Urbanisation and health in China

The greener the living environment, the better the health? Examining the effects of multiple green exposure metrics on physical activity and health among young students

The sedentary and less active lifestyle of modern college students has a significant impact on the physical and mental well-being of the college community. Campus Green Spaces (GSs) are crucial in promoting physical activity and improving students' health. However, previous research has focused on evaluating campuses as a whole, without considering the diverse spatial scenarios within the campus environment. Accordingly, this study focused on the young people's residential scenario in university and constructed a framework including a comprehensive set of objective and subjective GSs exposure metrics. A systematic, objective exposure assessment framework ranging from 2D (GSs areas), and 2.5D (GSs visibility) to 3D (GSs volume) was innovatively developed using spatial analysis, deep learning technology, and unmanned aerial vehicle (UAV) measurement technology. Subjective exposure metrics incorporated GSs visiting frequency, GSs visiting duration, and GSs perceived quality. Our cross-sectional study was based on 820 university students in Nanjing, China. Subjective measures of GSs exposure, physical activity, and health status were obtained through self-reported questionnaires. The Generalized Linear Model (GLM) was used to evaluate the associations between GSs exposure, physical activity, and perceived health. Physical activity and social cohesion were considered as mediators, and path analysis based on Structural Equation Modeling (SEM) was used to disentangle the mechanisms linking GSs exposure to the health status of college students. We found that (1) 2D indicator suggested significant associations with health in the 100m buffer, and the potential underlying mechanisms were: GSs area → Physical activity → Social cohesion → Physical health → Mental health; GSs area → Physical activity → Social cohesion → Mental health. (2) Subjective GSs exposure indicators were more relevant in illustrating exposure-response relationships than objective ones. This study can clarify the complex nexus and mechanisms between campus GSs, physical activity, and health, and provide a practical reference for health-oriented campus GSs planning.

Dynamics of respiratory infectious diseases under rapid urbanization and COVID-19 pandemic in the subcenter of Beijing during 2014-2022

Objective

The study analyzed the impact of urbanization on epidemiological characteristics of respiratory infectious disease in Tongzhou District, Beijing during 2014-2022 to provide reference for prevention and control priorities of respiratory infectious diseases during the innovative urbanization process in China.

Methods

The incidence data of notifiable respiratory infectious diseases (NRIDs) in Tongzhou Beijing during 2014-2022 were summarized. The trend of incidence rate was analyzed by Joinpoint regression model, and entropy method was performed to construct the comprehensive index of urbanization (CIU) and generalized linear model was used to analyze the influence of CIU on the incidence rate of respiratory infectious diseases.

Results

Totally 72616 NRIDs cases were reported in Tongzhou District during 2014-2022, and the incidence rate of NRIDs was higher during 2017-2019 (153/100 000) than during 2014-2016 (930/100 000) and during 2020-2022 (371/100 000), respectively (both P < 0.001). The CIU constantly increased with slight fluctuation in 2016 and 2018, respectively. The incidence rate of NRIDs showed an increase along with the CIU during 2014-2019 (r = 0.95, P = 0.004), while the incidence rate's tendency was interrupted by COVID-19 during 2020 with slight decrease in 2020-2021 and rebounded in 2022. For the patients aged <15 years, the incidence rate of NRIDs revealed a very sharp rise at the urbanization period without COVID-19 pandemic compared with that under pre-urbanization period (RR = 7.93, 95 % CI 7.63-8.24), and dropped off to the similar level as of pre-urbanization period when COVID-19 pandemic spread.

Conclusions

Urbanization process may increase the incidence of NRIDs but constrained by COVID-19. Certain measures should be taken to prevent and control the effects by urbanization process, such as good natural environment with less population density, ecological environment with good air quality, promoted hand hygiene, mask wearing, keeping interpersonal distance, vaccination, media publicity for NRIDs' prevention and control.

Diversity patterns in non-standard employment and their relationship with self-rated health in urban China from 2010 to 2021

In recent decades, the rise of non-standard employment in China is thought to profoundly influence workers' health. Using data from the China General Social Survey 2010-2021, this study compares the self-rated health of workers engaged in various non-standard employment types with those in unemployment or standard employment in urban China. The research also investigates how these patterns have evolved over time among urban residents with different hukou types amid the expansion of China's welfare system and labor market shifts. We find that while unemployment is significantly related to worse self-rated health, the effects vary across different types of non-standard employment. Precarious employment has a more substantial adverse effect on health than part-time and self-employment, although the effect is less severe than that of unemployment. Between 2010 and 2018, the health impact of precarious employment declined, aligning with China's enhanced welfare system. However, its negative effect re-emerged in 2021. These patterns are particularly pronounced for urban residents holding agricultural hukou, highlighting the intersection of non-standard employment with the household registration system in shaping health outcomes within evolving labor markets.

Unveiling the health consequences of air pollution in the world's most polluted nations

Air pollution poses a persuasive threat to global health, demonstrating widespread detrimental effects on populations worldwide. Exposure to pollutants, notably particulate matter with a diameter of 2.5 µm (PM2.5), has been unequivocally linked to a spectrum of adverse health outcomes. A nuanced understanding of the relationship between them is crucial for implementing effective policies. This study employs a comprehensive investigation, utilizing the extended health production function framework alongside the system generalized method of moments (SGMM) technique, to scrutinize the interplay between air pollution and health outcomes. Focusing on a panel of the top twenty polluted nations from 2000 to 2021, the findings yield substantial insights. Notably, PM2.5 concentration emerges as a significant factor, correlating with a reduction in life expectancy by 3.69 years and an increase in infant mortality rates by 0.294%. Urbanization is found to increase life expectancy by 0.083 years while concurrently decreasing infant mortality rates by 0.00022%. An increase in real per capita gross domestic product corresponds with an improvement in life expectancy by 0.21 years and a decrease in infant mortality rates by 0.00065%. Similarly, an elevated school enrollment rate is associated with a rise in life expectancy by 0.17 years and a decline in infant mortality rates by 0.00032%. However, a higher population growth rate is found to modestly decrease life expectancy by 0.019 years and slightly elevate infant mortality rates by 0.000016%. The analysis reveals that per capita greenhouse gas emissions exert a negative impact, diminishing life expectancy by 0.486 years and elevating infant mortality rates by 0.00061%, while per capita energy consumption marginally reduces life expectancy by 0.026 years and increases infant mortality rates by 0.00004%. Additionally, economic volatility shock presents a notable decrement in life expectancy by 0.041 years and an increase in infant mortality rates by 0.000045%, with inflationary shock further exacerbating adverse health outcomes by lowering life expectancy by 0.70 years and elevating infant mortality rates by 0.00025%. Moreover, the study scrutinizes the role of institutional quality, revealing a constructive impact on health outcomes. Specifically, the institutional quality index is associated with an increase in life expectancy by 0.66% and a decrease in infant mortality rates by 0.0006%. Extending the analysis to examine the nuanced dimensions of institutional quality, the findings discern that economic institutions wield a notably stronger positive influence on health outcomes compared to political and institutional governance indices. Finally, the results underscore the pivotal moderating role of institutional quality in mitigating the deleterious impact of PM2.5 concentration on health outcomes, counterbalancing the influence of external shocks, and improving the relationships between explanatory variables and health outcome indicators. These findings offer critical insights for guiding evidence-based policy implications, with a focus on fostering resilient, sustainable, and health-conscious societies.

The prevalence of preterm and low birth weight infants among migrant women in the Pearl River Delta region, China: a population-based birth cohort study

BACKGROUND

The existing literature evaluating the association between neonatal morbidity and migrant status presents contradictory results. The purpose of this study was to compare the risk of preterm birth (PTB) and low birth weight (LBW) among newborns from local and migrant women in China's Pearl River Delta (PRD) region.

METHODS

In this observational population-based study, we included all live singleton deliveries from PRD region local women and migrant women. Data were sourced from the Guangdong Medical Birth Registry Information System between Jan 1, 2014, and Dec 31, 2020. Women were categorized into three groups by maternal migrant status: local women from PRD region, migrant women from Guangdong province or from other provinces. The outcome variables that were examined included two adverse birth outcomes: PTB and LBW. The association between the risk of PTB and LBW and maternal migrant status was assessed using logistic regression.

RESULTS

During 2014-2020, 5,219,133 single live deliveries were recorded, corresponding 13.22% to local women and the rest to migrant women coming from Guangdong (53.51%) and other provinces (33.26%). PTB prevalence was highest among local women (5.79%), followed by migrant women from Guangdong (5.29%), and the lowest among migrants from other provinces (4.95%). This association did not change after including maternal age, infant sex, delivery mode, and birth season in the models. Compared to local women, migrant women from other provinces had a lower risk of LBW (4.00% vs. 4.98%, P < 0.001). The prevalence of PTB and LBW was higher among local women than migrants. The odds of delivery PTB and LBW were higher for women who were age ≥ 35. Among the three maternal migration groups, the age-LBW association displayed a typical U-shaped pattern, with those in the youngest (16-24 years) and oldest (≥ 35) age categories exhibiting the higher odds of delivering a LBW neonate. With respect to infant sex, the prevalence of PTB was significantly higher in males than females among the three maternal migration groups. An opposite trend was found for LBW, and the prevalence of LBW was higher in females among the three maternal migration groups.

CONCLUSION

The findings of this study contribute to the understanding of the epidemiology of PTB and LBW among migrant women. Our study suggests that it is the health and robust nature of migrant mothers that predisposes them to better birth outcomes. It is important to recognize that the results of this study, while supportive of the healthy migrant effect, cannot be considered definitive without some exploration of motivation for moving and changes in lifestyle postmigration.

Association between residential environment and emotional wellbeing among older adults in China: the mediating effect of health lifestyle

Introduction

The association between the residential environment and emotional wellbeing (EWB) in older adults has received extensive attention from gerontologists, especially during the COVID-19 pandemic; however, the mediating mechanism of how residential environment affects emotional wellbeing has not been fully explored. This study examined the effects of the residential environment on EWB and the mediating role of health lifestyle.

Methods

This study analyzed the survey data of 493 rural and 515 urban older adults from 2021 Chinese General Social Survey. General linear regression and structural equation models were used to examine the effects of residential environment and health lifestyle.

Results

Urban participants exhibited clear advantages in EWB, residential environment, and physical activity. Residential environment significantly affected the EWB of older adults, and health lifestyle played a mediating role in this relationship. The residential environment and health lifestyle did not significantly affect EWB in rural participants.

Discussion

This study revealed differences in the effects of health lifestyles and residential environments on EWB among older adults in rural and urban settings in China. This study provided empirical evidence of mental health disparities between older rural and urban Chinese residents.

Identify the significant landscape characteristics for the perceived restorativeness of 8 perceived sensory dimensions in urban green space

The restorative benefits of urban green spaces (UGSs) have been supported by many studies. Eight perceived sensory dimensions (PSDs) are regarded as a tool to classify green spaces based on perception. However, little attention has been given to the effects of landscape characteristics (LCs) on the perceived restorativeness (PR) of green spaces. Thus, this study aims to clarify this relationship using the eight PSDs. The research collected information, via video stimulus, from 30 participants on the restorative experiences of urban green parks, according to the eight kinds of PSDs. The skin conductance level obtained via biosensors was used to measure the PR. The subjective satisfaction evaluation of 10 LCs was further obtained using a 5-point Likert scale. The data were analyzed using correlation and regression analyses. The results show that the UGSs with dominant "serene," "open," and "sheltered" PSDs are rated highest for restoration. Furthermore, the findings identify the significant factors affecting the restoration of green spaces using different PSDs. In green spaces controlled by PSD, scene, vegetation, water features, and disturbances are more reliable predictors for restoration. The results indicate how different PSD spaces can be distributed in green urban planning and provide key points for designing each PSD for restoration. The use of physiological indexes rather than subjective feelings provides an alternative for demonstrating the restorative benefits of the environment. However, before it can officially be used by designers, more research is needed.

Childhood urbanicity is associated with emotional episodic memory-related striatal function and common variation in NTRK2

BACKGROUND

Childhoods in urban or rural environments may differentially affect the risk of neuropsychiatric disorders, possibly through memory processing and neural response to emotional stimuli. Genetic factors may not only influence individuals' choices of residence but also modulate how the living environment affects responses to episodic memory.

METHODS

We investigated the effects of childhood urbanicity on episodic memory in 410 adults (discovery sample) and 72 adults (replication sample) with comparable socioeconomic statuses in Beijing, China, distinguishing between those with rural backgrounds (resided in rural areas before age 12 and relocated to urban areas at or after age 12) and urban backgrounds (resided in cities before age 12). We examined the effect of childhood urbanicity on brain function across encoding and retrieval sessions using an fMRI episodic memory paradigm involving the processing of neutral or aversive pictures. Moreover, genetic association analyses were conducted to understand the potential genetic underpinnings that might contribute to memory processing and neural mechanisms influenced by early-life urban or rural environments.

RESULTS

Episodic memory retrieval accuracy for more difficult neutral stimuli was similar between those with urban and rural childhoods, whereas aversive stimuli elicited higher retrieval accuracy in the urban group (P = 0.023). For aversive stimuli, subjects with urban childhood had relatively decreased engagement of the striatum at encoding and decreased engagement of the hippocampus at retrieval. This more efficient striatal encoding of aversive stimuli in those with urban childhoods was associated with common variation in neurotrophic tyrosine kinase receptor type 2 (NTRK2) (right striatum: P = 1.58×10-6). These findings were confirmed in the replication sample.

CONCLUSIONS

We suggest that this differential striatal processing of aversive stimuli observed in individuals with urban or rural childhoods may represent mechanisms by which childhood urbanicity may affect brain circuits, heightening behavioral responses to negative stressors associated with urban environments. NTRK2-associated neural processes in the striatum may play a role in these processes.

Long-term variations of urban-Rural disparities in infectious disease burden of over 8.44 million children, adolescents, and youth in China from 2013 to 2021: An observational study

BACKGROUND

An accelerated epidemiological transition, spurred by economic development and urbanization, has led to a rapid transformation of the disease spectrum. However, this transition has resulted in a divergent change in the burden of infectious diseases between urban and rural areas. The objective of our study was to evaluate the long-term urban-rural disparities in infectious diseases among children, adolescents, and youths in China, while also examining the specific diseases driving these disparities.

METHODS AND FINDINGS

This observational study examined data on 43 notifiable infectious diseases from 8,442,956 cases from individuals aged 4 to 24 years, with 4,487,043 cases in urban areas and 3,955,913 in rural areas. The data from 2013 to 2021 were obtained from China's Notifiable Infectious Disease Surveillance System. The 43 infectious diseases were categorized into 7 categories: vaccine-preventable, bacterial, gastrointestinal and enterovirus, sexually transmitted and bloodborne, vectorborne, zoonotic, and quarantinable diseases. The calculation of infectious disease incidence was stratified by urban and rural areas. We used the index of incidence rate ratio (IRR), calculated by dividing the urban incidence rate by the rural incidence rate for each disease category, to assess the urban-rural disparity. During the nine-year study period, most notifiable infectious diseases in both urban and rural areas exhibited either a decreased or stable pattern. However, a significant and progressively widening urban-rural disparity in notifiable infectious diseases was observed. Children, adolescents, and youths in urban areas experienced a higher average yearly incidence compared to their rural counterparts, with rates of 439 per 100,000 compared to 211 per 100,000, respectively (IRR: 2.078, 95% CI [2.075, 2.081]; p < 0.001). From 2013 to 2021, this disparity was primarily driven by higher incidences of pertussis (IRR: 1.782, 95% CI [1.705, 1.862]; p < 0.001) and seasonal influenza (IRR: 3.213, 95% CI [3.205, 3.220]; p < 0.001) among vaccine-preventable diseases, tuberculosis (IRR: 1.011, 95% CI [1.006, 1.015]; p < 0.001), and scarlet fever (IRR: 2.942, 95% CI [2.918, 2.966]; p < 0.001) among bacterial diseases, infectious diarrhea (IRR: 1.932, 95% CI [1.924, 1.939]; p < 0.001), and hand, foot, and mouth disease (IRR: 2.501, 95% CI [2.491, 2.510]; p < 0.001) among gastrointestinal and enterovirus diseases, dengue (IRR: 11.952, 95% CI [11.313, 12.628]; p < 0.001) among vectorborne diseases, and 4 sexually transmitted and bloodborne diseases (syphilis: IRR 1.743, 95% CI [1.731, 1.755], p < 0.001; gonorrhea: IRR 2.658, 95% CI [2.635, 2.682], p < 0.001; HIV/AIDS: IRR 2.269, 95% CI [2.239, 2.299], p < 0.001; hepatitis C: IRR 1.540, 95% CI [1.506, 1.575], p < 0.001), but was partially offset by lower incidences of most zoonotic and quarantinable diseases in urban areas (for example, brucellosis among zoonotic: IRR 0.516, 95% CI [0.498, 0.534], p < 0.001; hemorrhagic fever among quarantinable: IRR 0.930, 95% CI [0.881, 0.981], p = 0.008). Additionally, the overall urban-rural disparity was particularly pronounced in the middle (IRR: 1.704, 95% CI [1.699, 1.708]; p < 0.001) and northeastern regions (IRR: 1.713, 95% CI [1.700, 1.726]; p < 0.001) of China. A primary limitation of our study is that the incidence was calculated based on annual average population data without accounting for population mobility.

CONCLUSIONS

A significant urban-rural disparity in notifiable infectious diseases among children, adolescents, and youths was evident from our study. The burden in urban areas exceeded that in rural areas by more than 2-fold, and this gap appears to be widening, particularly influenced by tuberculosis, scarlet fever, infectious diarrhea, and typhus. These findings underscore the urgent need for interventions to mitigate infectious diseases and address the growing urban-rural disparity.

Rationale, Design and Methodology of a Population-Based Ocular Study in a Suburbanization Region in Tianjin, China: The Beichen Eye Study

PURPOSE

The urbanization of suburbs has a significant impact on ocular health, however, the effect of this phenomenon on the epidemiology of eye diseases in the sub-urbanization region of China remains unclear. In this context, the population-based Beichen Eye Study (BCES) was conducted in the Beichen District of Tianjin, China. This article aims to summarize the background, design scheme and operation process of the study. The Chinese Clinical Trial Registry number was ChiCTR2000032280.

METHODS

In total, 8218 participants were randomly selected by a multi-stage sampling method. After their qualification was confirmed, participants were mainly invited to a centralized clinic via telephone interviews after promotion of the study in the community. Examinations included a standardized interview, anthropometric assessment, autorefraction, ocular biometry, visual acuity, anterior and posterior segment examinations, dry eye disease (DED), intra-ocular pressure, visual field testing, gonioscopy, and imaging of anterior segment, posterior segment, fundus, and optic disc. A peripheral venous blood sample was also collected for biochemical testing. For observational purposes, a community-based type II diabetes mellitus management mode was created and assessed for its effect in preventing the progression of diabetic retinopathy (DR).

RESULTS

Of the 8,218 residents, 7,271 were eligible for inclusion, and 5,840 (80.32%) subjects were enrolled in the BCES. Most of the participants were female (64.38%) with a median age of 63 years, and 98.23% representing Han Chinese descent. Conclusions: This study provides insights into the epidemiological characteristics of major ocular diseases and their moderators in a suburbanized region of China.

Impact of rural soundscape on environmental restoration: An empirical study based on the Taohuayuan Scenic Area in Changde, China

Previous studies on environmental restorative effects have mainly focused on visual landscapes, and less on the influence of soundscapes on restorative, but soundscapes play a crucial role in restorative environments, especially rural soundscapes, but there is insufficient existing theoretical evidence on the subject. Therefore, this study aims to investigate the influence of Rural Soundscape Perception on Environmental Restoration Perception, and introduces two affective variables, tourism nostalgia and place attachment, to explore the mechanism of Rural Soundscape Perception on Environmental Restoration Perception, as well as the moderating role of the number of trips is also discussed. Based on the theory of restorative environment, this study took the Taohuayuan Scenic Spot in Changde, Hunan Province, China, as the case site, and selected the rural soundscape in the area as the research object; a total of 506 valid data were collected through questionnaire surveys, and structural equation modeling was used to validate the collected data. It was found that rural soundscape perception had a significant positive effect on tourism nostalgia, place attachment, and environmental restoration perception. The results also showed that tourism nostalgia and place attachment mediated the relationship between rural soundscape perception and environmental restoration perception. Additionally, the results revealed that the number of trips did not play a moderating role in the structural relationship between rural soundscape perception and environmental restoration perception. Last, the results of the study shed light on the complex influence path of "rural soundscape perception→tourism nostalgia→place attachment→environmental restoration perception", which provides a new perspective for understanding the mechanism of the rural environment to people's health, and also has a certain guiding significance for the landscape planning of rural tourism sites.

Effect of health rights accessibility on the urban integration of minority rural migrants in China: a cross-sectional study

BACKGROUND

Accessing health rights is an integral component of people's aspirations for a better life. Existing discussions and evaluations regarding the accessibility of health rights for minority rural migrants are insufficient. In comparison to objective health conditions, inequalities in health rights lead to chronic and long-term depletion of human capital among minority rural migrants. This study aimed to assess the overall impact, heterogeneity effects, and mechanisms of health rights accessibility on the urban integration of minority rural migrants.

METHODS

Based on the 2017 China Migrants Dynamic Survey Data (CMDS), this study employs OLS models, 2SLS models, conditional mixed process (CMP) methods, and omitted variable tests to estimate the impact of health rights accessibility on the urban integration of minority rural migrants. Additionally, from the perspectives of migration scope and illness experience, this study explored the heterogeneity in the relationship between health rights accessibility and urban integration. Finally, using the Karlson-Holm-Breen (KHB) model, this study dissects the mechanisms through which health rights accessibility influences the urban integration of minority rural migrants.

RESULTS

Health rights accessibility significantly enhances the urban integration of minority rural migrants. Moreover, compared to minority rural migrants who move across provinces and who have no history of illness, those who migrate within the same province and who have experienced illness are more sensitive to the positive impact of health rights accessibility. However, the enhancing effect of health rights accessibility does not significantly differ between the new and old generations of minority rural migrants. Furthermore, health rights accessibility can indirectly improve the urban integration of minority rural migrants by elevating health levels, improving health habits, and reinforcing health behaviors. Among these, the indirect effects mediated by health habits are more pronounced.

CONCLUSION

The research conclusions underscore the issue of health accessibility and urban integration among minority rural migrants, providing a reexamination and clarification of the policy effects of health rights in promoting the urban integration of minority rural migrants. Relevant policy design should commence with improving the health rights of minority rural migrants, enhancing their health integration capabilities, and effectively boosting their ability to integrate into urban life.

The spatiotemporal trend of human brucellosis in China and driving factors using interpretability analysis

Human brucellosis has reemerged in China, with a distinct change in its geographical distribution. The incidence of human brucellosis has significantly risen in inland regions of China. To gain insights into epidemic characteristics and identify factors influencing the geographic spread of human brucellosis, our study utilized the Extreme Gradient Boosting (XGBoost) algorithm and interpretable machine learning techniques. The results showed a consistent upward trend in the incidence of human brucellosis, with a significant increase of 8.20% from 2004 to 2021 (95% CI: 1.70, 15.10). The northern region continued to face a serious human situation, with a gradual upward trend. Meanwhile, the western and southern regions have experienced a gradual spread of human brucellosis, encompassing all regions of China over the past decade. Further analysis using Shapley Additive Explanations (SHAP) demonstrated that higher Gross Domestic Product (GDP) per capita and increased funding for education have the potential to reduce the spread. Conversely, the expansion of human brucellosis showed a positive correlation with bed availability per 1000 individuals, humidity, railway mileage, and GDP. These findings strongly suggest that socioeconomic factors play a more significant role in the spread of human brucellosis than other factors.

Complex interplay of science reasoning and vaccine hesitancy among parents in Shanghai, China

The psychosocial underpinnings of vaccine hesitancy are complex. Research is needed to pinpoint the exact reasons why people hesitate to vaccinate themselves or their children against vaccine-preventable diseases. One possible reason are concerns that arise from a misunderstanding of vaccine science. We examined the impact of scientific reasoning on vaccine hesitancy and human papillomavirus (HPV) vaccination intent through a cross-sectional study of parents of vaccine-eligible children (N = 399) at immunization clinics in Shanghai, China. We assessed the relationship between science reasoning and both vaccine hesitancy and HPV vaccine acceptance using general additive models. We found a significant association between scientific reasoning and education level, with those with less than a high school education having a significantly lower scientific reasoning that those with a college education (ß = -1.31, p-value = 0.002). However, there was little evidence of a relationship between scientific reasoning and vaccine hesitancy. Scientific reasoning therefore appears not to exert primary influence on the formation of vaccine attitudes among the respondents surveyed. We suggest that research on vaccine hesitancy continues working to identify the styles of reasoning parents engage in when determining whether or not to vaccinate their children. This research could inform the development and implementation of tailored vaccination campaigns.

The association between urbanization and adolescent depression in China

Background

With the rapid urbanization in many countries, more attention is being paid to the relationship between urbanization and mental health, especially depression. However, in countries with rapid urbanization, few empirical studies exist on the relationship between urbanization and adolescent depression.

Methods

Nationally representative survey data from the China Family Panel Studies in 2012, 2016 and 2018 were used. Data of 1,588 adolescents were obtained from 25 provinces. Depression was measured using the Center for Epidemiology Studies of Depression 20-item score. The urbanization rate was obtained from the National Bureau of Statistics of China. The generalized estimating equation was used to estimate the statistical relationship.

Results

The participants' mean age at baseline was 15 years, and 51.2% (813/1,588) of participants were male. After adjusting for all covariates (gender, age, ethnicity, level of education, marital status, urban/rural areas, body mass index, self-rated health, academic pressure, smoking, drinking and exercise), the rate of urbanization was monotonically and negatively associated with adolescent depression (odds ratio 0.34, 95% CI [0.14-0.79]). Compared with female adolescents, male adolescents had a lower risk of depression (odds ratio 0.80, 95% CI [0.67-0.97]).

Conclusion

In the context of China, urbanization has a positive effect on the mental health of adolescents. Female adolescents are more likely to experience depression than male adolescents.

Urban-rural disparities in the association of nitrogen dioxide exposure with cardiovascular disease risk in China: effect size and economic burden

BACKGROUND

Together with rapid urbanization, ambient nitrogen dioxide (NO2) exposure has become a growing health threat. However, little is known about the urban-rural disparities in the health implications of short-term NO2 exposure. This study aimed to compare the association between short-term NO2 exposure and hospitalization for cardiovascular disease (CVD) among urban and rural residents in Shandong Province, China. Then, this study further explored the urban-rural disparities in the economic burden attributed to NO2 and the explanation for the disparities.

METHODS

Daily hospitalization data were obtained from an electronic medical records dataset covering a population of 5 million. In total, 303,217 hospital admissions for CVD were analyzed. A three-stage time-series analytic approach was used to estimate the county-level association and the attributed economic burden.

RESULTS

For every 10-μg/m3 increase in NO2 concentrations, this study observed a significant percentage increase in hospital admissions on the day of exposure of 1.42% (95% CI 0.92 to 1.92%) for CVD. The effect size was slightly higher in urban areas, while the urban-rural difference was not significant. However, a more pronounced displacement phenomenon was found in rural areas, and the economic burden attributed to NO2 was significantly higher in urban areas. At an annual average NO2 concentration of 10 μg/m3, total hospital days and expenses in urban areas were reduced by 81,801 (44,831 to 118,191) days and 60,121 (33,002 to 86,729) thousand CNY, respectively, almost twice as much as in rural areas. Due to disadvantages in socioeconomic status and medical resources, despite similar air pollution levels in the urban and rural areas of our sample sites, the rural population tended to spend less on hospitalization services.

CONCLUSIONS

Short-term exposure to ambient NO2 could lead to considerable health impacts in either urban or rural areas of Shandong Province, China. Moreover, urban-rural differences in socioeconomic status and medical resources contributed to the urban-rural disparities in the economic burden attributed to NO2 exposure. The health implications of NO2 exposure are a social problem in addition to an environmental problem. Thus, this study suggests a coordinated intervention system that targets environmental and social inequality factors simultaneously.

Correlations between China's socioeconomic status, disease burdens, and pharmaceuticals and personal care product levels in wastewater

The presence of pharmaceutical and personal care products (PPCPs) in domestic wastewater can potentially indicate socioeconomic status and disease burdens. However, current knowledge is limited to the correlation between specific pharmaceuticals and diseases. This study aims to explore the associations between socioeconomic status, disease burdens, and PPCP levels in domestic wastewater at a national level. Samples from 171 wastewater influents across China were used to measure PPCPs, and the per capita consumption of PPCPs was calculated. Results showed that the 31 targeted PPCPs were widely present in wastewater with varying occurrence characteristics. The mean consumption levels of different PPCPs varied greatly, ranging from 0.03 to 110723.15 µg/d/capita. While there were no significant regional differences in the overall pattern of PPCP consumption, 22 PPCPs showed regional variations between Northern China and Southern China. PPCPs with similar usage purposes exhibited similar distribution patterns. Disease burden (70.1%) was the main factor affecting most PPCP consumption compared to socioeconomic factors (26.4%). Through correlation analyses, specific types of PPCPs were identified that were highly associated with socioeconomic status and disease burdens, such as hypertension-bezafibrate, brucellosis-quinolones, sulfonamides, hepatitis-triclosan, triclocarban, socioeconomic development-fluoxetine, and people's living standards-gemfibrozil. Despite some uncertainties, this study provides valuable insights into the relationship between PPCPs in domestic wastewater and socioeconomic status and human health.

The Association Between Urbanization and Electrocardiogram Abnormalities in China: a Nationwide Longitudinal Study

The health effects of urbanization are controversial. The association between urbanization and reversible subclinical risks of cardiovascular diseases (e.g., electrocardiogram (ECG) abnormalities) has rarely been studied. This study aimed to assess the association between urbanization and ECG abnormalities in China based on the China National Stroke Screening Survey (CNSSS). We used changes in the satellite-measured impervious surfaces rate and nighttime light data to assess the level of urbanization. Every interquartile increment in the impervious surfaces rate or nighttime light was related to a decreased risk of ECG abnormalities, with odds ratios of 0.894 (95% CI, 0.869-0.920) or 0.809 (95% CI, 0.772-0.847), respectively. And we observed a U-shaped nonlinear exposure-response relationship curve between the impervious surfaces rate and ECG abnormalities. In conclusion, the current average level of urbanization among the studied Chinese adults remains a beneficial factor for reducing cardiovascular risks.

Does the population size of a city matter to its older adults' self-rated health? Results of China data analysis

Clarifying the association between city population size and older adults' health is vital in understanding the health disparity across different cities in China. Using a nationally representative dataset, this study employed Multilevel Mixed-effects Probit regression models and Sorting Analysis to elucidate this association, taking into account the sorting decisions made by older adults. The main results of the study include: (1) The association between city population size and the self-rated health of older adults shifts from a positive linear to an inverted U-shaped relationship once individual socioeconomic status is controlled for; the socioeconomic development of cities, intertwined with the growth of their populations, plays a pivotal role in yielding health benefits. (2) There is a sorting effect in older adults' residential decisions; compared to cities with over 5 million residents, unobserved factors result in smaller cities hosting more less-healthy older adults, which may cause overestimation of health benefits in cities with greater population size. (3) The evolving socioeconomic and human-made environment resulting from urban population growth introduces health risks for migratory older adults but yields benefits for those with local resident status who are male, aged over 70, and have lower living standards and socioeconomic status. And (4) The sorting effects are more pronounced among older adults with greater resources supporting their mobility or those without permanent local resident status. Thus, policymakers should adapt planning and development strategies to consider the intricate relationship between city population size and the health of older adults.

The effect of city size on the disability rate of the older adults: empirical evidence from CHARLS data

Background

Exploring the value orientation of city development from the perspective of people's well-being is key to clarifying the current debate on city size strategies.

Methods

Based on the survey data of the China Health and Retirement Longitudinal Study in two phases, and by using the unbalanced panel-ordered logit model, stepwise analysis method, and KHB method, among others, we discuss the impact of city size on the disability rate of older adults.

Results

The study finds that city size significantly and positively affects the activities of daily living (ADL) of older adults, with odd ratios of 1.3286 (95% CI = [1.082243, 1.631089]), and exhibits significant group heterogeneity in terms of age, registered residence, income, and education level. City size has indeed played an mediation role through the health improvement effect, disease mitigation effect, emotional effect, and employment structure optimization effect, with a cumulative contribution rate of the mediation effect of 35.17%. In addition, the urban sprawl index has a significant moderation role.

Discussion

Robust urban sprawl is conducive to promoting the improvement of the regional health environment, the improvement of the medical security policy, the optimization of the family support policy, and the employment structure, thus helping to reduce the disability rate of older adults.

Hypertension, socioeconomic status and depressive and anxiety disorders: a cross-sectional study of middle-aged and older Chinese women

OBJECTIVES

To investigate the association of hypertension with depressive and anxiety disorders in middle-aged and older Chinese women, and to further assess whether the association was influenced by socioeconomic status (SES).

DESIGN

Nationwide cross-sectional study.

SETTING

Six provinces of the eastern, central and western regions of China.

PARTICIPANTS

Women aged 40-70 years were included by a multistage stratified random cluster sampling in 2018 (N=9900).

PRIMARY OUTCOME MEASURES

Depressive and anxiety disorders were measured by the Patient Health Questionnaire-9 and the Generalized Anxiety Disorder-7, respectively. Logistic regression models were used to evaluate the OR and 95% CI for hypertension and the odds of depressive and anxiety disorders.

RESULTS

18.5% of participants reported having hypertension; 20.9% and 15.3% of women experienced depressive and anxiety disorders, respectively. After adjusting for potential confounders, women diagnosed with hypertension were more likely to have depressive (OR=1.27, 95% CI 1.11 to 1.45) and anxiety disorders (OR=1.48, 95% CI 1.28 to 1.71) than those without hypertension. Stratified analyses demonstrated that hypertension was significantly associated with higher odds of depressive disorders in women living in rural areas (OR=1.34, 95% CI 1.13 to 1.59), with lower levels of education (OR=1.28, 95% CI 1.12 to 1.46) and with average monthly household income <¥3000 (OR=1.33, 95% CI 1.12 to 1.59), while hypertension was significantly correlated with increased odds of anxiety disorders in women living in urban (OR=1.41, 95% CI 1.12 to 1.79) and rural areas (OR=1.53, 95% CI 1.27 to 1.84), with lower levels of education (OR=1.47, 95% CI 1.27 to 1.70), and with average monthly household income <¥3000 (OR=1.45, 95% CI 1.20 to 1.75) and ≥¥3000 (OR=1.49, 95% CI 1.18 to 1.86).

CONCLUSIONS

Hypertension was associated with increased odds of depressive and anxiety disorders among middle-aged and older women, especially in those with low SES. Effective strategies and actions for identification and management of hypertension and depressive and anxiety disorders are needed.

How does social integration work when older migrants obtain health services from community? Evidence from national database in China

Background

The roles of community are often overlooked when studying the older migrants' health issues, and more importantly, the mediating effect of social integration on the health of older migrants were rarely investigated empirically.

Methods

This study developed comprehensive index to explore this relationship. With data from the 2017 China Migrants Dynamic Survey, the study first examined the potential linkage between community-based health services and the health of older migrants. Ordered logit regressions was carried to investigate whether the self-rated health of older migrants is related to health education and health records provided by community, then the Causal Stepwise Regression and bootstrap method was used to looked into the potential mediation effect.

Results

The findings showed that older migrants with more community-based health education had higher self-rated health (β = 0.038, SE = 0.009, p < 0.001). However, the community-based health records were not associated with older migrants' health. Moreover, higher levels of social integration were associated with community health education (β = 0.142, SE = 0.014, p < 0.001), and social integration was positively associated with older migrants' health (β = 0.039, SE = 0.002, p = 0.024), indicating the mediation role of social integration.

Conclusion

The vital role of community-based health education in improving the health of older migrants was found, and social integration plays a mediating role.

Secular trends and urban-rural disparities in the median age at menarche among Chinese han girls from 1985 to 2019

BACKGROUND

Menarche is a substantial milestone of female puberty. Timing of age at menarche is considered the key to understanding the potential linkages with women's health outcomes later in life. This study aimed to explore the secular trends and urban‒rural disparities in the median age at menarche among Chinese Han girls from 1985 to 2019.

METHODS

Data were extracted from the 1985, 1995, 2005, 2014, and 2019 Chinese National Surveys on Students' Constitution and Health, which were nationally representative cross-sectional studies, and a total of 173,535 Han girls aged 9-18 years were examined. Girls were asked whether menarche had occurred. The median age at menarche was estimated by probit analysis. Z tests were used to compare the differences between survey years and between urban and rural areas.

RESULTS

The median age at menarche among Chinese Han girls decreased from 13.37 years in 1985 to 12.00 years in 2019, and the overall decrease was more significant in rural areas (1.77 years) than in urban areas (0.99 years). The average five-year change in the decrease in the median age at menarche showed an accelerating and then slowing pace; and it was observed similarly in both urban and rural areas. The urban‒rural disparities shrank from 0.64 years in 1985 to 0.44 years in 1995, then to 0.27 years in 2005, 0.24 years in 2014, and finally to - 0.14 years in 2019.

CONCLUSIONS

The median age at menarche among Chinese Han girls continued to decline from 1985 to 2019 but at a slowing pace in the last five years. Urban‒rural disparities gradually narrowed. Sexual and reproductive health education and interventions to prevent the decline in the age of menarche are needed, especially in rural areas.

A Bayesian multistage spatio-temporally dependent model for spatial clustering and variable selection

In spatio-temporal epidemiological analysis, it is of critical importance to identify the significant covariates and estimate the associated time-varying effects on the health outcome. Due to the heterogeneity of spatio-temporal data, the subsets of important covariates may vary across space and the temporal trends of covariate effects could be locally different. However, many spatial models neglected the potential local variation patterns, leading to inappropriate inference. Thus, this article proposes a flexible Bayesian hierarchical model to simultaneously identify spatial clusters of regression coefficients with common temporal trends, select significant covariates for each spatial group by introducing binary entry parameters and estimate spatio-temporally varying disease risks. A multistage strategy is employed to reduce the confounding bias caused by spatially structured random components. A simulation study demonstrates the outperformance of the proposed method, compared with several alternatives based on different assessment criteria. The methodology is motivated by two important case studies. The first concerns the low birth weight incidence data in 159 counties of Georgia, USA, for the years 2007 to 2018 and investigates the time-varying effects of potential contributing covariates in different cluster regions. The second concerns the circulatory disease risks across 323 local authorities in England over 10 years and explores the underlying spatial clusters and associated important risk factors.

Antagonism between ambient ozone increase and urbanization-oriented population migration on Chinese cardiopulmonary mortality

Ever-increasing ambient ozone (O3) pollution in China has been exacerbating cardiopulmonary premature deaths. However, the urban-rural exposure inequity has seldom been explored. Here, we assess population-scale O3 exposure and mortality burdens between 1990 and 2019 based on integrated pollution tracking and epidemiological evidence. We find Chinese population have been suffering from climbing O3 exposure by 4.3 ± 2.8 ppb per decade as a result of rapid urbanization and growing prosperity of socioeconomic activities. Rural residents are broadly exposed to 9.8 ± 4.1 ppb higher ambient O3 than the adjacent urban citizens, and thus urbanization-oriented migration compromises the exposure-associated mortality on total population. Cardiopulmonary excess premature deaths attributable to long-term O3 exposure, 373,500 (95% uncertainty interval [UI]: 240,600-510,900) in 2019, is underestimated in previous studies due to ignorance of cardiovascular causes. Future O3 pollution policy should focus more on rural population who are facing an aggravating threat of mortality risks to ameliorate environmental health injustice.

Direct and indirect costs for families of children with autism spectrum disorder in China

LAY ABSTRACT

This is the first comprehensive national study to explore the direct and indirect costs for families of children with autism spectrum disorder in China. The increasing prevalence of autism spectrum disorder highlights a growing need for resources to provide care for families of children with autism spectrum disorder. The medical and nonmedical costs and parents' productivity loss have caused a serious burden on their families. Our objective is to estimate the direct and indirect costs for the families of children with autism spectrum disorder in China. The target population was parents of children with autism spectrum disorder. We analyzed the costs using cross-sectional data from a Chinese national family survey with children aged 2-6 years (N = 3236) who were clinically diagnosed with autism spectrum disorder. Family data from 30 provinces in China were obtained. Cost items included direct medical costs, direct nonmedical costs, and indirect costs. In this study, we found that the largest part of family costs for autism spectrum disorder are nonmedical costs and productivity loss. Autism spectrum disorder has imposed a huge economic burden on parents having children with autism spectrum disorder in China, who need more support than the current health care system provides.

Relationship between social interaction and health of the floating elderly population in China: an analysis based on interaction type, mode and frequency

BACKGROUND

Although the health of the floating elderly population is an important part of active and healthy ageing, it is neglected in current Chinese society. Based on the general consensus that social interaction can affect the health of the floating population, this study explored whether the interaction type, mode and frequency influenced the health of the floating elderly population in China and investigated the variability of these influential effects.

METHODS

This study used the China Migrant Population Dynamic Survey Data 2017 and selected 5239 floating elderly individuals over 60 years old. Self-rated health was used to assess the comprehensive health status of respondents. Social interaction was measured by the interaction type, mode and frequency. Descriptive statistical analysis was used to analyse the health and social interaction status. An ordinal probit model was used to estimate the influential effects and differences on health caused by social interaction. The 2SLS model was used to examine the mutual causality relationship between interaction frequency and health, and a robustness test was conducted.

RESULTS

A total of 44.6% interacted with local residents, 14.2% participated in interaction activities based on geographical relations, and only 4.3% and 7% participated in interactions based on business and interest, respectively. Interacting with natives improved individuals' self-rated health by 18.5%; specifically, geographical interaction increased self-rated health by 40.9%, occupational interaction increased it by 25.2%, interest-based interaction increased it by 41.2%, and interaction frequency improved the self-rated health (β = 0.128). In addition, sex, education level, personal income, and floating into the eastern region had a positive effect on individuals' health. However, age, spouse and hukou exerted a negative effect.

CONCLUSIONS

This study demonstrated that interacting with local residents could improve the health of floating elderly population, and revealed that interest-based interaction and their frequency had a positive impact on health. The government should speed up the construction of the voluntary service system and encourage the floating elderly population to realize their personal value in social interaction. In addition, the reform of the hukou system should be further promoted, so as to remove institutional barriers to the social interaction.

Microscale models and urban heat island studies: a systematic review

Urban climate analysis usually uses data from weather stations, traverse, or satellite images. However, this methodology also has its limitations, since the series of data for climate monitoring can be scarce. Another option that has been earning attention in recent years is numeric models, which perform simulations in urban climate. Obtaining climate data is extremely important for climatology, as well as for related areas, such as urban planning, which uses this data to know how to best order the territory according to climate conditions and their projections. Our study aimed to carry out a literature review regarding urban heat island analysis methodologies, with emphasis on the use of models. We evaluated over 200 scientific documents and we used 68 in the results of this work, reporting different types of models. The results indicated that most of the works on urban climate use a more traditional methodological approach, with fieldwork, whereas studies with models have been carried out in a specific way, especially in cities in the northern hemisphere. Among the articles evaluated, the majority were published in Elsevier publisher journals, which have a more interdisciplinary approach. The most studied models were ENVI-met, SOLWEIG, PALM-4U, RayMan, and TEB. In this way, this work pointed out, unlike other works of review in urban climate methodologies, the difficulty in obtaining field data, emphasizing their importance, with regard to studies of urban heat islands and urban planning. We also conclude that the progress and development of the state of the art in numerical models are conditioned to scientific investment in the area.

Ultra-Processed Food Consumption and Risk of Overweight or Obesity in Chinese Adults: Chinese Food Consumption Survey 2017-2020

Overweight and obesity have increased rapidly in the past few decades in China, and less research has focused on the association between the consumption of ultra-processed foods (UPFs) and overweight or obesity in Chinese adults. The objective of this study was to determine the relationship of UPF consumption with the risk of overweight or obesity in Chinese adults. Residents aged 18 years and above who participated in the nationally representative survey Chinese Food Consumption Survey in 2017-2020 were included in this study. Dietary intake data were collected via non-consecutive three-day 24 h dietary recalls and weighing household foods and condiments. According to the NOVA food classification system, UPFs were classified depending on the purpose and extent of food processing. Multiple logistic regression and multivariate-adjusted restricted cubic spline (RCS) regressions were performed to estimate the association between UPF consumption (categorized into quartiles: quartile 1 (Q1), quartile 2 (Q2), quartile 3 (Q3), and quartile 4 (Q4)) and risk of overweight or obesity. A total of 38,658 adults aged 18 years and above participated in the present study. The prevalence of overweight and obesity in adults was 33.0% (95% CI: 32.91-33.10) and 9.6% (95% CI 9.55-9.67), respectively. After a multivariable adjustment, the risk of overweight or obesity was increased by 10% in Q3 (OR: 1.10, 95% CI: 1.04-1.17) compared to Q1 as a reference. Women (OR: 1.10, 95% CI: 1.01-1.20) and adults living in small and medium-sized cities (OR: 1.13, 95% CI: 1.01-1.26) with higher UPF consumption had higher odds of overweight or obesity. Nevertheless, the effect of higher UPF consumption on the risk of overweight or obesity was relatively weak for overall adults in China. The top three categories of subgroups consumption of UPFs were 1: sugar-sweetened beverages; 2: sauces, cheeses, spreads, and gravies; and 3: ultra-processed breads and breakfast cereals. These findings provide evidence that higher UPF consumption was positively associated with overweight or obesity, which was defined based on Chinese criteria among women and adults living in small and medium-sized cities in China. Further studies, such as intervention trials, are needed to identify the mechanism of correlation between the consumption of UPFs and health-related outcomes in Chinese adults. From a public health perspective, with the prevalence of overweight and obesity growing and the increase in UPF consumption in Chinese adults, it is necessary to promote healthy food intake and a balanced diet through active nutritional education actions for overweight and obesity prevention and control.

Does the integration of urban and rural health insurance influence the functional limitations of the middle-aged and elderly in rural China?

In January 2016, the Chinese government integrated the two systems of urban resident basic medical insurance and new rural cooperative medical system to establish a unified Urban and Rural Resident Medical Insurance. The integration of medical insurance is purported to enhance access for the rural population; however, a dearth of literature exists regarding its effect on functional impairment among middle-aged and elderly residing in rural areas. This study aims to evaluate the impact of urban-rural health insurance integration on functional limitation among middle-aged and elderly individuals in rural China. A longitudinal survey was conducted among 7855 middle-aged and elderly individuals in rural China. Using a nonequivalent control group pretest-posttest design, we exploit these policy changes to evaluate their impact on middle-aged and elderly individuals' functional limitation. The results showed that the integration of urban and rural health insurance systems was significantly associated with reduced functional limitation (Odds ratio .742; 95%CI 0.603, 0.914) among middle-aged and elderly individuals in rural China. Our findings also indicate that prevalent behaviors such as tobacco use, and alcohol consumption may exacerbate functional limitation among middle-aged and elderly individuals. These findings suggest that the integration of urban and rural health insurance systems can have a positive impact on the functional limitation of middle-aged and elderly individuals in rural China and could be an important factor in improving the health and well-being of middle-aged and elderly individuals in rural areas.

A tale of two rivers: development, destruction, and despair in Ongata Rongai, Kenya

Introduction

Ongata Rongai is a rapidly growing peri-urban space in Nairobi Metropolitan, Kenya. The last 10 years have seen exponential population growth and building development leading to overcrowding and pressure on water and environmental resources. This original research sheds light on interactions among humans, animals, and this rapidly changing urban environment. It is therefore a quintessentially One Health study.

Methods

Qualitative and ethnographically informed methods are employed to better understand the impact of rapid growth on the riparian environment and the effect of this on those who depend on it. The reflexive use of archival material and a historical ethnographic approach enabled in-depth narratives to address these issues within a longitudinal context, and the use of deliberate walking alongside visual methodologies and more traditional anthropological methods make this study novel both in terms of methodological approach and findings.

Results

This study finds that people cite high levels of pollution from solid waste and sewage have made the rivers almost unusable and a hazardous place for both humans and animals. Yet, in the past, these rivers played key roles in daily life. There is frustration with structural-level actors' moribund attitude to the environment. The poor health of the rivers and riparian environment leads to human and animal health challenges, increased pressure on water resources, and economic pressure due to a loss of livelihoods.

Discussion

The study contributes to what is currently a fairly small literature on urban riparian spaces globally, but one which is of growing and vital importance given the rapidly increasing percentage of humans who now reside in urban spaces. It contributes to WASH and urban clean water knowledge as well as One Health, public health, and urban growth narratives, and directly addresses challenges faced by SDG 6.

The effects of environmental factors associated with childhood urbanicity on brain structure and cognition

Urbanization is a trend lasting for more than one century worldwide. Four hundred ninety male and female adult Chinese Han participants with different urban and rural childhoods were included in this study. Early-life urban environment was found benefit for total grey matter volume (GMV), dorsolateral prefrontal cortex (DLPFC) GMV, temporal pole (TP) GMV and cognition function, and negatively correlated with medial prefrontal cortex (MPFC) GMV. Regression analysis showed that maternal education was a protective factor for total and DLPFC GMVs, while having siblings was better for MPFC GMV. Total, DLPFC and TP GMVs acts mediation effects between childhood urbanicity and different cognitive domains. These findings may suggest some pros and cons on brain structure associated with childhood urbanicity and related environmental factors.

Prevalence, drivers and surveillance of antibiotic resistance and antibiotic use in rural China: Interdisciplinary study

This study aimed to characterise antibiotic prescribing and dispensing patterns in rural health facilities in China and determine the community prevalence of antibiotic resistance. We investigated patterns and drivers of antibiotic use for common respiratory and urinary tract infections (RTI/UTI) in community settings, examined relationships between presenting symptoms, clinical diagnosis and microbiological results in rural outpatient clinics, and assessed potential for using patient records to monitor antibiotic use. This interdisciplinary mixed methods study included: (i) Observations and exit interviews in eight village clinics and township health centres and 15 retail pharmacies; (ii) Urine, throat swab and sputum samples from patients to identify potential pathogens and test susceptibility; (iii) 103 semi-structured interviews with doctors, patients, pharmacy workers and antibiotic-purchasing customers; (iv) Assessment of completeness and accuracy of electronic patient records through comparison with observational data. 87.9% of 1123 recruited clinic patients were prescribed antibiotics (of which 35.5% contained antibiotic combinations and >40% were for intravenous administration), most of whom had RTIs. Antibiotic prescribing for RTIs was not associated with presence of bacterial pathogens but was correlated with longer duration of infection (OR = 3.33) and presence of sore throat (OR = 1.64). Fever strongly predicted prescription of intravenous antibiotics (OR = 2.87). Resistance rates in bacterial pathogens isolated were low compared with national data. 25.8% of patients reported antibiotics use prior to their clinic visit, but only 56.2% of clinic patients and 53% of pharmacy customers could confirm their prescription or purchase included antibiotics. Diagnostic uncertainty, financial incentives, understanding of antibiotics as anti-inflammatory and limited doctor-patient communication were identified as key drivers of antibiotic use. Completion and accuracy of electronic patient records were highly variable. Prevalence of antibiotic resistance in this rural population is relatively low despite high levels of antibiotic prescribing and self-medication. More systematic use of e-records and in-service training could improve antibiotic surveillance and stewardship in rural facilities. Combining qualitative and observational anthropological methods and concepts with microbiological and epidemiological investigation of antibiotic resistance at both research design and analytic synthesis stages substantially increases the validity of research findings and their utility in informing future intervention development.

Impaired colonic motility in high-glycemic diet-induced diabetic mice is associated with disrupted gut microbiota and neuromuscular function

Background

Similar to the high-fat diet (HFD), the high-glycemic diet (HGD) contributes to the development and progression of type 2 diabetes mellitus (T2DM). However, the effect of HGD on gastrointestinal motility in T2DM and its underlying mechanisms remain unclear.

Methods

Thirty C57BL/6J mice were randomly designated into the normal-feeding diet (NFD) group, HFD group, and HGD group. The plasma glucose, plasma insulin, and gastrointestinal motility were examined. Meanwhile, the tension of isolated colonic smooth muscle rings was calculated, and the gut microbiota was analyzed by 16s rDNA high-throughput sequencing.

Result

After 16 weeks of HGD feeding, obesity, hyperglycemia, insulin resistance, and constipation were observed in HGD mice. Autonomic contraction frequency of the colonic neuromuscular system and electrical field stimulation-induced contractions were reduced in HGD mice. On the contrary, neuronal nitric oxide synthase activity and neuromuscular relaxation were found to be enhanced. Finally, gut microbiota analysis revealed that Rhodospirillaceae abundance significantly increased at the family level in HGD mice. At the genus level, the abundance of Insolitispirillum increased remarkably, whereas Turicibacter abundance decreased significantly in HGD mice.

Conclusion

HGD induced constipation in obese diabetic mice, which we speculated that it may be related to neuromuscular dysmotility and intestinal microbiota dysbiosis.

Air Quality, Pollution Perception, and Residents' Health: Evidence from China

Environmental and resident health issues associated with air pollution are an area of growing concern for both policy officials and the general public. In recent years, China has been accelerating the construction of a Beautiful China and a Healthy China, with the aim of protecting and improving the environment and ensuring public health. In this study, we aimed to explore the impact of air quality and air pollution perception on residents' health. This study used the 2017 Chinese General Social Survey data to measure self-rated health, mental health, and air pollution perception. Using matched socioeconomic indicators and air pollution data, we analyzed the relationship between subjective perception of air pollution, objective air pollution data, and residents' health. The results showed the following: (1) Air pollution perception has a significant negative impact on self-rated health and mental health. Thus, it needs more consideration to reduce environmental health risks. (2) Objective air pollution has a significant negative impact on mental health. At the same time, its effect on self-rated health was insignificant. These results provide empirical evidence supporting the Chinese government's decision to invest more in combating air pollution and ensuring the health of Chinese residents.

Vaccination in the childhood and awareness of basic public health services program among internal migrants: a nationwide cross-sectional study

BACKGROUND

Vaccination is proved to be one of the most effective and efficient way to prevent illness and reduce health inequality. Studies about association between vaccination inequalities in the childhood and awareness of basic public health services program among internal migrants in China are lacking. In this study, we aimed to explore the association between migrants' vaccination status between 0 and 6 years old and their awareness of the National Basic Public Health Services (BPHSs) project in China.

METHODS

We included 10,013 respondents aged 15 years old or above of eight provinces from 2017 Migrant Population Dynamic Monitoring Survey in China, a nationwide cross-sectional study. Univariate and multivariable logistic regressions were used to assess vaccination inequalities and the awareness of public health information.

RESULTS

Only 64.8% migrants were vaccinated in their childhood, which is far below the goal of national requirement of 100% vaccination. This also indicated the vaccination inequalities among migrants. Female, the middle-aged, married or having a relationship, the highly educated and the healthy population had higher awareness of this project than others. Both univariate and multivariate logistic regressions showed greatly significant association between vaccination status and some vaccines. Specifically, after adding convariates, the results showed that there were significant associations between the vaccination rates of eight recommended vaccines in the childhood and their awareness of BPHSs project (all p values < 0.001), including HepB vaccine (OR: 1.28; 95%CI: 1.19, 1.37), HepA vaccine (OR: 1.27; 95%CI: 1.15, 1.41), FIn vaccine (OR: 1.28; 95%CI: 1.16, 1.45), JE vaccine (OR: 1.14; 95%CI: 1.04, 1.27), TIG vaccine (OR: 1.27; 95%CI: 1.05, 1.47), DTaP vaccine (OR: 1.30; 95%CI: 1.11-1.53), MPSV vaccine (OR: 1.26; 95%CI: 1.07-1.49), HF vaccine (OR: 1.32; 95%CI: 1.11, 1.53), except for RaB vaccine (OR: 1.07; 95%CI: 0.89, 1.53).

CONCLUSIONS

The vaccination inequalities exist among migrants. There is a strong relationship between the vaccination status in the childhood and the awareness rate of BPHSs project among migrants. From our findings we could know that the promotion of vaccination rates of the disadvantaged population such as the internal migrants or other minority population can help them increase the awareness of free public health services, which was proved to be beneficial for health equity and effectiveness and could promote public health in the future.

Relationships between Health Education, Health Behaviors, and Health Status among Migrants in China: A Cross-Sectional Study Based on the China Migrant Dynamic Survey

Managing the health of migrants has become a crucial aspect of promoting social harmony and cohesion in China. This study investigates the impact of public health education on the health status of migrants in China using cross-sectional data from the China Migrants Dynamic Survey 2017. A total of 169,989 migrants in China were selected as samples for empirical test. Data were analyzed using descriptive statistics, logistic regression, and the structural equation model. The findings show that health education significantly influences the health status of migrants in China. Specifically, health education related to occupational diseases, venereal diseases/AIDS, and self-rescue in public emergencies had a significant positive impact on migrants' health, while health education regarding chronic diseases had a significant negative impact. Health education delivered through lectures and bulletin boards had a significant positive impact on migrants' health, but online education had a significant negative effect on the health status of migrants. The effects of health education differ by gender and age, with a stronger positive impact on female migrants and elderly migrants aged 60 and above. The mediating effect of health behaviors was significant only in the total effect. In conclusion, health education can effectively enhance the health status of migrants in China by modifying their health behaviors.

Impact of urbanization on morbidity of hepatitis A: a national panel study in China during 2005-2018

BACKGROUND

The effect of urbanization on the morbidity of hepatitis A remains unclear. We aimed to estimate the association between various urbanization-related indices and hepatitis A morbidity in China.

METHODS

Data on the annual morbidity of hepatitis A, urbanization-related measures (i.e., gross domestic product per capita, the number of hospitalization beds per 1000 persons, illiteracy rate, tap water coverage, motor vehicles per 100 persons, population density, and the proportion of arable land), and meteorological factors in 31 provincial-level administrative divisions of Chinese mainland during 2005-2018 were collected from the National Population and Health Science Data Sharing Platform, China Statistical Yearbooks, and the China Meteorological Data Sharing Service System, respectively. Generalized linear mixed models were applied to quantify the impacts of different urbanization-related indices on the morbidity of hepatitis A in China after adjusting for covariates.

RESULTS

A total of 537,466 hepatitis A cases were reported in China during 2005-2018. The annual morbidity had a decline of 79.4% from 5.64 cases to 1.16 cases per 100,000 people. There were obvious spatial variations with higher morbidity in western China. Nationally, gross domestic product per capita and the number of hospitalization beds per 1000 persons increased from 14,040 to 64,644 CNY and from 2.45 to 6.03 during 2005-2018, respectively. The illiteracy rate decreased from 11.0 to 4.9%. Gross domestic product per capita [relative risk (RR) = 0.96, 95% confidence interval (CI): 0.92-0.99], and the number of hospitalization beds per 1000 persons (RR = 0.79, 95% CI: 0.75-0.83) were associated with the declined morbidity of hepatitis A. By contrast, the increased morbidity of hepatitis A was linked to the illiteracy rate (RR = 1.04, 95% CI: 1.02-1.06). Similar influential factors were detected for children and adults, with greater effects witnessed for children.

CONCLUSIONS

People in the western region suffered the heaviest burden of hepatitis A in Chinese mainland. Nationally, there was a sharp decline in the morbidity of hepatitis A. The urbanization process was associated with the reduction of hepatitis A morbidity in China during 2005-2018.

Understanding the Interplay between Air Pollution, Biological Variables, and Major Depressive Disorder: Rationale and Study Protocol of the DeprAir Study

Major depressive disorder (MDD) is a serious and disabling condition, whose etiological mechanisms are not fully understood. The aim of the DeprAir study is to verify the hypothesis that air pollution exposure may exacerbate neuroinflammation with consequent alterations in DNA methylation of genes involved in circadian rhythms and hormonal dysregulation, resulting in the worsening of depressive symptoms. The study population consists of 420 depressed patients accessing the psychiatry unit of the Policlinico Hospital (Milan, Italy), from September 2020 to December 2022. Data collection is still ongoing for about 100 subjects. For each participant demographic and lifestyle information, depression history and characteristics, as well as blood samples, were collected. MDD severity was assessed through five rating scales commonly used in clinical practice to assess the severity of affective symptoms. Exposure to particulate and gaseous air pollutants is assigned to each subject using both air pollution monitoring station measurements and estimates derived from a chemical transport model. DeprAir is the first study investigating in a comprehensive picture whether air pollution exposure could be an important modifiable environmental factor associated with MDD severity and which biological mechanisms mediate the negative effect of air pollution on mental health. Its results will represent an opportunity for preventive strategies, thus entailing a tremendous impact on public health.

Labour-Market Characteristics and Self-Rated Health: Evidence from the China Health and Retirement Longitudinal Study

In the face of labour-force ageing, understanding labour-market characteristics and the health status of middle-aged and older workers is important for sustainable social and economic development. Self-rated health (SRH) is a widely-used instrument to detect health problems and predict mortality. This study investigated labour-market characteristics that may have an impact on the SRH among Chinese middle-aged and older workers, using data from the national baseline wave of the China Health and Retirement Longitudinal Study. The analytical sample included 3864 individuals who at the time held at least one non-agricultural job. Fourteen labour-market characteristics were clearly defined and investigated. Multiple logistic regression models of the associations of each labour-market characteristic with SRH were estimated. Seven labour-market characteristics were associated with higher odds of poor SRH when controlled for age and sex. Employment status and earned income remained significantly associated with poor SRH, when controlling for all the sociodemographic factors and health behaviours. Doing unpaid work in family businesses is associated with 2.07 (95% CI, 1.51-2.84) times probability of poor SRH, compared with employed individuals. Compared with more affluent individuals (highest quintile of earned income), people in the fourth and fifth quintiles had 1.92 (95% CI, 1.29-2.86) times and 2.72 (95% CI, 1.83-4.02) times higher chance, respectively, of poor SRH. In addition, residence type and region were important confounders. Measures improving adverse working conditions should be taken to prevent future risk of impaired health among the Chinese middle-aged and older workforce.

A Longitudinal Analysis of the Association Between Long-Term Exposure to Air Pollution and Cognitive Function Among Adults Aged 45 and Older in China

OBJECTIVES

Evidence suggests long-term exposure to fine particulate matter air pollution (PM2.5) is associated with a higher risk of cognitive impairment, especially among older adults. This study examines the relationship between PM2.5 exposure and cognitive function in China's aging population.

METHODS

We used longitudinal data from the China Health and Retirement Longitudinal Study (2011-2015) linked with historical PM2.5 concentrations (2000-2015) from remotely sensed satellite data. Growth curve models were applied to estimate associations between PM2.5 exposure (measured in intensity, duration, and a joint variable of intensity with duration for cumulative exposure) and cognitive function.

RESULTS

Relative to the lowest exposure group, exposure in the second group of PM2.5 intensity (35-50 μg/m3) is associated with poorer cognitive function, but higher levels of PM2.5 appear to be associated with better cognitive function, indicating a U-shaped association. Similar patterns are seen for fully adjusted models of PM2.5 duration: the second group (13-60 months) is associated with worse cognitive function than the first group (0-12 months), but coefficients are nonsignificant in longer duration groups. Joint analysis of PM2.5 intensity with duration suggests that duration may play a more detrimental role in cognitive function than intensity. However, we do not find a statistically significant association between PM2.5 exposure and the rate of cognitive decline.

DISCUSSION

Our findings are mixed and suggest that some categories of higher and longer exposure to PM2.5 are associated with poorer cognitive function, while that exposures do not hasten cognitive decline. However, more work is necessary to disentangle PM2.5 exposure from individuals' background characteristics, particularly those jointly associated with cognitive function and urban living.

How urbanization affects residents' health risks: evidence from China

Continued urbanization requires a deep understanding of how urbanization affects residents' health risks. This study used regression analysis of Chinese provincial-level panel data from 2004 to 2019 and empirically analyzed the nonlinear effects of urbanization on health risks and regional differences using STIRPAT model. Health risks were assessed by the average number of residents' visits to medical facilities and population mortality. We also examined the moderating effect of income and environmental factors. The results show that (1) urbanization increases the average number of residents' visits and reduces population mortality. The positive effect of urbanization in increasing the average number of visits is reinforced by an increase in income level and environmental pollution, whereas the negative effect of urbanization in reducing population mortality is weakened by environmental pollution. (2) Regarding long-term trends, urbanization has an N-shaped relationship with the average number of residents' visits, and a U-shaped relationship with population mortality; (3) Urbanization has an N-shaped relationship with the average number of residents' visits in the eastern, central, and western regions and an inverted N-shaped relationship with population mortality in the eastern region. Urbanization has significant effects on residents' health risks in areas with high levels of infrastructure. According to the results, suggestions are proposed, such as developing new-type urbanization, improving infrastructure, focusing on green urbanization, and promoting national fitness programs.

Regional urbanicity levels modify the association between ambient air pollution and prevalence of obesity: A nationwide cross-sectional survey

Ambient air pollution exposure may increase the risk of obesity, but the population susceptibility associated with urbanicity has been insufficiently investigated. Based on a nationwide representative cross-sectional survey on 44,544 adults, high-resolution night light satellite remote sensing products, and multi-source ambient air pollution inversion data, the present study evaluated the associations of fine particulate matter (PM_2.5) and nitrogen dioxide (NO₂) concentrations with the prevalence of obesity and abdominal obesity. We further calculated the associations in regions with different urbanicity levels characterized by both administrative classification of urban/rural regions and night light index (NLI). We found that 10 μg/m³ increments in PM_2.5 at 1-year moving average and in NO₂ at 5-year moving average were associated with increased prevalence of obesity [odds ratios (OR) = 1.16 (1.14, 1.19); 1.12 (1.09, 1.15), respectively] and abdominal obesity [OR = 1.08 (1.07, 1.10); 1.07 (1.05, 1.09), respectively]. People in rural regions experienced stronger adverse effects than those in urban regions. For instance, a 10 μg/m³ increment in PM_2.5 was associated with stronger odds of obesity in rural regions than in urban regions [OR = 1.27 (1.23, 1.31) vs 1.10 (1.05, 1.14), P for interaction <0.001]. In addition, lower NLI values were associated with constantly amplified associations of PM_2.5 and NO₂ with obesity and abdominal obesity (all P for interaction <0.001). In summary, people in less urbanized regions are more susceptible to the adverse effects of ambient air pollution on obesity, suggesting the significance of collaborative planning of urbanization development and air pollution control, especially in less urbanized regions.

Diminishing benefits of urban living for children and adolescents' growth and development

Optimal growth and development in childhood and adolescence is crucial for lifelong health and well-being1-6. Here we used data from 2,325 population-based studies, with measurements of height and weight from 71 million participants, to report the height and body-mass index (BMI) of children and adolescents aged 5-19 years on the basis of rural and urban place of residence in 200 countries and territories from 1990 to 2020. In 1990, children and adolescents residing in cities were taller than their rural counterparts in all but a few high-income countries. By 2020, the urban height advantage became smaller in most countries, and in many high-income western countries it reversed into a small urban-based disadvantage. The exception was for boys in most countries in sub-Saharan Africa and in some countries in Oceania, south Asia and the region of central Asia, Middle East and north Africa. In these countries, successive cohorts of boys from rural places either did not gain height or possibly became shorter, and hence fell further behind their urban peers. The difference between the age-standardized mean BMI of children in urban and rural areas was <1.1 kg m-2 in the vast majority of countries. Within this small range, BMI increased slightly more in cities than in rural areas, except in south Asia, sub-Saharan Africa and some countries in central and eastern Europe. Our results show that in much of the world, the growth and developmental advantages of living in cities have diminished in the twenty-first century, whereas in much of sub-Saharan Africa they have amplified.

Trends in elemental Pb concentrations within atmospheric PM2.5 and associated risk to human health in major cities of China

High concentrations of elemental lead (Pb) in the atmosphere pose a serious threat to human health. This study presents and summarizes data obtained from relevant literature on Pb concentrations within fine particulate matter (PM_2.5) recorded in major cities in China from 2008 to 2019. An environmental health risk assessment model was then used to evaluate the health hazards of inhaling Pb among adults and children in China. Owing to the promulgation and implementation of a series of air pollution control measures, the Pb concentrations within PM_2.5 measured in major cities in China showed a downward trend after peaking in 2013. The concentrations were higher in winter than in summer, and higher in northern cities than in southern cities. Although the Pb concentrations in most cities did not exceed the limit (500 ng/m³) set by China, they remained much higher than concentrations recorded in developed countries. The results of the environmental health risk analysis showed that the non-carcinogenic risk from atmospheric Pb exposure was higher in children than in adults (adult females > adult males), while the carcinogenic risk was higher in adults than in children. This study shows that even if the health risk of Pb in PM_2.5 does not exceed the acceptable limit, stricter Pb pollution control measures are required to safeguard population health due to the dangers of Pb.

Caring for Patients With Advanced Chronic Kidney Disease: Dietary Options and Conservative Care Instead of Maintenance Dialysis

An expert advisory board discussed the prevention and treatment of chronic kidney disease (CKD), with a focus on dietary options. This is timely, given the uptake of value based models for kidney care in the United States. Timing of dialysis start is influenced by patients' clinical status and complex patient-clinician interactions. Patients value personal freedom and quality of life and may want to delay dialysis, whilst physicians are sometimes more concerned with clinical outcomes. Kidney-preserving therapy can prolong the dialysis-free period and preserve residual kidney function, thus patients are asked to adjust their lifestyle and diet, to follow a low- or very low-protein diet, with or without ketoacid analogues. Multi-modal approaches include pharmacotherapies, management of symptoms, and a gradual, individualized dialysis transition. Patient empowerment is vital, including CKD education and involvement in decision making. These ideas may help patients, their families, and clinical teams to improve the management of CKD.

The Residential Environment and Health and Well-Being of Chinese Migrant Populations: A Systematic Review

China's internal migrants suffer from marginalised housing conditions, poor neighbourhood environments and residential segregation, which may have significant implications on health and well-being. Echoing recent calls for interdisciplinary research on migrant health and well-being, this study examines the associations and mechanisms of the impact of the residential environment on the health and well-being of Chinese migrants. We found that most of the relevant studies supported the "healthy migration effect", but the phenomenon was only applicable to migrants' self-reported physical health rather than mental health. The subjective well-being of migrants is lower than that of urban migrants. There is a debate between the effectiveness of residential environmental improvements and the ineffectiveness of residential environmental improvements in terms of the impact of the neighbourhood environment on migrants' health and well-being. Housing conditions and the neighbourhood's physical and social environment can enhance migrants' health and well-being by strengthening place attachment and social cohesion, building localised social capital and gaining neighbourhood social support. Residential segregation on the neighbourhood scale affects the health outcomes of migrant populations through the mechanism of relative deprivation. Our studies build a vivid and comprehensive picture of research to understand migration, urban life and health and well-being.

The Impact of Financial Literacy on Household Health Investment: Empirical Evidence from China

Based on the 2019 China Household Finance Survey (CHFS) data, this paper used factor analysis to measure the level of financial literacy of surveyed householders and used the Probit model and the negative binomial model to test the impact of financial literacy (FL) on household health investment (HHI). The results show that: (1) FL is an essential influencing factor in increasing participation in HHI, and householders with a higher level of FL are also more willing to pay for diversified investments. (2) We split the FL level from the two dimensions of knowledge and ability. We found that the primary FL (including financial knowledge, computing ability, and correct recognition of investment product risk) plays a more critical role in the investment decision process. (3) When information sources, health knowledge, and family income are used as mediating variables, FL can influence the decisions of HHI in three ways: expanding information sources, enriching health knowledge, and alleviating income constraints. (4) By analyzing the heterogeneity of household heads in different regions and with different personal characteristics, we found that the medical level of the household location and the life and work experience of the householders played a moderating role.