Haomiao Li

Family health is an important variable that links internal and external resources at the family level, exerting significant effects on individual health. However, there remains a lack of empirical evidence regarding its potential to mitigate health disparities. Therefore, the present study aimed to explore the effect of family health on income-related health disparity in China and analyze the heterogeneous effects of different dimensions of family health across different sub-populations. Using nationally representative data from the 2023-2024 Psychology and Behavior Investigation of Chinese Residents [n = 49,885], we employed health-related quality of life (HRQoL) as a proxy variable for individual health and applied the recentered influence function-index-ordinary least squares model to explore the contributions of family health and its four dimensions to the disparity in HRQoL. Our findings showed that family health had a significantly negative association with the concentration index of health utility index (UI; β = -0.0002, P < 0.05) and EuroQol Visual Analogue Scale (EQ-VAS; β = -0.0006, P < 0.01). Family social or emotional support was negatively associated with EQ-VAS disparity, and family external social support significantly contributed to lower UI disparity. However, family health resources were positively associated with the disparity in UI and EQ-VAS. Heterogeneity analysis revealed more pronounced effects of family health in mitigating health disparity among females, young populations, and urban residents. This study emphasizes the importance of alleviating health disparities through family health improvement. In addition, the study findings demonstrate the necessity of reshaping resource allocation at the family level-balancing external supply and internal equity of families among different subgroups-and accelerating the distribution of high-quality medical resources to economically disadvantaged areas.

The correlation between adverse childhood experiences (ACEs) and both diabetes mellitus (DM) prevalence and comorbidity is an underexplored research area in China. Understanding the mechanisms by which this relationship might be attenuated or mitigated is crucial. This study examines the correlation between ACEs and DM, including its comorbidities, and assesses whether lifestyle factors mediate this relationship in a Chinese population. Data were obtained from the 2023 Psychological and Behavioural Survey of Chinese Residents (PBICR‐2023), a nationwide cross‐sectional survey. The sample included 27,322 adults. Regression models evaluated the associations between ACEs, DM, and comorbidities, adjusting for potential confounders. Mediation effects of lifestyle (sleep quality, smoking, diet and physical activity [PA]) were tested using Sobel–Goodman tests, with mediation weights quantified via Karlson–Holm–Breen (KHB) decomposition. The results show that, compared with no ACEs, exposure to 1, 2, 3 or ≥ 4 ACEs was significantly associated with higher DM risk. ACEs were also positively correlated with comorbidity among DM patients. Lifestyle mediated the ACE–DM association, with sleep quality having the strongest effect (11.86%), followed by smoking (3.90%), dietary habits (2.96%) and PA (1.11%). For comorbidity, smoking was the only significant mediator (10.20%). Diabetes prevention strategies should address childhood adversities and promote healthier lifestyles.

Background: There are positive and negative correlations in different directions between smoking, personality traits, and health-related quality of life (HRQOL), where smoking may mask the pathway between personality traits and HRQOL. Understanding the masking pathway of smoking between personality traits and HRQOL can elucidate the mechanisms of smoking’s psychosocial effects and provide new ideas for developing tobacco control strategies. Objective: The purpose of this study was to investigate the correlation between Big Five personality traits and HRQOL and whether smoking mediates the relationship between them. Methods: This was a cross-sectional study using data from 21,916 respondents from the 2022 Psychology and Behavior Investigation of Chinese Residents survey. Linear regression models were used to analyze the correlations between smoking, Big Five personality traits, and HRQOL while controlling for potential confounders. The mediating role of smoking on the association between Big Five Personality traits and HRQOL was analyzed using the Sobel-Goodman mediation test. Results: Extraversion (β=.001; P=.04), agreeableness (β=.003; P<.001), and neuroticism (β=.003; P<.001) were positively correlated with HRQOL, whereas openness was negatively correlated with HRQOL (β=–.001; P=.003). Smoking was associated with a decrease in HRQOL and mediated the positive effect of HRQOL on extraversion (z=−2.482; P=.004), agreeableness (z=−2.264; P=.02), and neuroticism (z=−3.230; P=.001). Subgroup analyses further showed that smoking mediated the effect of neuroticism on HRQOL in the population with chronic illnesses (z=−2.724; P=.006), and in the population without chronic illnesses, smoking contributed to the effect of HRQOL on extraversion (z=−2.299; P=.02), agreeableness (z=−2.382; P=.02), and neuroticism (z=−2.213; P=.03). Conclusions: This study provided evidence that there is a correlation between personality traits and HRQOL. It also found that smoking plays a role in mediating the connection between personality traits and HRQOL. The development of future tobacco control strategies should consider the unique traits of each individual’s personality, highlighting the significance of extraversion, agreeableness, and neuroticism.

This study aimed to investigate whether social participation (SP) can decrease depressive symptom severity in disabled older adults. A total of 5,937 disabled participants (4877, 1970, 219, and 8 participants responding 1, 2, 3, 4 times, respectively), obtained from the China Health and Retirement Longitudinal Study, were enrolled in our analysis. Based on pooled Ordinary Least Square regressions, SP was associated with decreased depressive symptom severity, and this association was significant in recreational activities and interacting with friends. For brain-disabled respondents, the association was not significant. SP is effective in decreasing depressive symptom severity in disabled older populations. Diversified activities and targeted interventions should be applied to specified older disabled populations to prevent depression.

Background: Family health develops from the intersection of the health of each family member and their interactions and capacities as well as the family’s internal and external resources. Frailty is the most prominent and typical clinical manifestation during population aging. Family health may be effective in addressing frailty, and this association may be mediated by health literacy and health behaviors. Until now, it is unclear whether and how family health affects frailty in older adults. Objective: This study aimed to examine the associations between family health and frailty and the mediation roles of health literacy and health behaviors. Methods: A total of 3758 participants aged ≥60 years were recruited from a national survey conducted in 2022 in China for this cross-sectional study. Family health was measured using the Short Form of the Family Health Scale. Frailty was measured using the Fatigue, Resistance, Ambulation, Illnesses, and Loss of weight (FRAIL) scale. Potential mediators included health literacy and health behaviors (not smoking, not having alcohol intake, physical exercise for ≥150 minutes per week, longer sleep duration, and having breakfast every day). Ordered logistic regression was applied to explore the association between family health and frailty status. Mediation analysis based on Sobel tests was used to analyze the indirect effects mediated by health literacy and behaviors, and the Karlson-Holm-Breen method was used to composite the indirect effects. Results: Ordered logistic regression showed that family health is negatively associated with frailty (odds ratio 0.94, 95% CI 0.93-0.96) with covariates and potential mediators controlled. This association was mediated by health literacy (8.04%), not smoking (1.96%), longer sleep duration (5.74%), and having breakfast every day (10.98%) through the Karlson-Holm-Breen composition. Conclusions: Family health can be an important intervention target that appears to be negatively linked to frailty in Chinese older adults. Improving family health can be effective in promoting healthier lifestyles; improving health literacy; and delaying, managing, and reversing frailty.

Objective: This study aims to investigate the changes in admission appropriateness after patients were admitted and provide a reference for physicians to make admission decisions and for the supervision of medical service behavior by the medical insurance regulatory department.Methods: Medical records of 4,343 inpatients were obtained based on the largest and most capable public comprehensive hospital in four counties in central and western China for this retrospective study. The binary logistic regression model was employed to examine the determinants of changes in admission appropriateness.Results: Nearly two-in-thirds (65.39%) of the 3,401 inappropriate admissions changed to appropriate at discharge. Age, type of medical insurance, medical service type, severity of the patient upon admission, and disease category were found to be associated with the changes in the appropriateness of admission. Older patients (OR = 3.658, 95% CI [2.462–5.435]; P < 0.001) were more likely to go from “inappropriate” to “appropriate” than younger counterparts. Compared with circulatory diseases, the case evaluated as “appropriate” at discharge was more frequent in the urinary diseases (OR = 1.709, 95% CI [1.019–2.865]; P = 0.042) and genital diseases (OR = 2.998, 95% CI [1.737–5.174]; P < 0.001), whereas the opposite finding was observed for patients with respiratory diseases (OR = 0.347, 95% CI [0.268–0.451]; P < 0.001) and skeletal and muscular diseases (OR = 0.556, 95% CI [0.355–0.873]; P = 0.011).Conclusions: Many disease characteristics gradually emerged after the patient was admitted, thus the appropriateness of admission changed. Physicians and regulators need to take a dynamic view of disease progression and inappropriate admission. Aside from referring to the appropriateness evaluation protocol (AEP), they both should pay attention to individual and disease characteristics to make a comprehensive judgment, and strict control and attention should be paid to the admission of respiratory, skeletal, and muscular diseases.

Exposure to domestic violence (EDV) is a constant threat to social stability and global solidarity and may be associated with an increased risk of depression in later life. This study assessed the association between EDV during childhood and depressive symptoms in middle and older age. A total of 10,521 respondents obtained from the China Health and Retirement Longitudinal Study were enrolled in our analysis. Depressive symptoms were measured using the 10-item form of the Center for Epidemiological Studies Depression (CES-D) scale, and EDV included parental conflict and corporal punishment. A random-effects linear regression was used to assess associations. The results showed positive relationships between “not very often” (β = 0.862; 95% CI:0.512 to 1.211; p < 0.001), “sometimes” (β = 1.692; 95% CI:1.227 to 2.158; p < 0.001) and “often” (β = 2.143; 95% CI:1.299 to 2.987; p < 0.001) in parental conflict and the CES-D scores, compared with that of those reported “never” in parental conflict. Similarly, positive relationships between “sometimes” (β = 0.389; 95% CI:0.091 to 0.687; p = 0.011) and “often” (β = 1.892; 95% CI:1.372 to 2.413; p < 0.001) in corporal punishment and the CES-D scores were observed. EDV is associated with an increased risk of depression in later life. Future research could develop interventions that target EDV and explore the mechanisms in China to further decrease lifetime depression risk and improve the population’s mental health.

Corrigendum: Unmet healthcare needs predict frailty onset in the middle-aged and older population in China: A prospective cohort analysis