Background: Non-adherence or partial adherence is the main reason for poor therapeutic effect of hypertension. This paper aims to assess adherence behaviors and related factors among elderly hypertensive patients in China. Methods: Participants aged ≥ 60 years, with hypertension, and with complete data in 2018 interviews of the China Health and Retirement Longitudinal Study (CHARLS) were included. The adherence behaviors included medication, blood pressure monitoring and the combined adherence behaviors. Referring to the social-ecological theory, correlates of adherence behaviors were divided into three layers, namely demographic characteristics, health behaviors, living environment and retirement. Univariate and multivariable logistic regression models were performed to identify factors of adherence behaviors. Results: The prevalence of medication adherence (76.58%) was higher than that of blood pressure monitoring adherence (20.08%), and the full adherence rate was 18.53%. Self-rated health status, smoking status, living area, and health education status were detected to be associated with medication adherence and blood pressure monitoring adherence (all p < 0.05). Gender, sleep duration, health examination, and physical exercise were also detected to be associated with blood pressure monitoring adherence (all p < 0.05). Self-rated health status and health education status were detected to be associated with partially and fully adherence, while age, living area, and life satisfaction were detected to be associated with partially adherence, smoking status, sleep duration, health examination, and pension reliance were detected to be associated with fully adherence (all p < 0.05). Conclusion: Our study reveals the poor adherence behaviors of elderly hypertensive patients in China. This is most evident among those who were male, 60– 69 years old, living in rural areas, self-reported being healthier, those without health examination and health education. Targeting these vulnerable populations, we suggest to strengthen health education, increase the publicity of basic public health services and enhance the self-management ability of hypertensive patients.

There are few studies estimating the loneliness of the Hakka elderly in China. This study aims to examine the loneliness status and related factors among the Hakka elderly in Fujian, China. The short‐form UCLA Loneliness Scale (ULS‐8) was used to assess the loneliness of the Hakka elderly. Factors associated with loneliness were classified as individual indicators, behavioral indicators, interpersonal indicators, and social indicators according to the health ecological model (HEM). Hierarchical linear regression models were established to identify the main factors that were most predictive of loneliness. A sample of 1,262 Hakka elderly people was included in this study. Females (β = 0.631, P = 0.012), those with ≥2 chronic diseases (β = 1.340, P < 0.001), those who were currently living in rural areas (β = 4.863, P < 0.001) or suburban areas (β = 2.027, P < 0.001), those with parents both died (β = 0.886, P = 0.001), and those with the Urban Employees Basic Medical Insurance (UEBMI; β = 0.852, P = 0.030) obtained a higher score of ULS‐8. Those exercised regularly (β = −2.494, P < 0.001), those had leisure activities (β = −1.937, P < 0.001), those ate healthy (β = −1.270, P < 0.001), and those with better self‐rated financial status and higher education level received a lower score of ULS‐8. There are differences in loneliness among different Hakka elderly population subgroups, and healthy behaviors and lifestyles may reduce the loneliness of the Hakka elderly. Relevant interventions should be implemented in a targeted manner, focusing on susceptible populations. This is most evident among those who were female, living in rural areas, with parents both died, with lower education, and with multiple chronic diseases.

Previous studies have demonstrated perfluoroalkyl and polyfluoroalkyl substances (PFAS) impact renal function, with albumin playing dominant role in their transport and accumulation. However, the mediating role of albumin in PFAS-induced renal impairment and the identification of sensitive populations remain uninvestigated. This study included 9328 individuals from NHANES 1999-2018 with data on serum PFAS, creatinine, albumin, and covariates. The estimated glomerular filtration rate (eGFR) was calculated using standardized creatinine. Associations between perfluorooctanoic acid (PFOA), perfluorooctane sulfonic acid (PFOS), perfluorohexane sulfonate (PFHxS), and perfluorononanoic acid (PFNA) with eGFR and the risk of decreased renal function (eGFR < 90 vs. eGFR ≥ 90) using linear and logistic regression, weighted quantile sum (WQS) regression, Bayesian kernel machine regression (BKMR), and restricted cubic spline (RCS) analyses. Subgroup analyses identified sensitive populations. Mediation analysis was performed to examine the mediating role of albumin. Comparative toxicology databases identified relevant genes for mechanistic exploration. Ln-transformed PFOA (β = -1.91, 95 % CI: -2.82 to -1), PFOS (β = -1.48, 95 % CI: -2.19 to -0.78) and PFHxS (β = -0.94, 95 % CI: -1.65 to -0.23) were negatively correlated with eGFR. PFOA (aOR = 1.21, 95 % CI: 1.1-1.32), PFOS (aOR = 1.2, 95 % CI: 1.12-1.29), and PFHxS (aOR = 1.13, 95 % CI: 1.05-1.21) were positively correlated with the risk of decreased renal function. Subgroup analyses indicated that individuals ≤ 45 years, females and other races were more sensitive. Albumin mediated 18.2 %, 16.4 %, 29.8 %, and 18.7 % of the negative effects of PFOA, PFOS, PFHxS, and PFNA on eGFR, respectively. Functional enrichment analysis suggested PFAS impair renal function by affecting lipid metabolism and increasing oxidative stress. PFAS exposure is negatively associated with eGFR and positively associated with the risk of decreased renal function, with albumin playing a partial mediating role.

There is limited evidence regarding the factors correlated with dietary diversity (DD) and dietary pattern (DP) in rural residents of China. This study aims to identify the DD and DP of rural residents and their association with socio-demographic factors. A cross-sectional survey was conducted in Pingnan, China. The Food Frequency Questionnaire (FFQ) was applied to evaluate dietary intake. Latent class analysis (LCA) was used to identify patterns of six food varieties, including vegetables–fruits, red meat, aquatic products, eggs, milk, and beans–nuts. Generalized linear models and multiple logistic regression models were used to determine factors associated with the DD and DP. Three DPs were detected by LCA, namely “healthy” DP (47.94%), “traditional” DP (33.94%), and “meat/animal protein” DP (18.11%). Females exhibited lower DD (β = −0.23, p = 0.003) and were more likely to adhere to “traditional” DP (OR = 1.46, p = 0.039) and “meat/animal protein” DP (OR = 2.02, p < 0.001). Higher educational levels and annual household income (AHI) were positively associated with higher DD (p < 0.05) and less likely to have “traditional” DP and “meat/animal protein” DP (p < 0.05). Non-obese people exhibited higher DD (β = 0.15, p = 0.020) and were less likely to have “meat/animal protein” DP (OR = 0.59, p = 0.001). Our study reveals that females, those with lower educational levels and AHI, and obese people are more likely to have a lower DD and are more likely to adhere to “traditional” DP and “meat/animal protein” DP. The local, regional, and even national performance of specific diet-related health promotion measures and interventions must target these vulnerable populations to improve a healthier DD and DP.