Background: Worldwide around 50 million people experience severe cognitive impairment. Limited study investigated whether the increased risk of cognitive impairment can be offset by a broad combination of healthy lifestyle behaviors in low- and middle-income countries. This study aims to perform a 10-year nationwide population-based prospective study for examining long-term association between combined multiple modifiable lifestyle factors and cognitive impairment. Method: We used four waves (2008-2018) of the Chinese Longitudinal Healthy Longevity Survey, including 8,321 participants aged ≥65 years with normal cognition at baseline. Exposures include dietary behaviors, single lifestyle behaviors (sleep, housework, exercise and social connection), and combined multiple behaviors. Cognitive impairment was assessed by the Mini Mental State Examination (score< 24). Cox proportional hazards models were performed to examine the long-term association between multiple lifestyle behaviors and cognitive impairment. Results: Of total 8,321 participants, 24.88% (2,070) developed cognitive impairment during a 10-year follow-up. This study showed a significant association of combined multiple behaviors with cognitive impairment [hazard ratio (HR) 0.55, 95%CI: 0.35 - 0.86]. Compared with participants who had unhealthy lifestyle activity and dietary behaviors, HR for cognitive impairment was 0.65 (95% CI: 0.45 - 0.94) and 0.91 (95% CI: 0.82 - 0.99) in those who had good lifestyle activity and dietary behaviors, respectively. Subgroup analyses revealed significant relationships in females and individuals with lowest education. Conclusions: Adherence to a broad range of healthy lifestyle factors was associated with a significantly lower risk of cognitive impairment. Behavioral lifestyle modification through multifactorial approaches should be a priority for prevention and delayed onset of cognitive impairment and dementia.

Background: Adverse effects of medical treatment (AEMT) pose a substantial global health burden, yet their epidemiological profile remains incompletely characterized. This multinational study aims to characterize the burden of AEMT to guide the development of evidence-based, targeted prevention strategies across diverse health systems. Methods: This study analyzed the global epidemiology of AEMT from 1990 to 2021 using data from the GBD study. Age-standardized rates with 95% UIs were obtained for incidence (ASIR), mortality (ASMR), YLDs, YLLs, and DALYs to systematically evaluate the burden of AEMT. Furthermore, the Epidemiological Transition Effect (ETE) index was introduced to quantify shifts in AEMT burden patterns. Percentage changes with 95% UIs for each metric were calculated between 1990 and 2021. Subgroup analyses were also conducted stratified by age, sex, and region. Results: The global ASIR of AEMT was estimated at 150.11 per 100,000 (95% UIs: 131.19-171.81) in 2021. Meanwhile, the global ASMR in 2021 was 1.53 per 100,000, reflecting a 36% decrease since 1990. Similarly, the YLLs fell to 62.66 per 100,000, a reduction of 40% compared with 1990. In the same year, the global YLDs were 1.53 per 100,000. From 1990 to 2021, DALYs attributable to AEMT declined by 40%, reaching 64.19 per 100,000 population in 2021. Children under 5 years demonstrated disproportionately high YLLs and DALYs. The global ETE value was low at 0.02, indicating that the burden of AEMT was primarily driven by premature mortality. Significant sex disparity was observed, with higher burden rates among females and pronounced peaks among. Conclusions: This comprehensive analysis reveals a significant global reduction in the AEMT burden since 1990. Given the disproportionately high burden observed among children—characterized by substantial YLLs due to premature mortality—public health strategies should address not only fatal AEMT events but also prioritize targeted interventions for this vulnerable pediatric population.