Rural-urban difference in the association between particulate matters and stroke incidence: The evidence from a multi-city perspective cohort study.

Available evidence suggests that air pollutants can cause stroke, but little research has investigated the confounding effects of urban-rural differences. Here, we investigated the urban-rural difference in the correlation between particulate matter (PM2.5 and PM10) exposure and stroke. This cohort study was based on a prospective multi-city community-based cohort (Guizhou Population Health Cohort Study (GPHCS)) in Guizhou Province, China. A total of 7988 eligible individuals (≥18 years) were enrolled with baseline assessments from November 2010 to December 2012, and follow-up was completed by June 2020. Two major particulate matters (PMs, including PM2.5 and PM10) were assessed monthly from 2000 by using satellite-based spatiotemporal models. The risk of stroke was estimated using a Cox proportional hazard regression model. The association between particulate matters' exposure and stroke in different areas (total, urban, and rural) and the potential modification effect of comorbidities (hypertension, diabetes, and dyslipidemia) and age (≤65/>65 years) were examined using stratified analyses. The risk of stroke increased for every 10 µg/m3 increase in mean PMs' concentrations during the previous 1 year at the residential address (HR: 1.26, 95%CI: 1.24, 1.29 (PM2.5); HR: 1.13, 95%CI: 1.11, 1.15 (PM10)). The presence of diabetes and dyslipidemia increased the risk of PM10-induced stroke in whole, urban, and rural areas. Specifically, people living in rural areas were more likely to experience the effects of PMs in causing a stroke. The risk of stroke due to PMs was statistically increased in the young and older populations living in rural areas. In conclusion, long-term exposure to PMs increased the risk of stroke and such association was more pronounced in people living in rural areas with lower income levels. Diabetes and dyslipidemia seemed to strengthen the association between PMs and stroke.

[Differences in the Elderly Care Service Demand,Preference,and Tendency Between Urban and Rural Areas in the Pearl River Delta].

Objective To understand the differences in the demand,preference,and tendency for elderly care services between urban and rural areas in the Pearl River Delta (PRD),and to provide reference for the planning and balanced allocation of elderly care resources in urban and rural areas. Methods Using the multi-stage stratified random sampling method,we selected 7 community health service centers in 2 prefecture-level cities in the PRD and conducted a questionnaire survey on the elderly care service demand,preference,and tendency among 1919 regular residents aged 60 years and above who attended the centers. Results A total of 641 urban elderly residents (33.4%) and 1278 rural elderly residents (66.6%) were surveyed in the PRD.The urban and rural elderly residents showed differences in the child number (χ2=43.379,P<0.001),willingness to purchase socialized elderly care services (χ2=104.141,P<0.001),and attitudes to the concept of raising child to avoid elderly hardship (χ2=65.632,P<0.001).The proportion (71.8%) of rural elderly residents who prefer family-based elderly care was higher than that (57.1%) of urban elderly residents (χ2=41.373,P<0.001).The proportion (62.2%) of urban elderly residents clearly expressing their willingness to choose institutions for elderly care was higher than that (44.0%) of rural elderly residents (χ2=57.007,P<0.001).Compared with family-based elderly care,the willingness to choose institutional or community-based in-house elderly care was low among the urban elderly residents with surplus monthly household income or balanced income and expenditure;urban males,those with college education background or above,and those who purchased socialized elderly care services tended to prefer community-based in-house elderly care.In rural areas,the elderly residents who had local household registry were prone to choose institutional or community-based in-house elderly care,while those who had more than one child and those who were satisfied with the current living conditions were less willing to choose community-based in-house elderly care. Conclusions It is suggested that the urban-rural differences in the elderly care service demand,preference and tendency should be fully considered in the planning and allocation of urban and rural elderly care resources.Efforts remain to be made to develop diversified social elderly care services tailored to the characteristics of urban and rural areas.

Trend and heterogeneity in forced vital capacity among Chinese students during 1985-2019: results from Chinese National Survey on Students' Constitution and Health.

BACKGROUND: Forced vital capacity (FVC) reflects respiratory health, but the long-term trend and heterogeneity in FVC of Chinese students were understudied. METHODS: Data were from Chinese National Survey on Students' Constitution and Health 1985-2019. Super Imposition by Translation and Rotation model was used to draw FVC growth curves. Sex-, region-, and nationality-heterogeneity in FVC was evaluated. Spearman correlation and generalized additive model was used to reveal influencing factors for FVC. RESULTS: Compared to 1985, age at peak FVC velocity was 1.09, 3.17, 0.74, and 1.87 years earlier for urban male, urban female, rural male, and rural female in 2019, respectively. Peak FVC velocity first decreased and then increased during 1985-2019, only male rebounded to larger than 1985 level. FVC declined from 1985 to 2005 and then raised. Males consistently had higher FVC than females, with disparities increasing in the 13-15 age group. Urban students also had higher FVC than rural students. In 2019, FVC difference between 30 Chinese provinces and the national average showed four scenarios: consistently above national average; less than national average until age 18, then above; greater than national average until age 18, then this advantage reversed; less than national average in almost all the age. Most Chinese ethnic minority students had lower FVC levels compared to Han students. Spearman correlation and generalized additive model showed that age, sex, and height were the leading influencing factors of FVC, followed by socioeconomic and environmental factors. CONCLUSIONS: Chinese students experienced advanced FVC spurt, and there was sex-, region- and nationality-heterogeneity in FVC. Routine measurement of FVC is necessary in less developed areas of China.

Co-exposure and health risks of several typical endocrine disrupting chemicals in general population in eastern China.

Human exposure to endocrine disrupting chemicals (EDCs) is a health concern due to their wide use and interference with the human endocrine system. Parabens, bisphenols, benzophenones, triclosan (TCC), triclocarban (TCS), and tetrabromobisphenol-A (TBBPA) and its derivatives tetrachlorobisphenol-A (TCBPA) and tetrabromobisphenol-S (TBBPS), are typical EDCs that are frequently detected in environmental and human samples. However, only a few studies have assessed the co-exposure of these chemicals in humans. In this study, urine samples were collected from the general population in the city of Wuxi (n = 121) and a county, Taishun (n = 120), eastern China, and analyzed for these EDCs. Parabens, bisphenols, TCS, and benzophenones were frequently detected in urine, whereas TBBPA and its derivatives were not detected. The geometric mean concentrations of parabens, bisphenols, and benzophenones in urine from the Wuxi population were 25.7, 2.45, and 2.34 ng/mL, respectively, which were substantially higher than those from the Taishun population (17.2, 1.70, and 2.65 ng/mL). These results suggest an urban-rural difference in urinary EDCs. The exposure risks to these EDCs were estimated based on the measured urinary concentrations and acceptable daily intakes (ADIs). Hazard quotient values for EDCs in humans from both locations were generally less than 1, indicating a low exposure risk of EDCs in these regions. Nonetheless, the health risks caused by co-exposure to such EDCs cannot be ignored.

Urban-rural differences in the effect of empty-nest on mental health and behaviors of Chinese older population.

This study aimed to comprehensively analyze the effect of empty-nest on mental health and behaviors of the older population and explore the urban-rural differences. Data from the Cohort of Older People Health and Environment Controllable Factors were used, including 1071 older people aged 60 or over from a rural and an urban. Mental health, daily life behaviors, chronic physical diseases, and activities of daily living were evaluated. Logistic regression was used. The prevalence of empty-nest in older people was 55.0% in urban and 58.7% in rural. The empty-nest older people in urban were more likely to participate in physical exercise (OR[95%CI]: 1.55[1.03-2.31]), while the empty-nest older people in rural had lower rate of smoking (OR[95%CI]: 0.46[0.28-0.76]) and religious belief (OR[95%CI]: 1.61[1.01-2.58]), and higher prevalence of depression (OR[95%CI]: 1.55[1.03-2.35]) and higher level of total cholesterol (OR[95%CI]: 1.51[1.03-2.19]) compared with the non-empty-nest older people. In conclusion, the prevalence of empty-nest in older people was high both in rural and urban in China. Empty-nest exerts greater influences on the older people in rural than in urban, which should be given more attention, especially the depression and high total cholesterol.

Urban-rural differences in the association between social activities and depressive symptoms among older adults in China: a cross-sectional study.

BACKGROUND: Participation in social activities has positive health effects among older adults; however, few studies have investigated the association between social activity and depressive symptoms among Chinese older adults. This study aimed to examine the association between social activities and depressive symptoms among older adults in China regarding urban-rural differences. METHODS: Data were collected from 8255 respondents from the 2015 China Health and Retirement Longitudinal Study. Depressive symptoms were assessed using the 10-item Center for Epidemiologic Studies Depression Scale. Type and frequency of social activities were collected via a questionnaire. Multivariate logistic regression analysis was used to explore the relationship between social activities and depressive symptoms. RESULTS: In our study, the prevalence of depressive symptoms was lower in urban older adults compared with rural older adults (25.2% vs. 40.7%). After adjustment for all covariates, our results indicated that interacting with friends almost weekly or almost daily (almost weekly: OR = 0.568, 95%CI: 0.337-0.955; almost daily: OR = 0.664, 95%CI: 0.453-0.973) and participating in community organizations almost daily were inversely associated with depressive symptoms among urban older adults (OR = 0.107, 95%CI: 0.012-0.952). Interacting with friends almost daily (OR = 0.847, 95% CI: 0.720-0.996) and participation in hobby groups either almost every week or almost daily were both inversely associated with depressive symptoms among rural older adults (almost weekly: OR = 0.683, 95%CI: 0.518-0.902; almost daily: OR = 0.567, 95%CI: 0.440-0.731). Participating in sports groups almost daily was inversely associated with depressive symptoms among both urban and rural older adults (urban: OR = 0.664, 95%CI: 0.445-0.991; rural: OR = 0.506, 95%CI: 0.366-0.700). CONCLUSIONS: Our findings indicated that there is a cross-sectional association between participation in social activities and depressive symptoms among Chinese older adults, and the association differed between urban and rural older adults. This implies that participation in social activities may be significant for alleviating depressive symptoms of older adults. When encouraging older adults to participate in social activities, the government should consider urban-rural differences and take effective measures accordingly. Longitudinal studies are needed to examine the causal relationships between social activities and depressive symptoms among older adults.

Differential associations between subjective age and depressive symptoms among urban and rural Chinese older adults.

Objectives: Little research has investigated the prospective association between subjective-aging-perception and depressive symptoms in Chinese older adults. The aim of this study is to evaluate the differential associations of feeling old with depressive symptoms among urban and rural community-dwelling Chinese older adults using panel data drawn from two waves of nationally representative surveys.Method: We conducted secondary data analysis and utilized the data of 5,685 urban and 5,612 rural community-dwelling older adults aged 60 years and above who participated in both the 2006 and the 2010 Sample Survey on the Aged Population in Urban/Rural China (SSAPUR). A single-item measure of subjective age was used to distinguish between feeling old and feeling not old.Results: Ordinary least regression analyses indicated that the longitudinal effect of subjective age on depressive symptoms existed only in the urban sample (p<.001) but not in the rural sample and that feeling not old was related to less depressive symptoms in the urban sample, after controlling for baseline measures of depressive symptoms and sociodemographic and health factors.Conclusion: This study provides new longitudinal evidence of the impact of subjective age on depression among Chinese older individuals. The findings provide useful information for depression interventions among urban older Chinese individuals.

Urban-rural difference in satisfaction with primary healthcare services in Ghana.

BACKGROUND: Understanding regional variation in patient satisfaction about healthcare systems (PHCs) on the quality of services provided is instrumental to improving quality and developing a patient-centered healthcare system by making it more responsive especially to the cultural aspects of health demands of a population. Reaching to the innovative National Health Insurance Scheme (NHIS) in Ghana, surpassing several reforms in healthcare financing has been a milestone. However, the focus of NHIS is on the demand side of healthcare delivery. Studies focusing on the supply side of healthcare delivery, particularly the quality of service as perceived by the consumers are required. A growing number of studies have focused on regional differences of patient satisfaction in developed countries, however little research has been conducted concerning patient satisfaction in resource-poor settings like in Ghana. This study was therefore dedicated to examining the variation in satisfaction across rural and urban women in Ghana. METHODS: Data for the present study were obtained from the latest demographic and health survey in Ghana (GDHS 2014). Participants were 3576 women aged between 15 and 49 years living in non-institutional settings in Ghana. Summary statistics in percentages was used to present respondents' demographic, socioeconomic characteristics. Chi-square test was used to find association between urban-rural differentials with socio-economic variables. Multiple logistic regression was performed to measure the association of being satisfied with primary healthcare services with study variables. Model fitness was tested by pseudo R 2. Statistical significance was set at p < 0.05. RESULTS: The findings in this study revealed that about 57.1% were satisfied with primary health care services. The urban and rural areas reported 57.6 and 56.6% respectively which showed no statistically significant difference (z = 0.64; p = 0.523; 95%CI: -0.022, 0.043). Bivariate analysis showed that region, highest level of education, wealth index and type of facility were significantly associated with location of residence (urban-rural areas). After adjusting for confounding variables using logistic regression, geographical location became a key factor of satisfaction with primary healthcare services by location of residence. In urban areas, respondents from Greater Accra had 64% increase in the level of satisfaction when compared to those in Western region (OR = 1.64; 95CI: 1.09-2.47), Upper East had 75% increase in satisfaction compared to Western region (OR = 1.75; 95%CI: 1.08-2.84), Northern had an estimated 44% reduction in satisfaction when compared to Western region (OR = 0.56; 95%CI: 0.34-0.92). However, rural areas in Central, Volta, Eastern, Ashanti, Brong Aghafo, Northern and Upper West region had 51, 81, 69, 46, 62, 75 and 61% reduction respectively in the level of satisfaction when compared to Western region. CONCLUSIONS: Patient satisfaction is an important indicator of health outcomes. Quality of care and measuring level of patient satisfaction has been found to be the most useful tool to predict utilization and compliance. In fact, satisfied patients are more likely than unsatisfied ones to continue using health care services. Our results suggest that policymakers need to better understand the determinants of satisfaction with the health system and how different socio-demographic groups perceive satisfaction with healthcare services so as to address health inequalities between urban and rural areas within the same country.

The effects of family structure and function on mental health during China's transition: a cross-sectional analysis.

BACKGROUND: Social change, intensified by industrialization and globalization, has not only changed people's work lives but also their personal lives, especially in developing countries. The aim of this study was to provide evidence and recommendations regarding family structure, function, and mental health to actively respond to rapid social change. METHODS: A cross-sectional survey was conducted face-to-face and door-to-door from July 2011 to September 2012 in Hubei Province, central China. Family structure comprised alone, couple, nuclear family, and extended family; family function was measured using the family APGAR (Adaptation, Partnership, Growth, Affection, and Resolve) scale, and mental health was measured using the Chinese version of the 12-item General Health Questionnaire (GHQ-12). RESULTS: The urban-vs-rural difference of family structure among alone, couple, nuclear family, and extended family was statistically significant (5.21% vs 4.62%; 27.36% vs 13.14%; 33.22% vs 27.74%; 34.20% vs 54.50%, respectively; p < 0.0001); and those difference of family function was not statistically significant (8.11 ± 2.13 vs 8.09 ± 2.27, p = 0.9372). The general linear regression showed that the effect of family structure on mental health, whether urban or rural, was not significant, however, the effect of family function was significant, especially regarding better family functioning with better mental health. CONCLUSIONS: Combined the effects of family structure and function on mental health, the external form of family (family structure) may not be important; while the internal quality of role (family function) might be key. Improving the residents' family function would be a priority strategy for family practice with their mental health.

[Urban-Rural Differences in the Role of Family Support in Physical and Mental Health of Elderly People in China].

OBJECTIVES: To investigate social support for elderly in urban and rural settings, and determine its role in physical and psychological health of the elderly populations. METHODS: Data were extracted from the 2013 China Health and Retirement Longitudinal Study (CHARLS). Physical health was measured by the ADL/IADL scale. Mental health was measured by the CES-D scale. Family support included financial support, daily care and emotional care. Binary logistic models were established to test the associations between family support and physical and mental health. RESULTS: For the rural elderly people, financial support from children was positively associated with physical health (P <0.05); whereas, emotional comfort from children was associated with better mental health (P <0.01). Daily care from children was associated with physical and mental health of the elderly in both urban and rural settings (P <0.01). CONCLUSION: An urban-rural difference exists in the role of family support in physical and mental health of the elderly. Rural elderly people are more dependent on family support than their urban counterparts. Social support needs to be strengthened to reduce the urban-rural gap. Meanwhile, family support will continue to play a role in improving the health of elderly populations.

Rural-urban comparisons of dengue seroprevalence in Malaysia.

BACKGROUND: Each year an estimated 390 million dengue infections occur worldwide. In Malaysia, dengue is a growing public health concern but estimate of its disease burden remains uncertain. We compared the urban-rural difference of dengue seroprevalence and determined age-specific dengue seroprevalence in Malaysia. METHODS: We undertook analysis on 11,821 subjects from six seroprevalence surveys conducted in Malaysia between 2001 and 2013, which composed of five urban and two rural series. RESULTS: Prevalence of dengue increased with age in both urban and rural locations in Malaysia, which exceeded 90 % among those aged 70 years or beyond. The age-specific rates of the 5 urban surveys overlapped without clear separation among them, while prevalence was lower in younger subjects in rural series than in urban series, the trend reversed in older subjects. There were no differences in the seroprevalence by gender, ethnicity or region. Poisson regression model confirmed the prevalence have not changed in urban areas since 2001 but in rural areas, there was a significant positive time trend such that by year 2008, rural prevalence was as high as in urban areas. CONCLUSION: Dengue seroprevalence has stabilized but persisted at a high level in urban areas since 2001, and is fast stabilizing in rural areas at the same high urban levels by 2008. The cumulative seroprevalence of dengue exceeds 90 % by the age of 70 years, which translates into 16.5 million people or 55 % of the total population in Malaysia, being infected by dengue by 2013.

Urban-rural differences in the association between occupational physical activity and mortality in Chinese working population: evidence from a nationwide cohort study.

Background: Despite emerging studies suggesting that occupational physical activity (OPA) might be harmful to health, the available evidence is not definitive. Most of these research studies were conducted in high-income Western countries or in urbanized setting. In China, where over one-third of the population resides in rural area, the impact of OPA on health is not well understood. The goal of this study is to investigate how the association between OPA and mortality vary by urban-rural settings. Methods: Baseline data on OPA was gathered using the Global Physical Activity Questionnaire from 30,650 urban and 49,674 rural working adults as part of the 2013-2014 China Chronic Disease and Risk Factor Surveillance. Participants were followed for a median of 6.2 years, and death records were retrieved from the National Mortality Surveillance System until December 31, 2019. The multivariable Cox proportional hazard model was used to examine urban-rural differences in the association between OPA and all-cause and cardiovascular disease (CVD) mortality. Subgroup analyses were performed by sex, socioeconomic status, leisure time, transportation, and non-occupational physical activity. Findings: During the study period, 1342 deaths were recorded, of which 426 were caused by CVD. In rural area, working adults engaging in occupational moderate-to-vigorous physical activity (MVPA) for ≥40 h per week, compared to those without any, had an adjusted hazard ratio of 0.60 (95% CI: 0.49-0.73) for all-cause mortality and 0.55 (95% CI: 0.37-0.83) for CVD mortality. However, no significant association was found in urban area (0.84 [0.61-1.15] for all-cause mortality, Pinteraction = 0.036; and 0.94 [0.53-1.66] for CVD mortality, Pinteraction = 0.098). The negative associations of occupational MVPA with mortality were more pronounced in women, non-smokers, and those with less non-occupational physical activities. Hypertension, heart rate, and diabetes were important contributors to the relationship between occupational MVPA and mortality. Interpretation: The findings from the current study did not support the notion that high levels of OPA would induce harm. On the contrary, in rural setting, higher levels of OPA were associated with lower mortality risks. Furthermore, the observed urban-rural differences in the association between OPA and mortality underscored the need for context-specific public health guidelines on physical activities. Funding: R&D Program of Beijing Municipal Education Commission (KM202210025026),National Key Research and Development Program of China (2021YFC2500201), and Young Elite Scientist Sponsorship Program by BAST (BYESS2023385).

Evaluation of urban-rural difference in breast cancer mortality among Chinese women during 1987-2021: A hierarchical age-period-cohort analysis.

BACKGROUND: Breast cancer mortality varies in urban and rural areas in China. Studies have reported urban-rural difference across time period, however, the evaluation on urban-rural differences in age and birth cohort effects is limited. Our aim was to quantitatively assess urban-rural disparities in age, period and cohort effects in breast cancer mortality in China. METHODS: We collected age-specific breast cancer mortality rates for urban and rural females aged 20-84 years from 1987 to 2021. Hierarchical age-period-cohort (HAPC) models were used to evaluate the effect of area (urban, rural) on breast cancer mortality and investigate urban-rural differences in age, time period and birth cohort effects. RESULTS: We found a significant area (urban, rural) effect on breast cancer mortality in that rural females had a lower mortality risk than urban females [-0.25 (95 % confidence interval (CI): -0.32, -0.17)]. Age trajectories of mortality based on the HAPC model showed nonlinear trends with adjustment for area variable. The urban-rural difference in age effect appeared to be divergent with age, and urban women had higher mortality risk in the senior age group. The urban-rural difference in birth cohort effect indicated a reversal around the birth cohort group of 1962-1966, after which rural females had a higher mortality risk than urban females. CONCLUSION: The area (urban, rural) could affect breast cancer mortality among women, and the effect of urban-rural difference varies with age and birth cohort. To promote the health of urban and rural females, the gap between urban and rural areas should be shorten.

National age-specific mortality trends for cervical and breast cancers in urban-rural areas of China from 2009 to 2021: a population-based analysis.

BACKGROUND: Cervical and breast cancers are among the top 4 leading causes of cancer-related mortality in women. This study aimed to examine age-specific temporal trends in mortality for cervical and breast cancers in urban and rural areas of China from 2009 to 2021. METHODS: Age-specific mortality data for cervical and breast cancers among Chinese women aged 20-84 years were obtained from China's National Disease Surveillance Points system spanning the years 2009 to 2021. Negative binomial regression models were utilized to assess urban-rural differences in mortality rate ratios, while Joinpoint models with estimated average annual percent changes (AAPC) and slopes were employed to compare temporal trends and the acceleration of mortality rates within different age groups. RESULTS: From 2009 to 2021, there was a relative increase in age-specific mortality associated with the two cancers observed in rural areas compared with urban areas. A rising trend in the screening age of 35-64 [AAPC: 4.0%, 95% confidence interval (CI) 0.5-7.6%, P = 0.026] for cervical cancer was noted in rural areas, while a stable trend (AAPC: - 0.7%, 95% CI - 5.8 to 4.6%, P = 0.78) was observed in urban areas. As for breast cancer, a stable trend (AAPC: 0.3%, 95% CI - 0.3 to 0.9%, P = 0.28) was observed in rural areas compared to a decreasing trend (AAPC: - 2.7%, 95% CI - 4.6 to - 0.7%, P = 0.007) in urban areas. Urban-rural differences in mortality rates increased over time for cervical cancer but decreased for breast cancer. Mortality trends for both cervical and breast cancers showed an increase with age across 4 segments, with the most significant surge in mortality observed among the 35-54 age group across urban and rural areas, periods, and regions in China. CONCLUSIONS: Special attention should be given to women aged 35-54 years due to mortality trends and rural-urban disparities. Focusing on vulnerable age groups and addressing rural-urban differences in the delivery of cancer control programs can enhance resource efficiency and promote health equity.

Differences in the evolution of urban and rural surface thermal environment and their responses to urban renewal in Shanghai, China.

The rapid and extensive urbanization has profound impacts on urban thermal environment. It is of great significance to comprehensively understand how urbanization affects the evolution of urban thermal environment for urban ecological safety, environmental quality, and residents' health. Based on daily land surface temperature (LST) products of MODIS Aqua satellite in the summer of 2002-2020, we investigated the evolution of urban-rural differences in surface summer thermal environment in Shanghai during 2002-2020 and its response to urban spatial renewal. We used normalized land surface temperature (NLST) and urban heat island ratio index (URI) as the surface thermal environment measurement indicators, by combining vegetation index and impervious surface cove-rage, and used M-K trend analysis and interpretation analysis. The results showed that the linear growth rate of LST in Shanghai was 0.09 ℃·a-1 (2002-2020), and that URI showed a trend of first increasing (2002-2010) and then decreasing (2010-2020). The mean summer LST was generally in the order of urban core>suburban>rural. 1.6% of the areas showed a significant cooling trend, of which 54.0% were distributed in the urban core. 39.5% of the regions showed a significant warming trend, of which 77.6% were distributed in the suburban. In general, there were concentrated significant cooling areas in the highly urbanized urban areas, while there was a significant warming trend in the suburban. The transformation from urban expansion to urban renewal was the main reason for the emergence of concentrated and significant cooling areas in the urban. Nearly 20% of the urban area showed a signi-ficant increase of vegetation coverage. Urban renewal projects such as gathering vegetation or dispersing impervious surfaces in highly urbanized areas are important ways to effectively improve the urban residential thermal environment.

Vegetation growth enhancement modulated by urban development status.

Cities are natural laboratories for studying the vegetation response to global change due to their own climatic, atmospheric, and biological conditions. However, whether the urban environment promoted vegetation growth is still uncertain. Using the Yangtze River Delta (YRD), an economic powerhouse of modern China, as a case study, this paper investigated the impact of urban environment on vegetation growth at three scales: cities, sub-cities (rural-urban gradient) -pixels. Based on the satellite observations of vegetation growth indicated during 2000-2020, we explored the direct (replacement of original land by impervious surfaces) and indirect impact (e.g., climatic environment) of urbanization on vegetation growth and their trends with urbanization level. We found that significant greening accounted for 43.18 %, and significant browning accounted for 3.60 % of the pixels in the YRD. Urban area was turning green faster than suburban area. Moreover, land use change intensity (D) was a representation of the direct impact ωd of urbanization. The direct impact of urbanization on vegetation growth was positively correlated with the intensity of land use change. Furthermore, vegetation growth enhancement due to indirect impact ωi occurred in 31.71 %, 43.90 % and 41.46 % of the YRD cities in 2000, 2010 and 2020. And vegetation enhancement occurred in 94.12 % of highly urbanized cities in 2020, while in medium and low urbanization cities, the averaged indirect impact was near zero or even negative, proving that vegetation growth enhancement was modulated by urban development status. Also, the growth offset (τ) was most pronounced in high urbanization cities (4.92 %), but there was no growth compensation in medium urbanization cities (-4.48 %) and low urbanization cities (-57.47 %). When urbanization intensity reached a threshold value of 50 % in highly urbanized cities, the growth offset (τ) tended to saturate and remained unchanged. Our findings have important implications for understanding the vegetation response to continuing urbanization process and future climate change.

Prevalence and management of hypertension in Central China: a cross-sectional survey.

OBJECTIVE: We aimed to assess hypertension prevalence and management in Central China. METHODS: In this cross-sectional study conducted from February 2019 to February 2020, we applied stratified multistage random sampling to investigate residents aged 35 to 75 years in Dancheng county of Zhoukou city and Xincai county of Zhumadian city, both in Central China. RESULTS: We enrolled 63,940 participants in this survey. A total of 43.6% (95% confidence interval [CI]: 43.2-44.0) of participants had hypertension. Of these, 49.3% (95% CI: 48.7-49.9) were aware of their diagnosis, 36.5% (95% CI: 35.9-37.1) took antihypertensive medication, and 14.3% (95% CI: 13.9-14.7) had their blood pressure under control. Only 31.4% of hypertensive people receiving antihypertensive treatment had achieved control. The hypertension prevalence was lower in urban areas than in rural areas, with higher rates of awareness, treatment, and control. Among subgroups, rural men had the highest prevalence of hypertension. Prevalence, awareness, and treatment rates all increased with age, except for control rates, which declined in the 65- to 75-year-old group. CONCLUSIONS: People in Central China have a high hypertension prevalence but low rates of awareness, treatment, and control. Great effort is needed to improve the prevention and management of hypertension in this region.

Association between Social Participation and Remaining Teeth and Urban-Rural Difference among Older Adults in China.

Oral health is an important part of older adults' general health. The study examined the association between social participation (formal and informal) and remaining teeth and the urban-rural difference based on a national survey of older adults in China. The data of older adults were extracted from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) and analyzed. A total of 11,948 respondents were ultimately involved, including 6836 urban respondents and 5112 rural respondents. Informal social participation and formal social participation were used to assess social participation. The number of remaining natural teeth was measured. Social participation was significantly associated with remaining teeth among older adults, after adjusting for confounders, a one-level increase in the informal social participation was associated with a decrease in natural teeth by 0.152 (95% CI = -0.274; -0.030) and a one-level increase in the formal social participation was associated with a decrease in natural teeth by 0.370 (95% CI = -0.585; -0.156). In addition, the association between social participation (formal and informal) and remaining teeth was observed among urban older adults, but not rural older adults. A high level of social participation may effectively decrease the risk of oral-health problems for the Chinese older adults. The findings suggest recommendations for an older adults-targeted policy and the practice of oral-health promotion. However, the urban-rural difference should be taken into full consideration in social-participation-driven oral-health promotion interventions.

Differences in the influence of daily behavior on health among older adults in urban and rural areas: evidence from China.

Background: As the population of older adult in China keeps growing, the degree of aging is becoming increasingly serious and the health of older adults is a growing concern. Comparing the personal characteristics and health levels of urban and rural older adults and determining the relationship between these factors are of great significance in maintaining their health. In addition, exploring how these relationships differ between urban and rural areas is important. Method: This study conducted a literature review to examine the impact of various factors on the physical and mental health of older adults in urban and rural areas in China. Moreover, based on cross-sectional data from the 2017 Chinese General Social Survey (CGSS), urban-rural differences in the factors' degree of influence on the perceived health of older adults were studied using multiple logistic regression. Results: Regular physical exercise had a powerful protective effect on urban older adults' physical and mental health, whereas regular participation in social activities had a positive impact on rural older adults' health. Low income, low educational level, low social trust, lack of a partner, and having more than one child negatively affected the physical health of rural older people. Low socioeconomic status had a negative impact on rural people's health both in mind and body. Overall, the rural adults' health status was found to be relatively low and deserves more attention. Conclusion: This study demonstrated that older people's physical and mental health levels can be significantly affected by the frequency of daily activities and individual and family characteristics. Furthermore, urban-rural differences were observed. These findings could provide feasible suggestions for governments, communities, and older adults' family members to help alleviate health inequality.

Urban-Rural Difference in Treatment Adherence of Chinese Hypertensive Patients.

Objective: The aims of this study were to evaluate the treatment adherence and the main factors associated with adherence for Chinese hypertensive patients between urban and rural areas. Participants and Methods: A total of 529 hypertensive patients with 328 from urban areas and 201 from rural areas hospitalized in a tertiary hospital in Xi'an, China during the period from May 1 to December 31, 2021 were invited to participate in the cross-sectional study. The adherence to treatment was assessed by "modified Chinese Hill-Bone compliance to high blood pressure therapy scale". Binary logistic regression analysis was used to analyze independent risk factor for treatment adherence of hypertensive patients. General linear model was used to analyze the association of the independent risk factors to treatment adherence in each subgroup of the scale. Results: The treatment adherence of Chinese hypertensive patients in rural areas was 23.88% and it was significantly lower than that in urban areas (36.59%). Age and gender were the factors that independently associated with treatment adherence of hypertensive patients regardless of urban or rural status. The duration of antihypertensive drugs used was identified to be the factor that independently associated with treatment adherence only in urban patients. The subgroups including reduced sodium intake and medication taking had significant effects on treatment adherence in certain factors. Conclusion: The treatment adherence of Chinese hypertensive patients was low, especially in rural areas. More emphasis should be placed on patients in rural areas. Furthermore, more attention and effective strategies should be designed to address factors affecting treatment adherence in both urban and rural areas. Health programs should focus on education including the importance of taking continuous antihypertensive drugs and low sodium diet.