{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T17:51:36Z","timestamp":1787161896578,"version":"build-2736575974"},"reference-count":29,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2025,7,17]],"date-time":"2025-07-17T00:00:00Z","timestamp":1752710400000},"content-version":"am","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82370574"],"award-info":[{"award-number":["82370574"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82300654"],"award-info":[{"award-number":["82300654"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82270602"],"award-info":[{"award-number":["82270602"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100007834","name":"Ningbo Natural Science Foundation","doi-asserted-by":"publisher","award":["2024J038"],"award-info":[{"award-number":["2024J038"]}],"id":[{"id":"10.13039\/100007834","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100017531","name":"Ningbo Top Medical and Health Research","doi-asserted-by":"publisher","award":["2023020612"],"award-info":[{"award-number":["2023020612"]}],"id":[{"id":"10.13039\/501100017531","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100019446","name":"Medical Health Science and Technology","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100019446","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100017594","name":"Zhejiang Provincial Health Commission","doi-asserted-by":"publisher","award":["2023KY257"],"award-info":[{"award-number":["2023KY257"]}],"id":[{"id":"10.13039\/501100017594","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Circadian alignment plays a key role in cardiometabolic regulation. We examined whether accelerometer-derived alignment metrics independently predict all-cause and cardiovascular mortality in middle-aged and older adults.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>We included 4814\u2005U.S. adults aged \u226545 years from the 2011\u20132014 NHANES cycles. Circadian alignment was measured once for each participant during their examination year via wrist-worn accelerometer data. Two phasor metrics\u2014magnitude (synchronisation strength) and angle (timing deviation)\u2014were categorized into quartiles. Mortality was ascertained through linkage to the National Death Index, with follow-up through 31 December 2019. All-cause and cardiovascular disease (CVD)-specific mortality rates were analyzed via weighted Cox proportional hazards regression, Fine and Gray\u2019s competing risk models, and restricted cubic splines to account for non-linear associations. Over 31 280 person-years, 736 deaths occurred (235 CVD-related deaths). Compared with those in the highest quartile (Q4), participants in the lowest quartile of phasor magnitude (Q1) had a significantly greater risk of all-cause mortality (HR, 1.70; 95% CI: 1.08\u20132.68). A U-shaped association was observed for the phasor angle: both advanced (Q1) and most delayed (Q4) timing were linked to elevated all-cause mortality risk, with Q2 representing optimal alignment. For CVD-specific mortality, advanced timing (Q1 vs. Q2) was associated with a 68% increased risk (HR, 1.68; 95% CI: 1.09\u20132.60). Restricted cubic splines confirmed non-linear relationships.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>A lower phasor magnitude and both advanced and delayed phasor angles were associated with higher all-cause and CVD-specific mortality. Circadian metrics may serve as biomarkers to inform wearable-based monitoring and behavioural interventions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/eurjpc\/zwaf445","type":"journal-article","created":{"date-parts":[[2025,7,17]],"date-time":"2025-07-17T10:12:59Z","timestamp":1752747179000},"source":"Crossref","is-referenced-by-count":6,"title":["Accelerometer-measured circadian alignment predicts all-cause and cardiovascular mortality in middle-aged and older adults"],"prefix":"10.1093","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1262-3411","authenticated-orcid":false,"given":"Jiarong","family":"Xie","sequence":"first","affiliation":[{"name":"Department of Gastroenterology, The First Affiliated Hospital of Ningbo University , No. 59 Liuting Street, Haishu District, Ningbo 315000 ,","place":["China"]},{"name":"Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University School of Medicine , No. 79 Qingchun Road, Hangzhou 310003 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University , No. 59 Liuting Street, Haishu District, Ningbo 315000 ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6172-1253","authenticated-orcid":false,"given":"Chengfu","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University School of Medicine , No. 79 Qingchun Road, Hangzhou 310003 ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6017-3745","authenticated-orcid":false,"given":"Lei","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, The First Affiliated Hospital of Ningbo University , No. 59 Liuting Street, Haishu District, Ningbo 315000 ,","place":["China"]},{"name":"Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University School of Medicine , No. 79 Qingchun Road, Hangzhou 310003 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