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Background Fall is a major cause of mortality and cause a significant burden on the healthcare system and economic system. Weak grip strength signifies impaired function. Older people with weak grip strength are at a higher risk of death. China has the largest ageing population in the world today. This study aims to analyze the factors contributing to weak grip strength and fall among Chinese. Methods This study analyzed data from the 2011 baseline and 2015 follow-up survey of the China Health and Retirement Longitudinal Study (CHARLS). To identify the risk factors of fall and weak grip strength, we used a stepwise multivariable logistic regression model and a least absolute shrinkage and selection operator (LASSO) regression model. Results In the LASSO regression model, all the risk factors were not shrunken. In the stepwise logistic regression model, adjusted for gender, age, grip strength, depression, and chronic disease, we found that female (aOR = 1.376, 95% CI = 1.243–1.523; P  < 0.001), history of ischemic stroke (aOR = 1.786, 95% CI = 1.263–2.524; P  = 0.001), depression (aOR = 1.559, 95% CI = 1.396–1.742; P  < 0.001), weak grip strength (aOR = 1.285, 95% CI = 1.105–1.494; P  = 0.001), older age (aOR = 1.227, 95% CI = 1.163–1.294; P  < 0.001), rheumatoid arthritis (aOR = 1.410, 95% CI = 1.270–1.560; P  < 0.001), history of kidney disease (aOR = 1.383, 95% CI = 1.136–1.682; P  = 0.001) were factors associated with fall significantly. After further adjusting, we found the risk factors of weak grip strength included symptomatic knee osteoarthritis (aOR = 1.755, 95% CI 1.158–2.661; P  = 0.008), living in rural area (aOR = 2.056, 95% CI 1.290–3.277; P  = 0.002), depression (aOR = 1.523, 95% CI 1.116–2.078; P  = 0.008), older age (aOR = 2.116, 95% CI 1.801–2.486; P  < 0.001). Conclusion From the study, we found that older age and depression were risk factors of weak grip strength and fall. Weak grip strength was a risk factor of fall. Female, ischemic stroke, kidney disease, rheumatoid arthritis were risk factors of fall; living in rural area and symptomatic knee osteoarthritis were risk factors of weak grip strength.

Background Cardiovascular disease (CVD) poses a major health challenge in China. Lipid accumulation product (LAP), reflecting body fat distribution, has been associated with CVD risk. However, evidence regarding the relationship between LAP and CVD among Chinese populations remains limited. Methods This study utilized data from the China Health and Retirement Longitudinal Study, a large national cohort study. A total of 4,481 participants aged ≥ 45 years without CVD at baseline were included, with a 9-year follow-up. Cox regression analyses were performed to examine the association between LAP and CVD incidence. Subgroup and sensitivity analyses were also conducted. Results LAP was associated with CVD risk in a U-shaped manner, with higher risks observed at both low and high LAP levels (inflection point = 2.7). For LAP ≤ 2.7, the hazard ratio (HR) for CVD was 0.62 (95% CI: 0.40, 0.96, P  = 0.0309), indicating a 38% decreased risk with increasing LAP. For LAP > 2.7, the HR was 1.22 (95% CI: 1.04, 1.44, P  = 0.0153), suggesting a 22% increased risk. Conclusion This study revealed a U-shaped nonlinear relationship between LAP and CVD risk in Chinese adults, with risks elevated at both low and high LAP levels. The findings suggest LAP could serve as an effective predictor for CVD among the Chinese population. Further studies are warranted to validate the results.

Background Weight-adjusted waist index (WWI) is a new obesity-related index, which has advantages in assessing central obesity. The aim of this study was to investigate the relationship between WWI and cardiovascular disease (CVD). Methods We collected a nationally representative sample of middle-aged and older adults over 45 years of age from the China Health and Retirement Longitudinal Study (CHARLS). WWI was calculated by dividing waist circumference by the square root of body weight, whereas CVD was defined as self-reported having heart disease and/or stroke. We used restricted cubic spline (RCS) curves to investigate whether there is a nonlinear relationship between WWI and CVD. Subsequently, a two-piece linear regression model was developed, and a recursive algorithm was utilized to determine the inflection point. Results A total of 13,046 participants were included, 9138 of whom were followed up until 2018. The average age among these sample was 59.24(SD = 9.54), and the 24.62% of individual was older people aged 65 years old and more. A J-relationship was found between WWI and incident CVD, with the turning point at 10. After this inflection point, there was a statistically significant association between WWI and incident CVD in middle-aged and older adults. In Model III of the threshold effect analysis, the odds ratio was 1.13 (95%CI:1.06–1.23, P  < 0.001). Whereas, with the WWI ranged from 0 to 10, we did not observe a significant association between WWI and incident CVD(OR = 0.97,95%CI:0.91–1.04), P  = 0.366). Conclusions This prospective longitudinal study suggests a J-shaped relationship between WWI and incident CVD in Chinese population. WWI was positively associated with incident CVD only at WWI ≥ 10. This finding suggests that WWI may be an intervention indicator for reducing CVD.

Hearing loss (HL) is a common health issue among older adults worldwide, and its incidence is expected to increase as the population ages. A study has shown that among the estimated 500 million people with hearing impairments worldwide, 28 million Americans suffer from hearing disabilities, and the highest number of individuals with hearing impairments is found in the 45-to-64 years old age group. Depression is a significant public health concern for middle-aged and older adults. In 2015, researchers used data from over 100,000 participants that were collected by the UK Biobank to perform a cross-sectional study and reported that the association between hearing impairment and depression was more pronounced among younger participants (aged 40–49 years) and among those with milder forms of depression. These findings suggest that the impact of hearing impairment on mental health may begin to emerge in middle age. Hearing loss may lead to more obstacles for middle-aged individuals in terms of work and social interactions, thereby increasing the risk of depression. Early intervention for hearing impairment is particularly important for middle-aged people, as it can help identify early risk factors and provide more effective interventions to improve mental health and quality of life. Therefore, building on the existing literature that predominantly focused on older adults, this study involved analysing data from the China Health and Retirement Longitudinal Study(CHARLS) database, expanding the age range to 45 years, to investigate the relationship between self-reported hearing loss and depression among middle-aged and older adults. This research used data from the 2018 China Health and Retirement Longitudinal Study (CHARLS), including data from 5207 individuals aged 45 years and older. Hearing status was self-reported by the participants, whereas depression was assessed with the 10-item Center for Epidemiologic Studies Depression Scale (CES-D-10). A multivariable logistic regression model was used to investigate the association between self-reported hearing loss and depression, controlling for sociodemographic variables that are associated with depression in middle-aged and older populations. This study involved the use of a multinomial logistic regression model to analyse the relationship between self-reported hearing loss and depression among middle-aged and older adults, with adjustments made for potential confounding variables. The analysis revealed significant relationships between depression and factors such as hearing status, sex, place of residence, self-rated health, chronic diseases, disabilities with respect to activities of daily living (ADLs), and satisfaction with life. Specifically, individuals with self-reported hearing loss, female individuals, individuals residing in rural areas, individuals with poor self-rated health, individuals with chronic diseases, and individuals with disabilities related to ADLs were more likely to experience depression. In the unadjusted model that was used to analyse the relationship between self-reported hearing loss and depression among middle-aged and older adults, both fair hearing (unadjusted OR = 1.556, 95% CI 1.377–1.758) and poor hearing (unadjusted OR = 2.001, 95% CI 1.630–2.457) were significantly associated with the prevalence of depression. After controlling for various covariates, including sex, age, residential status, education level, marital status, health status, physical disability, chronic diseases, activities of daily living (ADLs), and satisfaction with life, our study revealed that both fair hearing (adjusted OR = 1.235, 95% CI: 1.078, 1.415) and poor hearing (adjusted OR = 1.335, 95% CI: 1.063, 1.677) remained significantly correlated with the prevalence of depression among middle-aged and older adults. Previous research has focused primarily on older adults. Therefore, the present study expanded the age range to include individuals as young as 45 years old. The results show that fair hearing and poor hearing are significantly associated with the prevalence of depression among middle-aged and older adults. These findings suggest that self-reported hearing loss is a risk factor for depression in this population in China. The association between self-reported hearing loss and depression is not limited to older adults but also includes middle-aged individuals.

Background Stroke represents the second most prevalent contributor to global mortality. The Chinese Visceral Adiposity Index (CVAI) serves as an established metric for assessing visceral adiposity in the Chinese population, exhibiting prognostic capabilities. This investigation aimed to explore the association of CVAI and new-onset stroke among middle-aged and older Chinese populations. Methods The study employed data from the 2011 and 2018 China Health and Retirement Longitudinal Study (CHARLS) to assess the association of CVAI and the incidence of new-onset stroke. Utilizing a directed acyclic graph (DAG), 10 potential confounders were identified. Moreover, to explore the association between CVAI and new-onset stroke, three multifactor logistic regression models were constructed, accounting for the identified confounders and mitigating their influence on the findings. Results The study comprised 7070 participants, among whom 417 (5.9%) experienced new-onset strokes. After controlling for confounding variables, regression analysis suggested that the new-onset stroke’s highest risk was linked to the fourth quartile (Q4) of the CVAI, with an odds ratio (OR) of 2.33 and a 95% confidence interval (CI) of 1.67–3.28. The decision tree analysis demonstrated a heightened probability of new-onset stroke among hypertensive individuals with a CVAI equal to or greater than 83, coupled with a C-reactive protein level no less than 1.1 mg/l. Age seemed to have a moderating influence on the CVAI and new-onset stroke association, exhibiting a more prominent interaction effect in participants under 60 years. Conclusions In middle-aged and older Chinese populations, a linear relationship was discerned between CVAI and the probability of new-onset stroke. CVAI provides a predictive framework for stroke incidence in this demographic, laying the groundwork for more sophisticated risk prediction models that improve the precision and specificity of stroke risk evaluations.

Background Multimorbidity poses a significant global economic burden, profoundly affecting individuals’ standard of living and leading to substantial increases in healthcare expenditures. Understanding how households strategically adjust expenditures to cope with multimorbidity-induced financial strain—and how these strategies differ across economic groups—is a critical and understudied issue that demands immediate research attention. Methods This study employs data from the China Health and Retirement Longitudinal Study (CHARLS) for the years 2013, 2015, 2018, and 2020. We apply a panel Tobit regression model combined with K-means clustering analysis to examine the effects of the number of chronic diseases and associated multimorbidity patterns on the levels and structure of household expenditures. Additionally, Recentered Influence Function (RIF) regression is implemented to investigate how transitions from the absence of chronic diseases to single or multiple chronic diseases reshape household expenditure allocations across survival-related, medical, non-medical developmental, and recreational expenditure categories. Findings The presence of multiple chronic conditions is significantly correlates with a decrease in household survival expenditures and an increase in medical expenditures, while expenditures on non-medical development and enjoyment remain largely unaffected. Patterns including cardiometabolic syndrome, single-system joint diseases, multi-system chronic diseases, major organ-mental comorbidities, and extreme chronic conditions progressively reduce the proportion of household survival expenditures while increasing medical expenditure proportions. The transition from no chronic disease to single chronic condition significantly widens the disparity between household survival and medical expenditure proportions. However, this effect diminishes as individuals progress from a single chronic condition to multimorbidity. Heterogeneity analysis reveals that, compared to low-income households, high-income households experience a smaller increase in the proportion of medical expenditures and a smaller decrease in the proportion of survival expenditures, reflecting their greater advantages in consumption planning and financial flexibility, and their higher likelihood of simultaneously accumulating both health and wealth. Due to differences in economic development levels, households in the Eastern regions are more likely to adjust the proportion of survival expenditures in response to chronic diseases. Cardiometabolic syndrome pattern reduce survival expenditure proportions in Eastern/Central regions (vs. no impact in Western/Northeastern), while single-system joint disease pattern mainly affect Eastern/Western regions with milder Central effects. Poorer self-perceived health amplifies multimorbidity’s negative impact on enjoyable expenditures. Interpretation By pinpointing how multimorbidity affects spending patterns, our study offers a novel perspective on the economic challenges families face. Multimorbidity compels households in rapidly developing countries to reallocate resources from basic survival needs toward medical care to manage health shocks. Low-income families, with limited financial flexibility, are compelled to significantly reduce survival expenditures to maintain non-medical developmental expenditures, which may lead to unequal development opportunities across different income groups. Efforts should be continuously made to improve infrastructure, public services, and financial support to better assist individuals and families affected by chronic diseases.

Objective Insulin resistance (IR) imposes a significant burden on inflammatory diseases, and the triglyceride-glucose (TyG) index, which is an easily accessible indicator for detecting IR, holds great application potential in predicting the risk of arthritis. The aim of this study is to analyze the association between the TyG index and the risk of new-onset arthritis in the common population aged over 45 using a prospective cohort study design. Method This population-based cohort study involved 4418 participants from the China Health and Retirement Longitudinal Study (from Wave 1 to Wave 4). Multivariate logistic regression models were employed to investigate the association between the TyG index and new-onset arthritis, and RCS analyses were used to investigate potential non-linear relationships. Moreover, decision trees were utilized to identify high-risk populations for incident arthritis. Result Throughout a 7-year follow-up interval, it was found that 396 participants (8.96%) developed arthritis. The last TyG index quartile group (Q4) presented the highest risk of arthritis (OR, 1.39; 95% CI, 1.01, 1.91). No dose-response relationship between the TyG index and new-onset arthritis was identified ( P overall =0.068, P non−linear =0.203). In the stratified analysis, we observed BMI ranging from 18.5 to 24 exhibited a heightened susceptibility to the adverse effects of the TyG index on the risk of developing arthritis ( P for interaction = 0.035). Conclusion The TyG index can be used as an independent risk indicator for predicting the start of new-onset arthritis within individuals aged 45 and above within the general population. Improving glucose and lipid metabolism, along with insulin resistance, may play a big part in improving the primary prevention of arthritis.

A range of previous studies have suggested that early-life conditions (ELCs) are associated with various health problems throughout life in Western societies. The aim of this study was to investigate whether, and how, early-life conditions predicted the level and trajectory of cognitive function in middle- and old-aged Chinese adults. Data were obtained from China Health and Retirement Longitudinal Study which comprised 16,258 adults at baseline. Cognitive function was assessed using mental intactness and episodic memory and ELCs were measured by early parental death, childhood socioeconomic status (SES), food deprivation, and childhood health. Growth curve modeling was used to examine the trajectory of cognitive function (three waves in a 6-year period)with particular attention paid to the effects of ELCs on cognition. The results show that early maternal death is associated with the baseline cognitive level among middle- and old-aged Chinese adults (β range between −0.44 and −0.35, p < 0.05), but that this association is also largely attenuated by adulthood education. Higher childhood SES predicts an enhanced level of baseline cognition in both age groups (β range between 0.08 and 1.27, p < 0.001), but only protects against cognitive decline at baseline in middle-aged adults. Participants who were less healthy during childhood tended to have lower cognitive performance than those who had enjoyed good health (β range between −0.36 and −0.14, p < 0.05). The results of this study highlight the detrimental impact of deleterious ELCs on cognitive function throughout later life.

Research to-date has examined the impact of intergenerational support in terms of isolated types of support, or at one point in time, failing to provide strong evidence of the complex effect of support on older persons’ wellbeing. Using the Harmonised China Health and Retirement Longitudinal Study (2011, 2013 and 2015), this paper investigates the impact of older people's living arrangements and intergenerational support provision/receipt on their physical and psychological wellbeing, focusing on rural–urban differences. The results show that receiving economic support from one's adult children was a stronger predictor for higher life satisfaction among rural residents compared to urban residents, while grandchild care provision was an important determinant for poor life satisfaction only for urban residents. Having weekly in-person and distant contact with one's adult children reduced the risk of depression in both rural and urban residents. Older women were more likely than men to receive support and to have contact with adult children, but also to report poor functional status and depression. The paper shows that it is important to improve the level of public economic transfers and public social care towards vulnerable older people in rural areas, and more emphasis should be placed on improving the psychological wellbeing of urban older residents, such as with the early diagnosis of depression.

Background There is growing evidence that the sensory impairments in visual and/or hearing are associated with dementia, however, the association with relationship between sensory impairments, assistive device use, and motoric cognitive risk syndrome (MCR) remains underexplored. Objective This study aimed to investigate the association between sensory impairment and MCR, and to assess the impact of sensory impairment severity and assistive devices. Design A prospective cohort study. Methods Participants aged ≥ 60 years from the China Health and Retirement Longitudinal Study (CHARLS) in 2011 and 2015 waves were included in the current study. Sensory impairments were assessed from self-reported questionnaire. MCR was defined as subjective cognitive complaints combined with slow gait speed. Participants were categorized by sensory function and assistive device use. Multivariate logistic regression analyses were conducted to examine the associations between sensory impairments, assistive device use, and MCR risk. Results Among 4882 participants, the overall prevalence of MCR was 11.92%, with 80.66% having visual impairment and 63.03% having hearing impairment. Cross-sectionally, visual and hearing impairments were associated with 1.59-fold (95% CI: 1.06–2.38) and 1.62-fold (95% CI: 1.17–2.24) higher odds of MCR, respectively. Longitudinally, severe sensory impairments significantly increased MCR risk (visual: OR = 2.15, 95% CI: 1.20–3.86; hearing: OR = 1.98, 95% CI: 1.29–3.04). Sensory impairment participants without assistive device showed increased risk of new-onset MCR (visual: OR = 2.01, 95% CI: 1.09–3.71; hearing: OR = 1.96, 95% CI: 1.30–2.96) but no significant association was detected in participants with visual assistive device. Conclusions This study highlights the significant association between sensory impairments and MCR in older Chinese adults, with severity of impairment and lack of assistive device use exacerbating risk. The findings underscore the importance of early detection and intervention for sensory deficits to mitigate cognitive decline. Highlights Sensory impairments including visual and hearing impairments were associated with motoric cognitive risk syndrome (MCR). In addition, the sensory impairment individuals without assistive device showed increased risk of new-onset MCR.