Urban-rural differences in the association between occupational physical activity and mortality in Chinese working population: evidence from a nationwide cohort study

Background

Despite emerging studies suggesting that occupational physical activity (OPA) might be harmful to health, the available evidence is not definitive. Most of these research studies were conducted in high-income Western countries or in urbanized setting. In China, where over one-third of the population resides in rural area, the impact of OPA on health is not well understood. The goal of this study is to investigate how the association between OPA and mortality vary by urban-rural settings.

Methods

Baseline data on OPA was gathered using the Global Physical Activity Questionnaire from 30,650 urban and 49,674 rural working adults as part of the 2013-2014 China Chronic Disease and Risk Factor Surveillance. Participants were followed for a median of 6.2 years, and death records were retrieved from the National Mortality Surveillance System until December 31, 2019. The multivariable Cox proportional hazard model was used to examine urban-rural differences in the association between OPA and all-cause and cardiovascular disease (CVD) mortality. Subgroup analyses were performed by sex, socioeconomic status, leisure time, transportation, and non-occupational physical activity.

Findings

During the study period, 1342 deaths were recorded, of which 426 were caused by CVD. In rural area, working adults engaging in occupational moderate-to-vigorous physical activity (MVPA) for ≥40 h per week, compared to those without any, had an adjusted hazard ratio of 0.60 (95% CI: 0.49-0.73) for all-cause mortality and 0.55 (95% CI: 0.37-0.83) for CVD mortality. However, no significant association was found in urban area (0.84 [0.61-1.15] for all-cause mortality, Pinteraction = 0.036; and 0.94 [0.53-1.66] for CVD mortality, Pinteraction = 0.098). The negative associations of occupational MVPA with mortality were more pronounced in women, non-smokers, and those with less non-occupational physical activities. Hypertension, heart rate, and diabetes were important contributors to the relationship between occupational MVPA and mortality.

Interpretation

The findings from the current study did not support the notion that high levels of OPA would induce harm. On the contrary, in rural setting, higher levels of OPA were associated with lower mortality risks. Furthermore, the observed urban-rural differences in the association between OPA and mortality underscored the need for context-specific public health guidelines on physical activities.

Funding

R&D Program of Beijing Municipal Education Commission (KM202210025026),National Key Research and Development Program of China (2021YFC2500201), and Young Elite Scientist Sponsorship Program by BAST (BYESS2023385).

Vegetation growth enhancement modulated by urban development status

Cities are natural laboratories for studying the vegetation response to global change due to their own climatic, atmospheric, and biological conditions. However, whether the urban environment promoted vegetation growth is still uncertain. Using the Yangtze River Delta (YRD), an economic powerhouse of modern China, as a case study, this paper investigated the impact of urban environment on vegetation growth at three scales: cities, sub-cities (rural-urban gradient) -pixels. Based on the satellite observations of vegetation growth indicated during 2000-2020, we explored the direct (replacement of original land by impervious surfaces) and indirect impact (e.g., climatic environment) of urbanization on vegetation growth and their trends with urbanization level. We found that significant greening accounted for 43.18 %, and significant browning accounted for 3.60 % of the pixels in the YRD. Urban area was turning green faster than suburban area. Moreover, land use change intensity (D) was a representation of the direct impact ω_d of urbanization. The direct impact of urbanization on vegetation growth was positively correlated with the intensity of land use change. Furthermore, vegetation growth enhancement due to indirect impact ω_i occurred in 31.71 %, 43.90 % and 41.46 % of the YRD cities in 2000, 2010 and 2020. And vegetation enhancement occurred in 94.12 % of highly urbanized cities in 2020, while in medium and low urbanization cities, the averaged indirect impact was near zero or even negative, proving that vegetation growth enhancement was modulated by urban development status. Also, the growth offset (τ) was most pronounced in high urbanization cities (4.92 %), but there was no growth compensation in medium urbanization cities (-4.48 %) and low urbanization cities (-57.47 %). When urbanization intensity reached a threshold value of 50 % in highly urbanized cities, the growth offset (τ) tended to saturate and remained unchanged. Our findings have important implications for understanding the vegetation response to continuing urbanization process and future climate change.

Co-exposure and health risks of several typical endocrine disrupting chemicals in general population in eastern China

Human exposure to endocrine disrupting chemicals (EDCs) is a health concern due to their wide use and interference with the human endocrine system. Parabens, bisphenols, benzophenones, triclosan (TCC), triclocarban (TCS), and tetrabromobisphenol-A (TBBPA) and its derivatives tetrachlorobisphenol-A (TCBPA) and tetrabromobisphenol-S (TBBPS), are typical EDCs that are frequently detected in environmental and human samples. However, only a few studies have assessed the co-exposure of these chemicals in humans. In this study, urine samples were collected from the general population in the city of Wuxi (n = 121) and a county, Taishun (n = 120), eastern China, and analyzed for these EDCs. Parabens, bisphenols, TCS, and benzophenones were frequently detected in urine, whereas TBBPA and its derivatives were not detected. The geometric mean concentrations of parabens, bisphenols, and benzophenones in urine from the Wuxi population were 25.7, 2.45, and 2.34 ng/mL, respectively, which were substantially higher than those from the Taishun population (17.2, 1.70, and 2.65 ng/mL). These results suggest an urban-rural difference in urinary EDCs. The exposure risks to these EDCs were estimated based on the measured urinary concentrations and acceptable daily intakes (ADIs). Hazard quotient values for EDCs in humans from both locations were generally less than 1, indicating a low exposure risk of EDCs in these regions. Nonetheless, the health risks caused by co-exposure to such EDCs cannot be ignored.

Urban-rural differences in the association between social activities and depressive symptoms among older adults in China: a cross-sectional study

BACKGROUND

Participation in social activities has positive health effects among older adults; however, few studies have investigated the association between social activity and depressive symptoms among Chinese older adults. This study aimed to examine the association between social activities and depressive symptoms among older adults in China regarding urban-rural differences.

METHODS

Data were collected from 8255 respondents from the 2015 China Health and Retirement Longitudinal Study. Depressive symptoms were assessed using the 10-item Center for Epidemiologic Studies Depression Scale. Type and frequency of social activities were collected via a questionnaire. Multivariate logistic regression analysis was used to explore the relationship between social activities and depressive symptoms.

RESULTS

In our study, the prevalence of depressive symptoms was lower in urban older adults compared with rural older adults (25.2% vs. 40.7%). After adjustment for all covariates, our results indicated that interacting with friends almost weekly or almost daily (almost weekly: OR = 0.568, 95%CI: 0.337-0.955; almost daily: OR = 0.664, 95%CI: 0.453-0.973) and participating in community organizations almost daily were inversely associated with depressive symptoms among urban older adults (OR = 0.107, 95%CI: 0.012-0.952). Interacting with friends almost daily (OR = 0.847, 95% CI: 0.720-0.996) and participation in hobby groups either almost every week or almost daily were both inversely associated with depressive symptoms among rural older adults (almost weekly: OR = 0.683, 95%CI: 0.518-0.902; almost daily: OR = 0.567, 95%CI: 0.440-0.731). Participating in sports groups almost daily was inversely associated with depressive symptoms among both urban and rural older adults (urban: OR = 0.664, 95%CI: 0.445-0.991; rural: OR = 0.506, 95%CI: 0.366-0.700).

CONCLUSIONS

Our findings indicated that there is a cross-sectional association between participation in social activities and depressive symptoms among Chinese older adults, and the association differed between urban and rural older adults. This implies that participation in social activities may be significant for alleviating depressive symptoms of older adults. When encouraging older adults to participate in social activities, the government should consider urban-rural differences and take effective measures accordingly. Longitudinal studies are needed to examine the causal relationships between social activities and depressive symptoms among older adults.

Attitudes toward aging, social support and depression among older adults: Difference by urban and rural areas in China

BACKGROUND

The specific impacts of attitudes toward aging on depressive symptoms have not been widely reported in previous studies in China.

OBJECTIVES

The aim is to examine the associations between attitudes toward aging, perceived social support, and depressive symptoms among older adults stratified by rural and urban dwelling.

METHODS

This study used a cross-sectional data including 7209 participants, among which 64.6% were urban adults and 35.4% were rural adults. Several multiple liner regression models were used to analysis the data. Three social support types were analyzed as moderators of the relationship between the attitudes toward aging and depressive symptoms.

RESULTS

Positive attitudes toward aging (β=-0.139, P<0.001), negative attitudes toward aging (β=0.284, P<0.001) were significantly associated with lower depressive symptoms among older Chinese adults. Support from family (β=-0.087, P<0.001), friends (β=-0.047, P<0.01) and the government (β=-0.035, P<0.01) were all significantly associated with urban older adults' levels of depressive symptoms. Only family support (β=-0.109, P<0.001) was associated with lower depressive symptoms among rural older adults'. In addition, family support buffered the effect of negative attitudes toward aging on depressive symptoms for all the older adults, while the moderation effects of support from friends and government only worked for urban elderly.

LIMITATIONS

A cross-sectional design is limited to establish causal associations.

CONCLUSIONS

Addressing depression among older adults should focus on improving attitudes toward aging and expanding the availability of social support. Moreover, deeper reforms are needed to address inequalities between urban and rural areas in China.

How do CO2 emissions and efficiencies vary in Chinese cities? Spatial variation and driving factors in 2007

Understanding the spatial variability of CO₂ emissions among and within cities and its driving factors is a prerequisite for emission reductions. Using 10 × 10 km national grid emission data (circa 2007), we quantified the spatial distribution of total CO₂ emissions and emission efficiency of Chinese cities at the prefectural city scale. The emission efficiency was measured according to the emission intensity, CO₂ emissions per capita, residential CO₂ emissions per capita and industrial CO₂ emissions per unit area. We found substantial variability in the total CO₂ emissions among cities ranging from <0.1 to 214.3 million tons. High total CO₂ emissions were mostly concentrated in northern, eastern and northeastern China. An overall analysis of the total CO₂ emissions and emission intensity revealed that 75% of the cities in northern China had higher total emissions and lower efficiencies than the national average, and these cities shall be the main targeted cities for CO₂ emissions reduction and emission intensity improvement. Additionally, urban districts had higher total CO₂ emissions and emissions per capita than their surrounding regions for the majority of the prefectural cities. Four indicators, including the industrial structure, gross domestic product (GDP), total population, and size of the built-up area, were significantly related to the CO₂ emissions and emission efficiency. Industrial structure was the most important driving force. Our results underscore the need to design region- and/or city-specific reduction strategies instead of a one-size-fits-all policy, and provide strategic information to public and private decision makers on controlling total emissions and improving emission efficiency.

An urban-rural and sex differences in cancer incidence and mortality and the relationship with PM2.5 exposure: An ecological study in the southeastern side of Hu line

This study investigates the urban-rural and sex differences in the increased risks of the ten most common cancers in China related to high PM_2.5 concentration in the southeastern side of Hu line. Pearson correlation coefficient is estimated to reveal how the cancers closely associated with PM_2.5 long-term exposure. Then linear regression is conducted to evaluate sex- and area-specific increased risks of those cancers from high level PM_2.5 long-term exposure. The major finding is with the increase of every 10 μg/m³ of annual mean PM_2.5 concentration, the increase of relative risks for lung cancer incidence and mortality are 15% and 23% for males, and 22% and 24% for females in rural area. For urban area, the increase of relative risk for ovarian cancer incidence is 9% for females, while that for prostatic cancer increases 17% for males. For leukemia, the increase of relative risks for incidence and mortality are 22% and 19% for females in rural area, while in urban area the increase of relative risk for mortality is 9% for males and for incidence is 6% for females. It is also found that with increased PM_2.5 exposure, the risks for ovarian and prostatic cancer rise significantly in urban area, while risks for lung cancer and leukemia rise significantly in rural area. The results demonstrate the higher risks for lung cancer and leukemia with increased PM_2.5 exposure are more significant for female. This study also suggests that the carcinogenic effects of PM_2.5 have obvious sex and urban-rural differences.

[Evaluation of activities of daily living and related factors in community elderly people in urban and rural areas of Beijing]

Objective: To evaluate the activities of daily living (ADL) and related factors in community elderly people in urban and rural areas of Beijing. Methods: A population-based cross-sectional study was conducted in Haidian and Miyun districts of Beijing using two-stage random cluster sampling method between 2011 and 2014. Results: A total of 4 499 community elderly people (1 815 males, 2 684 females) aged 60-95 years were included in the study. The mean age was (70.3±6.7) years. Compared with the participants from urban area, the participants from rural area had lower education level (85.2% had education level primary school), but higher level of smoking (22.8%) and drinking (43.1%). The ADL disability rate was higher in rural area than in urban area (12.4% vs. 11.8%, P=0.039). And it increased significantly with age (P<0.05). Multivariate logistic regression showed besides urban-rural difference (P=0.031), age (P=0.013), education level (P=0.015), physical activity (P=0.001) and stroke (P<0.001) were related factors influencing ADL disability. Conclusions: The ADL disability was relatively low in the community elderly people in Beijing, and there was significant difference between rural area and urban area. Older age, lower education level and physical inactivity and stroke were related factors.

Urban-rural difference in satisfaction with primary healthcare services in Ghana

Background

Understanding regional variation in patient satisfaction about healthcare systems (PHCs) on the quality of services provided is instrumental to improving quality and developing a patient-centered healthcare system by making it more responsive especially to the cultural aspects of health demands of a population. Reaching to the innovative National Health Insurance Scheme (NHIS) in Ghana, surpassing several reforms in healthcare financing has been a milestone. However, the focus of NHIS is on the demand side of healthcare delivery. Studies focusing on the supply side of healthcare delivery, particularly the quality of service as perceived by the consumers are required. A growing number of studies have focused on regional differences of patient satisfaction in developed countries, however little research has been conducted concerning patient satisfaction in resource-poor settings like in Ghana. This study was therefore dedicated to examining the variation in satisfaction across rural and urban women in Ghana.

Methods

Data for the present study were obtained from the latest demographic and health survey in Ghana (GDHS 2014). Participants were 3576 women aged between 15 and 49 years living in non-institutional settings in Ghana. Summary statistics in percentages was used to present respondents’ demographic, socioeconomic characteristics. Chi-square test was used to find association between urban-rural differentials with socio-economic variables. Multiple logistic regression was performed to measure the association of being satisfied with primary healthcare services with study variables. Model fitness was tested by pseudo R². Statistical significance was set at p < 0.05.

Results

The findings in this study revealed that about 57.1% were satisfied with primary health care services. The urban and rural areas reported 57.6 and 56.6% respectively which showed no statistically significant difference (z = 0.64; p = 0.523; 95%CI: -0.022, 0.043). Bivariate analysis showed that region, highest level of education, wealth index and type of facility were significantly associated with location of residence (urban-rural areas). After adjusting for confounding variables using logistic regression, geographical location became a key factor of satisfaction with primary healthcare services by location of residence. In urban areas, respondents from Greater Accra had 64% increase in the level of satisfaction when compared to those in Western region (OR = 1.64; 95CI: 1.09–2.47), Upper East had 75% increase in satisfaction compared to Western region (OR = 1.75; 95%CI: 1.08–2.84), Northern had an estimated 44% reduction in satisfaction when compared to Western region (OR = 0.56; 95%CI: 0.34–0.92). However, rural areas in Central, Volta, Eastern, Ashanti, Brong Aghafo, Northern and Upper West region had 51, 81, 69, 46, 62, 75 and 61% reduction respectively in the level of satisfaction when compared to Western region.

Conclusions

Patient satisfaction is an important indicator of health outcomes. Quality of care and measuring level of patient satisfaction has been found to be the most useful tool to predict utilization and compliance. In fact, satisfied patients are more likely than unsatisfied ones to continue using health care services. Our results suggest that policymakers need to better understand the determinants of satisfaction with the health system and how different socio-demographic groups perceive satisfaction with healthcare services so as to address health inequalities between urban and rural areas within the same country.