Physical activity among older Chinese adults living in urban and rural areas: A review

Impact of living patterns and social participation on the health vulnerability of urban and rural older persons in Jiangsu Province, China

BACKGROUND

This study analyzes the influence of living patterns and social participation on the health vulnerability of older people in urban and rural areas and provides a reference for addressing this vulnerability.

METHODS

A total of 3500 participants aged 60 years and above from Jiangsu Province, China, were surveyed. The vulnerability index, which evaluates self-rated health, risk of falling, general pain or discomfort, chronic diseases, emotional characteristics, depression, anxiety, is used to measure health vulnerability. A multiple linear regression model is used to evaluate the effects of living patterns and social participation on health vulnerability.

RESULTS

A certain level of health vulnerability exists among Chinese urban and rural older people. Living with family members has a positive effect on their health. Individuals who live alone have worse health and lower subjective well-being. Social participation significantly reduces the comprehensive levels of general health vulnerability, physical health vulnerability, and mental health vulnerability of older people. For urban older people, living with families reduces the level of physical and mental health vulnerability, whereas living alone significantly increases health vulnerability. Living patterns significantly affect the psychological vulnerability of rural older people. Social participation has an important impact on the health of older people who live alone, especially on the mental health vulnerability of older people who live alone in urban areas.

CONCLUSION

Living patterns and social participation are important factors that affect the health vulnerability of older people in both urban and rural areas. Social participation has a significant effect on the health of older people who live alone. In particular, for older people who live alone in cities, being socially active can help change their "sedentary" lifestyle, thereby promoting physical and mental health and reducing vulnerability.

Urban and rural disparities in stroke prediction using machine learning among Chinese older adults

Stroke is a significant health concern in China. Differences in stroke risk between rural and urban areas have been highlighted in prior research. However, there is a scarcity of studies on urban-rural differences in predicting stroke. This study aimed to develop stroke prediction models, and urban-rural subgroup analyses were conducted to explore disparities in determinants among middle-aged and older adults. We employed nine machine learning algorithms, namely logistic regression (LR), adaptive boosting classifier, support vector machines, extreme gradient boosting, random forest, Gaussian naive Bayes (GNB), gradient boosting machine, light gradient boosting decision machine, and K Nearest Neighbours, using data derived from 9,413 individuals aged 45 years and above obtained from the China Health and Retirement Longitudinal Study (CHARLS) conducted in 2011 to build stroke prediction models and analyze urban-rural subgroups. In the total population, GNB (AUC = 0.76) was the best model for predicting strokes, and the ten most important variables were the time taken for repeated chair stands, the chair height from floor to seat, knee height, creatinine, complete repeated chair stands, mean corpuscular volume, platelet, uric acid, body mass index, and white blood cell. In the rural subgroup, LR and GNB (AUC = 0.76) were the best, and the ten most important variables were the time taken for repeated chair stands, creatinine, platelet, the chair height from floor to seat, knee height, complete repeated chair stands, pulse, white blood cell, maintaining semi - tandem balance statically, and uric acid. In the urban subgroup, LR (AUC = 0.67) was the best, and the ten most important variables were the time taken for repeated chair stands, mean corpuscular volume, maintaining semi - tandem balance statically, uric acid, right-hand grip strength, age, blood urea nitrogen, use of trunk, arms, legs for semi - tandem balance, number of marriages, and night sleep duration. The time taken for repeated chair stands was more critical in the stroke risk model for rural individuals. Uric acid and maintaining semi - tandem balance statically were more critical in the stroke risk model for urban individuals. Our results revealed the importance of knee height and physical function predictors for stroke and highlighted the differences in determinants between urban and rural individuals, proposing targeted stroke prevention and control strategies in different populations in terms of physical function.

A Comparative Study of Physical Activity Levels Between Rural and Urban Settings in Zimbabwe

Background

Zimbabwe lacks information on physical activity levels, the available information is based on estimates.

Aim

This study compared physical activity levels in rural and urban settings. The relationship between the level of physical activity and metabolic risk factors for non-communicable diseases was also analysed.

Setting

The study took place in Bulawayo city (urban) and Mashonaland East province (rural).

Methods

Multi-stage probability-based sampling was used to select 200 male respondents from Bulawayo Province (urban) and 200 male respondents from Mashonaland East Province (rural). The study used the enumeration areas (EAs) used during the 2012 census and represented wards. In total, 10 enumeration areas were randomly selected, and 40 households were randomly selected in each of these enumeration areas. Logistic regression was used for all statistical analyses.

Results

Rural respondents were 62% more likely to meet the World Health Organisation (WHO) required physical activity level than urban respondents. The rural group was 158% more likely to have intermediate physical activity levels (600-2999 METs) than the urban group. Those meeting the WHO recommended physical activity level were 51% less likely to have elevated blood glucose. Facilities to promote physical health are not being used.

Conclusions

The rural group was more physically active than the urban group. High physical activity reduces the risk of metabolic risk factors for non-communicable diseases such as diabetes.

Contribution

Promotion of good health by reducing risk factors for non-communicable diseases.

Substituting time spent in physical activity and sedentary time and its association with cardiovascular disease among northwest Chinese adults

Objectives

To examine the association between physical activity (PA) and leisure-time sedentary time and cardiovascular disease (CVD).

Methods

This cross-sectional study used baseline data from the Regional Ethnic Cohort Study in Northwest China from June 2018 to May 2019. PA and leisure-time sedentary time were self-reported. Logistic regression models analyzed the association of PA and leisure-time sedentary time with CVD prevalence individually and jointly. Restricted cubic spline analyses assessed dose-response relationships. Isotemporal substitution models were used to investigate substituting leisure-time sedentary time, light physical activity (LPA), and moderate-to-vigorous physical activity (MVPA) with CVD prevalence.

Results

The prevalence of CVD was 31.8 %. Compared to the lowest quartile, participants in the highest quartile of total PA had a 32 % lower CVD prevalence (odds ratio [OR]: 0.68, 95 % confidence interval [CI]: 0.62-0.74; P for trend <0.001). The fully adjusted OR for the highest quartile of leisure-time sedentary time compared to the lowest quartile was 1.09 (1.01-1.18; P for trend =0.04). An L-shaped dose-response relationship was observed between PA and CVD prevalence. An active lifestyle and reduced daily leisure-time sedentary time were associated with a 26 % (0.74 [0.63-0.86]) lower CVD prevalence. Additionally, substituting 30 min/day of leisure-time sedentary time with equivalent MVPA was associated with a 2 % (0.98 [0.97-0.99]) reduction in CVD prevalence. Substituting sedentary time with LPA was associated with a lower CVD prevalence in females.

Conclusions

An active lifestyle was associated with a lower prevalence of CVD in regional populations, suggesting a feasible strategy for CVD prevention and regional health promotion.

Health-related quality of life and its associated factors among Chinese seasonal retired migrants in Hainan

Background

Seasonal retired migrants are mainly retired or semiretired people who migrate to warmer areas during the winter and then return to their original homes in the following year. Despite its increasing popularity, the evidence concerning the health status of Chinese seasonal retired migrants is controversial. Although some studies have shown that seasonal retired migrants have better health status, other studies note that migrants are driven involuntarily by health concerns and that their mental health suffers during migration. The objective of this study was to provide quantified evidence on the health-related quality of life (HRQoL) of seasonal retired migrants in China and to identify potential factors associated with HRQoL.

Methods

This was a community-based cross-sectional study of seasonal retired migrants who lived in Wuzhishan, Hainan during the winter. The Chinese version of the EuroQol 5-Dimension 5-Level (EQ-5D-5L) was used to assess participants' HRQoL. Data on demographic and behavioral characteristics, body mass index, and the presence of chronic diseases were collected using a self-administered survey. Logistic regressions were used to explore the factors associated with responses in each dimension of the EQ-5D-5L descriptive system, and a multiple linear regression model was used to explore the factors associated with EuroQol visual analogue scale (EQ-VAS) scores.

Results

A total of 992 participants (female: 56.5%) were enrolled in the current study, with a mean age of 67.87 ± 6.98 years. Most participants reported problems in the pain/discomfort dimension (16.7%), followed by the anxiety/depression dimension (8.3%). Few participants reported problems in the first three dimensions of the EQ-5D-5L: mobility (5.4%), usual activities (2.0%), and self-care (1.2%). The median EQ-VAS score was 84 (interquartile range: 80-89). The regression results indicated that poor sleep quality, the presence of chronic diseases, and low-level physical activity were important factors that were negatively associated with multiple dimensions of the EQ-5D-5L. In addition, the EQ-VAS score was negatively associated with age, the presence of chronic diseases, poor sleep quality, and low-level physical activity.

Conclusion

This study revealed that Chinese seasonal retired migrants have high HRQoL. In addition, this study revealed that sleep quality and physical activity are correlated with multiple dimensions of the EQ-5D-5L descriptive system and EQ-VAS. Therefore, lifestyle interventions related to sleep quality and physical activity are essential for improving HRQoL among Chinese seasonal retired migrants.

Disability-Adjusted Life Expectancy and Cognitive Function among Community-Dwelling Adults

We aimed to calculate disability-adjusted life expectancy (DALE) for Korean older adults based on their sex, educational attainment, and residential region across their cognitive status. We included 3,854 participants (aged 65-91 years) from the Korean Longitudinal Study of Aging's seventh survey data. The participant's cognitive function status (normal, moderately impaired, or severely impaired) was determined based on cognitive examination and physical function independence, which was used to calculate their DALE. Females with normal cognition had higher DALE (7.60 years, Standard Deviation (SD) = 3.88) than males (6.76, SD = 3.40); however, both sexes had comparable DALE for cognitive impairment. In contrast, the DALE values increased with higher educational achievements. Regarding residential areas, the DALE value for participants with normal cognition and moderate impairment was the highest among urban dwellers, while DALE for participants with severely impaired cognitive function was highest among rural dwellers; however, there were no statistically significant differences based on residential conditions. Our findings suggest that demographic characteristics should be considered when developing health policies and treatment strategies to meet the needs of the aging population in Korea.

Quality of life among community-dwelling elderly in rural and urban areas of Himalayan region, Northeast India: An analysis of factors affecting well-being

Background

There is a dearth of literature on the quality of life (QOL) experienced by the elderly population in the hilly terrains of the Himalayan region. The objective of this study was to highlight the QOL among community-dwelling elderly residing in rural and urban areas of the Himalayan region, Northeast India.

Materials and Method

A cross-sectional study was conducted involving 450 participants (324 in rural and 126 in urban areas) aged 60 years and above. The QOL score was assessed with the help of the World Health Organisation Quality of Life-Brief Questionnaire (WHOQOL-BREF). Mann-Whitney U test was performed to find out the difference in QOL between rural and urban areas. Binary logistic regression was conducted to find the association of QOL with demographic variables.

Results

The total mean QOL scores of elderlies in rural areas (39.4 ± 11.3) were significantly lower compared to urban areas (51.1 ± 11.5). QOL scores in all four domains were found to be low among elderly living in rural areas as compared to urban areas. Among the four domains, environmental QOL was found to be the lowest in both rural (29.5 ± 16.0) and urban areas (46.5 ± 17.2). Determinants of QOL differ in urban and rural areas.

Conclusion

QOL was found to be significantly lower among the elderly residing in rural areas as compared to urban areas. Targeted interventions and policies are necessary to address environmental challenges to improve the overall QOL of the elderly.

Association between metabolic syndrome severity score and cardiovascular disease: results from a longitudinal cohort study on Chinese adults

Objective

This study aimed to quantify the severity of metabolic syndrome(MetS) and investigate its association with cardiovascular disease(CVD) risk on Chinese adults.

Methods

13,500 participants from the Zhejiang Adult Chronic Disease Study were followed up between 2010 and 2021. A continuous MetS severity score derived from the five components of MetS was used to quantify MetS severity, and the association between MetS severity and the risk of incident CVD was assessed using Cox proportional hazard and restricted cubic spline regression.

Results

Both the presence and severity of MetS were strongly associated with CVD risk. MetS was related to an increased risk of CVD (hazard ratio(HR):1.700, 95% confidence interval(CI): 1.380-2.094). Compared with the hazard ratio for CVD in the lowest quartile of the MetS severity score, that in the second, third, and highest quartiles were 1.812 (1.329-2.470), 1.746 (1.265-2.410), and 2.817 (2.015-3.938), respectively. A linear and positive dose-response relationship was observed between the MetS severity and CVD risk (P for non-linearity = 0.437). Similar results were found in various sensitivity analyses.

Conclusion

The MetS severity score was significantly associated with CVD risk. Assessing MetS severity and further ensuring intervention measures according to the different severities of MetS may be more useful in preventing CVD.

Lifestyle behaviours and associated factors among people with type 2 diabetes attending a diabetes clinic in Ningbo, China: A cross-sectional study

The burden of type 2 diabetes (T2DM) in China is significant and growing, and this is reflected in high rates of T2DM in the city of Ningbo, China. Consequent impacts on morbidity, mortality, healthcare expenditure, and health-related quality of life, make this a problem of the utmost importance to address. One way to improve T2DM outcomes is to address lifestyle behaviours that may affect prognosis and complications, such as physical activity levels, dietary habits, smoking status, and alcohol intake. A cross-sectional survey was undertaken to describe the prevalence of being physically active, having a healthy diet, currently smoking, and currently drinking alcohol among people living with T2DM attending a diabetes clinic in Ningbo, China. Regression analysis was used to determine the factors associated with these lifestyle behaviours. We found a high prevalence of a healthy diet (97.8%, 95% CI 96.5-98.7%). Prevalence of being physically active (83.4%, 95% CI 80.6-85.9%), smoking (21.6%, 95% CI 18.8-24.6%), and alcohol drinking (32.9%. 95% CI 29.6-36.2%) appeared in keeping with those of the general population. Marked associations were demonstrated between male sex and smoking (OR 41.1, 95% CI 16.2-139.0), and male sex and alcohol drinking (OR 4.00, 95% CI 2.62-6.20). Correlation between lifestyle factors was demonstrated including between alcohol drinking and smoking, and between physical activity and reduced smoking. General diabetes self-management education programmes that address multiple lifestyle risk factors simultaneously may be beneficial in this population. Specific interventions targeting smoking cessation and reduction in alcohol drinking may be of benefit to men living with T2DM attending a diabetes clinic in Ningbo.

Physical activity and transitioning to retirement: evidence from the China health and retirement longitudinal study

BACKGROUND

The impact of retirement on physical activity among older individuals remains ambiguous. This study aims to investigate the influence of retirement on physical activity and delineate the trajectories of physical activity changes during the retirement transition among elderly Chinese residents. Additionally, we endeavor to examine the factors that contribute to each trajectory.

METHODS

This longitudinal cohort study used data from four surveys of the China Health and Retirement Longitudinal Study and included a sample of 428 individuals who underwent formal retirement and provided information on physical activity. We employed generalized estimating equation to explore the impact of the retirement transition on physical activity among Chinese older adults. Latent class growth analysis was used to identify distinct trajectories of physical activity, and binary logistic regression was performed to identify pre-retirement factors influencing changes in physical activity.

RESULTS

Our findings indicate that retirement can lead to a decline in physical activity among older Chinese residents (OR = 0.85, 95%CI 0.75 ~ 0.97). We identified three distinct trajectories of physical activity during the retirement transition: Trajectory 1 - "sustained low level of physical activity" (7.94%); Trajectory 2 - "middle level of physical activity with gradual decline" (69.16%); Trajectory 3 - "sustained high level of physical activity with significant fluctuations" (22.90%). Furthermore, we discovered that individuals in the "middle level of physical activity and gradual decline" trajectory were more likely to have an annual income exceeding 40,000 yuan (OR = 9.69, 95%CI 1.12 ~ 83.63), reside in urban areas (OR = 2.27, 95%CI 1.14 ~ 4.52), and have a fondness for playing Mahjong (OR = 2.42, 95%CI 1.18 ~ 5.00) compared to those in the "sustained high level of physical activity with significant fluctuations" trajectory. Additionally, having an annual income exceeding 40,000 yuan (OR = 19.67, 95%CI 1.30 ~ 298.61) predicted membership in the "sustained low level of physical activity" trajectory when compared to the "sustained high level of physical activity with significant fluctuations" trajectory.

CONCLUSION

Retirement represents a substantial milestone in the life course and is associated with notable alterations in physical activity patterns. Among older Chinese residents, the trajectories of physical activity during the retirement transition exhibit diverse paths and are influenced by pre-retirement factors, including annual income, residential location, and hobbies. The findings of this study have important implications for the formulation of policies aimed at promoting healthy aging among individuals approaching retirement age.

Health Behavior Patterns and Associated Risk of Memory-Related Disorders Among Middle-Aged and Older Chinese Couples

Objectives: Studies on the interdependence of couples' health behaviors and subsequent cognitive outcomes remain limited. Methods: Longitudinal data from the China Health and Retirement Longitudinal Study (2011-2018) were used (N = 1869 heterosexual couples). Latent class analysis identified the dyadic pattern of health behaviors in 2011 (i.e., alcohol consumption, smoking, and physical inactivity). Stratified Cox models examined the association of latent classes with risk of developing memory-related disorders in 2013-2018. Results: Three classes were identified: class 1 (21.25%, only husband smoke, and both active), class 2 (47.55%, both inactive, neither drink nor smoke), and class 3 (31.20%, both drink and smoke, and both active). Couples' sedentary lifestyle was associated with an increased risk of memory-related disorders among both husbands and wives. Conclusion: Couples were moderately concordant in their physical activity but weakly in smoking and drinking. Couple-based interventions, especially promoting physical activity, may reduce cognitive aging among middle-aged and older Chinese couples.

Prevalence of comorbidities and its associated factors among type-2 diabetes patients: a hospital-based study in Jashore District, Bangladesh

OBJECTIVE

This study aimed to estimate the prevalence of comorbidity and its associated factors among Bangladeshi type-2 diabetes (T2D) patients.

DESIGN

A hospital-based cross-sectional study.

SETTING

This study was conducted in two specialised diabetic centres residing in the Jashore District of Bangladesh. A systematic random sampling procedure was applied to identify the T2D patients through a face-to-face interview.

PARTICIPANTS

A total of 1036 patients with T2D were included in this study. A structured questionnaire was administered to collect data on demographic, lifestyle, medical and healthcare access-related data through face-to-face and medical record reviews.

OUTCOME MEASURES AND ANALYSES

The main outcome variable for this study was comorbidities. The prevalence of comorbidity was measured using descriptive statistics. A logistic regression model was performed to explore the factors associated with comorbidity among Bangladeshi T2D patients.

RESULTS

The overall prevalence of comorbidity was 41.4% and the most prevalent conditions were hypertension (50.4%), retinopathy (49.6%), obesity (28.7%) and oral problem (26.2). In the regression model, the odds of comorbidities increased with gender (male: OR: 1.27, 95% CI 0.62 to 1.87), age (50-64 years: OR: 2.14, 95% CI 1.32 to 2.93; and above 65 years: OR: 2.96, 95% CI 1.83 to 4.16), occupation (unemployment: OR: 3.32, 95% CI 0.92 to 6.02 and non-manual worker: OR: 2.31, 95% CI 0.91 to 5.82), duration of diabetes (above 15 years: OR: 3.28, 95% CI 1.44 to 5.37), body mass index (obese: OR: 2.62, 95% CI 1.24 to 4.26) of patients. We also found that individuals with recommended moderate to vigorous physical activity levels (OR: 0.41, 95% CI 1.44 to 5.37) had the lowest odds of having comorbidity. Meanwhile, respondents with limited self-care practice, unaffordable medicine and financial problems had 1.82 times, 1.94 times and 1.86 times higher odds of developing comorbidities.

CONCLUSION

The findings could be useful in designing and implementing effective intervention strategies and programmes for people with T2D to reduce the burden of comorbidity.

Analysis of national physical activity and sedentary behaviour policies in China

PURPOSE

The aims of this study were to advance knowledge on physical activity (PA) and sedentary behaviour (SB) policies in China and to highlight related gaps and opportunities in the Chinese policy landscape.

METHODS

Literature and web-based searches were performed to identify national PA and SB policies in China. We assessed which of the 17 elements of the Health-Enhancing Physical Activity Policy Audit Tool (HEPA PAT, version 2) are included in each of the policy documents and whether and how they address the 'cornerstones' of PA and SB policy: PA and SB guidelines, targets, surveillance and monitoring, and public education programmes.

RESULTS

We found 60 national PA and SB policies, of which 54 focused on PA only and 6 focused on both PA and SB. There was a rapid increase in the number of policies issued between 2002 and 2021. In totality, the policies include all 17 key elements for a successful national policy approach to PA promotion according to the HEPA PAT. The policies reflect engagement from a range of sectors and encompass PA targets, recommendations for PA and SB, mandates and recommendations for school-related PA, plans for public education on PA, and plans for surveillance and monitoring of PA and SB.

CONCLUSION

Our findings demonstrate that there has been increasing focus on PA and SB policies in China, which reflects efforts by policymakers to address the health burden of insufficient PA and excessive SB. More emphasis may be placed on SB in Chinese policy, particularly in terms of setting specific targets for population SB. Policymakers and other relevant public health stakeholders in China could also consider developing or adopting the 24-hour movement guidelines, in accordance with recent trends in several other countries. Collaboration and involvement of different sectors in the development and implementation of Chinese PA and SB policies should continue to be facilitated as part of a whole-of-system approach to health promotion.

Physical activity's impact on rural older adult health: The multiple mediating effects of education, income, and psychological capital

Introduction

This study aims to explore the influence mechanism of rural older adult health. By examining the mediating roles of education, income, and psychological capital in physical activity's impact on health, this study provides a reference for lifestyle interventions to improve the health level of rural older adults.

Methods

The analysis was conducted on a sample of 1778 rural older adults from CGSS2017, and data were analyzed using PROCESS V4.2 for multiple mediating effects.

Results

The findings indicate that physical activity impacts rural older adult health through multiple mediating pathways. The mediating role includes seven paths, comprising the independent effects of three mediating variables of income, education, and psychological capital, and the chain mediating effects generated together.

Discussion

Based on the influence mechanism of health on rural older adults, optimizing policy focus and developing a precise, interconnected, and sustainable health security system for older adults is necessary. These research results are of practical significance for advancing healthy aging in rural areas.

Associations of environmental factors with total cholesterol level of middle-aged and elderly people in China

BACKGROUND

Dyslipidemia is a key factor causing cardio cerebrovascular diseases, and the total cholesterol (TC) is an important lipid indicator among them. Studies have shown that environmental factors have a strong association with TC levels. Previous studies only focused on the seasonal variation of TC level and the short-term effects of some environmental factors on TC level over time, and few studies explored the geographical distribution of TC level and quantified the impact of environmental factors in space.

METHODS

Based on blood test data which was from China Health and Retirement Longitudinal Study (Charls) database, this study selected the TC level test data of middle-aged and elderly people in China in 2011 and 2015, and collected data from 665 meteorological stations and 1496 air pollutant monitoring stations in China. After pretreatment, the spatial distribution map of TC level was prepared and the regional statistics were made. GeoDetector and geographically weighted regression (GWR) were used to measure the relationship between environmental factors and TC level.

RESULTS

The TC level of middle-aged and elderly in China was higher in females than in males, and higher in urban areas than in rural areas, showing a clustered distribution. The high values were mainly in South China, Southwest China and North China. Temperature, humidity, PM₁₀ and PM_2.5 were significant environmental factors affecting TC level of middle-aged and elderly people. The impact of pollutants was more severe in northern China, and TC level in southern China was mainly affected by meteorological factors.

CONCLUSIONS

There were gender and urban-rural differences in TC levels among the middle-aged and elderly population in China, showing aggregation in geographical distribution. Meteorological factors and air pollutants may be very important control factors, and their influencing mechanism needs further study.

Population vulnerability to extreme cold days in rural and urban municipalities in ten provinces in Spain

BACKGROUND

The objective was to analyze whether there are differences in vulnerability to Extreme Cold Days (ECD) between rural and urban populations in Spain.

METHODOLOGY

Time series analysis carried out from January 1, 2000, through December 31, 2013. Municipalities with over 10,000 inhabitants were included from 10 Spanish provinces, classified into 42 groups by isoclimate and urban/rural character as defined by Eurostat criteria. The statistical strategy was carried out in two phases. First: It was analyzed the relationship between minimum daily temperature (Tmin) (source: AEMET) and the rate of daily winter mortality due to natural causes -CIE-10: A00 - R99- (source: National Statistics Institute). Then, It was determinated the threshold of Tmin that defines the ECD and its percentile in the series of winter Tmin (Pthreshold), which is a measure of vulnerability to ECD so that the higher the percentile, the higher the vulnerability. Second: possible explanatory variables of vulnerability were explored using Mixed Generalized Models, using 13 independent variables related to meteorology, environment, socioeconomics, demographics and housing quality.

RESULTS

The average Pthreshold was 18 %. The final model indicated that for each percentage point increase in unemployment, the vulnerability to ECD increased by 0.4 (0.2, 0.6) points. Also, with each point increase in rurality index, this vulnerability decreased by -6.1 (-2.1, -10.0) points. Although less determinant, other factors that could contribute to explaining vulnerability at the province level included minimum winter daily temperatures and the percentage of housing with poor insulation.

CONCLUSIONS

The vulnerability to ECD was greater in urban zones than in rural zones. Socioeconomic status is a key to understanding how this vulnerability is distributed. These results suggest the need to implement public health prevention plans to address ECD at the state level. These plans should be based on threshold temperatures determined at the smallest scale possible.

Prevalence and Factors Influencing Sarcopenia Among Community-Dwelling Older Adults Using the Asian Working Group for Sarcopenia Definition

OBJECTIVE

This study aimed to explore the prevalence and impact of related factors for sarcopenia among community-dwelling older people in Chongming district, China, according to the diagnostic criteria of the Asia Working Group for Sarcopenia-2019.

METHODS

We conducted a cross-sectional study from April 2021 to December 2021. Diagnosis of sarcopenia (non-sarcopenia, possible sarcopenia, sarcopenia, and severe sarcopenia) was based on appendicular skeletal muscle mass index, handgrip strength, gait speed, and the 5-time chair stand test. Staff collected all subjects' clinical and sociodemographic characteristics, cardiovascular disease (CVD) risk factors, inflammatory markers, physical activity (PA), and daily lifestyle activities to identify sarcopenia-related factors.

RESULTS

A total of 1407 older people aged ≥ 65 years were enrolled into the study (58.7% female). The prevalence of confirmed sarcopenia was 19.6% (17.1% in females and 23.1% in males). The prevalence of possible sarcopenia, sarcopenia, and severe sarcopenia were 19.7% (22.2% in females, 16.2% in males), 11.9% (10.1% in females, 14.5% in males), and 7.7% (7% in females, 8.6% in males), respectively. Increasing age, gender, depression status, and high-fat mass were associated with an increased likelihood of sarcopenia in all subjects. In females, living alone, high-fat mass, lower body mass index (BMI), lower body weight, and have no time spent doing housework increased the likelihood of sarcopenia. In males, depression status, high-fat mass, higher neutrophils-to-lymphocytes ratio (NLR), lower BMI, lower body weight increased the likelihood of sarcopenia.

CONCLUSION

Our study showed a high prevalence of sarcopenia among community-dwelling older people in the Chongming district. Detection, prevention, and treatment efforts are needed to reduce the impact of sarcopenia in older, rural communities in China.

Prevalence of Non-Communicable Diseases and Its Associated Factors Among Urban Elderly of Six Indian States

Aims The aim of this study is to investigate the prevalence, impact of health determinants on non-communicable diseases (NCDs), and multimorbidity among urban elderly in India. Methods This is a cross-sectional study involving a total of 1,671 (870 male and 801 female) respondents aged 60-80 years. Multistage sampling was used for the recruitment of the participants. A total of 12 sample areas from 12 cities of six southern states of south India were selected. Through survey form, information regarding demographic characteristics, health-influencing lifestyle factors, and history of nine NCDs was collected. Results The mean age of participants was 68.5 ± 6.01 years.. The prevalence of hypertension was 40.4%, followed by diabetes (31.2%), arthritis (22.1%), sensory impairment (10.1%), heart diseases (7.8%), and dyslipidemia (7.0%). 74.1% of participants had at least one morbidity, and 40.0% of people had multimorbidity. Being overweight is the highest risk health determinant for hypertension, diabetes, heart disease, high cholesterol, stroke, and joint pain. Obese people have 64% more risk of hypertension than people with normal BMI. People with disturbed sleep have increased risk of hypertension, high cholesterol, and joint pain by more than 80% compared to people with proper sleep. Among the modifiable health determinants of obesity, disturbed sleep, constipation, and physical activity up to 30 minutes were positively associated with multimorbidity. Those in the age group of 70 to 80 years have a high risk for NCDs and multimorbidity compared to those in the age group of 60 to 70 years. Conclusions A healthy lifestyle is necessary to reduce the burden of NCDs among the elderly. Developing holistic health policies seems an urgent need.

The impact of potentially modifiable risk factors for stroke in a middle-income area of China: A case-control study

Aims

To reveal the impact of eleven risk factors on stroke and provide estimates of the prevention potential.

Methods

We completed a multicenter case-control study in Jiangxi, China, a middle-income area. Neuroimaging examination was performed in all cases. Controls were stroke-free adults recruited from the community in the case concentration area. Conditional logistic regression and unconditional logistic regression were used for subgroup analysis of stroke type, and other groups (sex, age and urban-rural area), respectively. Odds ratios (ORs) and their population attributable risks (PARs) were calculated, with 95% confidence intervals.

Results

A total of 43,615 participants (11,735 cases and 31,880 controls) were recruited from February to September 2018, of whom we enrolled 11,729 case-control pairs. Physical inactivity [PAR 69.5% (66.9-71.9%)] and hypertension [53.4% (49.8-56.8%)] were two major risk factors for stroke, followed by high salt intake [23.9% (20.5-27.3%)], dyslipidemia [20.5% (17.1-24.0%)], meat-based diet [17.5% (14.9-20.4%)], diabetes [7.7% (5.9-9.7%)], cardiac causes [5.3% (4.0-6.7%)], alcohol intake [4.7% (0.2-10.0%)], and high homocysteine [4.3% (1.4-7.4%)]. Nine of these factors were associated with ischemic stroke, and five were associated with intracerebral hemorrhage. Collectively, eleven risk factors accounted for 59.9% of the PAR for all stroke (ischemic stroke: 61.0%; intracerebral hemorrhage: 46.5%), and were consistent across sex (men: 65.5%; women: 62.3%), age (≤55: 65.2%; >55: 63.5%), and urban-rural areas (city: 62.2%; county: 65.7%).

Conclusion

The 11 risk factors associated with stroke identified will provide an important reference for evidence-based planning for stroke prevention in middle-income areas. There is an urgent need to improve awareness, management and control of behavioral and metabolic risk factors, particularly to promote physical activity and reduce blood pressure.

Validation of a Model Predicting That Physical Activities Improve Health-Related Quality of Life in Older Japanese Adults with Pain, Dysesthesia, and Kinesiophobia after Lumbar Surgery: Structural Equation Modeling

Objectives. This study assessed the validity of a hypothesized model predicting that physical activity improves health-related quality of life (HRQOL) in older Japanese adults with pain, dysesthesia, and kinesiophobia following lumbar surgery. Methods. We included 431 elderly patients who underwent surgery for lumbar spinal stenosis at two hospitals. The frequency of physical activity, pain, dysesthesia, kinesiophobia (somatic focus and activity avoidance), and HRQOL were investigated using a questionnaire. Missing values were complemented by the stochastic regression imputation. We constructed the following model. (i) physical activity affects pain, dysesthesia, and kinesiophobia. (ii) pain, dysesthesia, and kinesiophobia separately affect HRQOL. This hypothetical model was tested by structural equation modeling. The model was improved based on a modified index. Results. Of the 431 respondents, 297 (median age 72 years, range 65–91 years; 158 men and 139 women) were analyzed (68.9%). The fit of the model improved based on the modification index and was acceptable comparative fit index, 0.948; Tucker–Lewis index, 0.919; root mean square error of approximation, 0.048 (90% confidence interval, 0.026–0.069), and standardized root mean square residual (0.046). The paths by which physical activities reduced pain or dysesthesia (standardized pass coefficients, −0.406) and somatic focus (−0.301) and consequently improved HRQOL were significant (pain/dysesthesia, −0.684; somatic focus, −0.218). Discussion. Our hypothesized model predicting that physical activity improves HRQOL in terms of pain, dysesthesia, and kinesiophobia in older Japanese adults after lumbar surgery was validated using cross-sectional data. Interventional studies on physical activity based on this model are required to establish the model.

The Impact of Physical Activity Levels and Functional Fitness Status on the Quality of Life Perceived by Older Adults Living in Rural and Urban Areas: The Portuguese Inland Case

Health-related quality of life (HRQoL) is influenced by several factors, such as living place, physical activity (PA), and functional fitness levels. Evidence shows that functional fitness and PA levels are strongly associated with positive HRQoL, especially in the older population. However, the impact of the living place has not been investigated as an influencing variable in this context. Therefore, this study aimed to investigate the relationship between the HRQoL, PA, and functional fitness of older adults living in rural and urban areas of Portugal. A cross-sectional study was performed with community-dwelling adults aged 65 years and over (n = 261) living in the city of Guarda. The participants were assessed for sociodemographic, anthropometric, clinical health, HRQoL, PA levels, and functional fitness status. The results showed that rural residents presented higher scores of HRQoL and functional fitness than older individuals living in urban areas. Regression models showed that functional fitness variables influence the HRQoL overall score and mental and physical subcomponents of HRQoL, regardless of the living place. In contrast, PA levels only influenced the HRQoL score in rural residents. The findings suggest that intervention programs to improve the physical health, quality of life, and well-being of the older population need to consider the country’s different geographical areas.

The Effect of Built Environment on Older People Leisure-Time Walking and Physical Activity in Different Sex Groups in the City of Ningbo, China

The aim of this study was to examine the effect of built environment (BE) elements on older people’s (OP) leisure-time physical activity (LTPA) and leisure-time walking (LTW) level in the city of Ningbo. Older participants numbering 312 were randomly recruited using cross-sectional survey in 2019. International Physical Activity Questionnaire-short version (IPAQ-S) and Neighborhood Environment Walkability Scale—abbreviated (NEWS-A)—were used to gather LTPA data and the perceive scores of BE, respectively. Liner regression analysis was performed to investigate the association relationship between the perceived scores of BE and OP’s LTW and LTPA. The study’s results showed that, when not considering different sex groups, OP’s LTW was significantly related with the perceived scores of access to services (AE, p = 0.045), walking/cycling facilities (W/CF, p = 0.007), aesthetics, and land use mix diversity (LUMD, p = 0.04). OP’s LTPA was significantly related with AE (p = 0.04) and aesthetics (p < 0.001). The association relationships of BE with LTW and LTPA varied in different sex groups. Three elements (AE, W/CF, and LUMD) and one element (pedestrian/traffic safety and P/TS) of BE were found be related with older male and older female’s LTW, respectively. One element (aesthetics) and two elements (aesthetics, LUMD) of BE were found be related with older male and older female’s LTPA, respectively. The results indicated that the effects of BE on OP’s LTW and the effects of BE on OP’s LTPA were different. The effect also varied in different sex groups. More studies are needed to confirm the effect of BE on OP’s LTW and LTPA in different sex groups to globally enrich the scientific data base.

Associations of public open space attributes with active and sedentary behaviors in dense urban areas: A systematic review of observational studies

In the context of rapid urbanization, public open spaces in dense urban areas are critical built environment elements to support active lifestyles. Several reviews have explored the associations of public open space attributes with physically active and sedentary behavior. However, few reviews have included studies from Asia, and no studies have focused on dense urban areas. This systematic review analyzed 18 observational studies investigating associations between public open space attributes with physical activity and sedentary behavior in dense urban areas of East Asian countries, including Japan, Taiwan, China, and Hong Kong. We found that closer distance to and a greater number of public open spaces and features within them were positively associated with leisure-time physical activity. Places near water features and corridors within public open spaces were associated with more sedentary behavior. These findings inform landscape and urban design guidelines for (re)designing public open spaces to support active lifestyles in high dense urban areas.

Analysis of vulnerability to heat in rural and urban areas in Spain: What factors explain Heat's geographic behavior?

INTRODUCTION

There is currently little knowledge and few published works on the subject of vulnerability to heat in rural environments at the country level. Therefore, the objective of this study was to determine whether rural areas are more vulnerable to extreme heat than urban areas in Spain. This study aimed to analyze whether a pattern of vulnerability depends on contextual, environmental, demographic, economic and housing variables.

METHODS

An ecological, longitudinal and retrospective study was carried out based on time series data between January 01, 2000 and December 31, 2013 in 42 geographic areas in 10 provinces in Spain. We first analyzed the functional relationship between the mortality rate per million inhabitants and maximum daily temperature (Tmax). We then determined the summer temperature threshold (Pthreshold) (June-September) at which increases in mortality are produced that are attributable to heat. In a second phase, based on Pthreshold, a vulnerability variable was calculated, and its distribution was analyzed using mixed linear models from the Poisson family (link = log). In these models, the dependent variable was vulnerability, and the independent variables were exposure to high temperatures, aridity of the climate, deprivation index, percentage of people over age 65, rurality index, percentage of housing built prior to 1980 and condition of dwellings.

RESULTS

Rurality was a protective factor, and vulnerability in urban areas was six times greater. In contrast, risk factors included aridity (RR = 5.89 (2.26 15.36)), living in cool summer zones (2.69 (1.23, 5.91)), poverty (4.05 (1.91 8.59)) and the percentage of dysfunctional housing (1.13 (1.04 1.24)).

CONCLUSIONS

Rural areas are less vulnerable to extreme heat than the urban areas analyzed. Also, population groups with worse working conditions and higher percentages of dwellings in poor conditions are more vulnerable.

Prevalence and characteristics associated with diabetes mellitus and impaired fasting glucose among people aged 15 to 64 years in rural and urban Rwanda: secondary data analysis of World Health Organization surveillance data

Introduction

diabetes mellitus is an increasing public health burden in developing countries. The magnitude of diabetes association with traditional risk factors for diabetes have been given less attention in rural population. This study aims to determine the prevalence of diabetes and impaired fasting glucose and to assess associated characteristics to hyperglycemia in rural and urban Rwanda.

Methods

this is a secondary analysis of data from a population-based cross-sectional study of 7240 people describing risk factors for non-communicable diseases using the WHO stepwise methods (STEPS). Relative frequencies of variables of interest were compared in rural and urban residence using Pearson chi-square tests. Diabetes and impaired fasting glucose were combined in a single hyperglycemia variable and odds ratios with 95% confidence intervals were used to explore associations between hyperglycemia, socio-demographic and health factors in urban and rural populations.

Results

the prevalence in rural and urban areas was 7.5% and 9.7% (p.005) for diabetes and 5.0% and 6.2% for impaired fasting glucose (p.079) respectively. Obesity (AOR 2.57: CI: 0.86-7.9), high total cholesterol (AOR 3.83: CI: 2.03-7.208), hypertension (AOR 1.18: CI: 0.69-2.00), increasing age were associated with hyperglycemia in urban participants but only high total cholesterol and low high density lipoproteins (HDL) cholesterol were risk factors for hyperglycemia in rural participants.

Conclusion

approximately one in six people in Rwanda have hyperglycemia. The magnitude of the association with traditional risk factors for diabetes differ in rural and urban settings. Different approaches to primary and secondary prevention of diabetes may be needed in rural populations.

Association between physical activity and falls among older adults in rural China: are there gender and age related differences?

BACKGROUND

The relationship between physical activity (PA) and falls among older adults is inconsistent, and little is known about the gender-specific association between falls and PA. Moreover, age may modify this relationship. This study aimed to test the association between PA and falls and to investigate the gender and age differences in the association among rural older adults.

METHODS

This cross-sectional data were derived from the baseline survey of Shandong Rural Elderly Health Cohort (SREHC). In total, 3,242 rural older adults aged 60 years and above were included in the analysis. PA was measured by the International Physical Activity Questionnaire Short Form (IPAQ-S). PA levels were classified as low, moderate, elevated and high according to quartiles. Volume of moderate-to-vigorous physical activity (MVPA) was categorized into low, moderate, elevated, and high level based on global recommendations. Information on falls was determined from in-person interviews. Falling was defined to participants as ending up on the floor or ground because they were unable to stop themselves. Logistic regression analysis was employed to explore the association between falls and PA.

RESULTS

Of 3,242 rural older adults, the incidence of falls was 13.1%. In older adults, high levels of PA [odds ratio (OR) = 0.65, 95% confidence interval (CI): 0.47-0.90] or MVPA (OR = 0.68, 95% CI: 0.50-0.94) were related to falls. Moderate (OR = 4.84, 95% CI: 1.68-13.94) or high (OR = 0.54, 95% CI: 0.30-0.99) levels of MVPA were associated with falls in older men. But elevated levels of PA were associated with falls (OR = 0.60, 95% CI: 0.42-0.87) in older women. Among older people younger than 75 years, elevated (OR = 0.54, 95% CI: 0.37-0.79) or high (OR = 0.68, 95% CI: 0.48-0.98) levels of PA were associated with falls.

CONCLUSIONS

Among Chinese rural older adults, PA and MVPA are associated with falls, and there are gender and age differences. To prevent falls, measures need to account for individuals' gender and age to encourage rural older adults to participate more actively in PA. We will conduct longitudinal studies to clarify the causal relationship between PA and fall.

Level of engagement of recreational physical activity of urban villagers in Luohu, Shenzhen, China

Physical activity is important for health. However, there is a lack of literature related to the physical activity levels of adults living in urban villagers, which is a vulnerable population in China. The aim of this study is to compare the physical activity and sedentary behavior engagements between urban villagers and non-urban villagers using the 2019 Luohu Shenzhen, China Community Diagnosis Questionnaire. A total of 1205 adults living in urban villages and non-urban villages were included in the analysis. Unadjusted and multiple multivariate logistic regression were conducted for the dependent variable of engagement in recreational physical activity, frequency of recreational physical activity per week, and hours spent in sedentary behaviors per day. Descriptive analysis was conducted to identify the reasons for not engaging in physical activity among urban villagers and non-urban villagers. Across the included sample, 29.05% were urban villagers and 70.95% were non-urban villagers. The results suggested that urban villagers are more likely to engage in physical activity than non-urban villager (OR = 1.90, 95% CI [1.40, 2.59], p < 0.001). However, it was also found that urban village status had no significant association for frequency in engaging in physical activity and average hours spent in sedentary behaviors. Both urban villagers and non-urban villages indicated that lack of time, lack of safe and appropriate environment, and working in labor intensive occupations as some of the reasons for not engaging in physical activity. There is a need for tailed interventions and policies for promoting physical activity among urban villagers and non-urban villagers. Additional studies are needed to further our understanding of the physical activity behaviors among urban villagers in China.

Productive engagement of older adults in China: A multilevel analysis

AIM

This study investigates how the personal characteristics and behavior, and health status of older adults in China influenced their productive engagement in paid and unpaid jobs.

METHODS

Data for this analysis came from 2002, 2005, 2008 and 2011 waves of the Chinese Longitudinal Healthy Longevity Survey (CLHLS). We used a random intercept multilevel multinomial logit model to analyze data from 3208 older adults aged 65 from the 2002 wave, which decreased to 1385 in 2011. The main study variable is older adults' engagement in paid jobs and unpaid work (including housework, care-taking, poultry farming, and planting vegetables that have an economic value).

RESULTS

There was a strong association between older adults' productive engagement and their functional limitations to daily living activities, health and healthy behavior. Older adults with inadequate finance were more likely to be working to support themselves. Those who exercised less and living in the provinces with higher GDP were less likely to work post-retirement. Chronic diseases, advances in age, no education and rural residence did not deter older adults from doing unpaid work.

CONCLUSION

Older adults in China were actively engaged in paid and unpaid activities. Efforts to support the active engagement of older adults require all stakeholders to promote healthy living, facilitate social engagements and provide an age-friendly work environment. Geriatr Gerontol Int 2021; 21: 1138-1146.

Urban-Rural Differences in Patterns and Associated Factors of Multimorbidity Among Older Adults in China: A Cross-Sectional Study Based on Apriori Algorithm and Multinomial Logistic Regression

Introduction: Multimorbidity has become one of the key issues in the public health sector. This study aimed to explore the urban–rural differences in patterns and associated factors of multimorbidity in China and to provide scientific reference for the development of health management strategies to reduce health inequality between urban and rural areas.

Methods: A cross-sectional study, which used a multi-stage random sampling method, was conducted effectively among 3,250 participants in the Shanxi province of China. The chi-square test was used to compare the prevalence of chronic diseases among older adults with different demographic characteristics. The Apriori algorithm and multinomial logistic regression were used to explore the patterns and associated factors of multimorbidity among older adults, respectively.

Results: The findings showed that 30.3% of older adults reported multimorbidity, with significantly higher proportions in rural areas. Among urban older adults, 10 binary chronic disease combinations with strong association strength were obtained. In addition, 11 binary chronic disease combinations and three ternary chronic disease combinations with strong association strength were obtained among rural older adults. In rural and urban areas, there is a large gap in patterns and factors associated with multimorbidity.

Conclusions: Multimorbidity was prevalent among older adults, which patterns mainly consisted of two or three chronic diseases. The patterns and associated factors of multimorbidity varied from urban to rural regions. Expanding the study of urban–rural differences in multimorbidity will help the country formulate more reasonable public health policies to maximize the benefits of medical services for all.

Physical activity and its association with cognitive function in middle- and older-aged Chinese: Evidence from China Health and Retirement Longitudinal Study, 2015

BACKGROUND

Despite the known benefits of physical activity (PA) on cognitive function, the specific dimensions of PA that are associated with cognitive function require further research in China. We aimed to explore the patterns of PA and elucidate the association between cognitive function and different levels of PA in middle aged and elderly Chinese individuals.

METHODS

A total of 8,023 participants aged ≥45 years were selected from the China Health and Retirement Longitudinal Study. The PA intensity was categorized as: vigorous (VPA), moderate (MPA), and light (LPA). The associations of frequency and duration of PA at different intensities with cognitive function were examined using the multivariable linear model, including all respondents and urban-rural subgroups.

RESULTS

Compared with those who had no VPA, those who spent 6-7 days/week (β = -0.59, 95% CI: -1.10, -0.09) or more than 240 min/each time on VPA had poorer cognitive function among rural respondents, whereas cognitive function was only associated with the duration in urban respondents. Compared with those who had no MPA, the rural respondents who spent 1-5 days/week (β = 0.66, 95% CI: 0.12, 1.20) or 6-7days/week, or spent < 2 hours each time had better cognitive function. For LPA, frequency and duration were both positively associated with cognitive function, and were observed in both rural and urban sub-groups.

CONCLUSIONS

The association between cognitive function and PA depended largely on the intensity and area. Cultural context and geographical differences should be considered when designing intervention policies.Highlights The prevalence of PA increased as the intensity decreased and was higher in rural respondents than in urban respondents.Cognitive function was related to the intensity, frequency, and duration of PA. However, the magnitude and direction of the association depended mainly on the intensity and geographical area.VPA was negatively correlated with cognitive function, and the association was significant only in rural respondents. However, MPA and LPA were positively correlated with cognitive function, while the association between LPA and cognitive function was significant in both rural and urban respondents.

The Associations of Built Environment with Older People Recreational Walking and Physical Activity in a Chinese Small-Scale City of Yiwu

Physical activity would bring in plenty of health benefits, especially recreational physical activity (RPA). Previous studies have suggested that built environment would affect older people's recreational walking (RW) and RPA, but how the effects exist in a small-scale Chinese city remains unclear. Two hundred and fifty-two older participants were recruited in the city of Yiwu using cross-sectional survey of random samples in 2019. RW and RPA level of participants and perceived scores of built environments were collected using the International Physical Activity Questionnaire and Neighborhood Environment Walkability Scale, respectively. Linear regression analysis was conducted to investigate the association of built environment with older people's RW and RPA. The results showed that two main factors affecting older people's RW and RPA were residential density and aesthetics. Additionally, access to services was related to RW, and street connectivity was correlated with RPA. The associations of RW with built environment varied slightly with demographic variables included in the regression model. All the results suggested that lower residential density, better aesthetics environment, and higher street connectivity would motivate older people to engage more in RW and RPA. The better access to services encourages only RW, not RPA, in older people. These findings would be helpful for policy decision makers in the urban construction process in Yiwu. More studies are needed to enlarge the scientific evidence base about small-scale cities in China.

Prevalence of comorbidities and their associated factors in patients with type 2 diabetes at a tertiary care department in Ningbo, China: a cross-sectional study

OBJECTIVES

To determine the prevalence of comorbidities in patients with type 2 diabetes mellitus (T2DM) and identify the factors independently associated with comorbidities in a tertiary care department in Ningbo, China.

DESIGN

A computerised medical records database was used to conduct a cross-sectional study.

SETTING

The study was conducted in a tertiary care department in Ningbo, China.

PARTICIPANTS

The study was conducted on adult patients with T2DM, and it included 8 years of data, from 1 January 2012 to 31 December 2019.

THE PRIMARY OUTCOME MEASURE

Comorbidity was defined as the coexistence of at least one other chronic condition, that is, either a physical non-communicable disease (duration ≥3 months), a mental health condition (duration ≥3 months) or an infectious disease (duration ≥3 months).

RESULTS

In total, 4777 patients with T2DM satisfied the eligibility criteria. Over 8 years, the prevalence of comorbidities was 93.7%. The odds of comorbidities increased with the age of patients (18 to 39 years: 1; 40 to 59 years: OR 2.80, 95% CI 1.98 to 3.96; 60 to 69 years: OR 4.43, 95% CI 3.04 to 6.44; and ≥70 years: OR 10.97, 95% CI 7.17 to 16.77). The odds were lower in female patients (OR 0.66, 95% CI 0.51 to 0.84), patients residing in rural areas (OR 0.75, 95% CI 0.59 to 0.95) and patients without health insurance (OR 0.62, 95% CI 0.46 to 0.83). The odds were higher in single/divorced/widowed patients compared with those in married patients (OR 1.95, 95% CI 1.21 to 3.12).

CONCLUSIONS

A large percentage of patients with T2DM in the tertiary care department in Ningbo, China, had comorbidities, and the factors associated with comorbidities were identified. The findings could be used in developing, evaluating and implementing interventions aimed at improving outcomes in patients with T2DM with comorbidities.

Comparison of Muscle Density in Middle-Aged and Older Chinese Adults Between a High-Altitude Area (Kunming) and a Low-Altitude Area (Beijing)

BACKGROUND AND PURPOSE

A high-altitude environment was known to have a negative effect on bone and lead to a higher incidence of hip fracture. However, the dependence of muscle composition on altitude is unclear. Thus, we aimed to compare muscle density and area in plateau and low altitude area and to determine the effect of the altitude on these outcomes.

METHODS

Community dwelling adults over 60 years old living in Beijing (elevation 50 m; 300 subjects,107 men and 193 women) or Kunming (elevation 2000 m; 218 subjects,83 men and 135 women) for more than 10 years were enrolled. Quantitative CT was performed in all subjects and cross-sectional area and attenuation measured in Hounsfield units (HU) were determined for the trunk, gluteus, and mid-thigh muscles.

RESULTS

Compared to Beijing, Kunming adults were slimmer (Beijing men vs Kunming men: 25.08 ± 2.62 vs 23.94 ± 3.10kg/m², P=0.013; Beijing women vs Kunming women: 25.31 ± 3.1 vs 23.98 ± 3.54 kg/m², P= 0.001) and had higher muscle density in the L2-trunk and gluteus maximus muscles after adjustment for age and BMI (L2-trunk muscles: Beijing men 29.99 ± 4.17 HU vs Kunming men 37.35 ± 4.25 HU, P< 0.0001; Beijing women 27.37 ± 3.76 HU vs Kunming women 31.51 ± 5.12 HU, P< 0.0001; Gluteus maximus muscle: Beijing men 35.11 ± 6.54 HU vs Kunming men 39.36 ± 4.39 HU, P= 0.0009; Beijing women 31.47 ± 6.26 HU vs Kunming women 34.20 ± 5.87 HU P=0.0375). Age was similar in both cohorts and no differences were observed in the gluteus medius and minimus muscle or the mid-thigh muscle, either in the area or density.

CONCLUSIONS

Compared with Beijing, the adults in Kunming had higher muscle density of the gluteus maximus and L2 trunk muscles, showing that living at a higher altitude might be beneficial to muscle quality.

Prevalence and Risk Factors of Type 2 Diabetes and Prediabetes Among 53,288 Middle-Aged and Elderly Adults in China: A Cross-Sectional Study

BACKGROUND

Diabetes is a metabolic disorder that causes a heavy burden on healthcare systems worldwide. The aim of this study was to determine the prevalence of type 2 diabetes and prediabetes and its associated factors among eight communities in Nanchong, China.

METHODS

This was an observational cross-sectional study conducted throughout eight communities in Nanchong, China. The participants were 53,288 individuals aged 45 years or older. The participants' characteristics, comorbidities, health behaviors, family history, and dietary intake were assessed. Multinomial logistic regression models were fitted to identify factors associated with type 2 diabetes and prediabetes.

RESULTS

The prevalence of diabetes and prediabetes was 13.9% (95% confidence interval [CI], 13.6-14.2) and 3.1% (95% CI, 2.9-3.2) of the population, respectively. After adjusting for other risk factors, advanced age, overweight, obesity, abdominal obesity, comorbidities, smoking, a family history of diabetes, and Chinese cooking vegetable intake were associated with an increased risk of type 2 diabetes and prediabetes.

CONCLUSION

The prevalence of type 2 diabetes in the Chinese population is rising compared with data from the past. The risk factors of type 2 diabetes and prediabetes identified in this study will aid the identification of individuals at a high-risk of diabetes and the implementation of effective health promotion programs and campaigns.

CLINICAL TRIAL REGISTRY NUMBER

ChiCTR-HOC-17013200.

Current status on the ability of the elderly in rural China: implications for future nursing and policy

Background

Aging is a global problem, and the ability assessment of the elderly plays an important role in the formulation of pension policies. It's necessary to evaluate the ability of the elderly in rural China to provide insights into future nursing care and policy making.

Methods

The elderly in 20 rural villages were selected by convenience sampling. We used "Elderly Ability Evaluation Form" issued by the Ministry of Civil Affairs of China as survey tool. The characteristics and score differences of the elderly of different ability level were compared and analyzed. And logistic regression analyses were conducted to identify the potential risk factors for disability in the elderly.

Results

A total of 2,878 elders were included, of which there were 1,916 elders with intact ability, 866 elders with mild disability, 42 elders with moderate disability, 54 elders with severe disability. The incidence of disability among respondents was 33.43%. There were significantly statistical differences in the dimensions of activities of daily living, mental state, perception and communication, and social participation among elders with intact ability, mild, moderate and severe disability (all P<0.05). The age, education level, marital status and living situations were all corrected to the scores on the activities of daily living, mental state, perception and communication, and social participation among elders (all P<0.05), and the elderly with age ≥75 years, illiteracy, unmarried and live alone had higher risk for disability (all P<0.05).

Conclusions

The current situation of the ability level of the elderly in rural China seems to be worrying, and it's necessary to establish a long-term nursing care system and aging policy to meet the needs of the elderly with regards to those potential influencing factors.

Individual-level factors attributable to urban-rural disparity in mortality among older adults in China

BACKGROUND

Urban-rural disparity in mortality at older ages is well documented in China. However, surprisingly few studies have systemically investigated factors that contribute to such disparity. This study examined the extent to which individual-level socioeconomic conditions, family/social support, health behaviors, and baseline health status contributed to the urban-rural difference in mortality among older adults in China.

METHODS

This research used the five waves of the Chinese Longitudinal Healthy Longevity Survey from 2002 to 2014, a nationally representative sample of older adults aged 65 years or older in China (n = 28,235). A series of hazard regression models by gender and age group examined the association between urban-rural residence and mortality and how this association was modified by a wide range of individual-level factors.

RESULTS

Older adults in urban areas had 11% (relative hazard ratio (HR) = 0.89, p < 0.01) lower risks of mortality than their rural counterparts when only demographic factors were taken into account. Further adjustments for family/social support, health behaviors, and health-related factors individually or jointly had a limited influence on the mortality differential between urban and rural older adults (HRs = 0.89-0.92, p < 0.05 to p < 0.01). However, we found no urban-rural difference in mortality (HR = 0.97, p > 0.10) after adjusting for individual socioeconomic factors. Similar results were found in women and men, and among the young-old and the oldest-old populations.

CONCLUSIONS

The urban-rural disparity in mortality among older adults in China was largely attributable to differences in individual socioeconomic resources (i.e., education, income, and access to healthcare) regardless of gender and age group.

Cross-cultural modifications and measurement properties of the CHAMPS questionnaire among Chinese older adults

Background/objective

The Community Health Activities Model Program for Seniors questionnaires (CHAMPS-Q) is one of the most extensively used instruments in assessing physical activity among older adults. However, no study had translated the CHAMPS-Q into Chinese, and no evaluations were made on the psychometric properties of the CHAMPS-Q among the Chinese population. Considering cultural differences in perceptions of language, cultural context and living habits, this study was of necessary to 1) translate and cross-culturally adapt the original CHAMPS-Q, and 2) examine the test-retest reliability and construct/predictive validity of the Chinese version of the CHAMPS-Q.

Methods

The English CHAMPS-Q was first translated into Chinese, synthesized, back-translated, and revised by an expert committee according to the pre-test results. The Chinese CHAMPS-Q was then assessed in a cross-sectional study consisting of 101 apparently healthy older adults. Test-retest reliability test was conducted with 7 days apart. The construct validity of the Chinese CHAMPS-Q was tested against accelerometer data, and the predictive validity was assessed against physical fitness as measured by the Senior Fitness Test.

Results

The Chinese CHAMPS-Q has moderate to excellent test-retest reliability (ICC = 0.72-.96, p < .05). Energy expenditure and duration in PA significantly correlated with all accelerometry outcomes (ρ = 0.22-.31, p < .05). All the outcomes from the CHAMPS-Q showed significant correlations with upper body muscle strength (ρ = 0.22-.34, p < .05).

Conclusion

The Chinese CHAMPS-Q has excellent test-retest reliability and acceptable construct and predictive validity in assessing the physical activity of Chinese older adults.

•

Cultural differences exist in physical activity habits between western and oriental older adults.

•

Cultural adaptions are necessary for the popularization of physical activity measurements.

•

Not only frequency and duration but also energy expenditures have significant meaning to physical activity evaluation.

•

The Chinese CHAMPS-Q is a reliable and valid instrument for assessing the physical activity of older adults.

Factors Associated with Healthy Ageing, Healthy Status and Community Nursing Needs among the Rural Elderly in an Empty Nest Family: Results from the China Health and Retirement Longitudinal Study

Health care for the rural elderly in and empty nest family is a major problem in such an ageing society such as China. Based on previous studies, China’s rural health care services only focus on the physical health of the elderly, while public health care services only provide primary services such as blood pressure and blood glucose measurement. This leads to the question of whether physical health is the most important issue for the Chinese rural empty nest elderly (CREE). It is necessary to find out their health status, nursing needs and influencing factors associated with healthy ageing (HA). Using the method of logistic regression, four dimensions of HA (adding psychological health, social participation and daily activities to physical health) among 618 respondents in total were analyzed based on public panel data from the national survey of the China Health and Retirement Longitudinal Study (CHARLS). Interesting results have been found; for example, the most important factor restricting the HA of the CREE is not physical health but social participation. The independence, health, good employment and economic conditions of their adult children play an important role in protecting the HA of the CREE.

Physical activity and posttraumatic growth in patients receiving maintenance hemodialysis: A prospective study

This study used a prospective design to examine the association between self-reported physical activity and posttraumatic growth (PTG) over a 1-year period among 150 patients receiving maintenance hemodialysis. Transport-related, household, and leisure-time physical activity were positively associated with PTG at baseline and follow-up. Total physical activity could predict higher levels of PTG at follow-up, after controlling for baseline PTG and other covariates. The findings indicate that daily physical activity could be a modifiable behavioral factor associated with PTG among patients receiving maintenance hemodialysis. Further study is needed using a randomized controlled design and objective measures of physical activity.

A healthy diet and physical activity are important to promote healthy ageing among older Chinese people

Objective

To examine the associations between multiple health behaviours and health outcomes among older Chinese adults.

Methods

Data from the World Health Organization’s Study on global AGEing and adult health Wave 1 (2007–2010), collected among the older Chinese population, were included in this study. Smoking, diet, and physical activity were analysed by linear regression for any associations with depressive symptoms, quality of life (QoL), cognitive function, and physical function.

Results

A total of 13 367 participants aged >49 years were included in the analyses. After controlling for key socioeconomic factors, healthy diet was significantly associated with higher QoL (β = 0.099) and better cognitive function (β = 0.023). Physical activity was significantly associated with fewer depressive symptoms (β = –0.020), higher QoL (β = 0.086), better cognitive function (β = 0.072), and better physical function (β = –0.155 [higher scores = poorer physical function]). No relationship was found between smoking and any health-related outcome included in this study.

Conclusion

This study demonstrates the importance of healthy diet and physical activity for health outcomes in the older Chinese population.

The Impact of Different Levels of Physical Activity on Health among Middle-Aged and Elderly Chinese Adults

BACKGROUND

There is a lack of specific study of the impact of physical activities on middle-aged and elderly adults in developing countries. We aimed to investigate the causal impact of different levels of physical activity on self-rated health status for Chinese adults with an average age of 61 yr from years 2011 to 2015.

METHODS

China Health and Retirement Longitudinal Study (CHARLS) conducted by the Peking University of China was utilized which was a longitudinal database and thus allowed to control for the effect of unobserved individual heterogeneities. In this study, this control was carried out using fixed effect and propensity score matching methods. In addition, this study further took into consideration of the discrete feature of our response variable, self-rated health status, by applying an ordered logit model.

RESULTS

Participating in moderate-to-vigorous physical activity significantly increased individuals' self-rated health status (P<.05) whereas lower intensity physical activity did not increase individuals' self-rated health status.

CONCLUSION

Moderate-to-vigorous physical activity is an important instrument to improve the health status of middle-aged and elderly population in China. Government should encourage people to involve in more moderate-to-vigorous physical activity as it is an efficient way to improve individuals' health status.

Understanding Levels and Motivation of Physical Activity for Health Promotion among Chinese Middle-Aged and Older Adults: A Cross-Sectional Investigation

Objective

Middle-aged and older Chinese adults (35 to 75) failed to meet the recommendations of physical activity guidelines for health promotion, because of a lack of understanding of their perspective on physical activity. This study considers the physical activity levels and motivation among middle-aged and older Chinese adults partitioned into three different participation groups (sports, exercise, and recreational and cultural activities).

Methods

A cross-sectional analysis was performed on 633 participants, based on two different levels of physical activity levels. The International Physical Activity Questionnaire (IPAQ) and the Exercise Motivation Inventory (EMI-2) with 14 subscales were used to measure the participant's physical activity levels and physical activity motivation for the three different group activities.

Results

Results indicate those participants' physical activity levels and motivation varied significantly among the different groups. The participants who engage in recreational and cultural activities have a higher motivation for physical activity, as compared with those whose primary form of physical activity is sports and exercise, and a higher probability to fulfill the global recommendations concerning physical activity. Participants who used recreational and cultural activities as their major type of physical activities were more motivated by “intrinsic” aspects. In contrast, those who participate in sports and exercise as their main type of physical activity are more motivated by “extrinsic” aspects.

Conclusion

Close friends and family members of one's home and community have potential influence in physical activity and recreational and cultural activity participants are highly motivated and luckier than others to fulfill the goal of physical activity levels.

Intensity, frequency, duration, and volume of physical activity and its association with risk of depression in middle- and older-aged Chinese: Evidence from the China Health and Retirement Longitudinal Study, 2015

Background

The general benefit of physical activity (PA) to one’s mental health has been widely acknowledged. Nevertheless, the specific type and amount of PA that associates with lower risk of depression in China awaits further investigation. The present study was conducted on middle- and older-aged Chinese population with two objectives: 1) to understand the patterns of PA; 2) to measure the associations between depression and PA at different levels from various aspects.

Methods

Using data from the China Health and Retirement Longitudinal Study (CHARLS, 2015), we selected 9118 community residents aged 45 years and older. Depressive symptoms were measured by 10-item Center for Epidemiologic Studies (CES-D 10). Multivariate logistic regression model was performed to examine the association between risk of depression and PA from four aspects including intensity, frequency, duration, and volume.

Results

Spending 1–2 days/week (OR = 0.58, 95% CI: 0.36, 0.91), less than 30 minutes each time (OR = 0.66, 95% CI: 0.42, 1.03) or 150–299 min/week (OR = 0.49, 95% CI: 0.28, 0.87) on Moderate Physical Activity (MPA) was associated with lower odds of depression in women. Spending 3–5 days/week (OR = 1.98, 95% CI: 1.29, 3.05) or 6–7 days/week (OR = 1.50, 95% CI: 1.07, 2.11), 4 hours and longer each time (OR = 1.65, 95% CI: 1.18, 2.32), 300 min/week or longer (OR = 1.65, 95% CI: 1.22, 2.24) on Vigorous Physical Activity (VPA) in total, or 2250 Metabolic Equivalent of Task (OR = 1.73, 95% CI: 1.26, 2.38) on Moderate-to-Vigorous PA was associated with higher risk of depression in men.

Conclusions

The association between depression and PA depended largely on intensity and gender. Lower frequency, shorter duration, and moderate amount of MPA was associated with lower risk of depression in women. Risk of depression was higher in men who spent higher frequency, longer duration, and overlong time on VPA.

Community readiness assessment for disseminating evidence-based physical activity programs to older adults in Changsha, China: a case for Enhance®Fitness

Physical activity (PA) has declined in China due to urbanization in the past two decades. Evidence-based programs are good approaches to promote PA, but are limited in China. Adopting existing programs can be a viable option. Prior to that, readiness assessment is needed. This study aimed to assess community readiness levels for disseminating evidence-based PA programs to older adults in Changsha, China. In-person interviews were conducted with 33 participants of five districts in Changsha to assess the community readiness level in five dimensions: community knowledge of efforts, community climate, community knowledge about the issue, leadership and resources. Data was transcribed, reviewed and compared with an anchored rating scale to provide a stage of readiness score ranging from 1 (no awareness) to 9 (high level of community ownership). Participants included 14 community staff, 13 older adults, four community leaders and three health professionals. The top three barriers to disseminating PA programs were lack of appropriate locations, funding and instructors. The top three resources were availability of indoor space, chairs and loudspeakers. Community leadership was the highest-rated readiness dimension (3.3 out of 9) followed by community climate (3.2), community knowledge of efforts (3.1) and resources (2.8); knowledge about the issue scored the lowest (2.7). The overall community stage readiness score of Changsha was 3.0 out of 9. The stage of readiness for communities in Changsha, China is 'vague awareness'. Developing strategies to improve community readiness levels may increase evidence-based PA program dissemination in Changsha, China.

Cell Phone Use and Happiness Among Chinese Older Adults: Does Rural/Urban Residence Status Matter?

This study explores the relationship between cell phone use and self-reported happiness among older adults in Mainland China and whether rural/urban residence status moderates this relationship. The analysis is based on a sample of 6,952 respondents over the age of 60, from the 2010 wave of China Family Panel Studies. Findings show that using own cell phone is positively associated with self-reported happiness among Chinese older adults (odds ratio [ OR] = 1.283, p < .001). This relationship remains for respondents residing in rural areas ( OR = 1.616, p < .01) but not for their urban counterparts. Findings reflect on how the happiness of Chinese older adults has been affected by a growing shift in the traditional family values due to the unprecedented economic growth. Results also highlight the disparities between state support for older adults in rural and urban areas as well as the necessity to develop relevant policies to improve the subjective well-being of China's rapidly growing population of older adults.

The Relationship between Urbanization, the Built Environment, and Physical Activity among Older Adults in Taiwan

Urbanization and ageing are global phenomena and offer unique challenges in different countries. A supportive environment plays a critical role in addressing the issue of behavioral change and health promotion among older adults. Many studies in the U.S., EU, and Australia have considered promoting physical activity in the community based on ecological models, whereas very few Asian studies have examined the relationships among urbanization, the built environment and physical activity in elderly at the ecological level, especially from a multi-level perspective. Due to the prevalence of post-war baby boomers and a very low birth-rate, the older population (aged 65 years old and older) in Taiwan has increased rapidly since 2011 and has exceeded the younger generation (0⁻14 years old) in 2017. Hence, the purpose of this study was first to examine the degree of urbanization in townships and the status of related built environments in Taiwan and then to investigate whether the built environment is associated with recommended amounts of physical activity among older adults. Three national datasets and a multi-level design were used in this research. Data at the individual level was obtained from the 2009 National Health Interview Survey (NHIS) which was taken from June 2009 to February 2010. Ecological data was obtained from the 2006 National Land Use Investigation of the National Geographic Information System and the 2010 Population and Housing Census. The analyses included a descriptive analysis, a bivariate analysis, a multiple logistic regression, and a multi-level analysis, utilizing a mostly hierarchical linear model (HLM). The results showed a significant relationship between factors at the environmental levels and physical activity in older adults. Urbanization, the built environment, and the median income of townships were positively correlated to the physical activity of the older adults. After controlling for individual-level factors, urbanization still exhibited this correlation. Parks and green spaces were associated with achieving the recommended amount of physical activity. However, there was no relationship after controlling for factors at the individual level. Detailed discussions were provided.

Greater Glycaemic Response to an Oral Glucose Load in Healthy, Lean, Active and Young Chinese Adults Compared to Matched Caucasians

There are ethnic differences recorded in glycaemic response and rates of type 2 diabetes mellitus (DM) between Chinese and Caucasian populations. Whether these differences are evident in matched healthy, lean, active, young adults is unclear. This study compares the postprandial glycaemic response of a group of Chinese participants (n = 49) with a group of similar Caucasians, (n = 48) aged 23.8 (±4.35 years), body mass index (BMI) 22.7 (±2.6) kg/m², healthy (free from non-communicable disease), and lean (body fat % 23.28% (±5.04)). Participants undertook an oral glucose tolerance test to identify any significant differences in postprandial blood glucose response. Body fat percentage, body mass, age, physical activity, baseline glucose and HbA1c did not significantly differ between groups. Data from food frequency questionnaires indicated that the Chinese participants consumed less starchy foods, candy and “other” sweets and sugary drinks, and more rice than the Caucasians (all p ≤ 0.001), but not a greater overall intake of carbohydrates or any other macronutrient (all p > 0.05). The two groups’ postprandial blood glucose responses and 2-h incremental area under the curve values (iAUC)—156.67 (74.12) mmol/L 120 min for Caucasians versus 214.03 (77.49) mmol/L 120 min for Chinese—indicate significant differences (p = 0.003 and p < 0.001 respectively) between groups. Findings suggest that the difference between the two groups’ iAUC values do not relate to obvious lifestyle factors. The Chinese group were eating the least sugary and starchy food but had the highest iAUC. It is argued that the Chinese group in this investigation have the most favourable BMI, body fat percentage, and body mass, yet “poorest” glycaemic response.