Biomedical and Environmental Sciences

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Report on Cardiovascular Health and Diseases in China 2023: An Updated Summary (30 day view times: 74)

National Center for Cardiovascular Diseases The Writing Committee of the Report on Cardiovascular Health and Diseases in China

2024, 37(9): 949-992. doi: 10.3967/bes2024.162

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Since 1990, China has made considerable progress in resolving the problem of “treatment difficulty” of cardiovascular diseases (CVD). The prevalent unhealthy lifestyle among Chinese residents has exposed a massive proportion of the population to CVD risk factors, and this situation is further worsened due to the accelerated aging population in China. CVD remains one of the greatest threats to the health of Chinese residents. In terms of the proportions of disease mortality among urban and rural residents in China, CVD has persistently ranked first. In 2021, CVD accounted for 48.98% and 47.35% of deaths in rural and urban areas, respectively. Two out of every five deaths can be attributed to CVD. To implement a national policy “focusing on the primary health institute and emphasizing prevention” and truly achieve a shift of CVD prevention and treatment from hospitals to communities, the National Center for Cardiovascular Diseases has organized experts from relevant fields across China to compile the “Report on Cardiovascular Health and Diseases in China” annually since 2005. The 2024 report is established based on representative, published, and high-quality big-data research results from cross-sectional and cohort population epidemiological surveys, randomized controlled clinical trials, large sample registry studies, and typical community prevention and treatment cases, along with data from some projects undertaken by the National Center for Cardiovascular Diseases. These firsthand data not only enrich the content of the current report but also provide a more timely and comprehensive reflection of the status of CVD prevention and treatment in China.

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Overweight Modified the Associations between Long-Term Exposure to Ambient Fine Particulate Matter and Its Constituent and the Risk of Type 2 Diabetes in Rural China (30 day view times: 27)

Donghui Yang, Yun Chen, Xia Meng, Xiaolian Dong, Haidong Kan, Chaowei Fu

2025, 38(11): 1359-1368. doi: 10.3967/bes2025.136

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Objective To investigate the association between long-term exposure to ambient fine particulate matter (PM_2.5) and its constituents and the risk of incident type 2 diabetes mellitus (T2DM), and to examine the modification roles of overweight status. Methods This prospective study included 27,507 adults living in rural China. The annual mean residential exposure to PM_2.5 and its constituents was estimated using a satellite-based statistical model. Cox models were used to estimate the risk of T2DM associated with PM_2.5 and its constituents. Stratified analysis quantified the role of overweight status in the association between PM_2.5 constituents and T2DM. Results Over a median follow-up of 9.4 years, 3,001 new T2DM cases were identified. The hazard ratio (HR) for a 10 μg/m³ increase in ambient PM_2.5 was 1.30 (95% confidence interval [CI]: 1.17, 1.45). Among the constituents, the strongest association was observed with black carbon. Being overweight significantly modified the association between certain constituents and the risk of T2DM. Participants who were overweight and exposed to the highest quartile of PM_2.5 constituents had the highest risk of T2DM (HR: 2.46, 95% CI: 2.04, 2.97). Conclusions Our findings indicate that PM_2.5 was associated with an increased risk of T2DM, with black carbon potentially being the primary contributor. Being overweight appeared to enhance the association between PM_2.5 and T2DM. This suggests that controlling both PM_2.5 exposure and overweight status may reduce the burden of T2DM.

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Interpretation of Annual Report on Cardiovascular Health and Diseases in China 2024 (30 day view times: 21)

Mingbo Liu, Xinye He, Xiaohong Yang, Zengwu Wang

2025, 38(8): 893-917. doi: 10.3967/bes2025.099

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Cardiovascular diseases (CVD) and their risk factors are exerting an increasingly significant impact on public health, and the incidence rate of CVD continues to rise. This article provides an interpretation of essentials from the newly published Annual Report on Cardiovascular Health and Diseases in China (2024), aiming to offer scientific evidence for CVD prevention, treatment, and the formulation of relevant policies.

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Bottlenecks and Innovative Breakthroughs in the Construction of China’s Environmental Health Risk Assessment Technological System (30 day view times: 19)

Xiaoyan Yang, Xu Han, Jiaxin Lyu, Qin Wang, Dongqun Xu

2025, 38(11): 1329-1350. doi: 10.3967/bes2025.135

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Progress on Wastewater-based Epidemiology in China: Implementation Challenges and Opportunities in Public Health (30 day view times: 18)

Qiuda Zheng, Xialu Lin, Yingsheng He, Zhe Wang, Peng Du, Xiqing Li, Yuan Ren, Degao Wang, Luhong Wen, Zeyang Zhao, Jianfa Gao, Phong K. Thai

2025, 38(11): 1354-1358. doi: 10.3967/bes2025.133

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Wastewater-based epidemiology has emerged as a transformative surveillance tool for estimating substance consumption and monitoring disease prevalence, particularly during the COVID-19 pandemic. It enables the population-level monitoring of illicit drug use, pathogen prevalence, and environmental pollutant exposure. In this perspective, we summarize the key challenges specific to the Chinese context: (1) Sampling inconsistencies, necessitating standardized 24-hour composite protocols with high-frequency autosamplers (≤ 15 min/event) to improve the representativeness of samples; (2) Biomarker validation, requiring rigorous assessment of excretion profiles and in-sewer stability; (3) Analytical method disparities, demanding inter-laboratory proficiency testing and the development of automated pretreatment instruments; (4) Catchment population dynamics, reducing estimation uncertainties through mobile phone data, flow-based models, or hydrochemical parameters; and (5) Ethical and data management concerns, including privacy risks for small communities, mitigated through data de-identification and tiered reporting platforms. To address these challenges, we propose an integrated framework that features adaptive sampling networks, multi-scale wastewater sample banks, biomarker databases with multidimensional metadata, and intelligent data dashboards. In summary, wastewater-based epidemiology offers unparalleled scalability for equitable health surveillance and can improve the health of the entire population by providing timely and objective information to guide the development of targeted policies.

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Associations of Exposure to Typical Environmental Organic Pollutants with Cardiopulmonary Health and the Mediating Role of Oxidative Stress: A Randomized Crossover Study (30 day view times: 17)

Ning Gao, Bin Wang, Ran Zhao, Han Zhang, Xiaoqian Jia, Tianxiang Wu, Mengyuan Ren, Lu Zhao, Jiazhang Shi, Jing Huang, Shaowei Wu, Guofeng Shen, Bo Pan, Mingliang Fang

2025, 38(11): 1388-1403. doi: 10.3967/bes2025.087

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Objective The study aim was to investigate the effects of exposure to multiple environmental organic pollutants on cardiopulmonary health with a focus on the potential mediating role of oxidative stress. Methods A repeated-measures randomized crossover study involving healthy college students in Beijing was conducted. Biological samples, including morning urine and venous blood, were collected to measure concentrations of 29 typical organic pollutants, including hydroxy polycyclic aromatic hydrocarbons (OH-PAHs), bisphenol A and its substitutes, phthalates and their metabolites, parabens, and five biomarkers of oxidative stress. Health assessments included blood pressure measurements and lung function indicators. Results Urinary concentrations of 2-hydroxyphenanthrene (2-OH-PHE) (β = 4.35% [95% confidence interval (CI): 0.85%, 7.97%]), 3-hydroxyphenanthrene (β = 3.44% [95% CI: 0.19%, 6.79%]), and 4-hydroxyphenanthrene (4-OH-PHE) (β = 5.78% [95% CI: 1.27%, 10.5%]) were significantly and positively associated with systolic blood pressure. Exposures to 1-hydroxypyrene (1-OH-PYR) (β = 3.05% [95% CI: −4.66%, −1.41%]), 2-OH-PHE (β = 2.68% [95% CI: −4%, −1.34%]), and 4-OH-PHE (β = 3% [95% CI: −4.68%, −1.29%]) were negatively associated with the ratio of forced expiratory volume in the first second to forced vital capacity. These findings highlight the adverse effects of exposure to multiple pollutants on cardiopulmonary health. Biomarkers of oxidative stress, including 8-hydroxy-2'-deoxyguanosine and extracellular superoxide dismutase, mediated the effects of multiple OH-PAHs on blood pressure and lung function. Conclusion Exposure to multiple organic pollutants can adversely affect cardiopulmonary health. Oxidative stress is a key mediator of the effects of OH-PAHs on blood pressure and lung function.

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Generalized Functional Linear Models: Efficient Modeling for High-dimensional Correlated Mixture Exposures (30 day view times: 17)

Bingsong Zhang, Haibin Yu, Xin Peng, Haiyi Yan, Siran Li, Shutong Luo, Renhuizi Wei, Zhujiang Zhou, Yalin Kuang, Yihuan Zheng, Chulan Ou, Linhua Liu, Yuehua Hu, Jindong Ni

2025, 38(8): 961-976. doi: 10.3967/bes2025.024

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Objective Humans are exposed to complex mixtures of environmental chemicals and other factors that can affect their health. Analysis of these mixture exposures presents several key challenges for environmental epidemiology and risk assessment, including high dimensionality, correlated exposure, and subtle individual effects. Methods We proposed a novel statistical approach, the generalized functional linear model (GFLM), to analyze the health effects of exposure mixtures. GFLM treats the effect of mixture exposures as a smooth function by reordering exposures based on specific mechanisms and capturing internal correlations to provide a meaningful estimation and interpretation. The robustness and efficiency was evaluated under various scenarios through extensive simulation studies. Results We applied the GFLM to two datasets from the National Health and Nutrition Examination Survey (NHANES). In the first application, we examined the effects of 37 nutrients on BMI (2011–2016 cycles). The GFLM identified a significant mixture effect, with fiber and fat emerging as the nutrients with the greatest negative and positive effects on BMI, respectively. For the second application, we investigated the association between four pre- and perfluoroalkyl substances (PFAS) and gout risk (2007–2018 cycles). Unlike traditional methods, the GFLM indicated no significant association, demonstrating its robustness to multicollinearity. Conclusion GFLM framework is a powerful tool for mixture exposure analysis, offering improved handling of correlated exposures and interpretable results. It demonstrates robust performance across various scenarios and real-world applications, advancing our understanding of complex environmental exposures and their health impacts on environmental epidemiology and toxicology.

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2025-11 Cover (30 day view times: 16)

2025, 38(11).

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Sandstorm-driven Particulate Matter Exposure and Elevated COPD Hospitalization Risk in Arid Regions of China: A Spatiotemporal Epidemiological Analysis (30 day view times: 16)

Hao Zhao, Ce Liu, Erkai Zhou, Baofeng Zhou, Sheng Li, Li He, Zhaoru Yang, Jiabei Jian, Huan Chen, Huanhuan Wei, Rongrong Cao, Bin Luo

2025, 38(11): 1404-1416. doi: 10.3967/bes2025.134

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Objective Chronic obstructive pulmonary disease (COPD) is a major health concern in northwest China; however, the impact of particulate matter (PM) exposure during sand-dust storms (SDS) remains poorly understood. Therefore, this study aimed to investigate the association between PM exposure on SDS days and COPD hospitalization risk in arid regions. Methods Data on daily COPD hospitalizations were collected from 323 hospitals from 2018 to 2022, along with the corresponding air pollutant and meteorological data for each city in Gansu Province. Employing a space-time-stratified case-crossover design and conditional Poisson regression, we analyzed 265,379 COPD hospitalizations. Results PM exposure during SDS days significantly increased COPD hospitalization risk [relative risk (RR) for PM_2.5, lag 3:1.028, 95% confidence interval (CI): 1.021–1.034], particularly among men and the elderly, and during the cold season. The burden of PM exposure on COPD hospitalization was substantially high in Northwest China, especially in the arid and semi-arid regions. Conclusion Our findings revealed a positive correlation between PM exposure during SDS episodes and elevated hospitalization rates for COPD in arid and semi-arid zones in China. This highlights the urgency of developing region-specific public health strategies to address adverse respiratory outcomes associated with SDS-related air quality deterioration.

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Air Pollution and Cardiac Biomarkers in Heart Failure: A Scoping Review (30 day view times: 15)

Gang Li, Yanhui Jia, Yunshang Cui, Shaowei Wu, Tongyu Ma, Yunxing Jiang, Hongbing Xu, Yuhui Zhang, Mary A Fox

2025, 38(11): 1430-1443. doi: 10.3967/bes2025.120

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Ambient air pollution is increasingly being recognized as a risk factor for heart failure; however, its effects on cardiac biomarkers remain unclear. This scoping review assessed the existing evidence on the association between air pollution and cardiac biomarkers in heart failure, described the key concepts, synthesized data, and identified research gaps. Following the PRISMA-ScR guidelines, PubMed, Embase, Web of Science, and CNKI databases were searched for studies on air pollution, heart failure, and biomarkers. A total of 765 records were screened, and 81 full texts were assessed for eligibility, resulting in 15 studies. The results showed that the exposure to particulate matter was associated with elevated N-terminal pro-B-type natriuretic peptide and troponin levels. Several studies have linked particulate matter exposure to a higher cardiovascular risk and heart failure biomarkers. Inflammatory and oxidative stress markers were consistently elevated across studies, supporting the biological relevance of these associations. However, few studies have focused specifically on populations with heart failure or clinically relevant biomarkers, and the evidence for gaseous pollutants remains inconclusive. These findings highlight the need to integrate environmental risk assessment into heart failure care and inform policy efforts to reduce the pollution-related cardiovascular burden. Further research should address these gaps through improved exposure assessments and the integration of mechanistic evidence.

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Risk of Hospitalization for Genitourinary System Diseases Following Exposure to Cold Spells (30 day view times: 15)

Qinghua Sun, Chen Chen, Jie Ban, Hanshuo Zhang, Jingyi Sun, Hang Du, Tiantian Li

2025, 38(11): 1369-1377. doi: 10.3967/bes2025.127

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Objective To assess relationships between cold spells and genitourinary hospitalization risk. Methods Hospitalization records for genitourinary system diseases (GUDs) from 16 districts in Beijing (2013–2018) were analyzed. Cold spells were defined based on varying intensity thresholds. A two-stage analytical method was employed: first, generalized linear models assessed district-specific associations between cold spells and hospitalizations; second, random-effects meta-analysis aggregated the district-level results. Subgroup analyses were performed by admission type (emergency vs. outpatient), age, and sex. Results A total of 271,579 GUD-related hospitalizations were recorded. Cold spells (p1day2, daily mean temperature below the 1^st percentiles of the daily mean temperature distribution from January 1, 2013, to December 31, 2018, lasting for two or more consecutive days) were linked to a significant rise in hospitalization risks: 1.43 (95% CI: 1.32–1.56) for all GUDs, 1.35 (95% CI: 1.23–1.49) for urinary system diseases, and 1.46 (95% CI: 1.28–1.67) for renal failure, when compared to non-cold spell days. Emergency admissions showed higher risk increases than outpatient admissions. Conclusion Extreme cold spells significantly elevate hospitalization risks for GUDs. This highlights the urgent need for targeted public health interventions to mitigate cold-related health impacts, especially for vulnerable populations.

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Climate-Sensitive Infectious Diseases under Global Climate Change (30 day view times: 14)

Qiao Liu, Min Liu, Jue Liu

2025, 38(9): 1129-1141. doi: 10.3967/bes2025.077

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Climate and weather significantly influence the duration, timing, and intensity of disease outbreaks, reshaping the global landscape of infectious diseases. Rising temperatures and shifts in precipitation patterns driven by climate change can directly impact the survival and reproduction of pathogens and vector organisms. Moreover, climate change is expected to exacerbate extreme weather events, including floods and droughts, which can disrupt infrastructure and increase the risk of water- and foodborne diseases. There are potential shifts in the temporal and spatial patterns of infectious disease transmission owing to climate change. Furthermore, climate change may alter the epidemiology of vaccine-preventable diseases. These climatic variations not only affect the ecological characteristics of pathogens and vectors but also indirectly influence human behaviors and socioeconomic conditions, further amplifying disease transmission risks. Addressing this challenge requires an interdisciplinary collaboration and comprehensive public health strategies. This review aims to synthesize the current evidence on the impact of climate change on climate-sensitive infectious diseases and elucidate the underlying mechanisms and transmission pathways. Additionally, we explored adaptive policy strategies to mitigate the public health burden of infectious diseases in the context of climate change, offering insights for global health governance and disease control efforts.

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Excess Body Weight and Its Influence on Colonoscopy Adherence and Findings: Results from an Opportunistic Colorectal Cancer Screening Program in Chongqing (30 day view times: 14)

Xiaoyue Shi, Jia Du, Xuesi Dong, Zeming Guo, Jiaxin Xie, Zilin Luo, Xiaolu Chen, Chenran Wang, Yadi Zheng, Yan Zhang, Wei Cao, Fei Wang, Ni Li, Mei He

2025, 38(12): 1482-1489. doi: 10.3967/bes2025.153

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Objective To examine the effect of excess body weight on adherence and lesion detection in colorectal cancer (CRC) screening. Methods A cross-sectional analysis was conducted within an opportunistic CRC screening program in Chongqing, which enrolled 43,797 adults aged 35–74 years between 2021 and 2022. A total of 42,279 participants were included in the final analysis, of whom 19,462 (46.0%) had excess body weight (BMI > 24.0 kg/m²). Colonoscopy adherence and detection were compared between normal and excess body weight group, and associated factors were examined. Results Of the 7,002 participants recommended for colonoscopy, 3,808 (54.4%) had excess body weight. Adherence was significantly lower in the excess weight group (6.6%) than in the normal weight group (10.7%, P < 0.001), and this trend was consistent across sex and age groups. The detection rates of advanced neoplasms (3.6% vs. 1.8%) and non-advanced adenomas (10.7% vs. 6.7%) were higher in the excess weight cohort, with a significant difference for any neoplasm (14.2% vs. 8.9%, P < 0.05). Differences in adherence- and detection-related factors were also observed between the groups. Conclusion Excess body weight was associated with lower colonoscopy adherence but higher neoplasm detection. These findings support the integration of weight management with targeted screening promotion to improve CRC prevention in this high-risk population.

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Ionizing Radiation Alters Circadian Gene Per1 Expression Profiles and Intracellular Distribution in HT22 and BV2 Cells (30 day view times: 14)

Zhiang Shao, Yuan Wang, Pei Qu, Zhouhang Zheng, Yixuan Li, Wei Wang, Qingfeng Wu, Dan Xu, Jufang Wang, Nan Ding

2025, 38(11): 1451-1457. doi: 10.3967/bes2025.139

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Decoding the Environmental Etiology of Non-communicable Diseases (30 day view times: 13)

Yuebin Lyu

2025, 38(11): 1327-1328. doi: 10.3967/bes2025.171

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Report on Cardiovascular Health and Diseases in China 2022: an Updated Summary (30 day view times: 13)

The Writing Committee of the Report on Cardiovascular Health and Diseases in China

2023, 36(8): 669-701. doi: 10.3967/bes2023.106

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In the past 30 years, the accessibility and quality index of medical care have made remarkable progress in China, ranking the first among middle-income countries. Many cardiovascular technologies are at or near the world's leading level, and significant progress has been achieved in China solving the problem of “treatment difficulty” of cardiovascular diseases (CVD). However, due to the prevalence of unhealthy lifestyles among Chinese residents, a huge population with CVD risk factors, accelerated population aging, and other reasons, the incidence and mortality rate of CVD are still increasing, and the turning point of the decline in disease burden has not appeared yet in China. In terms of proportions of disease mortality among urban and rural residents, CVD still ranks the first. In 2020, CVD accounted for 48.00% and 45.86% of the causes of death in rural and urban areas, respectively; two out of every five deaths were due to CVD. It is estimated that the number of current CVD patients in China is around 330 million, including 13 million stroke, 11.39 million coronary heart disease, 8.9 million heart failure, 5 million pulmonary heart disease, 4.87 million atrial fibrillation, 2.5 million rheumatic heart disease, 2 million congenital heart disease, 45.3 million peripheral artery disease, and 245 million hypertension cases. China has entered a new stage of transformation from high-speed development to high-quality development, and the prevention and control of CVD in China should also shift from previous emphasis on scale growth to strategies focusing more on strategic and key technological development in order to curb the trend of increasing incidence and mortality rates of CVD.

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Association between Neutrophil-to-lymphocyte Ratio and Renal Function: A Cross-sectional Study with Threshold Effects (30 day view times: 13)

Lin Hu, Mingcong Chen, Qiuwei Tian, Zisai Wang, Mingyi Zhao, Qingnan He

2025, 38(11): 1458-1462. doi: 10.3967/bes2025.140

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Association of Frailty with Mortality and Incident Cardiovascular Disease: The Role of Metabolic Status (30 day view times: 13)

Youjing Wang, Tingting Geng, Ku Xun, Jinchi Xie, Dan Xue, Yuxiang Wang, Gang Liu, An Pan

2025, 38(12): 1490-1501. doi: 10.3967/bes2025.154

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Objective To identify whether metabolic status mediates the associations between frailty and mortality and incident cardiovascular disease (CVD), and to assess of interactive or joint relationships between frailty and metabolic status on these outcomes. Methods In this prospective cohort study of 456,445 UK Biobank participants, frailty was assessed using five phenotype criteria. Metabolic status was scored (0–4) based on central obesity, hypertension, hyperglycemia, and dyslipidemia. Multivariable-adjusted Cox regression models were used to assess the associations between frailty and mortality and incident CVD. Results During a median follow-up of 13.8 years for mortality and 13.6 years for CVD, 30,907 deaths (7,467 CVD-related) and 37,115 incident CVD cases occurred. Frailty was associated with higher risks of all-cause mortality (hazard ratio [HR], 2.41; 95% confidence interval [CI], 2.31–2.51), CVD mortality (HR, 2.64; 95% CI, 2.43–2.87), and incident CVD (HR, 1.83; 95% CI, 1.75–1.91), compared with non-frail individuals. Metabolic status mediated 8.7%, 16.1%, and 16.4% of these associations, respectively. Frailty and metabolic status interacted multiplicatively for all-cause mortality (P-value for interaction < 0.001) and additively for CVD mortality [relative excess risk due to interaction (RERI), 1.78; 95% CI, 0.88–2.68] and incident CVD (RERI, 0.60; 95% CI, 0.33–0.86). Joint exposure to frailty and three to four metabolic disorders conferred 3.34-, 6.32-, and 3.30-fold risks of all-cause mortality, CVD mortality, and incident CVD, respectively, compared with metabolically healthy non-frail individuals. Conclusion This study highlights the need for integrated management strategies targeting both frailty and metabolic conditions to mitigate cardiovascular and mortality risks.

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Short-Term Lag Effects of Climate-Pollution Interactions on Cardiopulmonary Hospitalizations: A Multi-City Predictive Study Using the AE+LSTM Hybrid Model in Japan (30 day view times: 13)

Yijia Chen, Fan Zhao, Qingyang Wu, Yukitaka Ohashi, Tomohiko Ihara

2025, 38(11): 1378-1387. doi: 10.3967/bes2025.137

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Objective To assess the short-term lag effects of climate and air pollution on hospital admissions for cardiovascular and respiratory diseases, and to develop deep learning-based models for daily hospital admission prediction. Methods A multi-city study was conducted in Tokyo’s 23 wards, Osaka City, and Nagoya City. Random forest models were employed to assess the synergistic short-term lag effects (lag0, lag3, and lag7) of climate and air pollutants on hospitalization for five cardiovascular diseases (CVDs) and two respiratory diseases (RDs). Furthermore, we developed hybrid deep learning models that integrated an autoencoder (AE) with a Long Short-Term Memory network (AE+LSTM) to predict daily hospital admissions. Results On the day of exposure (lag0), air pollutants, particularly nitrogen oxides (NOx), exhibited the strongest influence on hospital admissions for CVD and RD, with pronounced effects observed for hypertension (I10–I15), ischemic heart disease (I20), arterial and capillary diseases (I70–I79), and lower respiratory infections (J20–J22 and J40–J47). At longer lags (lag3 and lag7), temperature and precipitation were more influential predictors. The AE+LSTM model outperformed the standard LSTM, improving the prediction accuracy by 32.4% for RD in Osaka and 20.94% for CVD in Nagoya. Conclusion Our findings reveal the dynamic, time-varying health risks associated with environmental exposure and demonstrate the utility of deep learnings in predicting short-term hospital admissions. This framework can inform early warning systems, enhance healthcare resource allocation, and support climate-adaptive public health strategies.

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Beyond the Number: Re-evaluating the History, Limitations, and Future of Body Mass Index (30 day view times: 12)

Jianqiang Lai

2025, 38(12): 1463-1465. doi: 10.3967/bes2025.172

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