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ABSTRACTObjectiveTo compare and validate neurocognitive tests in the Harmonized Cognitive Assessment Protocol (HCAP) for the China Health and Retirement Longitudinal Study (CHARLS), and to identify appropriate tests to be administered in future waves of CHARLS. MethodsWe recruited 825 individuals from the CHARLS sample and 766 subjects from hospitals in six provinces and cities in China. All participants were administered the HCAP-neurocognitive tests, and their informants were interviewed regarding the respondents’ functional status. Trained clinicians administered the Clinical Dementia Rating scale (CDR) to assess the respondents’ cognitive status independently. ResultsThe testing protocol took an average of 58 minutes to complete. Refusal rates for tests of general cognition, episodic memory, and language were less than 10%. All neurocognitive test scores significantly correlated with the CDR global score (correlation coefficients ranged from 0.139 to 0.641). The Mini-Mental State Examination (MMSE), the Health and Retirement Study (HRS) - telephone interview for cognitive status (TICS), community screening instrument for dementia (CSI-D) for respondent, episodic memory and language tests each accounted for more than 20% of the variance in global CDR score (p < 0.001) in bivariate tests. In the CHARLS subsample, age and education were associated with neuropsychological performance across most cognitive domains, and with functional status. ConclusionA brief set of the CHARLS-HCAP neurocognitive tests are feasible and valid to be used in the CHARLS sample and hospital samples. It could be applied in the future waves of the CHARLS study, and it allows estimating the prevalence of dementia in China through the population-based CHARLS.

Background Association between blood pressure (BP) and kidney function among the middle and old aged general population without hypertension remains unclear. Methods Participants aged ≥ 45 years, with complete data in 2011 and 2015 interviews of the China Health and Retirement Longitudinal Study(CHARLS), and without pre-existing hypertension were included. Systolic BP (SBP) was categorized as low (< 120 mmHg), medium (120–129 mmHg), and high (120–139 mmHg). Diastolic BP (DBP) was categorized as low (< 60 mmHg), medium (60–74 mmHg), and high (75–89 mmHg). Pulse pressure (PP) was categorized as normal (< 60 mmHg) and high (≥ 60 mmHg). The outcome was defined as rapid decline of estimated glomerular filtration rate(eGFR, decline ≥ 4 ml/min/1.73 m 2 /year). BP combination was designed according to the category of SBP and PP. The association between BP components, types of BP combination, and the risk of rapid decline of eGFR was analyzed using multivariate logistic regression models, respectively. Age-stratified analyses were conducted. Results Of 4,534 participants included, 695(15.3%) individuals were recognized as having rapid decline of eGFR. High PP[odds ratio(OR) = 1.34, 95%confidence interval(CI) 1.02–1.75], low SBP (OR = 1.28, 95%CI 1.03–1.59), and high SBP (OR = 1.32, 95% CI 1.02–1.71) were significantly associated with the risk of eGFR decline. Low SBP were associated with 65% increment of the risk of eGFR decline among participants aged < 55 years. The combination of high SBP and high PP (OR = 1.79, 95% CI 1.27–2.54) and the combination of low SBP and high PP (OR = 3.07, 95% CI 1.24–7.58) were associated with the increased risk of eGFR decline among the middle and old aged general population. Conclusion Single and combination of high PP and high SBP could be the risk indicators of eGFR decline among the middle and old aged general population.

Background China’s recent growth in income has been unequally distributed, resulting in an unusually rapid retreat from relative income equality, which has impacted negatively on health services access. There exists a significant gap between health care utilization in rural and urban areas and inequality in health care access due to differences in socioeconomic status is increasing. We investigate inequality in service utilization among the mid-aged and elderly, with a special attention of health insurance. Methods This paper measures the income-related inequality and horizontal inequity in inpatient and outpatient health care utilization among the mid-aged and elderly in two provinces of China. The data for this study come from the pilot survey of the China Health and Retirement Longitudinal Study in Gansu and Zhejiang. Concentration Index (CI) and its decomposition approach were deployed to reflect inequality degree and explore the source of these inequalities. Results There is a pro-rich inequality in the probability of receiving health service utilization in Gansu (CI outpatient = 0.067; CI inpatient = 0.011) and outpatient for Zhejiang (CI = 0.016), but a pro-poor inequality in inpatient utilization in Zhejiang (CI = −0.090). All the Horizontal Inequity Indices (HI) are positive. Income was the dominant factor in health care utilization for out-patient in Gansu (40.3 percent) and Zhejiang (55.5 percent). The non-need factors’ contribution to inequity in Gansu and Zhejiang outpatient care had the same pattern across the two provinces, with the factors evenly split between pro-rich and pro-poor biases. The insurance schemes were strongly pro-rich, except New Cooperative Medical Scheme (NCMS) in Zhejiang. Conclusions For the middle-aged and elderly, there is a strong pro-rich inequality of health care utilization in both provinces. Income was the most important factor in outpatient care in both provinces, but access to inpatient care was driven by a mix of income, need and non-need factors that significantly differed across and within the two provinces. These differences were the result of different levels of health care provision, different out-of-pocket expenses for health care and different access to and coverage of health insurance for rural and urban families. To address health care utilization inequality, China will need to reduce the unequal distribution of income and expand the coverage of its health insurance schemes.

In this paper, a double-focused conical inlet axisymmetric structure with double acceleration is proposed and the evolution of composite core-shell droplets is calculated using the volume of fluid (VOF) method, focusing on the size and droplet formation frequency of composite core-shell droplets as well as the quality control method. The results show that dripping and jetting regimes occur in the channel, and the generation period and flow distribution under the two mechanisms are investigated accordingly. The effect of local geometry on the evolution of composite droplets in the core-shell is investigated and analyzed using the composite droplet size, frequency, maximum extended length, and core droplet relative offset rate at the initial stage. It is found that changing the entrance angle can achieve the regulation of droplet size to a certain extent. With the increase of dimensionless width of the collection channel, the core-shell composite droplets size shows an overall increasing trend and is inversely proportional to the outer phase capillary number. Finally, a quality control method for composite droplet formation based on the maximum relative offset rate of core droplets is proposed for the purpose of controlling the integrity of composite droplets.

This study has explored the migration decisions of households in rural China using a household survey in Sichuan province. It answers two questions. First, what determines the migration decision? Second, is migration a temporary or a permanent choice for the household? Empirical results are consistent with the hypothesis that rural households make labor-allocation choices based on comparing marginal returns to labor in farming and alternative employment. Major findings are as follows. First, the shortage of farmland and the abundance of household labor are among the most important determinants of labor migration because they reduce the relative marginal income from labor in farming. Second, rural taxation has a statistically significant effect on the migration decision because it reduces the amount of income derived from agricultural production by the last farm laborer. Finally, rural households view impact migration as transit income, since it has very small impact on rural consumption.

Using recent household survey data from rural China, this article investigates determinants of labor migration, paying special attention to the role of migrant networks. Migrant networks are measured by the number of early migrants from the village, comprised of experienced migrants who continue their migratory activities and return migrants. Observations of early migrants are excluded from regression analyses to enable identification. Results show that experienced migrants have a positive and significant effect on subsequent migration, but return migrants do not. This implies that migrant networks are important, and their effects materialize through practical assistance in the process of migration. (JEL J61, O15, Z13)

Background The relationship between kidney function and hearing loss has long been recognized, but evidence of this association mostly comes from small observational studies or other populations. The aim of this study is to explore the association between reduced kidney function and hearing loss in a large population-based study among the middle-aged and elderly Chinese. Methods Data collected from the Chinese Health and Retirement Longitudinal Study (CHARLS) in 2015 were used for analysis. A cross-sectional study was conducted among 12,508 participants aged 45 years and older. Hearing loss, the outcome of this study, was defined according to interviewees’ responses to three survey questions related to hearing in the CHARLS. Estimated glomerular filtration rate (eGFR) was employed to assess kidney function, and participants were classified into three categories based on eGFR: ≥90, 60–89 and < 60 mL/min/1.73 m 2 . Multivariable logistic regression was employed to adjust for potential confounders, including demographics, health-related behaviors, and cardiovascular risk factors. Results The overall prevalence of self-reported hearing loss in the study population was 23.6%. Compared with participants with eGFR ≥90 mL/min/1.73 m 2 , participants with eGFR of 60–89 mL/min/1.73 m 2 (odds ratio [OR]: 1.11, 95% confidence interval [CI]: 1.00–1.23) and eGFR < 60 mL/min/1.73 m 2 (OR: 1.25, 95% CI: 1.04–1.49) showed increased risk of hearing loss after adjusting for potential confounders. Conclusions Reduced kidney function is independently associated with hearing loss. Testing for hearing should be included in the integrated management of patients with chronic kidney disease.

Objective: Increased cancer risk after dialysis or transplantation has been recognized, but studies of cancer in pre-dialysis chronic kidney disease (CKD) are extremely limited. Therefore, we aim to investigate the risk of cancer in individuals with reduced kidney function. Methods: This study was based on China Health and Retirement Longitudinal Study (CHARLS), a nationally representative population aged ≥ 45 years old. We included 11 508 (5364 male) individuals with measurement of serum creatinine and without history of cancer at baseline. Incident cancer cases were documented in the biennial questionnaire. Results: The mean age was 58.7 ± 9.8 years. Participants with estimated glomerular filtration rate (eGFR) ≥ 90 ml/min/1.73m2, 60 to 89 ml/min/1.73m2, and eGFR < 60 ml/min/1.73m2 accounted for 62.9%, 33.7% and 3.4%, respectively. During 42 895 person-years' follow-up, 217 new cases of cancer were recorded. In participants with eGFR < 90 ml/min/1.73m2, cubic spline showed linear relationship between the risk of cancer and eGFR, while remained stable and no association in participants with eGFR > 90 ml/min/1.73m2. Compared to participants with eGFR ≥ 90 ml/min/1.73m2, those with eGFR < 60 ml/min/1.73m2 was associated with the increased risk of cancer in the fully adjusted model (hazard ratio 2.08; 95% confidence interval 1.22-3.53); and the risk for kidney and lung cancers was higher among those with eGFR < 60 ml/min/1.73m2. Conclusion: Reduced kidney function is associated with a higher risk of cancer and should be integrated into risk-stratification of cancer screening and management.

To investigate the impact of Rho GTPase-activating protein 33 (ARHGAP33) and its synergistic interaction with SFPQ on the prognosis of hepatocellular carcinoma (HCC) through bioinformatics and experimental research. RNA sequencing data from The Cancer Genome Atlas (TCGA) were analyzed to assess ARHGAP33 expression in hepatocellular carcinoma (HCC). Co-expressed genes were identified using WGCNA and GSVA, and integrated into a multi-algorithm consensus prognostic model. The analysis of the TCGA database indicated a marked overexpression of ARHGAP33 mRNA in tissues from hepatocellular carcinoma (LIHC), with a statistically significant finding (P < 0.001). WGCNA revealed that SFPQ is a gene associated with ARHGAP33. In the developed consensus prognostic model, survival analysis using Kaplan-Meier (K-M) alongside the CoxBoost model demonstrated that the overall survival time for patients classified as high-risk was significantly less than that of those classified as low-risk (P < 0.05).The Institutional Review Board at Shihezi University granted ethical approval for this research (Ethics Application No.: KJ2025-290-01). The expression level of ARHGAP33 affects HCC prognosis, and its synergistic overexpression with SFPQ impairs the prognosis of HCC patients. ARHGAP33 could potentially be used as a biomarker for evaluating prognosis in hepatocellular carcinoma (HCC), offering a new theoretical foundation for enhancing HCC outcomes.

In this article, we model the associations of childhood health on adult health and socioeconomic status outcomes in China using a new sample of middle-aged and older Chinese respondents. Modeled after the American Health and Retirement Survey (HRS), the CHARLS Pilot survey respondents are 45 years and older in two quite distinct provinces—Zhejiang, a high growth industrialized province on the East Coast and Gansu, a largely agricultural and poor province in the West. Childhood health in CHARLS relies on two measures that proxy for different dimensions of health during the childhood years. The first is a retrospective self-evaluation using a standard five-point scale (excellent, very good, good, fair, or poor) of general state of one’s health when one was less than 16 years old. The second is adult height believed to be a good measure of levels of nutrition during early childhood and the prenatal period. We relate both these childhood health measures to adult health and SES outcomes during the adult years. We find strong associations of childhood health on adult health outcomes particularly among Chinese women and strong associations with adult BMI particularly for Chinese men.