Dongfeng Tang

Background: The increasing life expectancy provides an opportunity for healthy longevity, but frailty is a potential challenge. Existing studies of frailty prevalence in England are largely cross-sectional, use heterogeneous frailty definitions, and rarely break down population-level drivers or project future burden, limiting their use for health and social care planning. Objective: This study aimed to explore temporal trends of frailty prevalence and project scenario-based future prevalence up to 2040 for the community-dwelling population aged 50 years and older in England. Methods: Prevalence of frailty (measured using a frailty index) in the overall sample and subgroups of age, sex, educational level, and marital status from 2002 to 2022 was estimated among the community-dwelling population aged 50 years and older using 10 waves of nationally representative data from the English Longitudinal Study of Ageing (ELSA; n=6226 to 11,218 across waves). The number of individuals with frailty was also derived in each year. Joinpoint regression models were used to explore temporal trends of frailty prevalence. A linear probability regression model was performed using pooled data from 10 waves of the ELSA to explore driving factors and project future prevalence. Decomposition analysis was used to estimate the contribution of individual factors to the change in prevalence. Results: A statistically nonsignificant ( P =.61) increase of 2.3 percentage points from 15.5% (1738/11,218) in 2002 to 17.8% (1108/6226) in 2022 was observed, with the number of individuals with frailty growing from 2,560,122 to 3,791,038 among community-dwelling adults aged 50 years and older in England. Those with advanced age, who were female, had a lower educational level, and/or were single had a consistently higher prevalence of frailty. Opposing contributions netted to this overall change: improvements in sociodemographic conditions and educational attainment and healthier lifestyle behaviors offset 222.5%, 94.9%, and 51.6% of the observed increase, respectively. Under scenario-based projections, prevalence was estimated at 20.5% (95% CI 19.2%-21.9%) in 2040, corresponding to 5,213,689 people with frailty. Conclusions: Despite a modest increase in prevalence among the community-dwelling population aged 50 years and older, the substantial growth in the absolute number of individuals with frailty indicates a likely rise in future care demands. The study contributes a 20-year trend, decomposition, and forecast framework for community-dwelling older adults. Findings support prioritizing broader sociodemographic development alongside educational attainment and healthy lifestyles, with potential policy approaches including income and social protection, housing improvements, access to health care, and prevention. Key limitations include self-reported measures, exclusion of care home residents, and potential influence of unmeasured effects.

Frailty care needs are increasing in China's ageing population, but evidence on frailty progression and outcomes in this context has remained limited. This study aims to synthesize existing evidence on frailty trajectories as well as on the associations between frailty and mortality. English‐language databases (MEDLINE, Embase, Web of Science, PsycINFO, CINAHL) and Chinese databases (China National Knowledge Infrastructure, Wanfang Data, VIP Information) were searched up to October 2024. Random‐effects meta‐analysis was applied to estimate pooled frailty transitions and mortality risks, and frailty trajectories derived by statistical modelling were narratively summarized. Frailty status was stable for 61% (95% confidence interval [CI]: 57%–66%) of individuals, worsened for 29% (95% CI: 24%–34%), and improved for 10% (95% CI: 7%–13%) among Chinese adults aged ≥ 30 years with 2–11 years of follow‐up. Levels or changes of frailty were used to define trajectory patterns. A 1% increase in the frailty index was associated with a 5% higher mortality risk (hazard ratio = 1.05, 95% CI: 1.03–1.06), while frailty was linked to over a twofold higher mortality risk compared with robustness (hazard ratio = 2.34, 95% CI: 1.51–3.63). Frailty is associated with increased mortality risk among Chinese community‐dwelling adults, and progression is not inevitable, with many remaining stable. Distinct subpopulations can be identified by frailty levels or changes. Future research should examine determinants and outcomes of frailty transitions and trajectories to guide targeted interventions.

BACKGROUND: Hypertension and frailty frequently coexist in older adults. However, relationships between their trajectories are unclear. This study aims to examine whether frailty progressed differently between individuals with and without hypertension before and after diagnosis. METHODS: Data were drawn from 3 nationally representative cohorts across 14 countries, including 21 418 participants (mean baseline age 63.2±10.2 years) followed for 16 to 18 years. Individuals with hypertension at baseline were excluded. Hypertension was defined by self-reported physician diagnosis and antihypertensive medication use by self-report of taking any medication. Diagnosis timing was based on the first survey wave at which hypertension was reported. Coarsened exact matching matched participants who developed hypertension with those who did not. Piecewise linear mixed models estimated frailty trajectories before and after diagnosis. RESULTS: Among 10 709 participants who developed hypertension (median diagnosis age 70 years), frailty index rescaled to a 0 to 100 scale (0–100) increased by 0.63 points/y (95% CI, 0.57–0.70) before diagnosis and 1.09 points/y (95% CI, 0.97–1.21) after diagnosis. During the 8 years preceding diagnosis, participants who developed hypertension experienced greater increases in frailty index rescaled to a 0 to 100 scale than matched controls without hypertension (difference, 2.69 [95% CI, 2.43–2.95]). The corresponding difference during the 8 years after diagnosis was 1.51 (95% CI, 1.01–2.01). Among individuals with hypertension, antihypertensive medication use was associated with a nonsignificant reduction in frailty progression after diagnosis. Findings remained robust after excluding participants with cardiovascular conditions. CONCLUSIONS: Participants with hypertension experienced faster frailty progression before and after diagnosis. Studies using objective blood pressure measurement are needed to confirm this association.

Background: Women with intellectual disability experience significant health inequalities across the lifespan but evidence on their maternity care and perinatal outcomes is limited. Methods: We conducted a retrospective matched cohort study using linked electronic health records from the Early Life Cross Linkage in Research, Born in South London (eLIXIR-BiSL) network. Women with intellectual disability were identified in primary care and secondary mental healthcare. We matched 91 pregnancies in women with intellectual disability (mean maternal age 29·9 years) to 357 pregnancies in women without intellectual disability, on maternal age, parity, and calendar year between 2018 and 2023. We assessed whether intellectual disability was recorded in maternity records and compared socio-demographic and clinical characteristics and perinatal outcomes between groups using logistic regression. Findings: Intellectual disability was recorded in the maternity records for only 56.0% women with intellectual disability recorded in their primary care or secondary mental healthcare records. Recording was not associated with maternal characteristics and appeared to improve over time. Compared with women without intellectual disability, women with intellectual disability had higher levels of health-related risk factors and indicators of social vulnerability, including current smoking, mental health conditions, multimorbidity, socioeconomic deprivation, domestic abuse, and social services involvement. Their babies had lower mean birth weight than babies born to women without intellectual disability (2992g vs 3306g, p<0·001) and were more likely to be born preterm (21.4% vs 5·9%, p<0.001). In adjusted models, maternal intellectual disability remained associated with preterm birth (OR 3·09, 95%CI 1·34–7·16). Interpretation: Women with intellectual disability are more likely to have obstetric risk factors and to experience adverse birth outcomes. Intellectual disability was frequently absent from maternity records, potentially limiting recognition of women’s support needs and implementation of reasonable adjustments in maternity care.

Background: Polycystic ovary syndrome (PCOS) is the most common endocrine disorder among women of reproductive age, affecting 11%–13% globally and representing a primary cause of anovulatory infertility, with substantial socioeconomic disparities influencing its worldwide burden. However, data on temporal trends, regional variations, and sociodemographic drivers of PCOS are limited. We aimed to evaluate global, regional, and national PCOS trends from 1990 to 2021 and project future impacts to 2050. Methods: In this trend analysis based on the 2021 Global Burden of Diseases (GBD) study, we report on the prevalence, incidence, and years lived with disability (YLDs) rates per 100,000 individuals, as well as average annual percentage changes (AAPCs) for PCOS at the global, regional, and national levels. We analyzed these trends by age, SDI, and reproductive outcomes using age‐period‐cohort (APC) modelling, decomposition, inequality analysis, and Bayesian projections. Results: From 1990 to 2021, global PCOS prevalent cases increased from 36.65 million to 69.47 million (89.6% rise), with an age‐standardised prevalence rate (ASPR) of 1757.8 per 100,000 in 2021 (AAPC 0.81 [95% CI 0.77–0.85]). High‐middle SDI regions exhibited the highest burden (ASPR: 5237.6 per 100,000), while low‐SDI regions showed the steepest rise (AAPC: 2.22). Infertility accounted for the majority of YLDs, peaking at ages 25–29. Socioeconomic inequalities decreased (Slope Index of Inequality from 28.55 to 22.28). Projections indicate 103.91 million cases by 2050. Conclusion: From 1990 to 2021, global PCOS burden increased substantially, with marked socioeconomic and regional disparities. This underscores the need for enhanced screening, personalised treatments, and targeted interventions in low‐SDI regions to promote reproductive health equity.

Drawing on data from the Korean Longitudinal Study of Aging (n = 3252) and the Chinese Longitudinal Healthy Longevity Survey (n = 8281) from 2008 to 2018, this study employed fixed-effects panel data regressions to examine the differential association between healthy lifestyles and disability across education, income, and place of residence. Our results indicate that adopting one more healthy lifestyle was associated with a 0.1–0.2 point lower disability score among older adults in South Korea (β = −0.14, 95% CI, −0.19 to −0.09) and China (β = −0.24, 95% CI, −0.28 to −0.21). Specifically, this association was more pronounced among older adults with higher income, lower education, and urban residents, with a significant difference based on the Chow test (P < 0.05). Clinical and public health policies could pay attention to reducing the socioeconomic disparities highlighted in this study through tailored interventions. Our findings suggest that promoting healthy lifestyles among less-educated individuals might yield significant benefits against disability. They underscore the potential of promoting healthy lifestyles to mitigate education-related inequalities in disability within aging societies. We recommend that policymakers consider simultaneously emphasizing the enhancement of health literacy to delay disability onset among vulnerable groups and prevent the risk of low-income households slipping back into poverty. This article is part of a Special Collection on Cross-National Gerontology.

Frailty, as an important geriatric syndrome, has been considered an important public health issue worldwide, which will bring great challenges to health care systems and population health in the context of ageing [1]. It is characterised by multiple function declines and increased vulnerability to stressors and was found to be associated with many adverse health […]

Background: Hypertension is one of the main public health issues around worldwide, and midday napping is a popular habit. The association between the two remains to be explored. Objective: The goal of the research was to explore the association of midday napping with hypertension. Methods: This study separately selected 11,439, 12,689, and 9464 Chinese respondents aged over 45 years from the China Health and Retirement Longitudinal Study 2011, 2015, and 2018 data sets. Binary logistic regression was used to explore the association of midday napping with hypertension, and the 3-step method was used to test the mediation effect of BMI. Results: Among all respondents, the prevalence rates of hypertension were 24.6% (2818/11439) in 2011, 21.1% (2683/12689) in 2015, and 22.1% (2092/9464) in 2018. Midday napping was positively correlated with hypertension. In 2011 and 2015, napping 60 to 90 minutes had the greatest odds ratios [OR] (OR2011 1.705, OR2015 1.494). In 2018, the biggest OR came from the group napping 30 to 60 minutes (OR 1.223), and ORs of different napping durations decreased from 2011 to 2018. In addition, BMI had a partial mediation effect in 2015 and 2018. Conclusions: Midday napping is a potential risk factor for hypertension with BMI acting as a mediator. To prevent hypertension, avoiding prolonged duration of midday napping and taking action to maintain a normal BMI level are recommended.