To analyze the relationship between longitudinal changes in blood pressure and new-onset cardiovascular diseases (CVD) in older adults with hypertension in the community of Suzhou, and to provide a reference threshold for blood pressure management in older adults.

The physical examination data from 4 019 older adults with hypertension who participated in health check-ups at a community health service center in Suzhou from 2021 to 2023 were collected.Generalized Estimating Equations (GEE) and Restricted Cubic Splines(RCS) models were used to analyze the association between blood pressure changes and new-onset CVD in older adults with hypertension.

A total of 365 new cases of new-onset CVD were observed among older adults, with a cumulative incidence rate of 9.1%. GEE analysis showed that after adjusting for the control variables, diastolic blood pressure (DBP) was negatively associated with the risk of new-onset CVD (OR=0.97, 95% CI: 0.96-0.98, P<0.001), while pulse pressure (PP) was positively associated with the risk of new-onset CVD (OR=1.01, 95% CI: 1.00-1.01, P<0.05). The RCS model showed that there were significant non-linear dose-response relationships between low DBP and the increased risk of new-onset CVD, and between low PP and the decreased risk of new-onset CVD (non-linear test P<0.05). Subgroup analysis showed that DBP≤84 mm Hg and ≥95 mm Hg, and PP between 77 to 88 mm Hg in the uncontrolled systolic blood pressure(SBP) group were significantly associated with an increased risk of new-onset CVD,while PP≤51 mm Hg in the controlled SBP group was significantly associated with a decreased risk of new-onset CVD.

Low and/or high DBP may increase the risk of new-onset CVD in older adults with hypertension in the community, while low PP has a protective effect on new-onset CVD. However, when SBP is not controlled, PP will increase the risk of new-onset CVD in a higher threshold range.

To study the association between serum albumin level and the risk of respiratory failure after pulmonary infection in patients with pneumoconiosis.

This study utilized data of hospitalized pneumoconiosis patients from 2012 to 2021 and employed the Cox model to analyze the association between baseline serum albumin levels and the risk of respiratory failure following pulmonary infection in male pneumoconiosis patients.

The average age of 1 301 male inpatients with pneumoconiosis was 50.94 ±11.12 years, with a median age of 48 years old. Respiratory failure occurred in 194 patients after infection, and the incidence density was 44.14 per 1 000 person-years. Grouped by whether respiratory failure occurred, there were significant differences between the two groups in terms of age, smoking status, drinking status, length of dust exposure, ALB, BMI and stage of pneumoconiosis (P<0.05). Multivariate Cox regression analysis indicated that compared with pneumoconiosis patients with serum ALB≤35.1 g/L, those with ALB≥40.9 g/L had a reduced risk of developing respiratory failure after infection (HR=0.48, 95%CI: 0.02-0.94, P=0.002). Subgroup analysis revealed that compared with the lowest quartile group (Q1) of serum ALB, in the low BMI group (BMI<18.5 kg/m²), patients in the Q4 group of serum ALB had a significantly lower risk of developing respiratory failure after infection (HR=0.36, 95% CI: 0.20-0.64, P=0.001); in normal BMI group (18.5 kg/m²≤BMI<24 kg/m²), the Q4 group of serum ALB significantly reduced the risk of developing respiratory failure after infection (HR=0.22, 95% CI: 0.09-0.53, P=0.001); and in pneumoconiosis stage 3 group, the Q4 group of serum ALB significantly reduced the risk of developing respiratory failure after infection (HR=0.42, 95% CI: 0.25-0.71, P=0.001). The restricted cubic spline plot showed that when ALB>38.1 g/L, the risk of developing respiratory failure after pulmonary infection in male pneumoconiosis patients decreased progressively with increasing baseline serum albumin levels.

High serum albumin is a protective factor for respiratory failure in male pneumoconiosis patients after pulmonary infection. Serum ALB concentration higher than 38.1 g/L can reduce the risk of respiratory failure after infection.

To investigate the longitudinal association between the metabolic score for insulin resistance (METS-IR) and the risk of cardiovascular disease (CVD) and its subtypes (heart disease and stroke) in middle-aged and older adults.

This study used data from 4 567 participants in the China Health and Retirement Longitudinal Study (CHARLS) cohort. METS-IR levels measured in 2011 and 2015 were standardized, and K-means cluster analysis was used to classify participants into four categories (Class 1-4). Cumulative METS-IR exposure levels were calculated. Multivariable Cox regression models, adjusted for potential confounders, were used to evaluate the association between METS-IR and incident CVD. Restricted cubic spline analysis assessed the dose-response relationship between cumulative METS-IR exposure and CVD risk. Subgroup analyses explored heterogeneity by gender and age. The predictive performance of METS-IR for CVD was evaluated using time-dependent receiver operating characteristic (ROC) curves.

Over a median follow-up of 3 years, 531 CVD events occurred among 4 567 participants. Cox regression analysis showed that compared to Class 1 (lowest persistent METS-IR levels), Class 4(highest persistent METS-IR levels) was associated with a 77% increased risk of incident CVD (HR=1.77, 95%CI: 1.24-2.52), including a 67% increased risk of heart disease (HR=1.67, 95%CI: 1.10-2.54) and a significant 117% increased risk of stroke (HR=2.17,95%CI: 1.31-3.59). A significant linear dose-response relationship was observed between cumulative METS-IR exposure and CVD risk. ROC curve analysis indicated that cumulative METS-IR had the best predictive performance for CVD, with an area under the curve (AUC) of 0.613.

Persistently elevated longitudinal levels of METS-IR are associated with an increased risk of incident CVD. Dynamic monitoring of METS-IR levels is important for the prevention and treatment of CVD.

To explore the operational efficiency of primary care organizations in the pilot counties of close-knit county medical communities in Sichuan Province, and to provide a reference for continuing to promote the high-quality development of close-knit county medical communities across the country and help build a more synergistic and efficient county medical service network.

Primary care organizations in 37 pilot counties in Sichuan Province were used for the study, and data envelopment analysis and Malmquist index model were used for static and dynamic measurement of operational efficiency, respectively.

The mean values of comprehensive efficiency, pure technical efficiency, and scale efficiency of primary care organizations in pilot counties in Sichuan Province in 2022 were 0.806, 0.936, and 0.863, respectively. Among them, the operational efficiencies of Wenchuan (0.314), Jiuzhaigou (0.226), Seda (0.116), and Ganzi (0.061) were located below 0.400. Compared with 2018, their comprehensive efficiency and pure technical efficiency have improved, while scale efficiency was flat. The mean value of the total factor productivity index of primary care organizations in the pilot counties from 2018 to 2022 was 0.975. Further decomposing the total factor productivity index, the mean values of the technical efficiency index, the technical progress index, the pure technical efficiency index, and the scale efficiency index were 1.014, 0.962, 1.022, and 0.992, respectively.

After the implementation of the policy, the operational efficiency of primary care organizations in the pilot counties of Sichuan Province showed significant improvement, but there is still much room for improvement, and the differences between counties are more obvious. In the future, we should focus on the technical progress and scale efficiency, strengthen the continuing medical education of primary medical personnel, innovate and carry out the new technology of primary characteristics, and reasonably balance and effectively allocate the medical resources in the counties.

To analyze the trends of maternal, infant and neonatal mortality rates in Jiangxi Province from 2003 to 2020 in the aggregate and in urban and rural areas, and to predict the maternal mortality rate (MMR), infant mortality rate (IMR), and neonatal mortality rate (NMR) in the aggregate and in urban and rural areas in 2030, in order to provide a basis for the development and planning of the maternal and child health care industry in Jiangxi Province during the period of Healthy China 2030.

Based on the combined and urban-rural MMR, IMR, and NMR data of Jiangxi Province from 2003 to 2020, the Gray GM (1, 1), support vector machine (SVM), neural network auto-regression (NNAR), quadratic exponential smoothing (ES) models were established, and the optimal model was selected to predict the combined and urban-rural MMR, IMR, and NMR for the years 2021-2030. The already predicted aggregate mortality rates were then used to adjust the urban and rural MMR, IMR, and NMR.

In Jiangxi Province, the combined MMR, IMR, and NMR in 2025 and 2030 were 3.09/100 000, 2.52‰, 1.38‰, 1.67/100 000, 1.51‰, and 0.79‰. The urban MMR, IMR, and NMR in 2025 and 2030 were 2.44/100 000, 2.28‰, 1.28‰, and 1.22/100 000, 1.44‰, 0.75‰.And rural MMR, IMR, and NMR in 2025 and 2030 were 3.79/100 000, 2.81‰, 1.52‰,1.90/100 000, 1.63‰, and 0.89‰.

It is expected that Jiangxi Province will reach the targets set out in the “Healthy China 2030” Plan and other policies ahead of schedule in 2025 and 2030 in terms of MMR, IMR and NMR. Although the gap between urban and rural areas in terms of maternal, infant and neonatal mortality rates continues to narrow, the relevant indicators in rural areas are still higher than those in urban areas, an objective gap that indicates that the continued promotion of maternal and child health-care services in rural areas and the optimization of resource allocation at the grass-roots level are still the key directions of public health work.

To analyze the characteristics and issues of Jiangsu’s healthcare system policies and provide optimization insights.

Using Rothwell and Zegveld’s policy tool classification, a three-dimensional framework (policy tools, development process, policy goals) was constructed to quantify 70 policy texts from the 13th and 14th Five-Year Plan periods.

Policy tools: environmental-type dominated (58.83%), followed by supply-type (34.78%), demand-type (6.38%) was minimal. Policy process: implementation (52.27%) and planning (40.24%) prevailed, while supervision (6.48%) and evaluation (1.02%) were underdeveloped. Policy goals: advancing public hospital quality (44.11%) was prioritized, whereas strengthening medical insurance (9.03%) lagged.

Structural imbalance in policy tools, fragmented policy processes, and divergent goals were observed. Recommendations: optimize tool allocation by increasing demand-type tools, integrate policy processes, and align goals systematically.

To explore the relationship between intergenerational emotional support and depression of migrant elderly following children and its mechanism of action.

A total of 210 migrant elderly following children participated in this study. And they completed the Intergenerational Emotional Support Questionnaire, Flow Centre Depression Scale, Short boredom proneness scale and Seff-Rating Scale of Sleep.

(1) Intergenerational emotional support significantly and negatively predicted depression in migrant elderly following children (β=-0.354, P<0.001); (2) Boredom proneness played a mediating role between Intergenerational emotional support and depression of migrant elderly following children. The mediation effect value was -0.129 (95% Bootstrap CI=［-0.215，-0.068］), the mediating effect accounted for 36.44% of the total. (3) Sleep problem moderated the relationship between boredom proneness and depression of migrant elderly following children (β=0.137, P=0.009). Specifically, moderated mediation analysis showed that the impact of boredom proneness on depression strengthened with sleep problem getting worse among the migrant elderly following children (simple slope=0.384, 95% CI: 0.235-0.533, P<0.001). When there was mild sleep problem, the influence of boredom proneness function on depression was weaker (simple slope=0.110, 95% CI: -0.044-0.263, P=0.160).

This study highlights the mediating and moderating mechanisms linking intergenerational emotional support to depression of migrant elderly following children. More importantly, it has prominent implications for the prevention and intervention of depression among migrant elderly following children.

To investigate the effect of depressive symptoms on the risk of developing type 2 diabetes mellitus in middle-aged and elderly people in China.

Based on the data from the China Health and Retirement Longitudinal Study (CHARLS) 2011 and 2018, 9 697 middle-aged and elderly people aged 45 years or older were included as study subjects. Chained equations were used to perform g-formula analysis after multiple interpolation of missing values of covariates, and stratified analyses were performed to explore the association between depressive symptoms and the risk of developing type 2 diabetes mellitus with respect to age and gender.

The results of the analysis after multiple interpolation of covariates and adjustment for confounding showedthat the mean risk of developing type 2 diabetes mellitus in study participants with depressive symptoms which was 1.3 times higher than that of those without depressive symptoms ［RR(95% CI):1.37(1.15-1.62)］, with a mean hazard difference of 0.02. Those with mild depressive symptoms had a mean risk of type 2 diabetes mellitus of 1.27 times higher than that of those without depressive symptoms ［RR(95% CI):1.27(1.07-1.52)］, with a mean difference of 0.01; those with severe depressive symptoms had a mean risk of developing type 2 diabetes mellitus that was 2.22 times higher than that of those who were not depressed ［RR(95% CI):2.22(1.64-3.00)］; the mean difference was 0.06.

Depressive symptoms and the risk of type 2 diabetes mellitus were significantly associated with the risk of developing type 2 diabetes mellitus among middle-aged and elderly people in China. Associated with the risk of developing type 2 diabetes, the risk of developing the disease increased with the severity of depressive symptoms.

To explore the impact of the triglyceride-glucose index (TyG) and obesity indicators on the risk of non-alcoholic fatty liver disease (NAFLD) among participants aged ≥60 years, so as to provide evidence for the early prevention of NAFLD.

A stratified random cluster sampling method was used to select 95 932 elderly individuals in 2022 in Nanjing. These individuals underwent questionnaires, physical examinations, and laboratory tests. A logistic regression model was used to analyze the effects of the TyG and multiple obesity indicators on the risk of NAFLD, followed by the interaction analysis between TyG and each obesity indicator. The diagnostic value of the TyG and its combination with obesity indicators was assessed using receiver operating characteristic curves.

In the study, the prevalence of NAFLD was 39.66%. After adjusting for confounding factors, logistic regression analysis showed that as the increase of TyG and obesity indicators, including BMI, Chinese visceral adiposity index, and lipid accumulation product, the risk of NAFLD in the elderly increased, with odds ratios of 1.86 (1.80-1.93), 3.69 (3.57-3.80), 3.66 (3.54-3.79), and 3.28 (3.17-3.39), respectively (P<0.001). Interaction analysis revealed that compared to low levels of both the TyG and obesity indicator, one variable at a high level or both at high levels increased the risk of NAFLD, indicating a synergistic effect. The diagnostic ability of the TyG combined with obesity indicators for NAFLD risk was higher than that of the TyG alone.

The risk of NAFLD in individuals aged ≥60 years increases with higher levels of the TyG and obesity indicators, and they have a combined effect on NAFLD risk. TyG combined with BMI may be a simple and efficient tool for the early screening of NAFLD in elderly people.