School of Public Health, Fudan University, Shanghai, 200032, China.
Collaborative Innovation Cooperative Unit of National Clinical Research Center for Geriatric Diseases, Shanghai, 200032, China.
BMC Public Health. 2024 May 23;24(1):1382. doi: 10.1186/s12889-024-18895-y.
Positive self-perception of aging (SPA) is a well-known predictor of longevity, while how and to what extent SPA is linked with all-cause mortality among older adults is still unclear. This study aims to elucidate the relationship between positive SPA and all-cause mortality and its potential mediators among Chinese older adults.
This is a 20-year dynamic cohort study conducted among 22,957 older adults aged ≥ 65 years old from a nationally representative sample. Positive SPA was measured using a validated 7-item scale. Potential mediators including health behaviors and social participation were collected using a self-reported questionnaire. Cox proportional hazards regression models were conducted to examine the association between positive SPA and all-cause mortality. A mediation analysis was conducted to determine whether health behaviors and social participation mediated the association between SPA and all-cause mortality.
Throughout follow-up (median [interquartile range], 46 [21-84] months), all-cause mortality was 87.4%. Compared with older adults with the lowest quartile positive SPA, hazard ratio(HR) of all-cause mortality among older adults with the second, third, and fourth quartile of positive SPA was 0.96(95%CI:0.93-1.00), 0.93(95%CI:0.90-0.99), and 0.92(95%CI:0.87-0.96) respectively after controlling for all potential mediators and covariates. The mediation analysis showed that regular daily vegetable intake, physical activity, and high social participation explained 41.1-48.5% of the variance in the association between positive SPA and all-cause mortality.
In this cohort study, we found that high positive SPA was associated with decreased all-cause mortality directly, and indirectly through healthy lifestyle behaviors and social participation. These findings suggest that interventions targeted at promoting or maintaining positive SPA may contribute to healthy ageing among older adults in China.
积极的老化感知（SPA）是长寿的已知预测因素，而 SPA 与老年人全因死亡率之间的关联方式和程度仍不清楚。本研究旨在阐明积极的 SPA 与中国老年人全因死亡率之间的关系及其潜在的中介因素。
这是一项在全国代表性样本中进行的为期 20 年的动态队列研究，纳入了 22957 名年龄≥65 岁的老年人。使用经过验证的 7 项量表来衡量积极的 SPA。通过自报问卷收集潜在的中介因素，包括健康行为和社会参与。使用 Cox 比例风险回归模型来检验积极 SPA 与全因死亡率之间的关联。进行中介分析以确定健康行为和社会参与是否在 SPA 与全因死亡率之间的关联中起中介作用。
在整个随访期间（中位数[四分位数范围]，46[21-84]个月），全因死亡率为 87.4%。与 SPA 最低四分位数的老年人相比，SPA 第二、三、四分位数的老年人全因死亡率的危险比（HR）分别为 0.96（95%CI：0.93-1.00）、0.93（95%CI：0.90-0.99）和 0.92（95%CI：0.87-0.96），在控制所有潜在的中介因素和协变量后。中介分析表明，规律的每日蔬菜摄入、身体活动和高社会参与解释了积极 SPA 与全因死亡率之间关联的 41.1%-48.5%的变异。
在这项队列研究中，我们发现高积极 SPA 与全因死亡率直接相关，通过健康的生活方式行为和社会参与间接相关。这些发现表明，针对促进或维持积极 SPA 的干预措施可能有助于中国老年人的健康老龄化。
