Human ; Aging ; Population

INTRODUCTION: Visual impairment and obesity remain the major public health issues among school-age students in rural areas of China. Obesity is an underlying risk of vision problems. This study aimed to assess the association between visual impairment and body mass index (BMI) among school-age students in rural northwest China. METHODS: This study included 39,385 students from the 4 th to 9 th grade in rural northwest China. From 2018 to 2020, students underwent an assessment of visual acuity (VA) and completed a questionnaire on family demographics, and height and weight measurements. Multiple logistic regression analyses were used to analyse the data. RESULTS: The association between visual impairment and BMI groups was significant in the study population ( P = 0.002) and in different groups (at the different educational, provincial and national levels) ( P < 0.001, separately). Multiple logistic regression analyses revealed a positive relationship between visual impairment and obesity in the study population, including those attending primary school, Han students and the residents of Ningxia autonomous region. CONCLUSION The association between visual impairment and obesity was significant among school-age students in rural northwest China. There should be implementation of policies to address the problem about visual impairment and obesity among school-age students in rural areas.
Humans ; China/epidemiology* ; Body Mass Index ; Male ; Female ; Rural Population ; Vision Disorders/complications* ; Child ; Adolescent ; Students ; Surveys and Questionnaires ; Logistic Models ; Obesity/complications* ; Visual Acuity ; Cross-Sectional Studies

INTRODUCTION: Albeit comprising a small portion of the hospital population, persistent high utilisers (PHUs) contribute disproportionately to healthcare expenditures. Amid rising healthcare costs and an ageing population, this study examines factors associated with PHUs among residents in eastern Singapore. METHOD: This is a retrospective study of eligible patients at Changi General Hospital in Singapore between 1 January 2020 and 31 December 2022. The study included Singapore citizens who utilised any services offered by CGH. Patients were classified as PHUs if their annual healthcare expenditure exceeded SGD3700 for 3 consecutive years. Demographics, healthcare utilisation patterns and clinical profiles were compared, and multivariable analyses were conducted to identify factors associated with PHUs. RESULTS: There were 267,838 eligible patients identified, with 5316 (2%) classified as PHUs. PHUs accounted for 18.4% of the total healthcare expenditure, with the highest costs attributed to inpatient services, followed by outpatient services. PHUs were more likely to be older, male, non-Chinese and of lower socioeconomic status. Conditions with the strongest association with PHUs were mental health disorders, chronic obstructive pulmonary disease, osteoporosis, asthma and renal diseases. Inpatient discharges from renal medicine, psychological medicine and general/geriatric medicine wards had the strongest association with PHUs. Utilisation of allied health services had the highest odds of being a PHU in outpatient care. CONCLUSION This study identified key factors associated with PHUs, providing invaluable insights into the planning of population health services within the hospital's geographical region. Targeted service development and process improvements of medical care can help mitigate persistent high utilisation.
Humans ; Singapore/epidemiology* ; Male ; Female ; Retrospective Studies ; Middle Aged ; Aged ; Adult ; Health Expenditures/statistics & numerical data* ; Patient Acceptance of Health Care/statistics & numerical data* ; Population Health ; Aged, 80 and over ; Young Adult ; Adolescent

BACKGROUND: Congenital heart disease (CHD) is a leading cause of birth defect-related mortality. However, more recent CHD mortality data for China are lacking. Additionally, limited studies have evaluated sex, rural-urban, and region-specific disparities of CHD mortality in China. METHODS: We designed a population-based study using data from the Dataset of National Mortality Surveillance in China between 2008 and 2021. We calculated age-adjusted CHD mortality using the sixth census data of China in 2010 as the standard population. We assessed the temporal trends in CHD mortality by age, sex, area, and region from 2008 to 2021 using the joinpoint regression model. RESULTS: From 2008 to 2021, 33,534 deaths were attributed to CHD. The period witnessed a two-fold decrease in the age-adjusted CHD mortality from 1.61 to 0.76 per 100,000 persons (average annual percent change [AAPC] = -5.90%). Females tended to have lower age-adjusted CHD mortality than males, but with a similar decline rate from 2008 to 2021 (females: AAPC = -6.15%; males: AAPC = -5.84%). Similar AAPC values were observed among people living in urban (AAPC = -6.64%) and rural (AAPC = -6.12%) areas. Eastern regions experienced a more pronounced decrease in the age-adjusted CHD mortality (AAPC = -7.86%) than central (AAPC = -5.83%) and western regions (AAPC = -3.71%) between 2008 and 2021. Approximately half of the deaths (46.19%) due to CHD occurred during infancy. The CHD mortality rates in 2021 were lower than those in 2008 for people aged 0-39 years, with the largest decrease observed among children aged 1-4 years (AAPC = -8.26%), followed by infants (AAPC = -7.01%). CONCLUSIONS CHD mortality in China has dramatically decreased from 2008 to 2021. The slower decrease in CHD mortality in the central and western regions than in the eastern regions suggested that public health policymakers should pay more attention to health resources and health education for central and western regions.
Humans ; Heart Defects, Congenital/mortality* ; Male ; Female ; China/epidemiology* ; Infant ; Child, Preschool ; Adult ; Child ; Adolescent ; Infant, Newborn ; Middle Aged ; Young Adult ; Aged ; Rural Population

BACKGROUND: The urban-rural disparities in overweight and obesity among children and adolescents are narrowing, and there is a need for long-term and updated data to explain this inequality, understand the underlying mechanisms, and identify priority groups for interventions. METHODS: We analyzed data from seven rounds of the Chinese National Survey on Students Constitution and Health (CNSSCH) conducted from 1985 to 2019, focusing on school-age children and adolescents aged 7-18 years. Joinpoint regression was used to identify inflection points (indicating a change in the trend) in the prevalence of overweight and obesity during the study period, stratified by urban/rural areas and sex. Annual percent change (APC), average annual percent change (AAPC), and 95% confidence interval (CI) were used to describe changes in the prevalence of overweight and obesity. Polynomial regression models were used to predict the prevalence of overweight and obesity among children and adolescents in 2025 and 2030, considering urban/rural areas, sex, and age groups. RESULTS: The prevalence of overweight and obesity in urban boys and girls showed an inflection point of 2000, with AAPC values of 10.09% (95% CI: 7.33-12.92%, t = 7.414, P <0.001) and 8.67% (95% CI: 6.10-11.30%, t = 6.809, P <0.001), respectively. The APC for urban boys decreased from 18.31% (95% CI: 4.72-33.67%, t = 5.926, P = 0.027) to 4.01% (95% CI: 1.33-6.75%, t = 6.486, P = 0.023), while the APC for urban girls decreased from 13.88% (95% CI: 1.82-27.38%, t = 4.994, P = 0.038) to 4.72% (95% CI: 1.43-8.12%, t = 6.215, P = 0.025). However, no inflection points were observed in the best-fit models for rural boys and girls during the period 1985-2019. The prevalence of overweight and obesity for both urban and rural boys is expected to converge at 35.76% by approximately 2027. A similar pattern is observed for urban and rural girls, with a prevalence of overweight and obesity reaching 20.86% in 2025. CONCLUSIONS The prevalence of overweight and obesity among Chinese children and adolescents has been steadily increasing from 1985 to 2019. A complete reversal in urban-rural prevalence is expected by 2027, with a higher prevalence of overweight and obesity in rural areas. Urgent action is needed to address health inequities and increase investments, particularly policies targeting rural children and adolescents.
Humans ; Child ; Adolescent ; Female ; Male ; Rural Population/statistics & numerical data* ; Overweight/epidemiology* ; Prevalence ; China/epidemiology* ; Pediatric Obesity/epidemiology* ; Obesity/epidemiology* ; Urban Population

BACKGROUND: Metabolic-associated fatty liver disease (MAFLD) is the predominant form of chronic liver disease worldwide. This study was designed to investigate the proportion and characteristics of MAFLD within the general Chinese population and to identify the contributory risk factors for liver fibrosis among MAFLD individuals. METHODS: The participants were recruited from a cohort undergoing routine health evaluations at the Third Hospital of Hebei Medical University between May 2019 and March 2023. The diagnosis of MAFLD was based on the established clinical practice guidelines. The fibrosis-4 index score (FIB-4) was employed to evaluate hepatic fibrosis, with a FIB-4 score of ≥1.3 indicating significant fibrosis. Binary logistic regression analyses were used to determine risk factors associated with significant hepatic fibrosis in MAFLD. RESULTS: A total of 22,970 participants who underwent comprehensive medical examinations were included in the analysis. The overall proportion of MAFLD was 28.77% (6608/22,970), with 16.87% (1115/6608) of these patients showing significant fibrosis as assessed using FIB-4. Independent risk factors for significant liver fibrosis in MAFLD patients were male (odds ratio [OR] = 0.676, 95% confidence interval [CI]: 0.558-0.821), hepatitis B surface antigen (HBsAg) positivity (OR = 2.611, 95% CI: 1.557-4.379), body mass index ≥23.00 kg/m 2 (OR = 0.632, 95% CI: 0.470-0.851), blood pressure ≥130/85 mmHg (OR = 1.885, 95% CI: 1.564-2.272), and plasma glucose ≥5.6 mmol/L (OR = 1.815, 95% CI: 1.507-2.186) (all P <0.001). CONCLUSIONS The proportion of MAFLD in an urban Chinese population is 28.77%. About 16.87% of MAFLD patients presented with significant liver fibrosis. Independent risk factors for significant liver fibrosis in MAFLD patients should be noticed.
Humans ; Male ; Female ; Liver Cirrhosis/pathology* ; Middle Aged ; Risk Factors ; Adult ; Fatty Liver/pathology* ; Aged ; China/epidemiology* ; Logistic Models ; Urban Population ; East Asian People

BACKGROUND: Death burden of stroke is severe with over one-third rural residents in China, but there is still a lack of specific national and high-quality reports on the urban-rural differences in stroke burden, especially for subtypes. We aimed to update the understanding of urban-rural differences in stroke deaths. METHODS: This is a descriptive observational study. Data from the national mortality surveillance system, which covers 323.8 million with 605 disease surveillance points (DSPs) across all 31 provinces, municipalities, and autonomous regions in China. All deaths from stroke as the underlying cause from 2015 to 2020 according to DSPs. Crude mortality rate and age-standardized mortality rate (ASMR) were estimated through DSPs. Average annual percentage change was used to explain the change in mortality rate. RESULTS: From 2015 to 2020, the majority of deaths from all stroke subtypes occurred in rural areas. There were significant differences between the changes of urban and rural ASMRs. On the whole, the changes in urban areas were evidently better, and the ASMR differences were basically expanding. Stroke ASMR in urban China decreased by 15.5%. The rural ASMR of ischemic stroke increased by 12.9%. The rural and urban ASMRs of intracerebral hemorrhage decreased by 24.9% and 27.4%, and those of subarachnoid hemorrhage decreased by 29.5% and 40.4%, respectively. The highest ASMRs of all stroke subtypes and the increasing trend of ischemic stroke ASMR make rural males the focus of stroke management. CONCLUSIONS The death burden of stroke varies greatly between urban and rural China. Rural residents face unique challenges.
Humans ; China/epidemiology* ; Stroke/mortality* ; Rural Population/statistics & numerical data* ; Male ; Female ; Urban Population/statistics & numerical data* ; Middle Aged ; Aged ; Aged, 80 and over ; Adult

OBJECTIVES: The prevalence of overweight and obesity among children and adolescents continues to rise, becoming one of the most serious global public health issues of the 21st century. Given the differing growth and development environments between urban and rural children, associated risk factors also vary. This study aims to explore the distribution characteristics and influencing factors of overweight and obesity among urban and rural primary and secondary school students in Hunan Province, providing scientific evidence for targeted interventions. METHODS: A stratified, randomized cluster sampling method was used to select participants. A total of 197 084 students from primary and secondary schools across 14 prefectures in Hunan Province underwent physical examinations and questionnaire surveys. Population and spatial distribution characteristics of overweight and obesity were analyzed. Spatial distribution maps and spatial autocorrelation analyses were conducted using ArcGIS. Multivariate Logistic regression was used to identify influencing factors for overweight and obesity. RESULTS: The overall overweight and obesity rates among students in Hunan Province were 14.7% and 10.9%, respectively. Both rates were higher in urban areas than in rural counties (16.0% vs 13.9% for overweight; 12.1% vs 10.2% for obesity). Among both urban and rural students, boys had higher rates of overweight and obesity than girls. Higher-grade students had a higher overweight rate but a lower obesity rate than lower-grade students. In urban areas, the overweight and obesity rates of Han Chinese primary and secondary school students are lower than those of ethnic minority students (both P<0.05). In rural areas, the obesity rate of Han primary and secondary school students is lower than that of ethnic students (P<0.05). Across cities and prefectures, urban overweight and obesity rates ranged from 14.7% to 18.7% and 8.4% to 20.6% respectively, while rural rates ranged from 10.9% to 17.2% and 6.6% to 13.7% respectively. Spatial autocorrelation analysis revealed high-value clusters of overweight/obesity in urban areas of Changde and Zhangjiajie, and in rural areas of Loudi, Huaihua, and Shaoyang. Multivariate Logistic regression showed that gender, school stage, ethnicity, frequency of fresh vegetable intake, and sleep duration were associated with overweight and/or obesity in both urban and rural students. In urban students, frequency of fried food and fresh fruit intake, breakfast habits, physical activity on weekdays and holidays, and screen time on computers were also significant. In rural students, TV viewing time and sedentary duration were additional relevant factors. CONCLUSIONS The situation of overweight and obesity among primary and secondary school students in Hunan Province remains concerning. Greater attention should be paid to regions with high-value clusters of overweight/obesity, and targeted interventions should be developed based on urban-rural differences in influencing factors.
Humans ; China/epidemiology* ; Adolescent ; Male ; Female ; Rural Population/statistics & numerical data* ; Child ; Overweight/epidemiology* ; Students/statistics & numerical data* ; Urban Population/statistics & numerical data* ; Risk Factors ; Prevalence ; Obesity/epidemiology* ; Surveys and Questionnaires ; Pediatric Obesity/epidemiology* ; Schools

OBJECTIVES: The detection rate of scoliosis among school-aged children has been rising annually, varying by region, and has become a major public health concern affecting both physical and mental health. Its onset is multifactorial, and early screening combined with targeted interventions can alter disease progression. This study aims to investigate the prevalence and influencing factors of scoliosis among primary and secondary school students in Hunan Province, providing scientific evidence for targeted prevention strategies. METHODS: A stratified, randomized cluster sampling method was used to select 281 401 students from 14 prefecture-level cities in Hunan Province for scoliosis screening, physical examination, and questionnaire survey. The chi-square test was used for group comparisons, and trend chi-square test analyzed differences in screening positive rate by age. A multilevel regression model was applied to identify influencing factors, and ArcGIS was used to visualize spatial distribution patterns of scoliosis. RESULTS: The overall screening positive rate for scoliosis among Hunan students was 1.61%. Urban areas had a significantly higher rate than rural counties (2.81% vs 0.98%; P<0.01). The rate was equal between boys and girls (1.61% each). Underweight students had a higher rate than those with normal weight, overweight, or obesity (P<0.01). Stratified by age, urban students aged 6-18 years consistently showed higher positive rates than rural peers (P<0.001). No significant gender differences were observed at most ages (all P>0.05), except at age 11, where the females had a higher rate (1.28% vs 1.02%; P=0.048). After age 11, underweight students exhibited significantly higher positive rates than those with normal or higher BMI(all P<0.05). Across all groups, urban/rural, male/female, underweight/normal/overweight/obese, the scoliosis rate increased with age. By region, the screening positive rate ranged from 0.38% to 3.36%, with the top three being Chenzhou (3.36%), Xiangtan (2.78%), and Hengyang (2.71%), while the lowest was Xiangxi Tujia and Miao Autonomous Prefecture (0.38%). Multilevel regression analysis revealed that age (OR=1.160, 95% CI 1.135 to 1.186) and urban residence (OR=2.497, 95% CI 1.946 to 3.205) were positively associated with scoliosis risk (both P<0.01). Conversely, female gender (OR=0.931, 95% CI 0.874 to 0.993), normal nutritional status (OR=0.751, 95% CI 0.671 to 0.840), overweight (OR=0.513, 95% CI 0.447 to 0.590), obesity (OR=0.418, 95% CI 0.358 to 0.489), and engaging in ≥ 60 minutes of moderate-to-vigorous physical activity 2 to 4 days (OR=0.928, 95% CI 0.865 to 0.996) or 5 to 7 days per week (OR=0.912, 95% CI 0.833 to 0.998) were negatively associated with scoliosis risk (all P<0.05). CONCLUSIONS The prevalence of scoliosis among primary and secondary school students in Hunan Province is relatively high and is significantly associated with age, gender, urban-rural status, nutritional condition, and physical activity frequency. Targeted interventions and enhanced monitoring in high-risk regions and populations are essential to prevent and control scoliosis.
Humans ; Scoliosis/epidemiology* ; Male ; Female ; Adolescent ; China/epidemiology* ; Prevalence ; Child ; Students/statistics & numerical data* ; Rural Population/statistics & numerical data* ; Urban Population/statistics & numerical data* ; Surveys and Questionnaires ; Risk Factors ; Thinness/epidemiology*

OBJECTIVES: Older adults in rural areas with multiple chronic conditions (MCC) generally exhibit poorer medication adherence than the general elderly population. Considering individual heterogeneity helps to design precise subgroup-based interventions. This study aims to identify latent profile types of medication adherence mechanisms among rural older adults with MCC based on the capability-opportunity-motivation-behavior (COM-B) model, and to explore factors influencing medication adherence. METHODS: A multistage sampling method was used to recruit 349 rural older adults with MCC from 10 administrative villages in Jianghua County, Yongzhou City, Hunan Province, between July and September, 2024. Participants were surveyed using a general information questionnaire, the Health Literacy Scale for Chronic Patients, the Beliefs about Medicines Questionnaire-Specific, the Multidimensional Scale of Perceived Social Support, and the Morisky Medication Adherence Scale. Latent profile analysis based on the COM-B model was conducted to identify subgroups of medication adherence mechanisms. Univariate and Logistic regression analyses were used to identify influencing factors associated with different latent profiles and adherence levels. RESULTS: Among the participants, 33.5% demonstrated good medication adherence. The 5 most prevalent chronic diseases were hypertension (86.5%), diabetes (36.7%), arthritis or rheumatism (34.4%), stroke (21.8%), and heart disease (17.5%). Overall, rural older adults with MCC exhibited relatively good medication capability, opportunity, and motivation. Their medication adherence mechanisms were classified into 3 latent profiles: "family-support restrained type" (5.2%), "family-support driven type" (52.1%), and "comprehensive advantage type" (42.7%). Significant differences were observed among the three profiles in terms of education level, marital status, living arrangement, and per capita monthly household income (all P<0.05). Multivariate Logistic regression revealed that higher education level was a protective factor for belonging to the "comprehensive advantage type" rather than the "family-support driven type" [OR=0.277, 95% CI (PL) 0.126 to 0.614, P=0.002]. Furthermore, significant differences in education level, self-rated health status, and latent profile type were found between participants with good and poor adherence (P<0.05). Binary Logistic regression indicated that with each one-level increase in self-rated health status, the risk of poor adherence increased by 293.9% [OR=3.939, 95% CI (PL) 1.610 to 9.636, P=0.003]. Compared with the "family-support restrained type", individuals classified as the "comprehensive advantage type" had a 96.8% [OR=0.032, 95% CI (PL) 0.008 to 0.123, P<0.001] lower risk of poor medication adherence. CONCLUSIONS The mechanisms underlying medication adherence among rural older adults with MCC show clear heterogeneity. Primary healthcare providers should focus on the "family-support restrained type" subgroup, strengthen social support networks, and implement targeted interventions to improve medication adherence.
Humans ; Aged ; Rural Population ; Male ; Female ; China ; Medication Adherence/psychology* ; Surveys and Questionnaires ; Chronic Disease/drug therapy* ; Multiple Chronic Conditions/drug therapy* ; Social Support ; Motivation ; Middle Aged ; Health Literacy ; Aged, 80 and over