Lin Zhuoer, Fu Mingqi, Chen Xi
Department of Health Policy and Management, Yale School of Public Health, USA.
Center for Social Security Studies, Wuhan University, China.
SSM Popul Health. 2023 Feb 9;22:101361. doi: 10.1016/j.ssmph.2023.101361. eCollection 2023 Jun.
Cognitive misperception contributed to poor decision-making; yet their impact on health-related decisions is less known. We examined how self-perceived memory was associated with chronic disease awareness among older Chinese adults.
Data were obtained from the China Health and Retirement Longitudinal Study. Nationally representative blood biomarkers were collected in 2015 to identify participants' dyslipidemia and diabetes status. Among participants with biomarker identified dyslipidemia or diabetes, disease awareness was defined as self-reported diagnosis of the conditions as of 2018. The association of self-perceived memory with chronic disease awareness was determined by weighted multivariate logistic regressions adjusting for cognitive ability and covariates.
Among 4578 adults aged 60 and over, 1442 and 759 individuals were identified having dyslipidemia and diabetes, with proportions of disease awareness being 38.0% and 58.1%, respectively. The proportions were lower for individuals with better self-perceived memory and those with more impaired cognitive ability, showing opposite patterns. Adjusting for cognitive ability and covariates, self-perceived memory was negatively associated with the dyslipidemia (OR = 0.80, 95%CI: 0.63-1.02) and diabetes (OR = 0.71, 95%CI: 0.55-0.92) awareness. In particular, older adults with the highest level of self-perceived memory had significantly lower disease awareness as compared to those with the lowest level of self-perceived memory (OR = 0.51, 95%CI: 0.28-0.94 for dyslipidemia; and OR = 0.42, 95%CI: 0.21-0.84 for diabetes). The negative association was robust to adjusting for alternative cognitive measures, and was stronger for individuals with rural status, lower education, or living without children.
Cognitive misperception poses great challenges to chronic disease awareness. Targeted interventions and supports are needed, particularly for those more disadvantaged.
认知错误感知会导致决策失误；然而，其对健康相关决策的影响却鲜为人知。我们研究了中国老年人群中自我感知的记忆力与慢性病知晓情况之间的关联。
数据来自中国健康与养老追踪调查。2015年收集了具有全国代表性的血液生物标志物，以确定参与者的血脂异常和糖尿病状况。在通过生物标志物确定患有血脂异常或糖尿病的参与者中，疾病知晓情况定义为截至2018年的自我报告诊断。通过加权多元逻辑回归分析，在调整认知能力和协变量后，确定自我感知的记忆力与慢性病知晓情况之间的关联。
在4578名60岁及以上的成年人中，分别有1442人和759人被确定患有血脂异常和糖尿病，疾病知晓率分别为38.0%和58.1%。自我感知记忆力较好的个体以及认知能力受损较严重的个体，疾病知晓率较低，呈现出相反的模式。在调整认知能力和协变量后，自我感知的记忆力与血脂异常（比值比=0.80，95%置信区间：0.63 - 1.02）和糖尿病（比值比=0.71，95%置信区间：0.55 - 0.92）知晓情况呈负相关。特别是，自我感知记忆力水平最高的老年人与自我感知记忆力水平最低的老年人相比，疾病知晓率显著更低（血脂异常的比值比=0.51，95%置信区间：0.28 - 0.94；糖尿病的比值比=0.42，95%置信区间：0.21 - 0.84）。这种负相关在调整替代认知指标后依然稳健，并且在农村居民、受教育程度较低或无子女的个体中更为明显。
认知错误感知对慢性病知晓情况构成了巨大挑战。需要有针对性的干预措施和支持，特别是针对那些处于更不利地位的人群。
