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2 "Yan Li"
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Associations of chronic lung disease, insufficient sleep, and pain with incident frailty in Chinese middle-aged and older adults
Wenyan Hu, Lifang Chen, Tingyan Li, Yongping Gu
Epidemiol Health. 2026;48:e2026016.   Published online April 21, 2026
DOI: https://doi.org/10.4178/epih.e2026016
  • 1,346 View
  • 26 Download
AbstractAbstract AbstractSummary PDF
Abstract
OBJECTIVES
Chronic lung disease, insufficient sleep, and chronic pain are prevalent among middle-aged and older adults and may synergistically accelerate frailty. This study was conducted to examine the independent and combined associations of chronic lung disease, insufficient sleep, and pain with frailty risk among middle-aged and older Chinese adults.
METHODS
This study used data from the China Health and Retirement Longitudinal Study. Multivariable logistic regression and mediation analyses were used to examine the associations among chronic lung disease, insufficient sleep, pain, and frailty. Pain was categorized into any bodily pain and chest pain, with the latter analyzed separately due to its potential relationship with chronic lung disease. Subgroup analyses stratified by age and sex were also conducted to assess effect modification.
RESULTS
Chronic lung disease combined with insufficient sleep (odds ratio [OR], 2.71; 95% confidence interval [CI], 1.70 to 4.22), pain (OR, 3.04; 95% CI, 1.86 to 4.86), or chest pain (OR, 2.58; 95% CI, 1.07 to 5.56) was significantly associated with higher odds of frailty. Subgroup analyses showed an interaction among chronic lung disease, chest pain, and age (p for interaction <0.05). Mediation analysis indicated that sleep, pain, and chest pain mediated 10.1%, 26.2%, and 14.0% of the association between chronic lung disease and frailty.
CONCLUSIONS
The combined presence of chronic lung disease with insufficient sleep or pain was associated with an increased risk of incident frailty. Screening and interventions targeting these factors may help mitigate frailty among middle-aged and older adults.
Summary
Key Message
There remains an unmet need for integrated screening and management of insufficient sleep and pain especially chest pain in middle-aged and older adults with chronic lung disease to mitigate frailty risk. This study reveals that the coexistence of chronic lung disease with either short sleep or pain significantly amplifies new-onset frailty risk with systemic pain alone mediating 26.2 percent of the association. These findings underscore the value of multimodal early interventions targeting modifiable comorbidities to prevent or delay frailty in aging populations with respiratory disease.
Associations of racial and ethnic discrimination with adverse changes in exercise and screen time during the COVID-19 pandemic in the United States
Tong Xia, Gilbert C. Gee, Jian Li, Xinyue Liu, Jin Dai, Lu Shi, Donglan Zhang, Zhuo Chen, Xuesong Han, Yan Li, Hongmei Li, Ming Wen, Dejun Su, Liwei Chen
Epidemiol Health. 2023;45:e2023013.   Published online January 28, 2023
DOI: https://doi.org/10.4178/epih.e2023013
  • 22,625 View
  • 122 Download
  • 5 Web of Science
  • 5 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
During the coronavirus disease 2019 (COVID-19) pandemic, a growing prevalence of racial and ethnic discrimination occurred when many Americans struggled to maintain healthy lifestyles. This study investigated the associations of racial and ethnic discrimination with changes in exercise and screen time during the pandemic in the United States.
METHODS
We included 2,613 adults who self-identified as non-Hispanic White, non-Hispanic Black, non-Hispanic Asian, or Hispanic from the Health, Ethnicity, and Pandemic study, a cross-sectional survey conducted among a nationally representative sample of United States adults between October and November 2020. We assessed self-reported racial and ethnic discrimination by measuring COVID-19-related racial and ethnic bias and examined its associations with changes in exercise and screen time using multivariable logistic regression models. We analyzed data between September 2021 and March 2022.
RESULTS
COVID-19-related racial and ethnic bias was associated with decreased exercise time among non-Hispanic Asian (odds ratio [OR], 1.46; 95% confidence interval [CI], 1.13 to 1.89) and Hispanic people (OR, 1.91; 95% CI, 1.32 to 2.77), and with increased screen time among non-Hispanic Black people (OR, 1.94; 95% CI, 1.33 to 2.85), adjusting for age, sex, education, marital status, annual household income, insurance, and employment status.
CONCLUSIONS
Racial and ethnic discrimination may have adversely influenced exercise and screen time changes among racial and ethnic minorities during the COVID-19 pandemic in the United States. Further studies are needed to investigate the mechanisms through which racial and ethnic discrimination can impact lifestyles and to develop potential strategies to address racial and ethnic discrimination as a barrier to healthy lifestyles.
Summary
Key Message
In this study with a nationally representative sample of Americans, we found that racial discrimination during the COVID-19 pandemic was associated with undesired changes in exercise and screen time, particularly among minorities.

Citations

Citations to this article as recorded by  
  • Promoting Muscle-Strengthening Activities in Black Women: Formative Research Findings for Intervention Development
    Rodney P. Joseph, Glenn A. Gaesser, Tanya J. Benitez
    Translational Journal of the American College of Sports Medicine.2026; 11(3): e000368.     CrossRef
  • Addressing Racism and Discrimination in the Design of Physical Activity Interventions for Black Women: Insights and Recommendations From an Academic and Community Partnership
    Rodney P. Joseph, LaTanya Mathis, Iyana Harris, Shawntele M. Howie-Carlson, Kanika Jones, Darlene Little, Dawn Augusta
    Women's Health Issues.2025; 35(5): 301.     CrossRef
  • Asian American Women’s Experiences of Discrimination and Health Behaviors during the COVID-19 Pandemic
    Katarina Wang, Alice Guan, Janice Seto, Debora L. Oh, Kathie Lau, Christine Duffy, Esperanza Castillo, Valerie McGuire, Michelle Wadhwa, Clifford G. Tepper, Heather A. Wakelee, Mindy C. DeRouen, Salma Shariff-Marco, Iona Cheng, Scarlett Lin Gomez
    Journal of Immigrant and Minority Health.2024; 26(2): 421.     CrossRef
  • Facilitators, motivations, and barriers to physical activity among Chinese American women
    Jingxi Sheng, Hao Lei, Demetrius A. Abshire, Horng-Shiuann Wu, Michael D. Wirth, Sue P. Heiney
    Discover Social Science and Health.2024;[Epub]     CrossRef
  • Social Determinants of Cardiovascular Health in Asian Americans: A Scientific Statement From the American Heart Association
    Nilay S. Shah, Namratha R. Kandula, Yvonne Commodore-Mensah, Brittany N. Morey, Shivani A. Patel, Sally Wong, Eugene Yang, Stella Yi
    Circulation.2024;[Epub]     CrossRef
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