Jianjun Bai

Background: To analyze temporal trends, sociodemographic pattern, and quantify the independent contributions of age, period, and cohort effects in regular active exercise among Chinese adults over the past three decades. Methods: Based on nationally representative health service surveys (NHSS) in China spanning 1993-2023 and involving 1·56 million participants, we analyzed the prevalence of regular exercise, while also reported standardized rates and sociodemographic stratification by age, sex, education, income, employment status and urban-rural area. We then adopted the age-period-cohort (APC) model to further identify the age, period, and cohort effects. Findings: Regular exercise among Chinese adults increased substantially over the past three decades, with a marked acceleration following the launch of the Healthy China 2030 initiative: prevalence rose from 20·85% in 2013 to 38·78% in 2018, and further to 42·97% in 2023. Overall upward shifts in both period and cohort effects also corroborated the observed improvement in regular exercise participation. Nevertheless, regional and sociodemographic disparities persist, particularly among working-age adults and those living in rural areas. The urban–rural gap has narrowed due to accelerated improvements among rural residents; however, inequalities remain pronounced in western rural regions, where inadequate infrastructure continues to constrain exercise participation. Interpretation: Regular physical exercise has been increasingly promoted in China since the launch of Healthy China 2030, but persistent regional and sociodemographic disparities suggest that more targeted interventions are needed.

Objective: To analyse temporal trends, inequalities and projections in anaemia burden among women of childbearing age (WCBA). Design: Population‐based study. Setting: Data from the Global burden of Disease (GBD) Study. Population: WCBA (ages 15–49) diagnosed with anaemia. Methods: According to the GBD study, original data sources, including population‐based surveys, scientific studies and government reports, were synthesised to estimate WCBA anaemia prevalence and years lived with disability (YLD). We extracted annual estimates with 95% uncertainty intervals (UIs) from 1990 to 2021 and assessed relative prevalence risks by age, period and cohort. Inequality was evaluated via sociodemographic index (SDI). The Bayesian age‐period‐cohort model was used to predict progress toward the 2030 prevalence halving target. Main Outcomes Measures: The burden of WCBA anaemia. Results: Despite population growth increasing total case numbers, the global age‐standardised prevalence rate of WCBA anaemia declined from 35.64% (95% UI: 34.16 to 37.37) in 1990 to 33.77% (32.10–35.55) in 2021. Socioeconomic disparities persisted, with a stable concentration index around −0.21 over time, indicating sustained inequality disadvantaging lower‐SDI countries, especially in Western and Central Sub‐Saharan Africa and South Asia. Despite reductions in period/cohort prevalence risks, projections indicated insufficient progress toward the 2030 target. Conclusion: The persistent global burden, inequalities and insufficient progress in addressing WCBA anaemia continue to call for improving anaemia management, contextually tailored, multisectoral nutritional and non‐nutritional interventions to achieve the 2030 target.

Background: Early palliative care (PC) has received more attention for improving health-related outcomes for advanced cancer patients in recent years, but the results of previous studies are inconsistent. Objectives: This study aimed to use meta-analysis and trial sequence analysis to evaluate the effect of early PC on health-related outcomes of advanced cancer patients. Methods: All English publications were searched in PubMed, Web of Science, Embase, and the Cochrane Library from inception to March 2023, with a restriction that the study type was a randomized controlled trial. Results: The results showed that early PC positively affected quality of life, satisfaction with care, and symptom burden reduction. However, early PC had no significant effect on anxiety or survival. Trial sequence analysis results showed that the effect of early PC on the quality of life was stable. Discussion: This systematic review suggested that early PC could positively affect health-related outcomes for advanced cancer patients. Early PC can be used widely in clinical settings to improve health-related outcomes of advanced cancer. However, because of the trial sequence analysis results, further well-designed, clinical, randomized controlled trials with larger sample sizes are necessary to draw definitive conclusions.

Chronic obstructive pulmonary disease (COPD) has been the third leading cause of death worldwide. As the traditional risk factors (like smoking and ambient air pollution) on the burden of COPD being well characterized, the burden of COPD due to non-optimal temperature has been widely concerned. In this study, we extracted the relevant burden data of COPD attributable to non-optimal temperature from GBD 2019 and adopted estimated annual percent changes, Gaussian process regression (GPR), and age-period-cohort model to evaluate the spatiotemporal patterns, relationships with socio-demographic level, and the independent effects of age, period and cohort from 1990 to 2019. In brief, the global COPD burden attributable to non-optimal temperatures showed declining trends but was still more severe in the elderly, males, Asia, and regions with low socio-demographic index (SDI). And cold had a greater burden than heat. The inverted U-shape is expected for the relationship between SDI and the burden of COPD caused by non-optimal temperatures according to the GPR model, with the inflection point around SDI 0.45. Besides, the improvements were observed in period and cohort effects but were relatively limited in low and low-middle SDI regions. Public health managers should execute more targeted programs to lessen this burden predominantly among lower SDI countries.

Background: Chronic obstructive pulmonary disease (COPD) has been an important public health issue in China. This study aimed to analyze the temporal trends in mortality and years of life lost (YLL) from COPD, and explore the effects of age, period, and cohort in Wuhan, China from 2010 to 2019. Methods: Data were collected from the cause of death surveillance system in Wuhan. Age-standardized mortality rate (ASMR), age-standardized YLL rate (ASYR) and the estimated annual percent changes (EAPC) were calculated to evaluate the temporal trends. The age-period-cohort (APC) model was adopted to estimate the age, period, and cohort effects. Results: From 2010 to 2019, COPD accounted for 26,051.15 deaths and 394,659.58 person years YLL in Wuhan. Recently, the death burden of COPD in Wuhan has somewhat improved, especially after 2015, with declining trends in ASMR and ASYR. Additionally, the ASMR and ASYR of COPD was higher in males. And these of males showed the overall upward trends, with EAPCs of 1.06 (0.13, 2.00) and 1.21 (0.12, 2.31), respectively, while females showed downward trends since 2010. According to APC model, the age effect of COPD increased with age, and the cohort risk ratios (RRs) followed the overall downward trends. Period RRs for the Wuhan population generally tended to rise and then fall, with females showing a clear downward trend after 2015, while period RRs for males maintained an upward trend throughout the study period. Conclusions: Recently, the death burden from COPD in Wuhan has improved, especially after 2015, with improvements in ASMR, ASYR and period RRs. Sex differences still exist. COPD posed a greater threat to the elderly, especially males. Public health managers should continue to execute more targeted programs to lessen the death burden of COPD in Wuhan.

Background: Micromobility sharing platforms have involved skyrocketing numbers of users in multiple countries since 2010. However, few studies have examined the overall impact of the growing micromobility market on road injuries.Method: We use road injury data from the Global Burden of Disease Study database to examine the effect of age, period, and cohort on micromobility injury-related deaths and incidence. We compared four countries that vary in demographic background and road infrastructure. By comparing the countries, we analyzed the relationship between the trends in road injuries and these factors.Results: We found an overall upward trend in micromobility injuries. A higher risk of micromobility-related injuries was witnessed in China and the US in 2015-2019, and people older than 45 showed a growing micromobility-related mortality and incidence rate in China, India, and the US. Cohorts after 1960 showed higher micromobility injury incidence risks in China and India, but the population born after 1990 in India showed a slightly lower risk compared to those before it.Conclusions: The boosted usage of micromobility devices explains these increasing trends. Road infrastructure and separated traffic ease the collisions from micromobility devices. The overall situation calls for improvement in legislation as well as road infrastructure.

Background: As the emerging economies, the BRICS (Brazil, Russia, India, China, and South Africa) shared 61.58% of the global chronic respiratory diseases (CRD) deaths in 2017. This study aimed to assess the secular trends in CRD mortality and explore the effects of age, period, and cohort across main BRICS countries. Methods: Data were obtained from the Global Burden of Disease Study (GBD) 2019 and analyzed using the age-period-cohort (APC) model to estimate period and cohort effects between 1990 and 2019. The net drifts, local drifts, longitudinal age curves, period/cohort rate ratios (RRs) were obtained through the APC model. Results: In 2019, the CRD deaths across the BRICS were 2.39 (95%UI 1.95 to 2.84) million, accounting for 60.07% of global CRD deaths. Chronic obstructive pulmonary disease (COPD) and asthma remained the leading causes of CRD deaths. The age-standardized mortality rates (ASMR) have declined across the BRICS since 1990, with the most apparent decline in China. Meanwhile, the downward trends in CRD death counts were observed in China and Russia. The overall net drifts per year were obvious in China (-5.89%; -6.06% to -5.71%), and the local drift values were all below zero in all age groups for both sexes. The age effect of CRD presented increase with age, and the period and cohort RRs were following downward trends over time across countries. Similar trends were observed in COPD and asthma. The improvement of CRD mortality was the most obvious in China, especially in period and cohort effects. While South Africa showed the most rapid increase with age across all CRD categories, and the period and cohort effects were flat. Conclusions: BRICS accounted for a large proportion of CRD deaths, with China and India alone contributing more than half of the global CRD deaths. However, the declines in ASMR and improvements of period and cohort effects have been observed in both sexes and all age groups across main BRICS countries. China stands out for its remarkable reduction in CRD mortality and its experience may help reduce the burden of CRD in developing countries.