Biomedical Big Data Center, West China Hospital, Sichuan University, Sichuan, China; Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA.
Biomedical Big Data Center, West China Hospital, Sichuan University, Sichuan, China.
Soc Sci Med. 2021 Aug;283:114188. doi: 10.1016/j.socscimed.2021.114188. Epub 2021 Jun 30.
The effects of late-life subjective poverty on brain health are understudied. We aimed to investigate the association between duration of subjective poverty after age 64 and subsequent cognitive function and decline in China.
Data were from 4118 adults aged ≥64 at baseline in the population-based China Longitudinal Healthy Longevity Survey (CLHLS), 2005-2018. The duration of subjective poverty was measured from self-rated economic status relative to neighbors in 2005, 2008, and 2011 (never; one time point; two or three time points). Cognitive function was assessed by the Chinese Mini-Mental State Exam (CMMSE; range: 0-30) in 2011, 2014, and 2018. We fitted attrition-weighted, multivariable mixed-effects Tobit regression models to examine the relationship between duration of subjective poverty from 2005 to 2011 and subsequent cognitive function and decline from 2011 to 2018.
A total of 2675 (64.96%) participants never reported subjective poverty over the period 2005-2011, 930 (22.58%) participants reported subjective poverty at one time point, and 513 (12.46%) reported subjective poverty at two or three time points. Compared to those who never reported subjective poverty, participants experiencing subjective poverty at one time point (β = -0.95, 95% CI: -1.48 to -0.41) and two or three time points (β = -2.01; 95% CI: -2.73 to -1.29) had lower CMMSE scores in 2011, indicating a dose-response relationship. Individuals with a longer duration of subjective poverty had a slower rate of decline in CMMSE scores than those never in subjective poverty (β = 1.44; 95% CI: 0.20 to 2.68 for 2018 X Two or three time points).
Subjective poverty in late life may have unique and cumulative contributions to cognitive aging among older adults in China. The lower level of initial cognitive function but slower rate of cognitive decline observed for those with greater subjective poverty is consistent with theories of cognitive reserve and empirical evidence from Western settings on other socioeconomic markers.
关于晚年主观贫困对大脑健康的影响，目前研究还较少。本研究旨在调查中国老年人在 64 岁以后经历主观贫困的持续时间与认知功能及下降之间的关系。
本研究的数据来自于 2005-2018 年中国健康长寿纵向调查（CLHLS）中基线时年龄≥64 岁的 4118 名成年人。2005 年、2008 年和 2011 年，根据自评经济状况与邻居相比（从不；一个时间点；两个或三个时间点），测量主观贫困的持续时间。2011 年、2014 年和 2018 年，采用中国简易精神状态检查（CMMSE；范围：0-30）评估认知功能。我们采用了经删失权重的多变量混合效应 Tobit 回归模型，以检验 2005-2011 年期间主观贫困持续时间与 2011-2018 年期间认知功能和下降之间的关系。
在 2005-2011 年期间，共有 2675 名（64.96%）参与者从未报告过主观贫困，930 名（22.58%）参与者报告过一次主观贫困，513 名（12.46%）参与者报告过两次或三次主观贫困。与从未报告过主观贫困的参与者相比，报告过一次主观贫困的参与者（β=-0.95，95%CI：-1.48 至-0.41）和报告过两次或三次主观贫困的参与者（β=-2.01；95%CI：-2.73 至-1.29）在 2011 年的 CMMSE 得分较低，表明存在剂量反应关系。主观贫困持续时间较长的个体与从未经历过主观贫困的个体相比，CMMSE 评分下降的速度较慢（β=1.44；95%CI：2018 年的 2018X 两个或三个时间点为 0.20 至 2.68）。
晚年的主观贫困可能对中国老年人的认知衰老有独特的、累积的影响。与其他社会经济标志物的西方研究结果一致，本研究中观察到初始认知功能水平较低但认知衰退速度较慢的现象，这与认知储备理论相符。
