 142.469 (Hg), coupled with the regional comprehensive potential ecological risk index (RI) average of 251.573, signified that the region was overall characterized by a relatively high potential ecological risk status. The overall potential ecological risk for Pb and Cu in the region were mild, whereas Cd and Hg posed moderate to high risks, indicating that Cd and Hg were the dominant driving factors behind regional heavy metal pollution. The evaluation results of the information diffusion model based on the potential ecological risk indicated that the probability ranking of different levels of comprehensive potential ecological risk was as follows:slightly high (38.98%) > moderate (38.55%) > high (5.89%) > slight (5.15%) > extremely high (3.56%). The exceeding probabilities of potential ecological risk levels for Cd and Hg were significantly higher than those for Pb and Cu. The exceeding probability of different pollution levels of Hg were slight (94.89%), moderate (66.85%), slightly high (23.62%), high (3.9%), and extremely high (2%), of which only the surpassing probability of the slight level was lower than that of Cd. The prediction error of pollution probability of each potential ecological risk level was less than 5%, demonstrating the reliability of the information diffusion model based on the risk assessment. This research will provide technical reference and support for the monitoring and management of potential ecological risks from soil heavy metals in limited sample data regions.

Spatiotemporal characteristics of carbon emissions in Shaanxi, China, during 2012-2019: a machine learning method with multiple variables.

Global warming attributed to the emission of greenhouse gases has caused unprecedented extreme weather events, such as excessive heatwave and rainfall, posing enormous threats to human life and sustainable development. China, as the toppest CO2 emitter in the world, has promised to achieve carbon emission peak by 2030. However, it is difficult to estimate county-level carbon emissions in China because of the lack of statistical data. Previous studies have established relationship between carbon emission and nighttime light; however, using only nighttime light for carbon emission modeling ignores the impact of natural or other socioeconomic factors on emissions. In this paper, we adopted the back propagation neural network to estimate carbon emissions at county level in Shaanxi, China, using nighttime light, Normalized Difference Vegetation Index, precipitation, land surface temperature, elevation, and population density. Trend analysis, spatial autocorrelation, and standard deviation ellipse were employed to analyze the spatiotemporal distributions of carbon emission during 2012-2019. Three metrics (R2, root mean square error, and mean absolute error) were adopted to validate the accuracy of the proposed model, with the values of 0.95, 1.30, and 0.58 million tons, respectively, demonstrating a comparable estimation performance. The results present that carbon emissions in Shaanxi Province rise from 256.73 in 2012 to 305.87 million tons in 2019, formatting two hotspots in Xi'an and Yulin city. The proposed model can estimate carbon emissions of Shaanxi Province at a finer scale with an acceptable accuracy, which can be efficiently applied in other spatial or temporal domains after being localized, providing technical supports for carbon reduction.

Racial, Ethnic, and Rural Disparities in US Veteran COVID-19 Vaccine Rates.

Background: Race, ethnicity, and rurality-related disparities in coronavirus disease 2019 (COVID-19) vaccine uptake have been documented in the United States (US). Objective: We determined whether these disparities existed among patients at the Department of Veterans Affairs (VA), the largest healthcare system in the US. Design Settings Participants Measurements: Using VA Corporate Data Warehouse data, we included 5,871,438 patients (9.4% women) with at least one primary care visit in 2019 in a retrospective cohort study. Each patient was assigned a single race/ethnicity, which were mutually exclusive, self-reported categories. Rurality was based on 2019 home address at the zip code level. Our primary outcome was time-to-first COVID-19 vaccination between December 15, 2020-June 15, 2021. Additional covariates included age (in years), sex, geographic region (North Atlantic, Midwest, Southeast, Pacific, Continental), smoking status (current, former, never), Charlson Comorbidity Index (based on ≥1 inpatient or two outpatient ICD codes), service connection (any/none, using standardized VA-cutoffs for disability compensation), and influenza vaccination in 2019-2020 (yes/no). Results: Compared with unvaccinated patients, those vaccinated (n=3,238,532; 55.2%) were older (mean age in years vaccinated=66.3, (standard deviation=14.4) vs. unvaccinated=57.7, (18.0), p<.0001)). They were more likely to identify as Black (18.2% vs. 16.1%, p<.0001), Hispanic (7.0% vs. 6.6% p<.0001), or Asian American/Pacific Islander (AA/PI) (2.0% vs. 1.7%, P<.0001). In addition, they were more likely to reside in urban settings (68.0% vs. 62.8, p<.0001). Relative to non-Hispanic White urban Veterans, the reference group for race/ethnicity-urban/rural hazard ratios reported, all urban race/ethnicity groups were associated with increased likelihood for vaccination except American Indian/Alaskan Native (AI/AN) groups. Urban Black groups were 12% more likely (Hazard Ratio (HR)=1.12 [CI 1.12-1.13]) and rural Black groups were 6% more likely to receive a first vaccination (HR=1.06 [1.05-1.06]) relative to white urban groups. Urban Hispanic, AA/PI and Mixed groups were more likely to receive vaccination while rural members of these groups were less likely (Hispanic: Urban HR=1.17 [1.16-1.18], Rural HR=0.98 [0.97-0.99]; AA/PI: Urban HR=1.22 [1.21-1.23], Rural HR=0.86 [0.84-0.88]). Rural White Veterans were 21% less likely to receive an initial vaccine compared with urban White Veterans (HR=0.79 [0.78-0.79]). AI/AN groups were less likely to receive vaccination regardless of rurality: Urban HR=0.93 [0.91-0.95]; AI/AN-Rural HR=0.76 [0.74-0.78]. Conclusions: Urban Black, Hispanic, and AA/PI Veterans were more likely than their urban White counterparts to receive a first vaccination; all rural race/ethnicity groups except Black patients had lower likelihood for vaccination compared with urban White patients. A better understanding of disparities and rural outreach will inform equitable vaccine distribution.

Influence of Urbanization on the Spatial Distribution of Associations Between Air Pollution and Mortality in Beijing, China.

This study investigated the influence of urbanization on the intra-city spatial distribution of associations between air pollution and mortality in Beijing, China. First, we utilized the generalized additive model to establish the exposure-response associations of PM2.5, O3, with nonaccidental and cardiorespiratory mortality between urban and suburban areas. Second, we assessed district-specific air pollution-related mortality and analyzed how these associations were affected by the degree of urbanization. Finally, we analyzed the changes in air pollution-related mortality before and after the enforcement of the Air Pollution Prevention and Control Action Plan (referred to as the Action Plan). The effect estimates of PM2.5 for nonaccidental mortality were 0.20% (95% CI: 0.12-0.28) in urban areas and 0.46% (95% CI: 0.35-0.58) in suburban areas per 10 µg/m3 increase in PM2.5 concentrations. The corresponding estimates of O3 were 0.13% (95% CI: -0.04-0.29) in urban areas and 0.34% (95% CI: 0.12-0.56) in suburban areas per 10 µg/m3 increase in O3 concentrations; however, the difference between the estimates of O3 in urban and suburban areas was not statistically significant. The district-specific results suggested that the estimated risks increased along with urban vulnerability levels for the effects of PM2.5. Implementing the Action Plan reduced the mortality risks of PM2.5, but the risks of O3 increased in some districts. However, the difference in the estimates between the pre- and post-emission reductions was not statistically significant. Our study indicated that populations living in less urbanized areas are more vulnerable to the adverse effects of air pollution in Beijing, particularly for PM2.5.

Catastrophic health expenditure among Chinese adults living alone with cognitive impairment: findings from the CHARLS.

BACKGROUND: The catastrophic health expenditure of older adults results in serious consequences; however, the issue of whether cognitive status and living situations contribute to such financial burdens is uncertain. Our aim was to compare the differences in catastrophic health expenditure between adults living alone with cognitive impairment and those adults living with others and with normal cognition. METHODS: We identified 909 observations of participants living alone with cognitive impairment (cases) and 37,432 observations of participants living with others and with normal cognition (comparators) from the 2011/2012, 2013, 2015 and 2018 waves of the China Health and Retirement Longitudinal Study (CHARLS). We used propensity score matching (1:2) to create matched cases and comparators in a covariate-adjusted logistic regression analysis. Catastrophic health expenditure was defined as an out-of-pocket cost for health care ≥40% of a household's capacity to pay. RESULTS: In comparison with participants living with others and with normal cognition, those adults living alone with cognitive impairment reported a higher percentage of catastrophic health expenditure (19.5% vs. 11.8%, respectively, P < 0.001). When controlling for age, sex, education, marital status, residence areas, alcohol consumption, smoking status and disease counts, we found that this subpopulation had significantly higher odds of having catastrophic health expenditure (odds ratio [OR] = 1.89, 95% confidence interval [CI]: 1.40, 2.56). Additional analyses confirmed the robustness of the results. CONCLUSIONS: This study demonstrated that adults living alone with cognitive impairment in the CHARLS experienced a high burden of catastrophic health expenditure. Health care policies on social health insurance and medical assistance should consider these vulnerable adults.

Multidimensional Collaborative Management of Environment and Economy in the Internet-of-Things Environment.

In this study, multidimensional collaborative management of the modern environmental economy is proposed for strategic management, distribution management, service quality management, and warehouse management, which the modern environmental economy enterprises face under the internet-of-things environment. This study studies the law of multidimensional coordination of environmental economy and puts forward the classification of the modern multidimensional coordination of environmental economy. The multidimensional synergetic-order parameter equation of the modern environmental economic system is constructed, and the information synergy is the order parameter of the environmental economic system by accurate elimination method, and the fluctuation and balance of the environmental economic system are accurately controlled by the order parameter. By using structural equation modeling and other quantitative research methods, the corresponding planning and decision-making mathematical model is established, which provides relevant support for the realization of informatization and intelligentization of multidimensional collaborative management of the environment and economy. An incentive internal management collaboration model based on right of entry is proposed. Aiming at the problem of multidimensional environmental economic management coordination, a dynamic multidimensional environmental economic coordination management algorithm was designed by using the decomposition method, and the effectiveness of the algorithm was verified by numerical experiments.

Aggressive End-of-Life Care in the Veterans Health Administration versus Fee-for-Service Medicare among Patients with Advanced Lung Cancer.

Background: Unlike fee-for-service Medicare, the Veterans Health Administration (VHA) allows for the provision of concurrent care, incorporating cancer treatment while in hospice. Methods: We compared trends of aggressive care at end of life between Medicare and VHA decedents with advanced nonsmall cell lung cancer from 2006 to 2012, and the relation between regional level end-of-life care between Medicare and VHA beneficiaries. Results: Among 18,371 Veterans and 25,283 Medicare beneficiaries, aggressive care at end of life decreased 15% in VHA and 4% in SEER (Surveillance, Epidemiology, and End Results)-Medicare (p < 0.001). Hospice use significantly increased within both cohorts (VHA 28%-41%; SM 60%-73%, p < 0.001). Veterans receiving care in regions with higher hospice admissions among Medicare beneficiaries were significantly less likely to receive aggressive care at end of life (adjusted odds ratio: 0.13, 95% confidence interval: 0.08-0.23, p < 0.001). Conclusions: Patients receiving lung cancer care in the VHA had a greater decline in aggressive care at end of life, perhaps due to increasing concurrent care availability.

[Distribution Characteristics of Heavy Metals in Farmland Soils Around Mining Areas and Pollution Assessment].

In order to explore the spatial distribution and ecological risk of heavy metals in farmland soil around Tongguan Mining area, surface soil samples from Tongguan Mining area were collected in September 2020, and the contents and distribution characteristics of eight heavy metals (Pb, Cu, Cd, Hg, Cr, Ni, Zn, and As) in the samples were analyzed. The Nemerow comprehensive pollution index and potential ecological risk index were used to evaluate soil pollution. The results showed that the contents of the eight types of heavy metal elements in this area exceeded the standard, and the exceeding rates were 97.91%, 84.79%, 100%, 95.41%, 96.87%, 98.54%, 91.45%, and 28.95%, respectively. The variation coefficients of the eight heavy metals were ranked as Hg>Pb>Cu>Cd>Zn>As>Ni>Cr. The variation coefficients of Hg, Pb, Cu, Cd, and Zn were all greater than 1. Correlation analysis showed that these five heavy metals were obviously correlated. In terms of spatial distribution, Pb, Cd, Cu, Hg, Zn, and As were distributed in patches, whereas Cr and Ni were distributed in flakes. The high values of Hg, Cd, Pb, Cu, and Zn were mainly distributed in the southern and central part of the study area. The comprehensive pollution of Nemerow showed that the severe pollution rate reached 87.91%, and the moderate pollution rate and the mild pollution rate were 9.58% and 2.5%, respectively; thus, the overall pollution was severe. The potential ecological risk index showed that Hg, Cd, Pb, and Cu were the main risk elements. The total potential ecological risk index showed that the proportion of samples with strong pollution was 97.08%, and the proportion of extremely strongly, very strongly, and strongly polluted samples were 55.63%, 27.08%, and 14.37%, respectively, indicating that the overall potential ecological risk in the study area was very strong. Combining the two pollution assessment methods, it can be seen that the heavy metal pollution around Tongguan mining area, primarily by Hg, Cd, and Pb, was serious. These results can provide data support for regional pollution control, soil remediation, and ecological protection. It is suggested that the state of soil heavy metal pollution and its transformation in various media should be monitored continuously in the future.

Association Between Neighborhood Disadvantage and Functional Well-being in Community-Living Older Persons.

Importance: Neighborhood disadvantage is a novel social determinant of health that could adversely affect the functional well-being of older persons. Deficiencies in resource-poor environments can potentially be addressed through social and public health interventions. Objective: To evaluate whether estimates of active and disabled life expectancy differ on the basis of neighborhood disadvantage after accounting for individual-level socioeconomic characteristics and other prognostic factors. Design, Setting, and Participants: This prospective longitudinal cohort study included 754 nondisabled community-living persons, aged 70 years or older, who were members of the Precipitating Events Project in south central Connecticut from March 1998 to June 2020. Main Outcomes and Measures: Disability in 4 essential activities of daily living (bathing, dressing, walking, and transferring) was assessed each month. Scores on the Area Deprivation Index, a census-based socioeconomic measure with 17 education, employment, housing quality, and poverty indicators, were obtained through linkages with the 2000 Neighborhood Atlas. Area Deprivation Index scores were dichotomized at the 80th state percentile to distinguish neighborhoods that were disadvantaged (81-100) from those that were not (1-80). Results: Among the 754 participants, the mean (SD) age was 78.4 (5.3) years, and 487 (64.6%) were female. Within 5-year age increments from 70 to 90, active life expectancy was consistently lower in participants from neighborhoods that were disadvantaged vs not disadvantaged, and these differences persisted and remained statistically significant after adjustment for individual-level race and ethnicity, education, income, and other prognostic factors. At age 70 years, adjusted estimates (95% CI) for active life expectancy (in years) were 12.3 (11.5-13.1) in the disadvantaged group and 14.2 (13.5-14.7) in the nondisadvantaged group. At each age, participants from disadvantaged neighborhoods spent a greater percentage of their projected remaining life disabled, relative to those from nondisadvantaged neighborhoods, with adjusted values (SE) ranging from 17.7 (0.8) vs 15.3 (0.5) at age 70 years to 55.0 (1.7) vs 48.1 (1.3) at age 90 years. Conclusions and Relevance: In this prospective longitudinal cohort study, living in a disadvantaged neighborhood was associated with lower active life expectancy and a greater percentage of projected remaining life with disability. By addressing deficiencies in resource-poor environments, new or expanded social and public health initiatives have the potential to improve the functional well-being of community-living older persons and, in turn, reduce health disparities in the US.

Recent trends in premature mortality and health disparities attributable to ambient PM2.5 exposure in China: 2005-2017.

In the past decade, particulate matter with aerodynamic diameter less than 2.5 µm (PM2.5) has reached unprecedented levels in China and posed a significant threat to public health. Exploring the long-term trajectory of the PM2.5 attributable health burden and corresponding disparities across populations in China yields insights for policymakers regarding the effectiveness of efforts to reduce air pollution exposure. Therefore, we examine how the magnitude and equity of the PM2.5-related public health burden has changed nationally, and between provinces, as economic growth and pollution levels varied during 2005-2017. We derive long-term PM2.5 exposures in China from satellite-based observations and chemical transport models, and estimate attributable premature mortality using the Global Exposure Mortality Model (GEMM). We characterize national and interprovincial inequality in health outcomes using environmental Lorenz curves and Gini coefficients over the study period. PM2.5 exposure is linked to 1.8 (95% CI: 1.6, 2.0) million premature deaths over China in 2017, increasing by 31% from 2005. Approximately 70% of PM2.5 attributable deaths were caused by stroke and IHD (ischemic heart disease), though COPD (chronic obstructive pulmonary disease) and LRI (lower respiratory infection) disproportionately affected poorer provinces. While most economic gains and PM2.5-related deaths were concentrated in a few provinces, both gains and deaths became more equitably distributed across provinces over time. As a nation, however, trends toward equality were more recent and less clear cut across causes of death. The rise in premature mortality is due primarily to population growth and baseline risks of stroke and IHD. This rising health burden could be alleviated through policies to prevent pollution, exposure, and disease. More targeted programs may be warranted for poorer provinces with a disproportionate share of PM2.5-related premature deaths due to COPD and LRI.

Inversion and distribution of total suspended matter in water based on remote sensing images-A case study on Yuqiao Reservoir, China.

In this paper, Yuqiao Reservoir is taken as the research object. The total suspended matter (TSM) produced by the economic development in the upper reaches of the reservoir and its surrounding areas has brought great ecological harm to the safe operation of the reservoir. Satellite remote sensing technology provides a good way to obtain the temporal and spatial variation of TSM in the study area. Two field surveys were carried out in the Yuqiao Reservoir, a total of 44 sampling points collected in the two tests. The spectral data and concentration of TSM were obtained. We developed and validated a robust empirical model to estimate the concentration of TSM in the water of the Yuqiao Reservoir for the first time. The TSM distribution map of the Yuqiao Reservoir in 2013-2018 is retrieved based on Landsat 8 OLI images. This paper analyzes the spatial distribution characteristics of TSM concentration in the Yuqiao Reservoir for several years, as well as the interannual, seasonal, and monthly variation laws and development trends. The results show that the spatial distribution of TSM in Yuqiao Reservoir shows a decreasing trend from the periphery to the center; the interannual changes are mainly as follows: The annual change trend of TSM in Yuqiao Reservoir is not obvious; the seasonal changes are significant: the highest in summer (higher than 40 mg/L), the second in autumn, and the lowest in spring and winter (lower than 15 mg/L); and the monthly changes show regular fluctuations: In a year cycle, the concentration of TSM generally shows an inverted V-shaped trend; that is, TSM increases gradually from January to August and decreases gradually from August to December. The research results of this paper can be applied to other similar types of land water bodies, which will promote the wide application of Landsat 8 OLI images in the monitoring of TSM in lakes, rivers, and reservoirs in different regions across China, and provide data support for the scientific management of the safe operation of research areas. PRACTITIONER POINTS: The monitoring model of TSM in Yuqiao Reservoir was built for the first time. Temporal and spatial analysis of TSM concentration in Yuqiao Reservoir for the first time. The concentration of TSM is in Yuqiao Reservoir greatly affected by wind speed and precipitation.

Risk Factors and Precipitants of Severe Disability Among Community-Living Older Persons.

Importance: Severe disability greatly diminishes quality of life and often leads to a protracted period of long-term care or death, yet the processes underlying severe disability have not been fully evaluated. Objective: To evaluate potential risk factors and precipitants associated with severe disability that develops progressively (during ≥2 months) vs catastrophically (from 1 month to the next). Design, Setting, and Participants: Prospective cohort study conducted in greater New Haven, Connecticut, from March 1998 to December 2016, with 754 nondisabled community-living persons aged 70 years or older. Data analysis was conducted from November 2018 to May 2019. Main Outcomes and Measures: Candidate risk factors were assessed every 18 months. Functional status and potential precipitants, including illnesses or injuries leading to hospitalization, emergency department visit, or restricted activity, were assessed each month. Severe disability was defined as the need for personal assistance with at least 3 of 4 essential activities of daily living. The analysis was based on person-months within 18-month intervals. Results: The mean (SD) age for the 754 participants was 78.4 (5.3) years, 487 (64.6%) were women, and 683 (90.5%) were non-Hispanic white participants. The incidence of progressive and catastrophic severe disability was 3.5% and 9.7%, respectively, based on 3550 intervals. In multivariable analysis, 6 risk factors were independently associated with progressive disability (≥85 years: hazard ratio [HR], 1.6; 95% CI, 1.1-2.4; hearing impairment: HR, 1.7; 95% CI, 1.0-2.8; frailty: HR, 2.4; 95% CI, 1.6-3.7; cognitive impairment: HR, 2.0; 95% CI, 1.3-3.1; low functional self-efficacy: HR, 1.8; 95% CI, 1.2-2.8; low peak flow: HR, 1.7; 95% CI, 1.2-2.4), and 4 were independently associated with catastrophic disability (visual impairment: HR, 1.4; 95% CI, 1.1-1.8; hearing impairment: HR, 1.3; 95% CI, 1.0-1.7; poor physical performance: HR, 1.8; 95% CI, 1.3-2.5; low peak flow: HR, 1.3; 95% CI, 1.0-1.7). The associations of the precipitants were much more pronounced than those of the risk factors, with HRs as high as 321.4 (95% CI, 194.5-531.0) for hospitalization and catastrophic disability and 48.3 (95% CI, 31.0%-75.4%) for hospitalization and progressive disability. Elimination of an intervening hospitalization was associated with a decrease in the risk of progressive and catastrophic severe disability of 3.0% (95% CI, 3.0%-3.1%) and 12.3% (95% CI, 12.1%-12.5%), respectively. Risk differences were 0.6% (95% CI, 0.6%-0.6%) and 1.3% (95% CI, 1.3%-1.4%) for emergency department visit and 0.1% (95% CI, 0.1%-0.2%) and 0.4% (95% CI, 0.4%-0.4%) for restricted activity, and ranged from 0.1% (95% CI, 0.1%-0.1%) to 0.3% (95% CI, 0.3%-0.3%) for the independent risk factors, for progressive and catastrophic disability, respectively. Conclusions and Relevance: The findings of this study suggest that whether it develops progressively or catastrophically, severe disability among older community-living adults arises most commonly in the setting of an intervening illness or injury. To reduce the burden of severe disability, more aggressive efforts will be needed to prevent and manage intervening illnesses or injuries and to facilitate recovery after these debilitating events.

Prevalence and Patterns of Multimorbidity in a Nationally Representative Sample of Older Chinese: Results From the China Health and Retirement Longitudinal Study.

BACKGROUND: Multimorbidity has become a prominent problem worldwide; however, few population-based studies have been conducted among older Chinese with multimorbidity. This study aimed to examine the prevalence of multimorbidity and explore its common patterns among a nationally representative sample of older Chinese. METHODS: This study used data from the China Health and Retirement Longitudinal Study and included 19,841 participants aged at least 50 years. The prevalence of individual chronic diseases and multimorbidity during 2011-2015 were evaluated among the entire cohort and according to residential regions and gender. The relationships between participants' demographic characteristics and multimorbidity were examined using logistic regression model. Patterns of multimorbidity were explored using hierarchical cluster analysis and association rule mining. RESULTS: Multimorbidity occurred in 42.4% of the participants. The prevalence of multimorbidity was higher among women (odds ratio [OR] = 1.31, 95% confidence interval [CI]: 1.13-1.51) and urban residents (OR = 1.14, 95% CI: 1.02-1.27) than their respective counterparts after accounting for potential confounders of age, education, smoking, and alcohol consumption. Hierarchical cluster analysis revealed four common multimorbidity patterns: the vascular-metabolic cluster, the stomach-arthritis cluster, the cognitive-emotional cluster, and the hepatorenal cluster. Regional differences were found in the distributions of stroke and memory-related disease. Most combinations of conditions and urban-rural difference in multimorbidity patterns from hierarchical cluster analysis were also observed in association rule mining. CONCLUSION: The prevalence and patterns of multimorbidity vary by gender and residential regions among older Chinese. Women and urban residents are more vulnerable to multimorbidity. Future studies are needed to understand the mechanisms underlying the identified multimorbidity patterns and their policy and interventional implications.

Homologous and heterologous assessment of a novel biomaterial for venous patch.

OBJECTIVE: This study evaluated swine and bovine pulmonary visceral pleura (PVP) as a vascular patch. Venous patches are frequently used in surgery for repair or reconstruction of veins. Autologous patches are often limited by the number and dimension of donor tissue and can result in donor complications. Bovine pericardium is the most common heterologous patch used by vascular surgeons. Researchers, however, are continually seeking to improve heterologous and synthetic patches for improved outcome. METHODS: The PVP was peeled from swine and bovine lungs and cross-linked with glutaraldehyde. After sterilization and rinsing, the PVP patches were implanted in the jugular vein (10 × 35 mm) of pigs and dogs. Patency was evaluated by ultrasound, and animals were euthanized at 2 and 4 months. Neoendothelium and neomedia were evaluated by histologic analysis. RESULTS: The jugular vein patched by PVP in pigs and dogs remained patent at 2 and 4 months with no adhesions, inflammation, or aneurysm in the patches. The biomarkers of endothelial cells-factor VIII, platelet/endothelial cell adhesion molecule 1, and endothelial nitric oxide synthase-were detected in the neoendothelial cells. The expression of vascular smooth muscle cell (VSMC) α-actin was robust in the neomedia at 2 and 4 months. Neomedia composed of VSMCs developed to nearly double the thickness of adjacent jugular vein. The circumferential orientation of VSMCs in neomedia further increased in the 4-month group. CONCLUSIONS: The cross-linked swine and bovine PVP patch has a nonthrombogenic surface that maintains patency. The PVP patch may overcome the pitfall of compliance mismatch of synthetic patches. The proliferation of vascular cells assembled in the neoendothelium and neomedia in the patches may support long-term patency.

Are China's oldest-old living longer with less disability? A longitudinal modeling analysis of birth cohorts born 10 years apart.

BACKGROUND: China has transitioned from being one of the fastest-growing populations to among the most rapidly aging countries worldwide. In particular, the population of oldest-old individuals, those aged 80+, is projected to quadruple by 2050. The oldest-old represent a uniquely important group-they have high demand for personal assistance and the highest healthcare costs of any age group. Understanding trends in disability and longevity among the oldest-old-that is, whether successive generations are living longer and with less disability-is of great importance for policy and planning purposes. METHODS: We utilized data from successive birth cohorts (n = 20,520) of the Chinese oldest-old born 10 years apart (the earlier cohort was interviewed in 1998 and the later cohort in 2008). Disability was defined as needing personal assistance in performing one or more of five essential activities (bathing, transferring, dressing, eating, and toileting) or being incontinent. Participants were followed for age-specific disability transitions and mortality (in 2000 and 2002 for the earlier cohort and 2011 and 2014 for the later cohort), which were then used to generate microsimulation-based multistate life tables to estimate partial life expectancy (LE) and disability-free LE (DFLE), stratified by sex and age groups (octogenarians, nonagenarians, and centenarians). We additionally explored sociodemographic heterogeneity in LE and DFLE by urban/rural residence and educational attainment. RESULTS: More recently born Chinese octogenarians (born 1919-1928) had a longer partial LE between ages 80 and 89 than octogenarians born 1909-1918, and octogenarian women experienced an increase in partial DFLE of 0.32 years (P = 0.004) across the two birth cohorts. Although no increases in partial LE were observed among nonagenarians or centenarians, partial DFLE increased across birth cohorts, with a gain of 0.41 years (P < 0.001) among nonagenarians and 0.07 years (P = 0.050) among centenarians. Subgroup analyses revealed that gains in partial LE and DFLE primarily occurred among the urban resident population. CONCLUSIONS: Successive generations of China's oldest-old are living with less disability as a whole, and LE is expanding among octogenarians. However, we found a widening urban-rural disparity in longevity and disability, highlighting the need to improve policies to alleviate health inequality throughout the population.

Assessment of Landslide Susceptibility Using Integrated Ensemble Fractal Dimension with Kernel Logistic Regression Model.

The main aim of this study was to compare and evaluate the performance of fractal dimension as input data in the landslide susceptibility mapping of the Baota District, Yan'an City, China. First, a total of 632 points, including 316 landslide points and 316 non-landslide points, were located in the landslide inventory map. All points were divided into two parts according to the ratio of 70%:30%, with 70% (442) of the points used as the training dataset to train the models, and the remaining, namely the validation dataset, applied for validation. Second, 13 predisposing factors, including slope aspect, slope angle, altitude, lithology, mean annual precipitation (MAP), distance to rivers, distance to faults, distance to roads, normalized differential vegetation index (NDVI), topographic wetness index (TWI), plan curvature, profile curvature, and terrain roughness index (TRI), were selected. Then, the original numerical data, box-counting dimension, and correlation dimension corresponding to each predisposing factor were calculated to generate the input data and build three classification models, namely the kernel logistic regression model (KLR), kernel logistic regression based on box-counting dimension model (KLRbox-counting), and the kernel logistic regression based on correlation dimension model (KLRcorrelation). Next, the statistical indexes and the receiver operating characteristic (ROC) curve were employed to evaluate the models' performance. Finally, the KLRcorrelation model had the highest area under the curve (AUC) values of 0.8984 and 0.9224, obtained by the training and validation datasets, respectively, indicating that the fractal dimension can be used as the input data for landslide susceptibility mapping with a better effect.

Diabetes, Heart Disease, and Dementia: National Estimates of Functional Disability Trajectories.

OBJECTIVES: To estimate the associations between diabetes, heart disease, and dementia, which may increase the difficulty of self-care; model functional disability trajectories jointly with attrition (death or dropout) over 5 years. DESIGN: Population-based complex survey design. SETTING: National Health and Aging Trends Study. PARTICIPANTS: Community-dwelling Medicare beneficiaries aged 65 and older (N=7,609). MEASUREMENTS: National estimates were generated using sampling weights. Sociodemographic characteristics, self-reported physician-diagnosed chronic conditions, six activities of daily living (ADL), and cognitive status were ascertained in annual in-person interviews. A joint model using group-based trajectory modeling was used to estimate the number of ADL disabilities and attrition probability. Multinomial logistic regression with survey weights was used to estimate the association between diabetes, heart disease, and dementia and resultant trajectories of disability, with the least disabled trajectory used as a reference. RESULTS: Three functional disability trajectories were identified: 26.9 million (76.3%) individuals with no disability and a constant study attrition of 14.3%, 4.9 million (13.9%) with mild and increasing disability and 12% attrition in 2012 and 27.2% in 2015, and 3.4 million (9.7%) with severe and increasing disability and 25.4% attrition in 2012 and 35% in 2015. Persons with possible dementia, possible dementia and diabetes, or possible dementia with diabetes and heart disease had significantly greater odds of being on the mild disability trajectory than those with no disability. Persons with probable dementia, representing more than 1.5 million persons, regardless of concurrent conditions, had significantly greater odds of being on the severe disability trajectory than on the no disability trajectory. CONCLUSIONS: Methods that generate national estimates and account for attrition and for multiple chronic conditions and cognitive status may be useful for health policy-makers to make decisions on care provisions and services.

Disability Prior to Death Among the Oldest-Old in China.

Background: To estimate the prevalence of disability during the last 3 years prior to death among the oldest-old (≥80 years) in China. Methods: We used data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS), a nationally representative study of the oldest-old in China. The analytic sample included 23,934 decedents who died between 1998 and 2014 and had at least one interview within the last 3 years of life. Disability was defined as being incontinent or needing assistance in performing one or more of five other essential activities (bathing, transferring, dressing, eating, and toileting). Results: About 57.8% (weighted) of the study decedents were female. The prevalence of disability increased modestly from 36 months to 24 months prior to death (20% to 23%), more rapidly from 24-months to 12-months before death (23% to 31%), and substantially from 12 months before death to the last month of life (31% to 48%). The disability rates were lowest for participants who died between 80 and 89 years, intermediate for those who died between 90 and 99 years, and highest for those who died at age 100 or older, although the patterns over the 3-year period were comparable for the three age groups. At each time point prior to death, a higher percentage of women was disabled than men. Conclusions: In this large nationally representative sample of the oldest-old in China, the prevalence of disability during the 3 years prior to death is high and is greater in women than men and those who die at the oldest ages.

Joint Trajectories of Cognition and Frailty and Associated Burden of Patient-Reported Outcomes.

OBJECTIVES: To evaluate joint trajectories of cognition and frailty and their association with the cumulative burden of patient-reported outcomes, including hospitalization, nursing home admission, and disability. DESIGN: Longitudinal study of 754 community-living persons aged 70 or older. PARTICIPANTS: 690 participants who had a baseline and at least one follow-up assessment of cognition and frailty between 1998 and 2009. MEASUREMENTS: Cognition was assessed using the Mini-Mental State Examination (MMSE). Frailty was defined by the 5 criteria for the Fried phenotype: muscle weakness, exhaustion, low physical activity, shrinking, and slow walking speed. A group-based, mixture modeling approach was used to fit the joint trajectories of cognition and frailty. The cumulative burden of hospitalization, nursing home admission, and disability over 141 months associated with the joint trajectories was evaluated using a series of generalized estimating equation Poisson models. RESULTS: Four joint trajectories were identified, including No cognitive frailty (27.8%), Slow cognitive decline and progressive frailty (45.5%), Rapid cognitive decline and progressive frailty (20.2%), and Cognitive frailty (6.5%). For each joint trajectory group, the interval-specific incidence density rates of all patient-reported outcomes tended to increase over time, with the exception of hospitalization for which the increasing trend was apparent only for the Slow cognitive decline and progressive frailty group. The No cognitive frailty group had the lowest cumulative burden of all patient-reported outcomes [eg, nursing home admissions, 7.5/1000 person-months, 95% confidence interval (CI): 4.8-11.7], whereas the Cognitive frailty group had the highest cumulative burden (eg, nursing home admissions, 381.1/1000 person-months, 95% CI: 294.5-493.1), with the exception of hospitalization. Compared with the No cognitive frailty group, the 3 other joint trajectory groups all had significantly greater burden of the patient-reported outcomes. CONCLUSION: Community-living older persons exhibit distinct joint trajectories of cognition and frailty and experience an increasing burden of nursing home admission and disability as they age, with the greatest burden for those on a cognitive frailty trajectory.

Distressing Symptoms, Disability, and Hospice Services at the End of Life: Prospective Cohort Study.

OBJECTIVES: To evaluate the relationship between the presence and number of restricting symptoms and number of disabilities and subsequent admission to hospice at the end of life. DESIGN: Prospective cohort study. SETTING: Greater New Haven, Connecticut, from March 1998 to December 2014. PARTICIPANTS: Decedents from a cohort of 754 persons aged 70 and older (N = 562). MEASUREMENTS: Hospice admissions were identified primarily from Medicare claims, and 15 restricting symptoms and disability in 13 activities were assessed during monthly interviews. RESULTS: During their last year of life, 244 (43.4%) participants were admitted to hospice. The median duration of hospice was 12.5 days (interquartile range 4-43 days). Although the largest increases were observed in the last 2 months of life, the prevalence of restricting symptoms and mean number of restricting symptoms and disabilities in the preceding months were high and trending upward. During a specific month, the likelihood of hospice admission increased by 66% (adjusted hazard ratio (aHR) = 1.66, 95% confidence interval (CI) = 1.30-2.12) in the setting of any restricting symptoms, by 9% (aHR = 1.09, 95% CI = 1.05-1.12) for each additional restricting symptom, and by 10% (aHR = 1.10, 95% CI = 1.05-1.14) for each additional disability. Each additional month with any restricting symptoms increased the likelihood of hospice admission by 7% (aHR = 1.07, 95% CI = 1.01-1.13). CONCLUSION: Hospice services appear to be suitably targeted to older persons with the greatest needs at the end of life, although the short duration of hospice suggests that additional strategies are needed to better address the high burden of distressing symptoms and disability at the end of life.