Estimating the joint effect of household solid fuel use and social isolation on depression among middle-aged and older adults in China

Association between household solid fuel use and cognitive frailty in a middle-aged and older Chinese population

Objectives

Our research intended to investigate the association between the solid fuels use and the risk of cognitive frailty (CF).

Methods

The research utilized data from the China Health and Retirement Longitudinal Study (CHARLS), a nationwide longitudinal study focusing on individuals aged 45 and older. A total of 8,563 participants without CF were enrolled from 2011 and followed up to 2015. Household fuel types include solid fuels (such as coal, crop residue, or wood-burning) and clean fuels (such as solar power, natural gas, liquefied petroleum gas, electricity, or marsh gas). CF was defined as the co-existence of cognitive impairment and physical frailty. Cox proportional hazards models were utilized to evaluate the relationship between the solid fuels use and the risk of CF. Furthermore, sensitivity analyses were conducted.

Results

Over a median follow-up of 4.0 years, 131 subjects were diagnosed with CF. We observed that the solid fuels use for cooking or heating increased the risk of developing CF compared to clean fuels, with HRs of 2.02 (95% CI: 1.25 to 3.25) and 2.38 (95% CI: 1.26 to 4.48), respectively. In addition, participants who use solid fuel for heating (HR: 2.38 [95% CI: 1.26, 4.48]) and cooking (HR: 2.02 [95% CI: 1.25, 3.25]) might experience an increased risk of CF. However, transitioning from solid to clean fuels for cooking could potentially reduce these risks (HR: 0.38 [95% CI: 0.16, 0.88]).

Conclusion

Household solid fuels utilization was closely associated with the risk of CF.

Identifying early screening factors for depression in middle-aged and older adults: A cohort study

Objective

This study aims to explore the current status of depression and related factors in middle-aged and elderly people in China using a cohort database with multi-year follow-up.

Methods

The study population for this project was derived from the China Health and Retirement Longitudinal Study. Participants were divided into control and depression groups based on scores from the Center for Epidemiological Research Depression Scale. Continuous variables were compared using t-tests or Mann-Whitney U tests, while categorical variables were compared using chi-square tests. A multivariate logistic regression model was employed to evaluate factors associated with depression.

Results

A total of 9,749 participants were included in the study. Correlation analyses revealed that age, body mass index, diastolic blood pressure, waist circumference, total cholesterol, uric acid, and length of sleep were significantly associated with depression (p < 0.05). Women exhibited a higher risk of depression in middle and old age compared to men (p < 0.05). An increase in waist circumference was associated with a decreased risk of depression (p < 0.05). Longer sleep duration and higher educational levels were also associated with a reduced risk of depression (p < 0.05). Unfavorable marital status and decreased frequency of alcohol consumption were found to increase the risk of depression (p < 0.05).

Conclusion

In middle-aged and elderly individuals, women, low education level, and experiencing dissatisfaction in marriage are connected with a high risk of depression. On the other hand, increased waist circumference, moderate alcohol consumption, and longer sleep duration are connected with a low risk of depression.

Depressive symptoms and its influencing factors of older people with cataracts in China: a national cross-sectional survey

Background

Depressive symptoms are a common complication in patients with cataracts and may exacerbate cataract symptoms. Therefore, it is important to focus on depressive symptoms and their influencing factors in older people with cataracts. The purpose of this study was to investigate the prevalence rate of depressive symptoms and influencing factors in Chinese older people with cataracts.

Methods

Descriptive analyses were used to report the sociodemographic characteristics, lifestyle, health status, and depressive symptoms of old people with cataracts in China. The chi-square test was used to compare differences between subjects with different demographic characteristics. Binary logistic regression was used to analyze the factors that influenced the depressive symptoms of cataract patients. Meanwhile, a random forest model was developed in this study to rank the importance of the influencing factors.

Results

Three hundred and six (25.27%) of 1,211 cataract patients included in this study suffered from depressive symptoms. Logistic regression analysis suggested that poor economic situation (AOR = 3.162, 95%CI: 1.719-5.817), social participation (AOR = 1.530, 95%CI: 1.053-2.222), having hearing disorder (AOR = 1.445, 95%CI: 1.040-2.008), poor self-reported health status (AOR = 2.646, 95%CI: 1.705-4.106), poor life satisfaction (AOR = 3.586, 95%CI: 1.652-7.784) were risk factors for depressive symptoms in cataract patients and consumption of fresh fruits (AOR = 0.587, 95%CI: 0.369-0.933) was a protective factor for depressive symptoms in cataract patients. The results of the random forest showed that self-reported health status was the most important factor influencing depressive symptoms in cataract patients. The other factors, in order of importance, were life satisfaction, economic situation, fruits, hearing disorder, and social participation.

Conclusion

The results suggested that the development of depressive symptoms in cataract patients was influenced by various factors. Medical staff should monitor these influencing factors more closely when treating and caring for patients with cataracts.

Separate and joint associations of adverse childhood experiences and childhood socioeconomic status with depressive symptoms: The mediating role of unhealthy lifestyle factors

BACKGROUND

The associations between adverse childhood experiences (ACEs), childhood socioeconomic status (SES), and depressive symptoms (DS) remain unclear. This study aimed to assess the separate and joint associations of ACEs and childhood SES with DS and explore the potential mediating role of lifestyles.

METHODS

Data were obtained from the China Health and Retirement Longitudinal Study, which included 6879 participants. Cox proportional hazard models were used to evaluate the associations of ACEs and childhood SES with DS. Additive and multiplicative interactions between ACEs and childhood SES on DS were also examined. Causal mediation analyses were then conducted to quantify the mediating role of lifestyle factors in these associations.

RESULTS

During a median follow-up of 3.0 years, 1283 (18.7 %) participants were identified with DS. ACEs and low childhood SES were significantly associated with an increased risk of DS (ACEs [3 or more vs 0]: HR = 1.68, 95 % CI: 1.43-1.99; childhood SES [low vs high]: HR = 1.48, 95 % CI: 1.22-1.79). Compared to the no ACEs-moderate/high childhood SES group, the group with 1 or more ACEs-low childhood SES had the highest risk of DS (HR = 1.76, 95 % CI: 1.47-2.10). Significant additive interaction of ACEs with low childhood SES on DS was observed with relative excess risk due to an interaction of 1.21 (95 % CI: 0.27, 2.15). Sleep duration and smoking were identified as the potentially modifiable mediators.

CONCLUSIONS

The findings highlight the importance of promoting initiatives to address ACEs, low childhood SES, and unhealthy lifestyles as part of DS prevention strategies.

Switching indoor fuels and the incidence of physical-psychological-cognitive multimorbidity: A prospective cohort study

BACKGROUND

In developing countries, including China, solid-fuel-based heating and cooking is common. For older people, the multimorbidity prevalence is exceptionally high. Nevertheless, studies on the associations of indoor solid fuels use, especially switching fuels types, on multimorbidity in middle-aged and older people is scarce.

METHODS

Data from five waves of the China Health and Retirement Longitudinal Study were used in this study. Indoor fuels were classified as solid or clean fuels. Physical-psychological-cognitive multimorbidity (PPC-multimorbidity) was defined as the simultaneous presence of three disease types (physical illness, psychological disorders, cognitive impairment). Using Cox proportional risk models, hazard ratios (HRs) and 95 % confidence intervals (95 % CI) were calculated to investigate the associations of heating- and cooking-related baseline indoor fuels and switching indoor fuels with PPC-multimorbidity incidence.

RESULTS

In the heating (n=3121, mean age=56.55 years, male proportion=54.25 %) and cooking (n=3574, mean age=56.67 years, male proportion=52.94 %) analyses, 75.07 % and 45.64 % of the participants used solid fuels at baseline, and 564 (18.07 %) and 613 (17.15 %) PPC-multimorbidity cases were diagnosed during follow-up, respectively. Participants with baseline heating- and cooking-based solid fuels use had greater PPC-multimorbidity incidences [HRs (95 % CIs): 1.23 (0.98, 1.55) and 1.44 (1.21, 1.73)], respectively. Additionally, combined baseline heating- and cooking-based solid fuels use was associated with even greater PPC-multimorbidity incidence [HR (95 % CI): 1.55 (1.18, 2.04)]. Persistent solid fuels use obviously increased the PPC-multimorbidity incidence [HRs (95 % CIs): 2.43 (1.67, 3.55) for heating and 2.63 (2.03, 3.40) for cooking]. Moreover, switching from solid to clean fuels was associated with a significantly decreased PPC-multimorbidity incidence [HRs (95 % CIs): 0.27 (0.20, 0.35) for heating and 0.36 (0.28, 0.46) for cooking].

CONCLUSIONS

Long-term solid-fuels use is associated with an increased PPC-multimorbidity incidence, and switching to cleaner fuels is associated with a decreased PPC-multimorbidity incidence in adults aged ≥45 years.

Effects of indoor air pollution from household solid fuel use on the risk of gastrointestinal and liver diseases in middle aged and elderly adults

Solid fuels are widely used in China and increase the concentrations of indoor air pollutants. Nevertheless, there is limited longitudinal evidence linking solid fuel use and Gastrointestinal (GI) and liver diseases. This study aimed to prospectively investigate the association between household solid fuel use and the risk of GI and liver diseases in middle aged and elderly adults. This work was based on the China Health and Retirement Longitudinal Study (CHARLS). Longitudinal data incorporate with cross-sectional data were analyzed. Compared with individuals using clean fuel for cooking, solid fuel users were observed to have higher risk of GI diseases (OR in 2011, 2013, 2015, 2018 wave separately: 1.37, 95 % CI: 1.24-1.50, P < 0.001; 1.24, 95 % CI: 1.11-1.39, P < 0.001; 1.18, 95 % CI: 1.06-1.33, P < 0.001; 1.23, 95 % CI: 1.04-1.45, P < 0.05). The associations between solid fuel use and liver diseases were not significant in most of the groups. Participants transforming from solid to clean cooking fuels had lower risk of GI and liver diseases than persistent solid fuel users. Moreover, biomass cooking fuel users were at a significant higher risk of both liver and GI diseases compared with clean fuel users. Overall, household solid fuel use, especially for cooking, was related to higher risk of GI and liver diseases, while switching from solid to clean fuels could reduce this risk. Using biomass for cooking was identified to be more associated with the increasing risk of GI and liver diseases than cooking with coal.

Association between indoor air pollution and depression: a systematic review and meta-analysis of cohort studies

OBJECTIVES

Incomplete combustion of solid fuel and exposure to secondhand smoke (SHS) are the primary causes of indoor air pollution (IAP), potentially leading to detrimental effects on individual mental health. However, current evidence regarding the association between IAP and depression remains inconclusive. This study aims to systematically investigate the evidence regarding the association between IAP and the risk of depression.

DESIGN

Systematic review and meta-analysis of cohort studies.

DATA SOURCES

Two independent reviewers searched PubMed, the Cochrane Library, Web of Science and EMBASE for available studies published up to 13 January 2024.

ELIGIBILITY CRITERIA

We included all cohort studies published in English that aimed to explore the relationship between IAP from solid fuel use and SHS exposure and the risk of depression.

DATA EXTRACTION AND SYNTHESIS

Two independent reviewers extracted data and assessed the risk of bias. The association between IAP and depression was calculated using pooled relative risk (RR) with 95% CIs. Heterogeneity was assessed using the I2 value, and the effect estimates were pooled using fixed-effects or random-effects models depending on the results of homogeneity analysis.

RESULTS

We included 12 articles with data from 61 217 participants. The overall findings demonstrated a significant association between IAP exposure and depression (RR=1.22, 95% CI: 1.13 to 1.31), although with substantial heterogeneity (I2=75%). Subgroup analyses based on pollutant type revealed that IAP from solid fuel use was associated with a higher risk of depression (RR=1.20, 95% CI: 1.13 to 1.26; I2=62%; 5 studies, 36 768 participants) than that from SHS exposure (RR=1.11, 95% CI: 0.87 to 1.41; I2=80%; 7 studies, 24 449 participants). In terms of fuel use, the use of solid fuel for cooking (RR: 1.23, 95% CI: 1.16 to 1.31; I2=58%; 4 studies, 34 044 participants) and heating (RR 1.15, 95% CI: 1.04 to 1.27; I2=65%; 3 studies, 24 874 participants) was associated with increased depression risk.

CONCLUSIONS

The findings from this systematic review and meta-analysis of cohort studies indicated an association between exposure to IAP and depression.

PROSPERO REGISTRATION NUMBER

CRD42022383285.

A predictive model for depression in Chinese middle-aged and elderly people with physical disabilities

BACKGROUND

Middle-aged and older adults with physical disabilities exhibit more common and severe depressive symptoms than those without physical disabilities. Such symptoms can greatly affect the physical and mental health and life expectancy of middle-aged and older persons with disabilities.

METHOD

This study selected 2015 and 2018 data from the China Longitudinal Study of Health and Retirement. After analyzing the effect of age on depression, we used whether middle-aged and older adults with physical disabilities were depressed as the dependent variable and included a total of 24 predictor variables, including demographic factors, health behaviors, physical functioning and socialization, as independent variables. The data were randomly divided into training and validation sets on a 7:3 basis. LASSO regression analysis combined with binary logistic regression analysis was performed in the training set to screen the predictor variables of the model. Construct models in the training set and perform model evaluation, model visualization and internal validation. Perform external validation of the model in the validation set.

RESULT

A total of 1052 middle-aged and elderly persons with physical disabilities were included in this study, and the prevalence of depression in the elderly group > middle-aged group. Restricted triple spline indicated that age had different effects on depression in the middle-aged and elderly groups. LASSO regression analysis combined with binary logistic regression screened out Gender, Location of Residential Address, Shortsightedness, Hearing, Any possible helper in the future, Alcoholic in the Past Year, Difficulty with Using the Toilet, Difficulty with Preparing Hot Meals, and Unable to work due to disability constructed the Chinese Depression Prediction Model for Middle-aged and Older People with Physical Disabilities. The nomogram shows that living in a rural area, lack of assistance, difficulties with activities of daily living, alcohol abuse, visual and hearing impairments, unemployment and being female are risk factors for depression in middle-aged and older persons with physical disabilities. The area under the ROC curve for the model, internal validation and external validation were all greater than 0.70, the mean absolute error was less than 0.02, and the recall and precision were both greater than 0.65, indicating that the model performs well in terms of discriminability, accuracy and generalisation. The DCA curve and net gain curve of the model indicate that the model has high gain in predicting depression.

CONCLUSION

In this study, we showed that being female, living in rural areas, having poor vision and/or hearing, lack of assistance from others, drinking alcohol, having difficulty using the restroom and preparing food, and being unable to work due to a disability were risk factors for depression among middle-aged and older adults with physical disabilities. We developed a depression prediction model to assess the likelihood of depression in Chinese middle-aged and older adults with physical disabilities based on the above risk factors, so that early identification, intervention, and treatment can be provided to middle-aged and older adults with physical disabilities who are at high risk of developing depression.