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Background This prospective cohort study aimed to investigate the relationship between sleep duration and cancer incidence among 9996 participants over a median follow-up period of 9 years. Methods Participants without cancer at baseline were followed for over 88,790 person-years. The incidence of cancer and sleep duration was self-reported. The relationship between sleep duration and cancer incidence was analyzed using Cox proportional hazards models adjusted for various confounding factors, including age, gender, lifestyle factors, and comorbidities. Results During the follow-up, 325 participants were diagnosed with incident cancer, resulting in an incidence rate of 20.49 per 1000 person-years. After adjusting for confounders, a total sleep duration of less than 6 h was significantly associated with an increased risk of cancer (HR: 1.27; 95% CI: 1.01–1.61). This association was particularly strong for cancers in the digestive and respiratory systems (HR: 1.41; 95% CI: 1.03–1.93). Longer sleep durations (> 9 h) showed a potential increase in cancer risk, but results were not consistently significant. Age-stratified analyses revealed a similar significant increase in cancer incidence among individuals aged 60 years or younger with less than 6 h of sleep per day, showing a 35% increase in overall cancer risk and an 83% increase in digestive and respiratory system cancer. No significant association was found between nocturnal sleep durations or daytime naps and cancer incidence. However, a significant interaction was observed between daytime naps longer than 30 min and cancer incidence in women ( p  = 0.041). Conclusions We observed that short sleep duration may increase the risk of cancer, particularly cancers in the digestive and respiratory systems. Additionally, while longer sleep durations might also increase cancer risk, this finding requires validation with larger sample sizes.

This study aimed to propose an operational definition of late-onset hypogonadism (LOH) that incorporates both clinical symptoms and serum testosterone measurements to evaluate the prevalence of LOH in aging males in China. A population-based sample of 6296 men aged 40 years-79 years old was enrolled from six representative provinces in China. Serum total testosterone (TT), sex hormone-binding globulin (SHBG), and luteinizing hormone (LH) were measured and free testosterone (cFT) was calculated. The Aging Males' Symptoms (AMS) scale was used to evaluate the LOH symptoms. Finally, 5078 men were included in this analysis. The TT levels did not decrease with age (P = 0.59), and had no relationship with AMS symptoms (P = 0.87 for AMS total score, P = 0.74 for ≥ 3 sexual symptoms). The cFT levels decreased significantly with age (P < 0.01) and showed a negative association with the presence of ≥ 3 sexual symptoms (P = 0.03). The overall estimated prevalence of LOH was 7.8% (395/5078) if a cFT level <210 pmol l−1 combined with the presence of ≥ 3 sexual symptoms was used as the criterion of LOH. Among them, 26.1% (103/395) and 73.9% (292/395) had primary and secondary hypogonadism, respectively. After adjustment for confounding factors, primary and secondary hypogonadism was positively related to age and comorbidities. Body mass index was an independent risk factor for secondary hypogonadism. The results suggest that the AMS total score is not an appropriate indicator for decreased testosterone, and that the cFT level is more reliable than TT for LOH diagnosis. Secondary hypogonadism is the most common form of LOH.

Background Non‐Hodgkin lymphoma (NHL) is increasingly prevalent in middle‐aged and elderly populations, contributing to the rising global health burden, particularly in high‐income countries. Methods This retrospective analysis utilized data from the Global Burden of Disease (GBD) study (1990–2021) to examine temporal trends in age‐standardized incidence, mortality, and disability‐adjusted life year (DALY) rates of NHL among middle‐aged and older adult populations, incorporating age‐ and sex‐stratified comparisons. Furthermore, projections for the subsequent 30 years were generated using Bayesian age‐period‐cohort (BAPC) modeling. Results From 1990 to 2021, the number of cases, deaths, and DALYs in middle‐aged and older people with NHL had significant increases. Age‐standardized incidence rates exhibited an increasing trend (estimated annual percentage change [EAPC] = 0.53), whereas mortality (EAPC = −0.33) and DALY rates (EAPC = −0.52) demonstrated a decreasing trend. The Western European region and high SDI countries are the core burden areas for middle‐aged and elderly populations with NHL globally. Lower‐middle SDI countries experienced the fastest increase in mortality (EAPC = 0.38) and DALY rates (EAPC = 0.22), while high‐SDI countries experienced the steepest decline in all metrics. The DALY burden showed its peak value at 65–69 years among middle‐aged and aged adults with NHL, while the morbidity and mortality burden reached their highest point at 70–74 years. When stratified by gender, the overall burden was higher in males than in females. High BMI causes the burden of NHL DALY to rise with increasing SDI, up to 39.14% in High‐income North America. By 2050, global NHL incidence is projected to increase modestly by 0.28%, whereas mortality and DALY burdens are expected to decline markedly by 30.67% and 23.02%, respectively. Conclusions NHL in middle‐aged and older adults represents a significant global public health burden, necessitating context‐specific interventions due to variations across regions, genders, and age groups.

Orthostatic hypotension (OH) is a common autonomic disorder. This study aimed to investigate the influencing factors and hemodynamic mechanisms of initial and sustained OH in middle‐aged and elderly patients. The authors analyzed the clinical characteristics and hemodynamic variables of patients aged ≥ 50 years according to the various forms of OH, diagnosed by an active orthostatic test using the CNAP monitor. The study included 473 participants; 119 (25.2%) patients had initial (54, 45.4%) or sustained (65, 54.6%) OH. Age, comorbidities, or medications did not differ significantly between the initial OH and non‐OH groups. Sustained OH was associated with age and diabetes (p = .003 and p = .015, respectively). Hemodynamic analysis revealed higher cardiac output (CO) in the sustained OH group within 15 s than in the non‐OH and initial OH groups (both p < .001); no difference in CO was observed between the initial OH and non‐OH groups. The systemic vascular resistance (SVR) in both initial OH and sustained OH groups within 15 s was lower than that in the non‐OH group (both p < .001). No differences in SVR at 3 min were observed between the initial OH and non‐OH groups. The SVR at 3 min in the sustained OH group was significantly lower than in non‐OH and initial OH groups (both p < .001). Age and diabetes emerged as the independent risk factors associated with sustained OH. Initial OH is associated with a mismatch of increase in CO and decrease in SVR. Sustained OH is mainly associated with sustained inadequate adjustment in SVR.

Background Previous studies have acknowledged that higher body weight and waist circumference were associated with an increased risk of heart failure. Notably, both body weight and waist circumference can change over time. However, no previous study has investigated the association between combined changes in weight and waist circumference in middle‐aged and older adults and incident heart failure. Methods This prospective study included 45 620 middle‐aged and older Chinese adults (aged 45–104 years). These participants were free of critical diseases at baseline, including coronary heart disease, stroke, heart failure, atrial fibrillation and cancer. Weight change from 2006–2007 to 2012–2013 was categorized into five groups: excessive weight loss (change < −10%, N = 3943), lesser weight loss (−10% ≤ change < −5%, N = 5890), stable weight (±5%, N = 23 208), lesser weight gain (5% < change ≤ 10%, N = 7153) and excessive weight gain (> 10%, N = 5426). Waist circumference change was categorized into five groups: excessive waist circumference loss (change < −10%, N = 8236), lesser waist circumference loss (−10% ≤ change < −5%, N = 6215), stable waist circumference (±5%, N = 16 953), lesser waist circumference gain (5% < change ≤ 10%, N = 6642) and excessive waist circumference gain (> 10%, N = 7574). Combined changes in weight and waist circumference were divided into 25 groups, i.e., cross‐classified combinations derived from the five categories of weight change and five categories of waist circumference change. Incident heart failure cases that occurred from 2012–2013 to December 31, 2022 were recorded. Cox proportional hazards regression models were used to estimate the associations of weight change, waist circumference change or both with heart failure. Multivariate models were stratified by age at risk (in 5‐year intervals) and sex, and were adjusted for variables including height, smoking, drinking, educational attainment, occupation, dietary pattern, physical activity, hypertension, fasting blood glucose and total serum cholesterol. In the analysis of weight change, we additionally adjusted for weight at baseline and waist circumference change. Conversely, for the analysis of waist circumference change, adjustments were made for baseline waist circumference and weight change. When examining combined weight and waist circumference changes, adjustments were made for both baseline weight and waist circumference. Additionally, we employed restricted cubic spline analyses to examine the nonlinear associations between changes in weight or waist circumference and heart failure. Results We identified 1036 heart failure cases during follow‐up. The median (interquartile range, IQR) of follow‐up time was 9.66 (9.40, 9.96) years. The incidence rate of heart failure was 2.47 cases per 1000 person‐years. The median (IQR) age of our participants was 52.1 (46.8, 57.7) years. The proportion of men was 77.9%. The mean (standard deviation) of weight and waist circumference at baseline (baseline, 2006–2007) was 70.1 (10.4) kg and 87.2 (9.0) cm, respectively. Compared with those who kept stable weight, participants in the excessive weight gain group had a higher risk (HR [hazard ratio], 1.27; 95% CI [confidence interval]: 1.03–1.57). Compared with those who kept stable waist circumference, participants in the excessive waist circumference gain group had a higher risk (HR, 1.28; 95% CI: 1.05–1.56), while those in the excessive waist circumference loss group had a lower risk of heart failure (HR, 0.76; 95% CI: 0.64–0.92). Compared with participants with stable weight and waist circumference, those who lost excessive weight and kept stable waist circumference (HR, 1.53; 95% CI: 1.10–2.14), those who lost lesser weight and gained excessive waist circumference (HR, 2.19; 95% CI: 1.38–3.46), and those who gained excessive weight and excessive waist circumference (HR, 1.48; 95% CI: 1.03–2.14) had a higher risk of heart failure. The restricted cubic spline illustrated a U‐shaped relation between weight change and incident heart failure (P overall = 0.027, P for non‐linear relation = 0.007), whereas a positive linear relation was observed for waist circumference change with incident heart failure (p overall < 0.001, p for non‐linear relation = 0.675). Conclusions Excessive weight gain and waist circumference gain were associated with 27% and 28% higher risk of heart failure, while excessive waist circumference loss was associated with a 24% lower risk of heart failure.

Objective To explore the mediating effect of nighttime sleep duration between digestive diseases and depressive symptoms among middle‐aged and elderly adults, so as to guide clinical intervention and treatment of depression related to digestive diseases. Methods Based on the data of the China Health and Retirement Longitudinal Study (CHARLS) from 2015 to 2020, difference analysis, Spearman correlation analysis, and multivariate logistic regression were conducted to analyze the relationships among digestive diseases, nighttime sleep duration, and depressive symptoms. The mediating effect model was established and tested by the Bootstrap method. Results The prevalence rate of digestive diseases was 23.05%, and the detection rate of depressive symptoms was 35.90%. Correlation and regression analysis indicated that digestive diseases (OR = 1.62, 95% CI: 1.45–1.81) and insufficient nighttime sleep (OR = 2.22, 95% CI: 2.01–2.45) significantly impacted depressive symptoms. The results of the mediating effect model showed that insufficient nighttime sleep had a partial mediating effect between digestive diseases and depressive symptoms among middle‐aged and elderly adults. Conclusion Digestive diseases can lead to insufficient nighttime sleep and promote the occurrence of depressive symptoms among middle‐aged and elderly adults. Therefore, in clinical practice, when treating digestive patients with comorbid depression, the quality and duration of their nighttime sleep should not be ignored. Improving sleep conditions is expected to alleviate depressive symptoms.

In this study, we investigated the essential criteria for late-onset hypogonadism （LOH） syndrome based on the presence of symptoms associated with low testosterone levels in Han Chinese men. Blood tests for total testosterone （TT） and sex hormone-binding globulin （SHBG） were performed, and the aging male symptoms （AMS） questionnaire was conducted in a randomly selected cohort composed of 944 Chinese men aged 40 to 79 years from nine urban communities. Three sexual symptoms （decreased ability/frequency of sexual activity, decreased number of morning erections, and decreased libido） were confirmed to be related to the total and free testosterone levels. The thresholds for TT were approximately 12.55 nmol l^-1 for a decreased ability/frequency to perform sex, 12.55 nmol l^-1 for decreased frequency of morning erections, and 14.35 nmol l^-1 for decreased sexual desire. The calculated free testosterone （CFT） thresholds for these three sexual symptoms were 281.14, 264.90, and 287.21 pmol l^-1, respectively. TT 〈13.21 nmol l^-1 （OR =1.4, 95%Ch 1.0-1.9, P= 0.037） or CFT 〈268.89 pmol l^-1 （OR - 1.5, 95%Ch 1.1-20, P=0.020） was associated with an increase in the aforementioned three sexual symptoms. The prevalence of LOH was 9.1% under the criteria, including all three sexual symptoms with TT levels 〈13.21 nmol l^-1 and CFT levels 〈268.89 pmol l^-1. Our results may improve the diagnostic accuracy of LOH in older men.

Background:There is growing evidence that the internet has beneficial effects on the mental health of middle-aged and older people (≥45 years), but the evidence is inconclusive, and the underlying mechanisms are less known.Objective:This study aims to explore the relationship between multidimensional (devices, frequency, and purpose) internet use and depression in middle-aged and elderly Chinese, as well as the mediating effect of social participation. Moreover, this study will explore the moderating effect of the regional informatization development level (RIDL) on the relationships between individual internet use, social participation, and depression.Methods:Data on 17,676 participants aged 45 years or older were obtained from the China Health and Retirement Longitudinal Study (CHARLS) 2018 data set. The 10-item Center for Epidemiologic Studies Depression Scale (CES-D-10) was used to identify the presence of depression. Logistic regression was used to explore the relationship between each dimension of internet use and depression. Multiple linear regression was used to explore the mediating effect of social participation and the moderating effect of the RIDL.Results:The results showed that 28.33% (5008/17,676) of the total population had depression. In terms of regional subgroups, respondents living in the western region exhibited the highest proportion of depression (2041/5884, 34.69%). Internet use was negatively associated with depression (odds ratio 0.613, 95% CI 0.542-0.692; P<.001). Various dimensions of internet use positively contributed to individual social participation and reduced individual depression (devices: β=–.170, 95% CI –0.209 to –0.127; frequency: β=–.065, 95% CI –0.081 to –0.047; and purpose: β=–.043, 95% CI –0.053 to –0.031). In addition, the RIDL weakened the relationship between individual-level internet use and social participation (internet use: F74.12,9.82=7.55, P<.001; devices: F51.65/9.88=5.23, P=.005; frequency: F66.74/10.08=6.62, P=.001; and purpose: F66.52/9.78=6.80, P=.001), and negatively moderated the relationship between the frequency of internet use and depression (frequency: F662.67/188.79=3.51, P=.03).Conclusions:This study found that different dimensions of internet use are associated with lower levels of depression. Social participation partially mediates the association between multidimensional internet use and depression in the eastern, central, and western regions, respectively. Additionally, the RIDL helps individuals further their internet use and social participation, reducing the impact of depression. However, this effect weakens sequentially from the western region to the central region and then to the eastern region.

Background To investigate the incidence of depression in middle-aged and elderly patients with diabetes in China and the influencing factors to provide a theoretical basis to improve the mental health of middle-aged and elderly patients with diabetes and formulate prevention, control, and intervention strategies. Methods The sample of this study was obtained from the China Health and Aging Tracking Survey (CHARLS) 2018 survey data, and middle-aged and older patients with diabetes(responding “Yes” to the questionnaire: “Have you ever been told by a doctor that you have diabetes or elevated blood glucose [including abnormal glucose tolerance and elevated fasting glucose]?”) aged ≥ 45 years were selected as study subjects (n = 2,613 ). Depressive symptoms of the study subjects were determined using the simplified version of the Depression Scale for Epidemiological Surveys scores(a score ≥ 10 was defined as depression), influence factors were analyzed using binary logistic regression, and proportion of depressive symptoms was standardized using the sex ratio of the seventh census. Results Among the 2,613 middle-aged and elderly patients with diabetes, 1782 (68.2%) had depressive symptoms and 831 (31.8%) had no depressive symptoms. There were 481 (27.0%) patients aged 45−59 years, 978 (54.9%) aged 60−74 years, and 323 (18.1%) aged ≥ 75 years. The depression rate among middle-aged and elderly Chinese patients with diabetes after standardization correction was 67.5%. Binary logistic regression results showed that age, education level, life satisfaction, marital satisfaction, self-rated health grade, somatic pain, visual impairment, physical disability, and the presence of comorbid chronic diseases were factors that influenced the onset of depression in middle-aged and elderly Chinese patients with diabetes (P < 0.05). Conclusion According to a survey analysis of the CHARLS 2018 data, depression is influenced by a combination of factors among middle-aged and elderly patients with diabetes in China. Therefore, for this population, targeted prevention and control should be carried out for key populations, such as middle-aged and elderly people, poor physical health, and low life satisfaction and marital satisfaction, from various dimensions (e.g., demographic and sociological factors, physical health status, and life satisfaction and marital satisfaction).

To investigate the screening and predicting functions of obesity- and lipid-related indices for type 2 diabetes (T2D) in middle-aged and elderly Chinese, as well as the ideal predicted cut-off value. This study's data comes from the 2011 China Health and Retirement Longitudinal Study (CHARLS). A cross-sectional study design was used to investigate the relationship of T2D and 13 obesity- and lipid-related indices, including body mass index (BMI), waist circumference (WC), waist–height ratio (WHtR), visceral adiposity index (VAI), a body shape index (ABSI), body roundness index (BRI), lipid accumulation product (LAP), conicity index (CI), Chinese visceral adiposity index (CVAI), triglyceride- glucose index (TyG index) and its correlation index (TyG-BMI, TyG-WC, TyG-WHtR). The unadjusted and adjusted correlations between 13 indices and T2D were assessed using binary logistic regression analysis. The receiver operating characteristic curve (ROC) was used to determine the usefulness of anthropometric indices for screening for T2D and determining their cut‑off value, sensitivity, specificity, and area under the curve (AUC). The study comprised 9488 people aged 45 years or above in total, of whom 4354 (45.89%) were males and 5134 (54.11%) were females. Among them were 716 male cases of T2D (16.44%) and 870 female cases of T2D (16.95%). A total of 13 obesity- and lipid-related indices were independently associated with T2D risk after adjusted for confounding factors ( P  < 0.05). According to ROC analysis, the TyG index was the best predictor of T2D among males (AUC = 0.780, 95% CI 0.761, 0.799) and females (AUC = 0.782, 95% CI 0.764, 0.799). The AUC values of the 13 indicators were higher than 0.5, indicating that they have predictive values for T2D in middle-aged and elderly Chinese. The 13 obesity- and lipid-related indices can predict the risk of T2D in middle‑aged and elderly Chinese. Among 13 indicators, the TyG index is the best predictor of T2D in both males and females. TyG-WC, TyG-BMI, TyG-WHtR, LAP, and CVAI all outperformed BMI, WC, and WHtR in predicting T2D.