Rui Deng

Purpose: Healthy lifestyle is considered a modifiable factor related to cognitive health, while evidence from multi-ethnic regions remains scarce. This study aimed to examine the association between healthy lifestyle and cognitive function among middle-aged and older adults in ethnically diverse communities and to explore heterogeneity across population characteristics. Methods: This cross-sectional study was conducted in Yunnan Province, China from July to December 2022. Cognitive function was assessed using the Brief Community Screening Instrument for Dementia (BCSI-D). Healthy lifestyle scores were constructed based on seven behaviors: smoking status, alcohol consumption, physical activity, social contact, sleep duration, physical examination and body mass index (BMI) categories. Each behavior was assigned 1 point if the participant met the healthy criteria and 0 otherwise. Participants were categorized into favourable, intermediate, and unfavourable lifestyle groups according to the final score. Chi-square tests were used to compare cognitive function status across population characteristics, and Kruskal–Wallis tests were used to compare BCSI-D scores across lifestyle groups within each subgroup. Logistic regression models and subgroup analyses were conducted to examine the lifestyle-cognition association, with formal interaction tests performed to assess effect modification across subgroups. A sensitivity analysis was additionally conducted using the healthy lifestyle score as a continuous variable. Results: Out of the total 2708 participants, approximately 68.76% were classified in the favourable lifestyle category. Across nearly all characteristics, the unfavourable lifestyle category consistently showed the lowest mean BCSI-D scores. An unhealthy lifestyle was significantly associated with higher odds of cognitive impairment in the overall population (OR= 1.272, 95% CI:1.012– 1.598). Subgroup analyses further revealed apparent heterogeneity, with the associations observed among two key populations: participants aged 60– 74 years (OR= 1.486, 95% CI:1.066– 2.070) and those from Zhiguo ethnic minority groups (OR= 1.570, 95% CI:1.132– 2.178). Significant associations were also observed among married (OR= 1.366, 95% CI:1.046– 1.784), educated (OR= 1.562, 95% CI:1.106– 2.204), monthly household income of 1000– 2999 Chinese Yuan (OR= 1.582, 95% CI:1.057– 2.367) and without ADL impairment (OR= 1.498, 95% CI:1.074– 2.088) individuals. However, formal interaction testing confirmed statistically significant effect modification only for education level (P =0.036), while no significant interactions were observed for the remaining characteristics. Conclusion: This study suggests that a healthy lifestyle was associated with better cognitive outcomes among middle-aged and older adults in this resource-limited, multi-ethnic population. The association was observed in certain population groups, although this potential heterogeneity warrants further confirmation. These findings highlight that culturally tailored lifestyle interventions may offer a feasible strategy to reduce cognitive health disparities in diverse settings.

BACKGROUND Digital health technologies can support health information seeking, service access, and self-management, but benefits are uneven among middle-aged and older adults. How digital access, general digital use, and digital health literacy (DHL) jointly relate to digital health use and outcomes, and whether disparities differ by stage, remains unclear in multiethnic Southwest China. OBJECTIVE This study aimed to examine associations across the pathway from digital access and general digital use through DHL and digital health use to digital health outcomes, and to assess whether sociodemographic disparities varied by stage among adults aged 45 years or older in multiethnic communities of Yunnan Province, Southwest China. METHODS We conducted a cross-sectional household survey in Yunnan Province from August to December 2025 using stratified multistage cluster random sampling. Eligible participants were usual residents aged 45 years or older who had lived locally for at least 6 of the preceding 12 months. Digital access, general digital use, digital health use, and digital health outcomes were measured using additive indices; DHL was assessed with a 15-item scale (ordinal Cronbach α=0.942). Partial least squares structural equation modeling (PLS-SEM) with 5000 bootstrap resamples estimated standardized direct, indirect, and total effects. RESULTS Among 2234 participants (mean age 63.21, SD 9.41 years), 1295 (57.97%) were female, 1168 (52.28%) lived in rural areas, and 777 (34.78%) belonged to ethnic minority groups. The model explained 22.2%-58.2% of the variance in endogenous constructs. Digital access was associated with everyday digital use (β=0.276, P<.001) and DHL (β=0.081, P<.001), but not digital health use (β=0.016, P=.385). Its indirect (β=0.129, P<.001) and total effects (β=0.145, P<.001) on digital health use were significant. Everyday digital use was associated with DHL (β=0.266, P<.001) and had positive total effects on digital health use (β=0.336, P<.001) and digital health outcomes (β=0.296, P<.001). DHL had the strongest direct effect on digital health use (β=0.452, P<.001) and a positive total effect on digital health outcomes (β=0.440, P<.001). Education was positively associated with all 5 constructs. Older age was mainly associated with lower upstream construct levels, whereas ethnic minority status was mainly associated with lower everyday digital use and DHL. CONCLUSIONS Digital health inequalities among middle-aged and older adults in multiethnic communities of Southwest China were characterized by linked, stage-specific associations. DHL showed the strongest direct association with digital health use, whereas digital access was associated with digital health use indirectly rather than directly. Stage-specific sociodemographic disparities indicate that interventions should be tailored to the point of disadvantage and combine access support, practical digital-skills training, DHL support, guided service use, and culturally responsive design.

The borderland between China and Myanmar is a region marked by transnational aspirations and significant anxieties, including a heightened risk of contagious diseases. Notably, the human immunodeficiency virus (HIV) epidemic has been intensifying, especially among linguistic minorities in this area. To ensure that public healthcare provisions are accessible for linguistic minorities living with HIV, we examine the communication experiences of HIV-infected Burmese wives in a Chinese border town. Drawing on a critical sociolinguistic ethnography conducted between May 2022 and December 2023, this study collected multiple types of data including: semi-structured interviews with two Burmese wives and four stakeholders including two Chinese healthcare providers and two Chinese husbands; participant observation; field notes; and China’s HIV healthcare policies and other relevant written documents. The findings reveal that HIV-infected Burmese wives are confronted with multiple linguistic and social vulnerabilities in their access to HIV healthcare services. Despite that, their Chinese husbands and healthcare providers developed a collective resilience to enhance the quality of HIV healthcare services. Our study demonstrates that language, intersected with other social factors, complicates the HIV communication disparity. Our study contributes to multilingual crisis communication by addressing the lived communication experiences of linguistic minorities at the intersections of language, gender, class and migration status.

Universal health coverage (UHC) is a paramount concern within the health domain. A worldwide consensus exists on attaining UHC by 2030, aiming to improve health equity and enhance universal health [1,2]. However, the global ongoing pursuit of UHC, particularly in low- and middle-income countries, is confronted by several persistent issues and challenges. There are evident […]