Background: Disability in aged people became one of the major challenges in China due to the acceleration of population aging. Nevertheless, there were limited methods to appropriately discriminate the degree of combined basic activity of daily living (BADL) and instrumental activity of daily living (IADL). The present study explored an empirical typology of the activity of daily living (ADL) and its association with health status among the elderly in China. Methods: Data throughout the Chinese Longitudinal Healthy Longevity Survey (CLHLS) was retrieved and Latent profile analysis (LPA) was conducted to identify the subgroups of ADL for included elderly subjects. Multinomial regression was performed to detect the effect of identified characteristics with ADL subgroups, and the restricted cubic spine was drawn to show the changes in the relationship between age-specific ADL disability and BMI. Results: The overall participants (n=8108) were divided into three ADL classes by LPA - ‘no BADL limitation-no IADL limitation’ (Class one, n=6062, 75%), ‘no BADL limitation- IADL impairment’ (Class two, n=1526, 19%), and ‘BADL impairment- IADL impairment’ (Class three, n=520, 6%). Compared with the participants in Class one, the oldest-old, living without spouse, lacking of exercise, short in social activities, having experience of falls, having comorbidity of diabetes, heart disease, stroke, decreased cognitive function, depression symptom were highly associated with Class two and Class three. Additionally, malnutrition and asthma were associated with combined BADL/IADL impairment (Class three), while illiteracy was only associated with IADL impairment (Class two). Furthermore, a statistically significant U-shape association was detected between age and BADL/IADL disability (Class three vs. Class two) as well as BMI and BADL/IADL disability (Class three vs. Class one). The elderly aged 80–90 with IADL impairment were less likely to evolve into combined BADL/IADL impairment, and the elderly who were underweight or obese may have higher risk of combined BADL/IADL impairment. Conclusion: A novel functional assessment was explored based on LPA, by which elderly people could be classified into three distinct classes of combined BADL/IADL. The predictors identified with particular IADL/BADL classes could draw early attention to the onset of functional disability and enlighten targeted interventions to address consequent problems of aged people.

BACKGROUND: This study aims to perform a comprehensive analysis of stroke burden from the Global Burden of Disease 2021. METHODS: We conducted a comprehensive analysis of the burden, including prevalence, incidence, mortality, and disability-adjusted life year rates, for stroke across 204 countries and regions from 1990 to 2021 using data from the Global Burden of Disease 2021. We calculated the estimated annual percentage change (EAPC) and performed a joinpoint regression analysis to identify the trends. We also explored the association between the stroke burden and sociodemographic index. RESULTS: The age-standardized prevalence, incidence, mortality, and disability-adjusted life year rates for stroke were 1099.310, 141.553, 87.454, and 1886.196 per 100 000 persons in 2021, respectively. The general stroke burden trends declined in EAPC analysis (age-standardized prevalence: EAPC, −0.37; age-standardized incidence: EAPC, −0.99; age-standardized mortality: EAPC, −1.81; and disability-adjusted life year: EAPC, −1.76). However, we found an increasing burden of stroke in East Asia and Southern Sub-Saharan Africa (EAPC >0). The global burdens of intracerebral hemorrhage, subarachnoid hemorrhage, and ischemic stroke showed a similar trend. The stroke, intracerebral hemorrhage, and ischemic stroke burdens were heavier in men than in women, except for that of subarachnoid hemorrhage in women. Our joinpoint regression analysis revealed that the age-standardized burden rates of stroke decreased from 1990 to 2021 (average annual percent change 0). The burden of stroke was inversely proportional to the sociodemographic index ( P <0.05), except in the case of subarachnoid hemorrhage. The actual stroke burden showed an increasing trend for stroke, intracerebral hemorrhage, subarachnoid hemorrhage, and ischemic stroke in 2021 (during the coronavirus pandemic). CONCLUSIONS: We found age-standardized rates of stroke burden declining over time, but some areas exhibited a notable increase in the prevalence, incidence, mortality, and disability-adjusted life year rates.

The causal association between modifiable risk factors and erectile dysfunction (ED) remains unclear, which hinders the early identification and intervention of patients with ED. The present study aimed to clarify the causal association between 42 predominant risk factors and ED. Univariate Mendelian Randomization (MR), multivariate MR, and mediation MR analyses were used to investigate the causal association between 42 modifiable risk factors and ED. Combined results were pooled from two independent ED genome-wide association studies to verify the findings. Genetically predicted body mass index (BMI), waist circumference, trunk fat mass, whole body fat mass, poor overall health rating, type 2 diabetes, basal metabolic rate, adiponectin, cigarette consumption, insomnia, snoring, hypertension, stroke, ischemic stroke, coronary heart disease, myocardial infarction, heart failure, and major depressive disorder were found to increase the risk of ED (all P < 0.05). Additionally, genetic liability to higher body fat percentage and alcohol consumption were suggestively associated with an increased risk of ED (P < 0.05 and adjusted P > 0.05). Genetic predisposition to higher sex hormone-binding globulin (SHBG) levels could decrease the risk of ED (P < 0.05). No significant association was detected between lipid levels and ED. Multivariate MR identified type 2 diabetes, basal metabolic rate, cigarette consumption, hypertension, and coronary heart disease as risk factors for ED. The combined results confirmed that waist circumference, whole body fat mass, poor overall health rating, type 2 diabetes, basal metabolic rate, adiponectin, cigarette consumption, snoring, hypertension, ischemic stroke, coronary heart disease, myocardial infarction, heart failure, and major depressive disorder could increase the risk of ED (all P < 0.05), while higher SHBG decreased the risk of ED (P = 0.004). There were suggestive significances of BMI, insomnia, and stroke on ED (P < 0.05 and adjusted P > 0.05). This comprehensive MR study supported the causal role of obesity, type 2 diabetes, basal metabolic rate, poor self-health rating, cigarette and alcohol consumption, insomnia and snoring, depression, hypertension, stroke, ischemic stroke, coronary heart disease, myocardial infarction, heart failure, SHBG, and adiponectin in the onset and development of ED.

Sleep is a modifiable behavior that can be targeted in interventions aimed at promoting healthy aging. This study aims to (i) identify the sleep duration trend in US adults; (ii) investigate the relationship between sleep duration and phenotypic age; and (iii) explore the role of exercise in this relationship. Phenotypic age as a novel index was calculated according to biomarkers collected from US adults based on the National Health and Nutrition Examination Survey (NHANES). Sleep information was self-reported by participants and discerned through individual interviews. The principal analytical method employed was weighted multivariable linear regression modeling, which accommodated for the complex multi-stage sampling design. The potential non-linear relationship was explored using a restricted cubic spline (RCS) model. Furthermore, subgroup analyses evaluated the potential effects of sociodemographic and lifestyle factors on the primary study outcomes. A total of 13,569 participants were finally included in, thereby resulting in a weighted population of 78,880,615. An examination of the temporal trends in sleep duration revealed a declining proportion of individuals with insufficient and markedly deficient sleep time since the 2015–2016 cycle. Taken normal sleep group as a reference, participants with extreme short sleep [β (95% CI) 0.582 (0.018, 1.146), p = 0.044] and long sleep [β (95% CI) 0.694 (0.186, 1.203), p = 0.010] were both positively associated with phenotypic age using the fully adjusted model. According to the dose–response relationship between sleep duration and phenotypic age, long sleep duration can benefit from regular exercise activity, whereas short sleep duration with more exercise tended to have higher phenotypic age. There is an inverted U-shaped relationship between short and long sleep durations and phenotypic age. This study represents an important step forward in our understanding of the complex relationship between sleep and healthy aging. By shedding light on this topic and providing practical exercise recommendations for promoting healthy sleep habits, researchers can help individuals live longer, healthier, and more fulfilling lives.

The neurotoxicity of heavy metals received increasingly attention in recent years. Sleeping is regulated and coordinated by nervous system, however, the health hazard of heavy metal like cadmium (Cd) exposure on sleep health remained unknown. Rescue strategies like physical exercise (PE) has emerged to mitigate such influence. An epidemiological design with cross-sectional data from National Health and Nutrition Examination Survey 2007–2010 was applied. The relationship between three blood heavy metals [cadmium (Cd), lead (Pb), mercury (Hg)] and sleep disturbance was analyzed. A total of 8,751 participants were finally included in and the weighted participants were 330,239,463. Weighted quantile sum (WQS) regression indicated that mixed blood metals were positively related to risk of sleep disturbance and the mixture effect of exposure to heavy metals was mainly attributable to Cd (89.1%). Weighted logistic regression showed a significant positive association between the highest quartile of blood Cd and sleep disturbance [(OR (95% CI)): 1.191 (1.014,1.400), p = 0.036] in the fully adjusted model, while no association was found under Pb and Hg exposure. In the association between Q3 and Q4 level of blood Cd and sleep disturbance, moderate-to-vigorous physical exercise group had lower risks than none and low exercise group. In the restricted cubic spline model, it was also verified that higher PE participation was associated with the lowest incidence of sleep disturbance with the increment in Cd concentration. Our study suggested that both policy makers and the public should minimize heavy metal exposure. Moreover, conducting moderate to vigorous physical exercise is a protecting factor to mitigate Cd’s influence on sleep health.

Background: Research on the association between blood lead (Pb) and lipid biomarkers have yielded inconsistent results, and epidemiological studies on blood Pb levels and hyperlipidemia are scarce. The present study aimed to examine the association between blood Pb levels and hyperlipidemia in adults from the National Health and Nutrition Examination Survey (NHANES).Methods: A total of 43,196 participants in the NHANES from 1999 to 2018 were included in the final analysis. Hyperlipidemia was determined based on the National Cholesterol Education Program guidelines. Blood Pb levels were assessed using inductively-coupled plasma mass spectrometry. Weighted multivariable logistic regression analysis and subgroup analysis were conducted to determine the correlation between blood Pb levels and hyperlipidemia.Results: In the multivariable logistic regression model, high blood Pb levels were significantly associated with hyperlipidemia after adjusting for confounders (OR 1.41; 95%CI: 1.18–1.67). Furthermore, elevated blood Pb levels were associated with an increased risk of hyperlipidemia across the four quartile (Q) groups (Q1: OR 1.00; Q2: OR 1.16 [95%CI: 1.04–1.29]; Q3: OR 1.39 [95%CI: 1.21–1.59]; and Q4: OR 1.33 [95%CI: 1.15–1.54]; P for trend <0.05). Significant moderating effects were found in the subgroup analysis stratified by age, education, hypertension, and diabetes (P < 0.05). In sensitivity analysis, the ORs for hyperlipidemia across the quartiles of blood Pb levels were 1.00, 1.17 (95%CI: 1.05–1.30), 1.42 (95%CI: 1.24–1.62), and 1.38 (95%CI: 1.19–1.60) for Q1, Q2, Q3, and Q4, respectively (P for trend <0.001) after removing adults with arteriosclerotic cardiovascular disease, and the ORs were 1.00, 1.13 (95%CI: 1.01–1.25), 1.38 (95%CI: 1.21–1.56), and 1.32 (95%CI: 1.16–1.52) for Q1, Q2, Q3, and Q4, respectively (P for trend <0.001) after including pregnant women.Conclusion: The current study showed a positive association between blood lead levels and hyperlipidemia.