Background: Catastrophic health expenditure (CHE) represents a key indicator for excessive financial burden due to out-of-pocket (OOP) healthcare costs, which could push the household into poverty and is highly pronounced in households with members at an advanced age. Previous studies have been devoted to understanding the determinants for CHE, yet little evidence exists on its association with frailty, an important geriatric syndrome attracting growing recognition. We thus aim to examine the relationship between frailty and CHE and to explore whether this effect is moderated by socioeconomic-related factors.Methods: A total of 3,277 older adults were drawn from two waves (2011 and 2013) of the China Health and Retirement Longitudinal Study (CHARLS). CHE was defined when OOP healthcare expenditure exceeded a specific proportion of the capacity of the household to pay. Frailty was measured following the Fried Phenotype (FP) scale. Mixed-effects logistic regression models were employed to assess the longitudinal relationship between frailty and CHE, and stratification analyses were conducted to explore the moderation effect.Results: The incidence of CHE among Chinese community-dwelling older adults was 21.76% in 2011 and increased to 26.46% in 2013. Compared with non-frail individuals, prefrail or frail adults were associated with higher odds for CHE after controlling for age, gender, residence, education, marriage, income, health insurance, smoking, drinking, and comorbidity (prefrail: odds ratio (OR) = 1.32, 95%CI = 1.14–1.52; frail: OR = 1.67, 95%CI = 1.13–2.47). Three frailty components including weakness, exhaustion, and shrinking contributed to a significantly increased likelihood of CHE (all p < 0.05), while the other two components including slowness and inactivity showed a non-significant effect (all p > 0.05). Similar effects from frailty on CHE were observed across socioeconomic-related subgroups differentiated by gender, residence, education, household income, and social health insurance.Conclusions: Frailty is a significant predictor for CHE in China. Developing and implementing cost-effective strategies for the prevention and management of frailty is imperative to protect households from financial catastrophe.

Background: Insufficient sleep and skipping breakfast are very common phenomena in China and have been proposed as possible causes of overweight/obesity, but the results of former studies remain inconsistent. Objective: To investigate the individual and joint association of insufficient sleep and skipping breakfast with overweight/obesity among children and adolescents in Jiangsu Province, China. Methods: Participants were 36 849 students aged 8-17 years from the 2019-2020 project "Surveillance for common disease and health risk factors among students." Self-reported insufficient sleep and skipping breakfast were ascertained by selfreported sleep duration and breakfast habit. Overweight/obesity was assessed according to the gender-and age-specific body mass index. We used logistic regression models to explore the association of sleep and breakfast with overweight/obesity, and stratification analyses to test age or gender differences. Results: The overall prevalence of overweight/obesity was 33.2%. Insufficient sleep (OR = 1.09, 95% CI = 1.03-1.16) or skipping breakfast (OR = 1.14, 95% CI = 1.07-1.21) was associated with overweight/obesity. Compared to participants with 'sufficient sleep and breakfast', ORs were 1.25 (95% CI = 1.15-1.35) for those with 'both insufficient sleep and skipping breakfast'. The separate and joint association of sleep and breakfast with overweight/obesity remained generally consistent across different age and gender subgroups, except that the 8-12-year-olds group and female students appear more susceptible. Conclusions: Insufficient sleep and skipping breakfast were jointly associated with overweight/obesity in children and adolescents. Appropriate attention should be paid to these modifiable behaviours including sleep and breakfast in the context of the rapidly growing obesity epidemic among children and adolescents.

IMPORTANCE Functional limitation is increasingly common as people age and is often associated with negative consequences. Evidence of the dynamics of functional limitation within couples in China is still inadequate.OBJECTIVES To examine whether functional limitation was associated within middle-aged and older couples and to explore sex differences in spousal associations. DESIGN, SETTING, AND PARTICIPANTSIn this nationwide, population-based cohort study performed from January 1, 2011, to December 31, 2018, participants were selected using multistage probability sampling, and 5207 community-dwelling couples (10 414 individuals) 45 years or older were included in the nationally representative China Health and Retirement Longitudinal Study. Data analysis was performed from January 1 to February 28, 2021. EXPOSURESThe exposure variable was the presence of functional limitation in spouses. Functional limitation was measured by the activities of daily living (ADLs) and instrumental activities of daily living (IADLs) scales and was defined as having difficulty in independently performing at least 1 ADL or IADL item. MAIN OUTCOMES AND MEASURESThe main outcome was functional limitation in index participants. Multivariable logistic regression with generalized estimating equations was used to estimate the reciprocal association of functional limitation within couples over time. RESULTS A total of 5207 married, different-sex couples (mean [SD] age, 59.1 [8.8] years for husbands and 57.0 [8.2] years for wives) were included in the study. For husbands, the number (percentage) of participants classified with baseline functional limitation was 1140 (21.9%), the number (percentage) with ADL limitation was 684 (13.1%), and the number (percentage) with IADL limitation was 834 (16.0%). For wives, the number (percentage) of participants classified with baseline functional limitation was 1502 (28.8%), the number (percentage) with ADL limitation was 887 (17.0%), and the number (percentage) with IADL limitation was 1183 (22.7%). Longitudinal results demonstrated an association in spouses developing functional limitation (adjusted odds ratio[OR], 2.55; 95% CI, 2.41-2.69; P < .001), ADL limitation (adjusted OR, 2.26; 95% CI, 2.11-2.41; P < .001), and IADL limitation (adjusted OR, 2.58; 95% CI, 2.43-2.73; P < .001). Subgroup analyses by sex revealed similar patterns of spousal health concordance in terms of all studied outcomes, indicating no sex specificity. CONCLUSIONS AND RELEVANCE This population-based cohort study suggests that amongChinese middle-aged and older couples there is significant concordance in the development of functional limitation. This study of spousal functional ability from a dyadic perspective may help in (continued) Key Points Question Are spouses concordant in the development of functional limitation over time in middle and old age? Findings In this cohort study of 10 414 community-dwelling participants (5207 married, different-sex couples) 45 years or older in China, significant interdependent associations were ...

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