Previous studies have thoroughly evaluated the association between long-term exposure to PM2.5 and mortality, but the effect of socioeconomic status on the association remains controversial. We utilized the data of all-cause mortality per year, concentration of PM2.5, socioeconomic and demographic characteristics for 345 cities in China from 2000-2019. We applied the Poisson generalized estimating equations (Poisson GEE) model to explore the association between PM2.5 and mortality in cities with different quartiles of demographic and socioeconomic characteristics. Overall, every 10 µg/m ³ increase in PM2.5, the RR was 1.082 (95% CI:1.058-1.106) for all-cause mortality, with residents of the Northeast and Southwest regions having a higher risk of death. Cities with the highest quartiles of gender ratio, age, dependency rate, and migration rate had relative risks of 1.110 (95% CI: 1.020-1.208), 1.075 (95% CI: 1.018-1.135), 1.101 (95% CI: 1.068-1.135), and 1.108 (95% CI: 1.053-1.165), respectively. Stratified analyses showed that the exposure-mortality associations were strongest in cities with both the lowest and highest socioeconomic status (SES) quartiles. The association between PM2.5 and mortality varied by socioeconomic status, demonstrating a U-shaped pattern with the highest mortality risk observed among residents in cities with both the lowest and highest socioeconomic levels.

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.

Cardiovascular disease (CVD) is a major contributor to disability and the leading cause of global mortality. This study aims to perform a population-based prospective cohort study to examine the combined impact of multiple lifestyle factors on CVD risk and examine the differences in the relationships across sociodemographic groups. We used data from the UK Biobank. Exposures include seven lifestyle behaviors (smoking, physical activity, alcohol consumption, diet, sleep duration, sedentary behavior, and social connection) and combined multiple behaviors. The lifestyle score was subsequently categorized as favorable (5 to 7 healthy lifestyle factors), intermediate (2 to 4 healthy lifestyle factors), and unfavorable (0 to 1 healthy lifestyle factor) lifestyle classes. Cox proportional hazards models were used to estimate hazard ratios (HRs) for incident CVD and its subtypes. This study showed a significant association of favorable lifestyle with incident CVD (HR = 0.58, 95% CI: 0.54-0.63), myocardial infarction (HR = 0.58, 95% CI: 0.54-0.64), and ischemic stroke (HR = 0.56, 95% CI: 0.48-0.65). Similarly, there was a significant association of intermediate lifestyle with incident CVD (HR = 0.69, 95% CI: 0.64-0.75), myocardial infarction (HR = 0.70, 95% CI: 0.64-0.77), and ischemic stroke (HR = 0.66, 95% CI: 0.57-0.77). The protection effect of lifestyle was more pronounced in the midlife group, females, and those individuals with high Townsend deprivation index levels. Adherence to a broad range of healthy lifestyle factors was associated with a significantly lower risk of CVD and subtypes. Lifestyle modification through multifactorial approaches should be prioritized for preventing and delaying onset of CVD.