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• Five multimorbidity clusters were identified among middle-aged and older adults in China: minimal disease, arthritis, cardiovascular disease, lung/asthma, and multisystem morbidity. • The multisystem morbidity group had the highest use in outpatient, inpatient and self-treament healthcare, and the highest cost in self-treatment. • The five groups did not show significant differences in outpatient costs. While the lung/asthma and arthritis groups reported lower inpatient costs than other groups. This study investigated multimorbidity patterns among middle-aged and older Chinese people and whether healthcare costs varied among different multimorbidity patterns. Data were from the 2011–2018 waves of the China Health and Retirement Longitudinal Study (CHARLS). We included 20,855 unique observations with information coming from their last wave of interviews and aged at least 45 years or older. Latent class analysis (LCA) was performed to classify individuals with common multimorbidity clusters based on 14 self-reported chronic diseases. Healthcare costs were from participants' self-reports and categorized into outpatient, inpatient, and self-treatment. Two-part regression was performed to analyze the association of multimorbidity patterns with healthcare costs. Five multimorbidity clusters were identified: minimal disease, arthritis, cardiovascular disease (CVD), lung/asthma, and multisystem morbidity. The multisystem morbidity group had the highest use in all three types of healthcare and the highest self-treatment cost. Compared with the minimal disease group, the other four groups did not show significant differences in outpatient costs. Relative to the minimal disease group, the lung/asthma group reported lower inpatient costs. Healthcare use and costs varied across multimorbidity patterns among middle-aged and older Chinese people. Implementing an integrated care plan for multimorbidity is suggested to improve the cost-effectiveness of healthcare provision and reduce the financial burden of the healthcare system. Reimbursement policy design should also take multimorbidity patterns into account. [ABSTRACT FROM AUTHOR]

Exposure to long-term ambient air pollution is believed to have adverse effects on human health. However, the mechanisms underlying these impacts are poorly understood. DNA methylation, a crucial epigenetic modification, is susceptible to environmental factors and likely involved in these processes. We conducted a whole-genome bisulfite sequencing study on 120 participants from a highly polluted region (HPR) and a less polluted region (LPR) in China, where the HPR had much higher concentrations of five air pollutants (PM 2.5 , PM 10 , SO 2 , NO 2 , and CO) (fold difference 1.6 to 6.6 times; P value 1.80E-07 to 3.19E-23). Genome-wide methylation analysis revealed 371 DMRs in subjects from the two areas and these DMRs were located primarily in gene regulatory elements such as promoters and enhancers. Gene enrichment analysis showed that DMR-related genes were significantly enriched in diseases related to pulmonary disorders and cancers and in biological processes related to mitochondrial assembly and cytokine production. Further, HPR participants showed a higher mtDNA copy number. Of those identified DMRs, 15 were significantly correlated with mtDNA copy number. Finally, cytokine assay indicated that an increased plasma interleukin-5 level was associated with greater air pollution. Taken together, our findings suggest that exposure to long-term ambient air pollution can lead to alterations in DNA methylation whose functions relate to mitochondria and immune responses. Image 1 • We used whole-genome bisulfite sequencing to study the influence of air pollution on DNA methylation in blood leukocyte. • DNA methylation levels were compared between residents from two areas with distinct air quality in China. • Differentially methylated regions were enriched in gene regulatory elements. • Genes involved in mitochondrial function and immune response are preferentially impacted by air pollution. Summary: By comparing DNA methylation of subjects from two areas with distinct air quality in China, we identified differential methylation regions whose functions are mostly related to mitochondria and immune responses. [ABSTRACT FROM AUTHOR]

• LB children were more vulnerable to psychological problems and more attention should be paid to how psychological trait resilience interplays with protective support for LB children and affects their psychological status. • LB children with higher level of trait resilience would perceive themselves as more confident and valuable, therefore, their self-esteem would be higher. • LB children with higher level of protective support would feel warmth and goodwill from the surroundings, and pay more attention to positive aspects of life and had lower depression. The left-behind children phenomenon appeared in the process of development of industrialization and urbanization in China has become a social problem that needs close attention. Meanwhile, the importance of resilience on the psychological health of left-behind children has been highlighted in academic field. This study examined the mediating effect of psychological trait resilience on the relationship between protective factors from social network and self-esteem/depression of the left-behind children in China. A total of 345 left-behind children at middle schools completed the questionnaire of Healthy Kids Resilience Assessment (HKRA), Self-Esteem Scale (SES) and Children's Depression Inventory (CDI). Path analysis showed that psychological trait resilience played a fully mediating role on the relationship between protective factors and self-esteem, as well on the association between the relationship between protective factors and depression. Building protective social network may be helpful to improve trait resilience of left-behind children, which further increase self-esteem and mitigate depression of them. The implications of these findings on social work practice were discussed. [ABSTRACT FROM AUTHOR]