{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T07:03:42Z","timestamp":1790233422734,"version":"4.1.0"},"reference-count":21,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T00:00:00Z","timestamp":1788739200000},"content-version":"vor","delay-in-days":6,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["8207152007"],"award-info":[{"award-number":["8207152007"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003785","name":"Guangdong Medical Research Foundation","doi-asserted-by":"publisher","award":["B2026515"],"award-info":[{"award-number":["B2026515"]}],"id":[{"id":"10.13039\/501100003785","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Geriatrics Gerontology Int"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Continence impairment and depressive symptoms frequently coexist in older adults, but whether their co\u2010occurrence identifies a subgroup at elevated mortality risk across populations remains uncertain.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted parallel analyses among adults aged \u2265\u200960\u2009years in the 2005\u20132010 National Health and Nutrition Examination Survey (NHANES) linked mortality files and the 2011\u20132018 China Health and Retirement Longitudinal Study (CHARLS). Continence impairment was defined as urinary or fecal incontinence in NHANES and by a combined functional item on difficulty controlling urination and defecation in CHARLS; these measures were harmonized at the conceptual rather than item level. Participants were classified as having neither exposure, depressive symptoms only, continence impairment only, or both. NHANES used survey\u2010weighted Cox models, whereas CHARLS used ordinary unweighted Cox models in a unified fixed 7\u2010year cohort. Missing covariates were addressed by multiple imputation with 20 datasets. Additive interaction measures were estimated from fixed\u2010horizon risk ratios, not hazard ratios.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The analyses included 4851 NHANES participants (1052 deaths) and 4690 CHARLS participants (1044 deaths). Compared with neither exposure, the co\u2010occurring group had higher mortality in NHANES (HR 1.60, 95% CI 1.20\u20132.13;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.001) and CHARLS (HR 1.50, 95% CI 1.19\u20131.87;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Fixed\u2010horizon risk\u2010ratio analyses provided no statistical evidence of additive interaction. The CHARLS midpoint death\u2010time analysis produced a similar co\u2010occurring\u2010group estimate (HR 1.54, 95% CI 1.23\u20131.93).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Co\u2010occurring continence impairment and depressive symptoms identified a higher\u2010risk subgroup relative to participants with neither exposure in both cohorts, highlighting the value of considering these conditions together in mortality risk assessment.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/ggi.70831","type":"journal-article","created":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T03:21:31Z","timestamp":1788837691000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Continence Impairment and Depressive Symptoms Jointly Identify Older Adults at Increased Risk of Mortality: Parallel Analyses From\n                    <scp>NHANES<\/scp>\n                    and\n                    <scp>CHARLS<\/scp>"],"prefix":"10.1111","volume":"26","author":[{"given":"Xin","family":"Jin","sequence":"first","affiliation":[{"name":"The First Affiliated Hospital of Guangzhou University of Chinese Medicine  Guangzhou China"},{"name":"First Clinical Medical School of Guangzhou University of Chinese Medicine  Guangzhou China"},{"name":"Guangdong Clinical Research Academy of Chinese Medicine  Guangzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-6026-8128","authenticated-orcid":false,"given":"Xinming","family":"Chen","sequence":"additional","affiliation":[{"name":"The First Affiliated Hospital of Guangzhou University of Chinese Medicine  Guangzhou China"},{"name":"First Clinical Medical School of Guangzhou University of Chinese Medicine  Guangzhou China"},{"name":"Guangdong Clinical Research Academy of Chinese Medicine  Guangzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qian","family":"Ye","sequence":"additional","affiliation":[{"name":"The First Affiliated Hospital of Guangzhou University of Chinese Medicine  Guangzhou China"},{"name":"First Clinical Medical School of Guangzhou University of Chinese Medicine  Guangzhou China"},{"name":"Guangdong Clinical Research Academy of Chinese Medicine  Guangzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-5866-0976","authenticated-orcid":false,"given":"Feng","family":"Sun","sequence":"additional","affiliation":[{"name":"The First Affiliated Hospital of Guangzhou University of Chinese Medicine  Guangzhou China"},{"name":"First Clinical Medical School of Guangzhou University of Chinese Medicine  Guangzhou China"},{"name":"Guangdong Clinical Research Academy of Chinese Medicine  Guangzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,7]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2013.07.020"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e31829efbff"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1177\/0300060520931348"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1038\/s43856-025-01350-3"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1080\/13548506.2025.2502841"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2025.119407"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1532-5415.2000.tb04699.x"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.puhe.2022.08.018"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.13385"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/dys203"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1525-1497.2001.016009606.x"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0749-3797(18)30622-6"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12933-026-03109-z"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.3389\/fnut.2025.1569798"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/dom.70528"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1532-5415.2007.01156.x"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12603-021-1722-3"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.3389\/fnagi.2023.1121190"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.3346\/jkms.2021.36.e99"},{"key":"e_1_2_11_21_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40520-022-02336-0"},{"key":"e_1_2_11_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.annepidem.2006.10.009"}],"container-title":["Geriatrics &amp; 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