Institute of Population Research, Peking University, Beijing, China.
Peking University Sixth Hospital, Beijing, China.
BMC Geriatr. 2022 Mar 22;22(1):239. doi: 10.1186/s12877-022-02946-3.
Although numerous studies focused on the relationship between area socioeconomic status (SES) and health, only a few of them investigated how community-level SES was linked to late-life cognitive function as well as the potential pathways underlying this association, and very few of them focused on the context of China. This study examined how community-level SES was linked to cognitive function and the potential pathways underlying this association among middle-aged and older adults in China.
Data was drawn from the waves 1-4 of China Health and Retirement Longitudinal Study. We measured cognitive function with the components of the Telephone Interview of Cognitive Status battery. Community-level SES was derived from a sum of z scores of the percentage of the illiterate and the per-capita net income status within communities. We adopted two-level hierarchical linear regression models to explore the associations between community-level SES and cognitive function. A multilevel mediation analysis with structural equation modeling was undertaken to disaggregate the direct and indirect pathways of the associations.
Higher community-level SES was associated with better cognitive function (β = 0.562, 95% CI = 0.390, 0.734), and this significant association was only present in rural participants, not in urban participants. Furthermore, we discovered the mediating effects of outdoor exercise facilities within communities (β = 0.023, 95% CI = 0.000, 0.056) and individual-level SES (β = 0.108, 95% CI = 0.057, 0.156) to explain the relationship between community SES and cognitive function.
These findings highlight the importance of community environmental interventions in maintaining individuals' cognitive health in China, especially for older adults. Our results provided solid empirical evidence for reducing mental health inequalities in China, and suggested that developing an aging-friendly environment and properly distributing community resources are important to improve cognitive function of older adults.
尽管许多研究都集中在地区社会经济地位（SES）与健康之间的关系上，但只有少数研究调查了社区层面的 SES 如何与老年人的认知功能相关，以及这种关联的潜在途径，而且很少有研究关注中国的情况。本研究探讨了社区层面的 SES 如何与中国中老年人群的认知功能相关，以及这种关联的潜在途径。
数据来自中国健康与退休纵向研究的第 1-4 波。我们使用电话认知状态测试的组成部分来衡量认知功能。社区层面的 SES 是通过社区内文盲比例和人均净收入状况的 z 分数之和得出的。我们采用两层层次线性回归模型来探讨社区层面 SES 与认知功能之间的关系。采用结构方程模型的多层次中介分析来分解关联的直接和间接途径。
较高的社区层面 SES 与较好的认知功能相关（β=0.562，95%置信区间=0.390，0.734），这种显著关联仅存在于农村参与者中，而不存在于城市参与者中。此外，我们发现了社区内户外活动设施（β=0.023，95%置信区间=0.000，0.056）和个体层面 SES（β=0.108，95%置信区间=0.057，0.156）在解释社区 SES 与认知功能之间关系的中介作用。
这些发现强调了社区环境干预对维持中国个体认知健康的重要性，特别是对老年人而言。我们的研究结果为减少中国心理健康不平等提供了有力的实证依据，并表明发展一个适合老年人的环境和合理分配社区资源对于提高老年人的认知功能是重要的。
