Jian Wu, MD, PHD, Department of Health management, College of Public Health, Zhengzhou University, 100 Kexue Road, Gaoxin district, Zhengzhou 450001, China, Telephone: +8613393729001, E-mail:
J Prev Alzheimers Dis. 2024;11(5):1513-1522. doi: 10.14283/jpad.2024.127.
Numerous studies have shown that there are socioeconomic disparities in people's health. Health behavior is considered to be an effective strategy to alleviate socio-economic differences. However, the independent or joint relationship between socioeconomic status (SES) and lifestyle behaviors (LBs) on the cognition of Chinese elderly are not clear. Therefore, this study aimed to reveal the impact of SES and LBs on cognitive impairment in elder Chinese.
The data from the 2017-2018 wave of Chinese Longitudinal Healthy Longevity Survey was used. SES was created using latent class analysis based on annual per-capita household income, education level, and occupation. Six LBs were considered in calculating LB scores. Restricted cubic splines were used to model the association of LB scores and cognitive impairment to investigate the dose-response relationship. LB scores were divided into three groups: unhealthy, intermediate, and healthy lifestyle. Multivariate Logistic regression models were applied to explore both the independent and joint effects of SES and LB scores on cognitive impairment.
Among 10,116 participants, 1,872 (18.51%) were recorded as having cognitive impariment. After adjusting for multivariable confounding factors, compared with participants of high SES, those of low SES had higher risks of cognitive impairment [Odds ratio (OR): 1.385; 95% confidence interval (CI): 1.137-1.689]. In contrast to those with unhealthy lifestyle, participants adhering to a healthy lifestyle were found to be associated with a reduced risk of cognitive impairment (OR: 0.198; 95%CI: 0.150-0.263). A non-linear relationship was observed between LB scores and cognitive impairment (Pnonlinearity =0.001), indicating a protective effect on cognitive impairment when having more than two LBs. Participants with high SES and engaged in healthy lifestyle had the lowest risk of cognitive impairment compared to those with low SES and unhealthy lifestyle (OR: 0.123; 95% CI 0.073-0.207).
Cognitive impairment has socioeconomic disparities among the elderly Chinese population. A healthy lifestyle may attenuate the impact of socioeconomic inequality on cognitive impairment, emphasizing the important role of LBs modification in reducing the disease burden of cognitive impairment, especially in the elderly population with low SES.
大量研究表明，人们的健康状况存在社会经济差异。健康行为被认为是缓解社会经济差异的有效策略。然而，社会经济地位（SES）和生活方式行为（LBs）之间的独立或联合关系对中国老年人的认知尚不清楚。因此，本研究旨在揭示 SES 和 LBs 对中国老年人认知障碍的影响。
使用 2017-2018 年中国长寿纵向研究的数据集。SES 是根据人均家庭收入、教育水平和职业采用潜在类别分析创建的。计算 LB 分数时考虑了 6 种 LBs。受限立方样条用于对 LB 分数与认知障碍的关联进行建模，以探讨剂量反应关系。LB 分数分为三组：不健康、中等和健康生活方式。应用多变量 Logistic 回归模型来探讨 SES 和 LB 分数对认知障碍的独立和联合作用。
在 10116 名参与者中，有 1872 名（18.51%）被记录为认知受损。在调整了多变量混杂因素后，与 SES 较高的参与者相比，SES 较低的参与者认知障碍的风险更高[比值比（OR）：1.385；95%置信区间（CI）：1.137-1.689]。与不健康生活方式的参与者相比，坚持健康生活方式的参与者认知障碍的风险较低（OR：0.198；95%CI：0.150-0.263）。LB 分数与认知障碍之间存在非线性关系（Pnonlinearity =0.001），表明当有两个以上的 LB 时，对认知障碍有保护作用。与 SES 较低且生活方式不健康的参与者相比，SES 较高且生活方式健康的参与者认知障碍的风险最低（OR：0.123；95%CI 0.073-0.207）。
认知障碍在老年中国人群中存在社会经济差异。健康的生活方式可能会减轻社会经济不平等对认知障碍的影响，强调了生活方式改变在减轻认知障碍疾病负担方面的重要作用，尤其是在 SES 较低的老年人群中。
