A Multicenter Study of Multimorbidity in Older Adult Inpatients in China

Objectives

Multimorbidity is common in older hospitalized adults. To date, however, few studies have addressed multimorbidity in the older population of Chinese inpatients. We aimed to investigate the multimorbidity rate and associated risk factors in older adult inpatients in China.

Design, Setting, Participants

This study was conducted in the medical wards of a tertiary-care hospital from. The patients were recruited aged between 60 to 101 (74.14±8.46) years.

Measurements

Data were obtained from the China Comprehensive Geriatric Assessment Study, conducted in 2011–2012 in China. A total of 4,633 inpatients older than 60 years was recruited from 12 hospitals in 7 cities throughout China. The prevalence of comorbidity, distribution of common chronic diseases, and the associated risk factors were studied.

Results

A total of 4,348 people aged 60 to 101 (74.14±8.46) years completed questionnaires. The average frequency of multimorbidity was 69.3% (95% CI, 67.9% to 70.6%). The prevalence of multimorbidity increased with age and was higher in men (71.6%; 95% CI, 69.9% to 73.3%) than in women (65.3%, 95% CI 63.0% to 67.6%), and higher in the northern region (71.7%, 95% CI 69.9% to 73.5%) than in the southern region (66.0%; 95% CI, 63.8% to 68.1%). The most frequent chronic diseases were hypertension, coronary heart disease, diabetes, cataract, and stroke. Area (OR=0.556; 95% CI, 0.465 to 0.666), region (OR=0.834; 95% CI, 0.723 to 0.962), body mass index (BMI) (OR=1.124; 95% CI, 1.017 to 1.242), and impairment of activities of daily living (OR=0.911; 95% CI, 0.855 to 0.970) were independent factors associated with multimorbidity.

Conclusions

Multimorbidity is common in older Chinese inpatients with a national prevalence of 69.3% that increases in line with age. Age, region, area, BMI, and daily activities were independent factors significantly associated with multimorbidity in older inpatients. Clinicians should therefore focus more attention on multimorbidity.

     

云南省农村老年人五种常见慢性病及共病的流行现状及与社会经济地位的关系

  目的  分析云南省农村老年人高血压、糖尿病、脑卒中、冠心病、慢性阻塞性肺疾病(chronic obstructive pneumonia diseases，COPD)及共病的流行现状及与社会经济地位的关系。  方法  采用多阶段分层随机抽样的方法抽取云南省4 833名60岁及以上农村老年人进行问卷调查和体格检查，采用主成分分析法构建社会经济地位。  结果  云南农村老年人高血压、糖尿病、脑卒中、冠心病、COPD和共病的患病率分别为50.6%、10.2%、6.4%、5.5%、5.4%和16.1%。女性高血压和糖尿病的患病率均高于男性(均有P < 0.05)，而男性COPD的患病率高于女性(χ2=5.499，P=0.019)；高血压、冠心病、脑卒中、COPD和共病的患病率均随年龄的增长而增加(均有P < 0.05)；少数民族高血压、冠心病、COPD和共病的患病率均高于汉族(均有P < 0.05)。多因素Logistic回归分析结果显示，社会经济地位越低的老年人，其患高血压、冠心病、脑卒中、COPD和共病的风险越高(均有P < 0.05)。  结论  云南省农村老年人五种慢性病及共病的患病存在明显的社会经济差异，低社会经济地位的老年人是慢性病防控的重点人群。     

Association of the Time to First Cigarette and the Prevalence of Chronic Respiratory Diseases in Chinese Elderly Population

BackgroundIncreasing number of studies have suggested the time to first cigarette after waking (TTFC) have significant positive effect on respiratory diseases. However, few of them focused on the Chinese population. This study aims to estimate the impact of TTFC on the prevalence of chronic respiratory diseases (CRD) in Chinese elderly and explore the association in different sub-populations.MethodsCross-sectional data of demographic characteristics, living environment, smoking-related variables, and CRD were drawn from the Chinese Longitudinal Healthy Longevity Survey in 2018. Multivariate stepwise logistic regression analyses were conducted to examine the association of the TTFC with the prevalence of CRD.ResultsThis study includes 13,208 subjects aged 52 years and older, with a mean age of 85.3 years. Of them, 3,779 participants were ex- or current smokers (44.9% had the TTFC ≤30 minutes, 55.1% >30 minutes) and 1,492 had suffered from CRD. Compared with non-smokers, participants with TTFC ≤30 minutes seemed to have higher prevalence of CRD (OR 1.97; 95% CI, 1.65–2.35) than those with TTFC >30 minutes (OR 1.70; 95% CI, 1.44–2.00), although the difference was statistically insignificant (P_interaction = 0.12). Compared with TTFC >30 minutes, TTFC ≤30 minutes could drive a higher prevalence of CRD among female participants, those aged 90 years and older, urban residents, and ex-smokers (P_interaction < 0.05).ConclusionShorter TTFC relates to higher prevalences of CRD in Chinese older females, those aged 90 years and older, urban residents, and ex-smokers. Delaying TTFC might partially reduce its detrimental impact on respiratory disease in these specific subpopulations.Key words: time to first morning cigarette, chronic respiratory diseases, Chinese elderly, Chinese Longitudinal Healthy Longevity Survey     

成都市成年人慢性病相关生活方式和行为习惯的调查

目的 调查成都市成年人慢性病患病情况及其生活方式和行为习惯, 为预防慢性疾病提高参考依据。方法 采用多阶段等比例分层整群随机抽样方法调查成都市18岁以上常住居民8 324人, 填写调查问卷, 统计分析慢性疾病分布及其与生活方式和行为习惯的相关性。结果 1 329例罹患慢性疾病, 患病率为16.0%;吸烟、被动吸烟、饮食不规律、烟熏腌制食品等食物摄入量大、饮食口味重和缺乏体育锻炼等因素与慢性病明显相关(P<0.05);其中饮食不规律、烟熏腌制食品等食物摄入量大、饮食口味重和缺乏体育锻炼是成年人慢性病的独立危险因素(P<0.05)。结论 成都市成年人慢性病患病率较高, 与其相关的生活方式和行为习惯危险因素较多, 应加强健康生活的宣传力度, 养成良好的生活习惯, 降低慢性病风险。     

Neighborhood resources associated with frailty trajectories over time among community-dwelling older adults in China

Background and objectivesRecent research has identified neighborhoods as an important contributor to later-life frailty. However, little is known about how neighborhood resources are associated with frailty trajectories over time, especially in developing countries. This study examines the impact of neighborhood physical and social resources on the trajectories of frailty over time among older people in China.Research design and methodsUsing the four waves of the China Health and Retirement Longitudinal Study (2011–2018), 5673 respondents aged 60 and above at baseline were included for analyses. Multilevel growth modeling was fitted to estimate the effects of neighborhood resources on frailty trajectories over a 7-year period, controlling for individual-level characteristics.ResultsOlder Chinese people who lived in neighborhoods with better basic infrastructures and a greater number of voluntary organizations were less frail at baseline. Accessible exercise facilities were associated with a lower initial level of frailty only among rural older adults, while higher community-level socioeconomic status (SES) was associated with a lower initial level of frailty only among urban older adults. Over the 7-year follow-up period, better basic infrastructures and accessible exercise facilities were associated with a slower increase rate of frailty scores among rural residents.Discussion and implicationsNeighborhood resources are important contributors to the level of frailty among older Chinese people. Our findings of significant urban-rural differences have important implications for designing and implementing infrastructure development and community building programs in rural and urban China.     

Stroke and activity limitation in Chinese adults 65 Years or older

BackgroundDifferences in activity limitations between stroke survivors and people with other chronic conditions and how their levels of activity limitation vary by sociodemographic characteristics have not been well quantified.ObjectiveTo quantify activity limitations experienced by Chinese older adult stroke survivors and explore stroke effects in specific subgroups.MethodsWe used Chinese Longitudinal Healthy Longevity Survey 2017–2018 data (N = 11,743) to produce population-weighted estimates of activity limitations using the Activities of Daily Living (ADL) and the Instrumental ADL (IADL) scales for older adults (age 65 and older) stroke survivors compared to those with non-stroke chronic conditions and those without chronic conditions. Multinomial logistic regressions were run with outcomes “no activity limitation,” “IADL only limitation,” and “ADL limitation.”ResultsThe weighted marginal prevalence of ADL limitation was higher in the stroke group (14.8%) than in those with non-stroke chronic condition (4.8%) or no chronic conditions (3.6%) (p < 0.01). The corresponding prevalence of IADL limitation for the three groups was 36.0%, 31.4%, and 22.2%, respectively (p < 0.01). Stroke survivors aged ≥ 80 years had a higher prevalence of ADL/IADL limitation than those aged 65–79 years (p < 0.01). Formal education was associated with a lower prevalence of ADL/IADL limitation in each chronic condition group (p < 0.01).ConclusionsPrevalence and severity of activity limitation among Chinese older adult stroke survivors were several times higher than those without chronic conditions and those with non-stroke chronic conditions. Stroke survivors, particularly those aged ≥80 years and those without formal education, might be predisposed to more severe activity limitation and require more support to compensate.     

Decomposition of Socioeconomic Inequality in Cardiovascular Disease Prevalence in the Adult Population: A Cohort-based Cross-sectional Study in Northwest Iran

ObjectivesThe incidence of cardiovascular disease (CVD) mortality is increasing in developing countries. This study aimed to decompose the socioeconomic inequality of CVD in Iran.MethodsThis cross-sectional population-based study was conducted on 20 519 adults who enrolled in the Ardabil Non-Communicable Disease cohort study. Principal component analysis and multivariable logistic regression were used, respectively, to estimate socioeconomic status and to describe the relationships between CVD prevalence and the explanatory variables. The relative concentration index, concentration curve, and Blinder-Oaxaca decomposition model were used to measure and decompose the socioeconomic inequality.ResultsThe overall age-adjusted prevalence of CVD was 8.4% in northwest Iran. Multivariable logistic regression showed that older adults, overweight or obese adults, and people with hypertension and diabetes were more likely to have CVD. Moreover, people with low economic status were 38% more likely to have CVD than people with high economic status. The prevalence of CVD was mainly concentrated among the poor (concentration index, −0.077: 95% confidence interval, −0.103 to −0.060), and 78.66% of the gap between the poorest and richest groups was attributed to differences in the distribution of the explanatory variables included in the model.ConclusionsThe most important factors affecting inequality in CVD were old age, chronic illness (hypertension and diabetes), marital status, and socioeconomic status. This study documented stark inequality in the prevalence of CVD, wherein the poor were more affected than the rich. Therefore, it is necessary to implement policies to monitor, screen, and control CVD in poor people living in northwest Iran.     

Disease prevalence based on older people's self-reports increased,but patient–general practitioner agreement remained stable, 1992–2009

ObjectivesPrevious studies revealed increases in the prevalence of chronic diseases in older people in most countries. This study investigated if a changed inclination to report diseases underlies these increases, by comparing the agreement between self-reports and general practitioner (GP) records of chronic diseases between 1992–1993 and 2008–2009.Study Design and SettingsCross-sectional analyses were performed on data from two waves of the Longitudinal Aging Study Amsterdam. Data from older adults aged 60–85 years came from 1992–1993 (N = 1,896) and from the same age group in 2008–2009 (N = 1,086). We compared respondent (R) and GP records of lung disease, cardiac disease, peripheral arterial disease, stroke, diabetes, arthritis, and cancer. Multilevel regression models were applied to examine (change in) predictors of over-reporting (R+, GP−) and under-reporting (R−, GP+).ResultsOver-reporting of chronic diseases became significantly more common over time, whereas under-reporting became less common. Agreement and change in agreement differed across the specific diseases. Under-reporting was associated with male gender; over-reporting with female gender, worse self-rated health, and worse physical functioning. Older adults were less accurate in their self-reports than younger adults.ConclusionTrends in self-reported chronic diseases may be influenced by changes in reporting behavior, and future studies should take this possibility into account.     

The Prevalence of Social Frailty Among Older Adults: A Systematic Review and Meta-Analysis

ObjectiveTo report the overall prevalence of social frailty among older people and provide information for policymakers and authorities to use in developing policies and social care.DesignA systematic review and meta-analysis.Setting and participantsWe searched 4 databases (PubMed, Embase, Web of Science, and Google Scholar) to find articles from inception to July 30, 2022. We included cross-sectional and cohort studies that provided the prevalence of social frailty among adults aged 60 years or older, in any setting.MethodsThree researchers independently reviewed the literature and retrieved the data. A risk of bias tool was used to assess each study’s quality. A random-effect meta-analysis was performed to pool the data, followed by subgroup analysis, sensitivity analysis, and meta-regression.ResultsFrom 761 records, we extracted 43 studies with 83,907 participants for meta-analysis. The pooled prevalence of social frailty in hospital settings was 47.3% (95% CI: 32.2%–62.4%); among studies in community settings, the pooled prevalence was 18.8% (95% CI: 14.9%–22.7%; P < .001). The prevalence of social frailty was higher when assessed using the Tilburg Frailty Indicator (32.3%; 95% CI: 23.1%–41.5%) than the Makizako Social Frailty Index (27.7%; 95% CI: 21.6%–33.8%) or Social Frailty Screening Index (13.4%; 95% CI: 8.4%–18.4%). Based on limited community studies in individual countries using various instruments, social frailty was lowest in China (4.9%; 95% CI: 4.2%–5.7%), followed by Spain (11.6%; 95% CI: 9.9%–13.3%), Japan (16.2%; 95% CI: 12.2%–20.3%), Korea (26.6%; 95% CI: 7.1%–46.1%), European urban centers (29.2%; 95% CI: 27.9%–30.5%), and the Netherlands (27.2%; 95% CI: 16.9%–37.5%). No other subgroup analyses showed any statistically significant prevalence difference between groups.Conclusion and ImplicationsThe prevalence of social frailty among older adults is high. Settings, country, and method for assessing social frailty affected the prevalence. More valid comparisons will await consensus on measurement tools and more research on geographically representative populations. Nevertheless, these results suggest that public health professionals and policymakers should seriously consider social frailty in research and program planning involving older adults.     

Relationship Between Food Insecurity and Functional Limitations in Older Adults from 2005–2014 NHANES

Abstract

Background: Food insecurity refers to the physical, social, and economic inability to access and secure sufficient, safe and nutritious food. Food insecurity has been found to be associated with poor health status, obesity, and chronic disease. To date, a relationship between food insecurity and functional limitations has not been described in of older adults.

Methods: We examined 9309 adults ≥60 years old from the 2005–2014 National Health and Nutrition Examination Surveys (NHANES). Food security was categorized as full, marginal, low, and very low. Functional limitations were assessed as having difficulty in physical, basic or instrumental activities of daily living.

Results: Of adults ≥60 years old (mean age: 70.5?±?0.08, 51% female), the prevalence of full, marginal, low, or very low food insecurity was 7572 (81%), 717 (7%), 667 (8%), and 353 (4%), respectively. The prevalence of any functional limitations was 5895 (66.3%). The adjusted odds (OR [95%CI]) of having any functional limitation in marginal, low, and very low food security levels compared to full food security are: 1.08 [1.02–1.13], 1.16 [1.10–1.22], 1.14 [1.07–1.21], respectively. The association between levels of food insecurity and functional limitation is modified by race/ethnicity.

Conclusions: Functional limitation is significantly associated with increasing food insecurity in older adults.     

Health Care Utilization and Unmet Needs in Chinese Older Adults With Multimorbidity and Functional Impairment

ObjectivesChina has the world's largest aging population, of which 46% have multimorbidity and 38% have functional impairment. Older adults with multimorbidity often suffer functional impairment as well; however, it is not clear how current health care services have been used in this population. This study aimed to compare health care utilization among Chinese older adults at different levels of chronic disease and functional impairment.DesignA cross-sectional design. Multivariate 2-part models were used to examine the probability and frequency of health care utilization.Setting and ParticipantsData were from 5166 adults aged 65 or older from the 2015 wave of the China Health and Retirement Longitudinal Study. The sample included 22% without any chronic condition, 27% with 1 chronic condition, 44% with multimorbidity, and 7% with multimorbidity and functional impairment.MeasuresHealth care utilization included outpatient visits, inpatient visits, and unmet hospitalization needs.ResultsAs the number of chronic conditions and functional impairments increased, older adults tend to access health care more. Older adults with both multimorbidity and functional impairment tend to use health care services most, but still reported the highest level of unmet hospitalization needs among all groups.Conclusions and ImplicationsChinese older adults with multimorbidity and functional impairment may have experienced multiple barriers in accessing health care. Social programs should be created to make health care more accessible among older adults. The health care delivery system could be oriented to home-based medical care, which have been found effective in delivering high-quality care and reducing health care costs.     

2013年中国成年人吸烟状况与多种慢性病的关联研究

目的 研究我国成年人吸烟现状及不同吸烟人群与多种慢性病的关联。方法 基于2013年全国慢性病及其危险因素监测,覆盖31个省份的298个监测县（区）,按多阶段分层整群抽样方法抽取全国≥ 18岁居民176 534人。利用询问调查收集对象前12个月的吸烟行为（吸烟状态、现在吸烟者日均吸烟量、现在每日吸烟者吸烟年限等）、慢性病（高血压、糖尿病、高TC血症和高TG血症）相关信息,测量血压,检测血糖和血脂。采用基于复杂抽样设计的权重对指标进行分析。结果 共收集有效样本175 386人。其中男性占42.7%,女性占57.3%。成年人男性吸烟者高血压、高TC血症和高TG血症患病率分别为30.4%、7.2%和18.0%,高于非吸烟者;女性吸烟者高血压、糖尿病、高TC血症和高TG血症患病率分别为35.6%、14.0%、10.3%和15.9%,均高于非吸烟者,差异均有统计学意义（均P<0.05）。多因素分析结果显示,我国成年人男性吸烟者比非吸烟者高血压患病风险有所降低,患高TG血症风险比非吸烟者高19%（OR=1.19,95% CI：1.10~1.30）。其中,现在日均吸烟≥ 20支男性高TG血症患病风险比非吸烟者高41%（OR=1.41,95% CI：1.28~1.55）。我国成年人女性吸烟者比非吸烟者高TG血症患病风险高40%（OR=1.40,95% CI：1.15~1.70）;每日吸烟年限≥ 20年者高TG血症比<20年者高60%（OR=1.60,95% CI：1.31~1.95）。结论 吸烟者比非吸烟者总体慢性病患病率高,且吸烟年限长或现在每日吸烟量大的人群患病风险大幅增加。     

Socioeconomic and Ethnic Inequalities in the Progress of Multimorbidity and the Role of Health Behaviors

ObjectivesTo assess socioeconomic and ethnic inequalities in the progress of multimorbidity and whether behavioral factors explain these inequalities among older Americans.DesignHealth and Retirement Study, a longitudinal survey of older American adults.Setting and ParticipantsData pooled from 2006 to 2018 (waves 8–14), which include 38,061 participants.MethodsWe used 7 waves of the survey from 2006 to 2018. Socioeconomic factors were indicated by education, total wealth, poverty-income ratio (income), and race/ethnicity. Multimorbidity was indicated by self-reported diagnoses of 5 chronic conditions: diabetes, heart conditions, lung diseases, cancer, and stroke. Behavioral factors were smoking, excessive alcohol consumption, physical activity, and body mass index (BMI). Multilevel mixed effects generalized linear models were constructed to assess socioeconomic and ethnic inequalities in the progress of multimorbidity and the role of behavior. All variables included in the analysis were time-varying except gender, race/ethnicity, and education.ResultsAfrican American individuals had higher rates of multimorbidity than White individuals; however, after adjusting for income and education, the association was reversed. There were clear income, wealth, and education gradients in the progress of multimorbidity. After adjusting for behavioral factors, the relationships were attenuated. The rate ratio (RR) of multimorbidity attenuated by 9% among participants with the lowest level of education after accounting for behavior (RR 1.21; 95% CI 1.18–1.23 and 1.11; 95% CI 1.17–1.14) in the models unadjusted and adjusted for behaviors, respectively. Similarly, RR for multimorbidity among those in the lowest wealth quartile attenuated from 1.47 (95% CI 1.44–1.51) and 1.31 (95% CI 1.26–1.36) after accounting for behaviors.Conclusion and implicationsEthnic inequalities in the progress of multimorbidity were explained by wealth, income, and education. Behavioral factors partially attenuated socioeconomic inequalities in multimorbidity. The findings are useful in identifying the behaviors that should be included in health promotion programs aiming at tackling inequalities in multimorbidity.     

中国10个地区成年人共病流行特征分析

目的 描述中国成年人的共病流行情况及其长期变化,以及常见的共病模式。方法 本研究纳入参与中国慢性病前瞻性研究第二次重复调查的25 033人,利用研究对象参加2004-2008年基线调查和2013-2014年第二次重复调查时采集的信息进行分析。根据自报疾病史、现场体格检查及血液样本检测等信息定义了13种慢性病或健康问题,将共病定义为同时患有≥2种慢性病或健康问题。采用系统聚类分析法描述共病模式。结果 研究对象在基线调查时的年龄为（51.5±10.1）岁,第二次重复调查时为（59.5±10.2）岁。2次调查平均间隔时间（8.0±0.8）年,共病率由33.5%上升至58.1%,人均患病数由1.15个增加至1.82个,平均每5年增长0.42个患病数。年长者、城市人群、文化程度低者的共病率较高,且患病数量随年龄的增速更快。吸烟及过量饮酒者的患病数量随年龄增速也更快。该人群中最常见的共病组合为：超重肥胖、高血压、糖尿病、中风和冠心病。结论 我国成年人群共病率较高,且随年龄增长而增加。共病情况在不同地区、文化程度水平和不同生活方式人群中存在差异。     

Geriatric Syndromes and Incident Chronic Health Conditions Among 9094 Older Community-Dwellers: Findings from the Lifelines Cohort Study

ObjectivesTo determine the association between geriatric syndromes and any specific incident chronic health conditions among older community-dwellers.DesignPopulation-based cohort study over a median follow-up period of 43 months.Setting and ParticipantsParticipants from the Lifelines Cohort Study aged 60 years and older without presence of the studied chronic health conditions at baseline (n = 9094).MethodsBaseline assessment took place between November 2006 and December 2013 and included information on socioeconomic (age, sex, level of education and income), social contact, and health-related factors [eg, self-rated health, body mass index, chronic health conditions, and health behavior (alcohol consumption and smoking)]. Participants also reported the presence of geriatric syndromes (ie, included falls, incontinence, vision impairment, hearing impairment, depressive symptoms, and frailty at baseline). Three follow-up questionnaires were used to examine the incidence of any and specific chronic health conditions (ie, pulmonary and cardiovascular diseases, diabetes, cancer, and neurological diseases). Cox regression was used to analyze the longitudinal associations between geriatric syndromes and incident chronic health conditions.ResultsOlder community-dwelling individuals with at least one geriatric syndrome (44.7%, n = 4038) had an increased risk of developing any new chronic health condition [hazard ratio (HR) 1.35; 95% confidence interval (CI) 1.21–1.51]. The association was attenuated but remained significant after adjustment for socioeconomic factors, social contact, health status, and health behavior (HR 1.27; 95% CI 1.12–1.43). Analyses for specific chronic health conditions showed that compared with older community-dwellers without geriatric syndromes, those with geriatric syndromes had an increased risk to develop a cardiovascular health condition (HR 1.42; 95% CI 1.13–1.79) or diabetes (HR 1.53; 95% CI 1.11–2.11). They had no increased risk to develop pulmonary conditions, cancer, or neurological conditions.Conclusion and ImplicationsThe presence of geriatric syndromes is associated with incident chronic health conditions, specifically cardiovascular conditions and diabetes. Increased awareness is needed among older people with geriatric syndromes and their physicians. Comprehensive assessments of geriatric syndromes may help to prevent or at least delay the development of chronic health conditions.     

Influenza vaccination rate and its association with chronic diseases in China: Results of a national cross-sectional study

IntroductionInfluenza vaccination is the most effective way to prevent influenza. Few studies on its rate were reported throughout China and for populations with chronic diseases. An estimation of the rates in China was accomplished.MethodsAll data were from a national cross-sectional survey of a sample representing the population aged 40 years or older in mainland China in 2014–15. A total of 74,484 individuals with complete self-reported influenza vaccination status were analyzed in 2018–19.ResultsThe overall influenza vaccination rate was 2.4% (95% CI 1.4–3.3) with 1.7% (95% CI 1.2–2.2) for the age group 40–59 years and 3.8% (95% CI 1.6–5.9) for the group ≥60 years. The rate was 4.0% (95% CI 2.0–5.9) among people with a chronic disease. People with asthma and people with emphysema had the highest rates (7.1%, 95% CI 3.2–11.0 and 6.6%, 95% CI 3.6–9.7) while people with chronic obstructive pulmonary disease (COPD) and people with chronic bronchitis had the lower rates (3.6%, 95% CI 2.0–5.2 and 4.8%, 95% CI 2.6–7.0). The rate was the highest among former smokers (3.3%, 95% CI 2.3–4.4) compared to current smokers (1.8%, 95% CI 0.9–2.7) and never smokers (2.5%, 95% CI 1.4–3.6). People living with finance-reimbursed vaccination policy, a positive factor for vaccination, had a higher vaccination rate (11.5%, 95% CI 10.8–12.2) (p < 0.05). People with older age, higher education level, occupation of professionals or technical personnel, living in rural areas or Northern China, former/never smoking were more likely to be vaccinated (p < 0.05).ConclusionsThe influenza vaccination rate is low among adults aged ≥40 years, those ≥60 years and those with chronic diseases in China. Reimbursement policy targeting the elderly should be implemented widely and strategies towards patients with chronic diseases need urgent attention to increase the influenza vaccination coverage.     

Transitions in Frailty States Among Community-Living Older Adults and Their Associated Factors

BackgroundFrailty renders older individuals more prone to adverse health outcomes. Little has been reported about the transitions between the different frailty states. We attempted to examine the rate of these transitions and their associated factors.MethodsWe recruited 3018 Chinese community-living adults 65 years or older. Frailty status was classified according to the Fried criteria in 2 visits 2 years apart. Demographic data, medical conditions, hospitalizations, and cognition were recorded. Rates of transitions and associated factors were studied.ResultsAt baseline, 850 (48.7%) men and 884 (52.6%) women were prefrail. Among these, 23.4% men and 26.6% women improved after 2 years; 11.1% of men and 6.6% of women worsened. More men than women (P < .001) deteriorated into frailty. Hospitalizations, older age, previous stroke, lower cognition, and osteoarthritis were risk factors for decline among prefrail participants. Having diabetes was associated with 50% lower chance of improvement in women. Among the robust, older age and previous cancer, hospitalizations, chronic lung diseases, and stroke were risk factors for worsening. Higher socioeconomic status was protective. Previous stroke reduced the chance of improvement by 78% in frail men. Only younger age was associated with improvement in frail women.ConclusionWomen were less likely to decline in frailty status than men. Hospitalizations, older age, previous stroke, lower cognitive function, diabetes, and osteoarthritis were associated with worsening or less improvement. Older age, previous cancer, hospitalizations, lung diseases, and stroke were risk factors for worsening in the robust and higher socioeconomic status was protective.     

Subject Index to Volume 11

A survey of Negro residents of Charleston County, SC, in 1960 to 1964 revealed a high prevalence of the sickle cell trait at 14.6%. The prevalence did not differ between the sexes, nor did it vary significantly with age groups, (ages 35 to 74). Thus, there is no suggestion based on these cross-sectional data of selective mortality in adults associated with possession of the sickle cell trait.

The prevalence of the sickle cell trait was significantly higher in the occupational groups of lowest socioeconomic status. Among individuals of low socioeconomic status, the prevalence was higher in residents of rural areas of Charleston County. Probable explanations for these findings include selective malarial mortality in childhood, cultural, and physical isolation, assortative mating, and endogamy.