To explore the potential multidimensional health transition patterns of the middle-aged and elderly and their impact on healthcare service utilization from the perspective of physical, psychological, and social dimensions, incorporating potential population heterogeneity, and to provide insights for promoting healthy aging.

Using four waves of data (2011 - 2018) from the China Health and Retirement Longitudinal Study (CHARLS), we applied repeated measurement latent class analysis to identify potential multidimensional health transition patterns among middle-aged and elderly. A two-part model was employed to analyze the impact of these patterns on healthcare service utilization. The first part used a logit model to determine whether healthcare services were utilized, while the second part took linear regression and negative binomial regression models for cost and frequency, respectively.

Seven distinct multidimensional health transition patterns were identified the among middle-aged and elderly: “Deteriorating Psychological Health” (11.11%), “Deteriorating Social Health” (27.89%), “Poor Physical and Social Health” (7.02%), “Poor Psychological and Social Health” (13.44%), “Persistently Unhealthy” (7.09%), “Death During Follow-up” (10.46%), and “Persistently Healthy” (22.98%). These health transition patterns significantly influenced both outpatient and inpatient healthcare service utilization, particularly regarding whether outpatient services were used, whether hospitalization occurred, and the frequency of outpatient visits. Compared to the “Persistently Healthy” group, the “Deteriorating Psychological Health,” “Poor Physical and Social Health,” “Poor Psychological and Social Health,” and “Persistently Unhealthy” groups had higher probabilities of utilizing both outpatient and inpatient services. The “Deteriorating Social Health” group (OR = 0.83, 95%CI: 0.70 - 0.98) had a lower probability of utilizing outpatient services (P < 0.05). The “Deteriorating Psychological Health” (β = 0.30, 95%CI: 0.03 - 0.58) and “Persistently Unhealthy” (β = 0.33, 95%CI: 0.00 - 0.65) groups incurred higher outpatient service costs (P < 0.05), while the “Poor Physical and Social Health” group (β = 0.28, 95%CI: 0.03 - 0.52) had higher inpatient service costs (P < 0.05). The “Deteriorating Psychological Health” (IRR = 1.48, 95%CI: 1.27 - 1.73), “Deteriorating Social Health” (IRR = 1.19, 95%CI: 1.03 - 1.38), “Poor Physical and Social Health” (IRR = 1.28, 95%CI: 1.06 - 1.55), “Poor Psychological and Social Health” (IRR = 1.39, 95%CI: 1.18 - 1.64), and “Persistently Unhealthy” (IRR = 1.49, 95%CI: 1.25 - 1.78) groups had a higher frequency of outpatient service utilization (P < 0.05). The “Deteriorating Psychological Health” group also had a higher frequency of inpatient service utilization (IRR = 1.15, 95%CI: 1.01 - 1.32) (P < 0.05).

Seven heterogeneous multidimensional health transition patterns exist among middle-aged and elderly in China. These patterns differentially affect the cost and frequency of outpatient and inpatient service utilization.

To investigate the latent categories and influencing factors of frailty change over time among elderly residents in Ma′anshan city, Anhui province, and to provide a reference for the development of prevention and control measures against the onset and progression of frailty in this population.

A multistage random sampling method was used to recruit 3 476 community-dwelling adults aged ≥ 60 years from three districts of Ma′anshan city. Baseline data were collected through face-to-face interviews (December 2016-March 2017) using standardized instruments: a self-developed questionnaire, the Scale of Elderly Self-neglect (SESN), the Psychological Stress Resilience Quotient Scale, the Social Support Scale (both validated by Chinese researchers), and the Frailty Index to assess frailty status. Follow-up surveys were conducted in December 2018 and December 2021. Among the initial cohort, 2 495 participants completed all three surveys and were included in the final analysis. Latent class analysis (LCA) identified distinct trajectories of in frailty over time, while multinomial logistic regression identified key influencing factors.

Among the participants included in the analysis, three latent categories of change in frailty during the observation period were identified: improvement, progression, and early fluctuation, with percentages of 534 (21.4%), 188 (7.5%), and 1 773 (71.1%) participants, respectively. The results of multinomial logistic regression analyses (with the improvement group as the reference) revealed the following significant baseline factors influencing membership in either the progression or early fluctuation groups: increased odds of being in the progression or early fluctuation groups were associated with age ≥ 75 years, annual or occasional physical examinations (occasional examinations significant only for the progression group), occasional or regular physical activity (significant only for the early fluctuation group), history of falls in the past year, self-neglect, and central obesity; whereas decreased odds of being in either group were associated with average monthly income of 2 000 - 4 999 Chinese yuan, living alone (significant only for the progression group), moderate or higher self-rated work intensity, alcohol consumption, and high psychological resilience scores.

The main latent category of frailty status among community-dwelling older adults in Ma′anshan city was early fluctuation. Age, average monthly income, living alone, self-reported work intensity, alcohol consumption, physical examination status, physical activity, falls in the past year, self-neglect, central obesity, and psychological resilience score were the main influencing factors of latent categories of frailty among the elderly.

To investigate the prevalence and common comorbidity patterns of chronic diseases among elderly inpatients in Shenzhen city, Guangdong province, from 2017 to 2022, and to provide scientific evidence for the development of comorbidity management and prevention strategies.

Data from the discharge summaries of 410 814 inpatients aged 65 years and older from 142 primary and higher-level hospitals in Shenzhen city between January 1, 2017, and December 31, 2022, were collected. Frequency combination analysis was used to identify common chronic disease comorbidity combinations, and association rule analysis was used to identify common non-random disease combinations.

Among the 410 814 elderly inpatients in Shenzhen city from 2017 to 2022, 387 020 (94.21%) had chronic disease comorbidities. Hypertension was the most prevalent chronic disease (59.14%), accounting for 97.79% of the comorbidity composition. The most common two- and three-disease combinations were “hypertension + stroke” (106 005 cases, 25.80%) and “hypertension + peripheral artery disease + stroke” (55 343 cases, 13.47%), respectively. The top 20 two- and three-disease combinations mainly consisted of hypertension, stroke, ischemic heart disease, heart failure, peripheral artery disease, dyslipidemia, and type 2 diabetes, with cardiovascular diseases predominating, followed by metabolic diseases. Association rule analysis showed that among the top 20 rules, the rule “(refractive errors and accommodation disorders) => (cataract)” had the highest lift value of 6.128. The remaining association rules all involved cardiovascular and cerebrovascular diseases, with the rule “(chronic ischemic heart disease, hypertension, peripheral artery disease) => (heart failure)” having a lift value of 3.082.

The prevalence of chronic disease comorbidities among elderly inpatients in Shenzhen city is high. Cardiovascular diseases dominate the two- and three-disease combinations. Cataracts and cardiovascular and cerebrovascular diseases are the main non-random comorbidity association patterns.

To analyze the trends in esophageal cancer mortality and its influencing factors in key rural areas of four Chinese provinces from 2008 to 2021, and to explore the correlation between esophageal cancer mortality and behavioral and dietary factors, providing a reference for the prevention and control of esophageal cancer in rural China.

Based on the National Mortality Surveillance Database from 2008 to 2021 and data from three surveys on tumors and behavioral risk factors conducted in 2013, 2016, and 2019 among residents in key rural areas of Jiangsu, Anhui, Shandong, and Henan provinces, Joinpoint 5.2.0 software was used to calculate the average annual percentage change (AAPC) and analyze the temporal trends of the age-standardized mortality rate of esophageal cancer in the Chinese population (referred to as the Chinese standardized mortality rate). The chi-square test for trend was used to analyze the temporal trends of behavioral and dietary factors. Panel models were established using Stata 16 software to analyze the correlation between behavioral and dietary factors and esophageal cancer mortality.

The age-standardized mortality rates (per 100 000) of esophageal cancer in key rural areas of the four provinces from 2008 to 2021 were 40.55, 36.30, 33.99, 29.65, 27.74, 26.80, 25.11, 22.76, 22.81, 19.73, 18.95, 18.12, 17.53, and 15.19, respectively, showing a decreasing trend overall (AAPC = -6.76, P < 0.001), declining from 40.55/100 000 in 2008 to 15.19/100 000 in 2021. The results of the three surveys showed that the current smoking rate, drinking rate, dietary habits (fast eating, preference for salty tastes, preference for hot food, preference for dry and hard food), and the intake frequency of some foods (pickled and salted fish, chili peppers, meat, aquatic products, and soy products) all decreased in the key rural areas of the four provinces (P < 0.001). The rates of high body mass index (BMI), insufficient physical activity, and the intake frequency of some foods (rice and rice products, fresh vegetables, fresh fruits, dairy products, and garlic) all increased (P < 0.001). Drinking rate (β = 0.51, P = 0.036), high BMI rate (β = 0.34, P = 0.041), intake frequency of pickled and fermented bean curd (β = 1.46, P = 0.010), and garlic intake frequency (β = 0.16, P = 0.025) were positively correlated with esophageal cancer mortality; while the intake frequency of rice and rice products (β = -0.21, P = 0.001), chili peppers (β = -0.35, P < 0.001) was negatively correlated with esophageal cancer mortality.

The age-standardized mortality rate of esophageal cancer in key rural areas of the four provinces in China showed a downward trend from 2008 to 2021. Drinking rate, high BMI rate, and the intake frequency of certain foods (pickled and fermented bean curd, garlic, rice and rice products, and chili peppers) were associated with esophageal cancer mortality.

To construct a competency evaluation index system for Chinese public health professionals engaged in global health, providing a measurement tool for the selection and assessment of health professionals for overseas positions in international and regional organizations related to global health.

A preliminary competency evaluation index system for Chinese public health professionals engaged in global health was established through literature review. Twenty-six experts with extensive experience in global health were selected for three rounds of Delphi expert consultation. The analytic hierarchy process was used to calculate the weights of indicators at each level.

The expert positive coefficient for the three rounds of expert consultation were 100%, 92.3%, and 92.3%, respectively. The expert authority coefficient were 0.89, 0.91, and 0.91, respectively. Kendall′s W coefficient of concordance for expert opinions were 0.151, 0.159, and 0.150 (all P < 0.001), respectively, indicating good agreement among experts. The competency index system for Chinese public health professionals engaged in global health, constructed after expert consultation, includes 18 first-level indicators and 58 second-level indicators across three domains: basic professional qualities, core competencies, and management abilities. The mean scores of expert ratings on the importance of each indicator in the three rounds of consultation were (4.54 ± 0.42), (4.53 ± 0.40), and (4.53 ± 0.40), respectively. The coefficients of variation were 3.95% - 18.33%, 5.74% - 16.25%, and 5.74% - 16.25%, respectively. In the constructed evaluation index system, the weights of the first-level indicators ranged from 0.021 2 to 0.139 4, the weights of the second-level indicators ranged from 0.077 8 to 0.750 0, and the comprehensive weights ranged from 0.003 1 to 0.058 3.

The competency evaluation index system for Chinese public health professionals engaged in global health constructed in this study has good scientific validity and reliability, and can provide theoretical support and practical tools for the development of a global health talent pool among Chinese health professionals.

To investigate the correlation between atmospheric sulfur dioxide (SO₂) and the incidence of stroke in residents of Shanghai city, and to provide a reference for the development of stroke prevention and control measures.

Data on 263 872 new stroke cases reported to the Shanghai Stroke and Acute Myocardial Infarction Registry Information System from 2017 through 2021 were collected. Daily mean concentrations of atmospheric pollutants-including SO₂, nitrogen dioxide (NO₂), ozone (O₃), particulate matter with an aerodynamic diameter < 2.5 μm (PM_2.5), and particulate matter with an aerodynamic diameter < 10 μm (PM₁₀), as well as meteorological factors such as daily average temperature and relative humidity, were obtained from the national air pollution monitoring stations of the Ministry of Ecology and Environment during the same period. A generalized additive model with a quasi-Poisson distribution link function was used to analyze the time-series relationship between atmospheric SO₂ concentration and the daily number of stroke cases.

Throughout the study period conducted in Shanghai, the average daily incidence of registered stroke cases was 145 ± 28, while the mean daily concentration of SO₂ was measured at 8.00 ± 3.71 µg/m³. The analysis of the single-day lag model demonstrated that a 10 µg/m³ increase in the mean SO₂ concentration was significantly associated with percentage changes (%) in daily stroke incidence across different populations and lag days, as follows: 1. General population: Decreases of 0.21%, 0.28%, 0.29%, and 0.21% were observed at lag days 7, 8, 26, and 27, respectively, while increases of 0.16%, 0.34%, 0.33%, 0.42%, 0.32%, and 0.20% were noted at lag days 19, 20, 21, 22, 23, and 24, respectively. 2. Males: A 0.37% decrease was observed at lag day 26, whereas increases of 0.47%, 0.36%, 0.61%, and 0.33% were recorded at lag days 20, 21, 22, and 23, respectively. 3. Females: A 0.40% increase was observed at lag day 0. 4. Residents aged 60 years and above: Decreases of 0.33% and 0.36% were observed at lag days 8 and 26, respectively, while increases of 0.35%, 0.32%, 0.41%, and 0.32% were noted at lag days 20, 21, 22, and 23, respectively. All reported associations were statistically significant (P < 0.05). Multi-day lag model analysis yielded results consistent with those from the single-day lag analysis: 1. General population: Increases of 16.84%, 18.40%, and 17.95% were observed at lag days 0 - 24, 0 - 25, and 0 - 26, respectively. 2. Males: Increases of 16.73%, 21.09%, 22.39%, and 21.80% were observed at lag days 0 - 23, 0 - 24, 0 - 25 d, and 0 - 26, respectively. 3. Females: An increase of 4.10% was noted at lag days 0-1.4. Residents aged < 60 years: Decreases of 8.60%, 9.89%, 9.36%, 10.67%, 10.98%, and 11.38% were observed at lag days 0 - 4, 0 - 5, 0 - 6, 0 - 7, 0 - 8, and 0 - 9, respectively. 5. Residents aged 60 years and above: Decreases of 15.91%, 19.18%, 20.22%, and 18.99% were observed at lag days 0 - 23, 0 - 24, 0 - 25, and 0 - 26, respectively (all P < 0.05).

The elevated atmospheric SO₂ concentration exhibited a significant correlation with a higher daily incidence of stroke on single-lag days 19 - 24 and multi-lag days 0 - 24 to 0 - 26 among Shanghai residents, particularly affecting male individuals and those aged 60 years or older.

To investigate the relationship between resting heart rate and the detection rate of carotid plaques in individuals at high risk for cardiovascular disease (CVD) in Nanjing city, Jiangsu province, and to provide a reference for reducing the risk of CVD events in this population.

From January 2020 to December 2021, a multi-stage stratified cluster random sampling method was used to select 38 488 permanent residents aged 35 - 79 years from Jianye district, Pukou district, Lishui district, Gaochun district, and Jiangbei New Area in Nanjing city. Participants underwent questionnaires, physical examinations, laboratory tests, and carotid ultrasound examinations to screen for high CVD risk. The 8 905 individuals identified as high-risk for CVD were divided into five groups based on their resting heart rate: ≤ 60, 61 - 70, 71 - 80, 81 - 90, and ≥ 91 beats/min. The detection rates of carotid plaques were compared among the different resting heart rate groups. Multivariable unconditional logistic regression models were used to analyze the relationship between resting heart rate and carotid plaque detection.

The detection rate of carotid plaques in the 8 905 high-risk CVD individuals in Nanjing city was 39.97%. The detection rates in men and women were 42.99% and 36.25%, respectively, with a statistically significant difference (χ² = 41.81, P < 0.001). The detection rates of carotid plaques in the high-risk CVD individuals with resting heart rates of ≤ 60, 61 - 70, 71 - 80, 81 - 90, and ≥ 91 beats/min were 39.65%, 35.37%, 38.56%, 39.77%, and 49.80%, respectively. In men, the corresponding rates were 42.64%, 37.62%, 40.07%, 43.16%, and 54.00%, and in women, they were 36.50%, 32.77%, 36.71%, 35.28%, and 42.16%. Statistically significant differences were observed in the detection rates of carotid plaques among different resting heart rate groups in both the overall high-risk CVD population and in men and women separately (all P < 0.05). After adjusting for confounding factors including sex, age, education level, marital status, smoking status, alcohol consumption, hypertension, diabetes, dyslipidemia, body mass index, and central obesity, multivariable unconditional logistic regression analysis showed that individuals with a resting heart rate ≥ 91 beats/min had a 1.26-fold higher risk of carotid plaque detection compared to those with a resting heart rate ≤ 60 beats/min (OR = 1.26, 95%CI: 1.07 - 1.68). After adjusting for age, education level, marital status, smoking status, alcohol consumption, hypertension, diabetes, dyslipidemia, body mass index, and central obesity, multivariable unconditional logistic regression analysis showed that men with a resting heart rate ≥ 91 beats/min had a 1.62-fold higher risk of carotid plaque detection compared to men with a resting heart rate ≤60 beats/min (OR = 1.62, 95%CI: 1.16 - 2.18).

The detection rate of carotid plaques is high in the high-risk CVD population in Nanjing city. A resting heart rate ≥ 91 beats/min is an independent risk factor for carotid plaque detection in high-risk CVD individuals, especially men.

To understand the correlation between the incidence of varicella and meteorological factors in Jiangxi province from 2015 to 2021, and to provide a reference for meteorological prediction and early warning of varicella incidence.

Daily varicella incidence data reported by direct reporting units for infectious diseases in Jiangxi province from January 1, 2015, to December 31, 2021, were collected from the Chinese Center for Disease Control and Prevention Information System. Meteorological data for the same period, including daily minimum temperature, daily maximum temperature, daily average temperature, sunshine duration, daily maximum wind speed, daily precipitation, and daily average relative humidity, were collected from the Jiangxi Meteorological Bureau. Pearson correlation analysis and generalized linear regression models were used to analyze the relationship between varicella incidence and different meteorological factors in Jiangxi province.

A total of 133 370 varicella cases were reported in Jiangxi province from 2015 to 2021, with a daily incidence of (51 ± 36) cases. Among these cases, 31 604 (23.70%) were in the 0 - 4 age group, 26 910 (20.18%) were in the 5 - 9 age group, 45 938 (34.44%) were in the 10 - 14 age group, and 28 918 (21.68%) were in the ≥ 15 age group. Pearson correlation analysis showed that the daily incidence of varicella was negatively correlated with daily minimum temperature (r = -0.280, P < 0.001), daily maximum temperature (r = -0.270, P < 0.001), daily average temperature (r = -0.280, P < 0.001), sunshine duration (r = -0.079, P < 0.001), daily maximum wind speed (r = -0.130, P < 0.001), and daily precipitation (r = -0.093, P < 0.001). Generalized linear regression analysis showed that the daily incidence of varicella in the 0 - 4 and 5 - 9 age groups was negatively correlated with daily average temperature (β = -0.032 and -0.027, both P < 0.001) and daily maximum wind speed (β = -0.004 and -0.062, both P < 0.05). The daily incidence of varicella in the 10 - 14 and ≥ 15 age groups was negatively correlated with daily average temperature (β = -0.022 and -0.024, both P < 0.001) and daily precipitation (β = -0.007 and -0.007, both P < 0.05).

There was a significant negative correlation between the incidence of varicella and various meteorological factors, including daily minimum temperature, daily maximum temperature, daily average temperature, sunshine duration, daily maximum wind speed, and daily precipitation, in Jiangxi province from 2015 to 2021. The correlation between the daily incidence of varicella and meteorological factors varied across different age groups.

To understand the epidemiological characteristics of human respiratory syncytial virus (HRSV) infection in Guangzhou city.

Data were sourced from two parts: national influenza sentinel surveillance and Guangzhou city′s acute respiratory infection cluster surveillance. Sentinel surveillance data, collected from August 2023 to July 2024, included outpatient and emergency department influenza-like illness (ILI) cases and hospitalized severe acute respiratory infection (SARI) cases from four national-level influenza sentinel hospitals in Guangzhou. Cluster surveillance data, from 2021 to 2023, included acute respiratory infection (ARI) clusters caused by HRSV in Guangzhou. Respiratory specimens were collected from cases for multiple respiratory pathogen nucleic acid testing. The HRSV positive detection rate among sentinel surveillance cases was calculated, and indicators such as the HRSV infection attack rate among children in cluster settings were comparatively analyzed.

The overall HRSV positive detection rate among the included sentinel surveillance cases was 3.75% (51/1 360). Among the positive cases, 68.63% (35/51) were children under 5 years old, with the highest positive detection rate observed in the < 6 months age group (10.29%, 7/68). The HRSV positive detection rate among hospitalized SARI cases in this age group was as high as 31.25% (5/16). Two HRSV epidemics occurred in Guangzhou, one in the summer and autumn of 2023 (August - September) with subtype A as the dominant strain, and the other in the spring of 2024 (February-April) with subtype B. All four monitored HRSV-induced ARI clusters occurred in summer; three in postpartum care centers and one in a childcare facility. The overall attack rate among children was 42.42% (84/198). The overall asymptomatic infection rates among mothers and staff in these facilities were 83.33% (5/6) and 82.35% (14/17), respectively. Positive environmental samples from postpartum care centers were mainly from infant common areas or nursing areas.

HRSV epidemics in Guangzhou show clear seasonality. Children under 5 years old, especially infants under 6 months, are the main population affected by HRSV infection and hospitalization. Postpartum care centers and childcare facilities are prone to HRSV clusters. Timely detection of asymptomatic infections and effective environmental cleaning and disinfection are crucial for epidemic control.

To analyze the characteristics of suspected adverse events following immunization (AEFI) with human papillomavirus (HPV) vaccine administered in Ningbo city and evaluate the safety of the vaccine.

Data on reported AEFI cases after HPV vaccination from 2018 to 2022 were collected from the National Adverse Event Following Immunization Surveillance System. The number of HPV vaccine doses administered was obtained from the Zhejiang Province Vaccine and Immunization Management Information System. Indicators such as the reported AEFI incidence rates, distribution characteristics, and clinical symptoms were analyzed to assess the safety of HPV vaccination.

A total of 843 913 doses of HPV vaccine were administered in Ningbo city over a 5-year period, during which 262 cases of AEFI related to HPV vaccination were reported. The mean annual reporting incidence rate was 31.05 per 100 000 doses. The reported AEFI cases were predominantly adverse reactions (259 cases), with a total reporting incidence rate of 30.69 per 100 000 doses. Among the adverse reactions, 253 cases (96.56%) were common reactions, and 6 cases (2.29%) were rare reactions, with incidence rates of 29.98 and 0.71 per 100 000 doses, respectively. The reporting incidence rates of main common reactions were 15.76, 9.01, and 8.06 per 100 000 doses for local redness and swelling, fever, and local induration, respectively. The reported rare reactions included 3 cases of allergic rash and 2 cases of urticaria. No serious AEFIs were reported. The reported AEFIs mainly occurred within 0 - 1 day after HPV vaccination (217 cases, 82.82%) and following the first dose (112 cases, 42.75%). They were primarily observed in the 20 - 39 age group (201 cases, 76.72%). All 262 AEFI cases recovered or improved during the follow-up observation periods.

From 2018 to 2022 in Ningbo city, the reported AEFIs associated with the HPV vaccine were primarily common reactions, with very few rare reactions and no serious AEFIs reported, indicating a favorable safety profile for the HPV vaccine.