Zhang Chi, Bai Anying, Kang Yuting, Zhang Yushan, Zhao Jianliang, Shi Hong, Shen Ji
The Key Laboratory of Geriatrics, Beijing Institute of Geriatrics, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing Hospital, National Center of Gerontology of National Health Commission, Beijing, China.
School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
J Glob Health. 2025 May 16;15:04119. doi: 10.7189/jogh.15.04119.
Leisure activities (LAs) are vital for healthy ageing and are linked to lower mortality risk in older adults. However, most previous longitudinal studies have assessed LAs at only one time point. We aimed to explore the impact of dynamic changes in LAs on subsequent all-cause mortality among older adults.
We enrolled 21 262 older adults who had participated in the six waves of the Chinese Longitudinal Healthy Longevity Survey (CLHLS) in 1998, 2000, 2002, 2005, 2008, and 2011. All participants completed two consecutive assessments of LAs (including seven typical activities) during the first two waves (mean interval = 2.72 years (standard deviation = 0.08)); we further followed them up until 2018, i.e. beyond the 2011 CLHLS. We divided them into five categories according to the change pattern of LAs: stable low (low-low), stable moderate (moderate-moderate), stable high (high-high), LAs increase (low-moderate, low-high, moderate-high), and LAs decrease (high-moderate, high-low, moderate-low). We used a Cox proportional hazard model to test the association between changes in LAs and all-cause mortality, including demographic characteristics, health behaviours, and disease history as covariates.
We documented 15 065 death events during 80 045.39 person-years of follow-up. Compared with the stable moderate group, the adjusted hazard ratios (aHRs) of mortality for the stable low group and stable high group were 1.27 (95% confidence interval (CI) = 1.21-1.35) and 0.66 (95% CI = 0.62-0.71), respectively. An increase in LAs was associated with a lower risk of mortality (aHR = 0.83; 95% CI = 0.78-0.88), while a decrease in LAs was associated with a higher risk of mortality (aHR = 1.05; 95% CI = 1.01-1.09). The protective effect of LAs increase on premature death was more pronounced in men than in women. The main results remained stable in subgroup and sensitivity analyses.
Maintaining and increasing participation in leisure time activities significantly reduced the risk of all-cause mortality in community-dwelling older individuals in our sample.
休闲活动对健康老龄化至关重要，并且与老年人较低的死亡风险相关。然而，以往大多数纵向研究仅在一个时间点评估休闲活动。我们旨在探讨休闲活动的动态变化对老年人随后全因死亡率的影响。
我们纳入了21262名老年人，他们参加了1998年、2000年、2002年、2005年、2008年和2011年的六轮中国健康与养老追踪调查（CLHLS）。所有参与者在前两轮调查中完成了对休闲活动（包括七种典型活动）的连续两次评估（平均间隔=2.72年（标准差=0.08））；我们对他们进行进一步随访至2018年，即超过2011年CLHLS的时间范围。我们根据休闲活动的变化模式将他们分为五类：稳定低水平（低-低）、稳定中等水平（中等-中等）、稳定高水平（高-高）、休闲活动增加（低-中等、低-高、中等-高）和休闲活动减少（高-中等、高-低、中等-低）。我们使用Cox比例风险模型来检验休闲活动变化与全因死亡率之间的关联，将人口统计学特征、健康行为和疾病史作为协变量。
在80045.39人年的随访期间，我们记录了15065例死亡事件。与稳定中等水平组相比，稳定低水平组和稳定高水平组的死亡率调整后风险比（aHRs）分别为1.27（95%置信区间（CI）=1.21-1.35）和0.66（95%CI=0.62-0.71）。休闲活动增加与较低的死亡风险相关（aHR=0.83；95%CI=0.78-0.88），而休闲活动减少与较高的死亡风险相关（aHR=1.05；95%CI=1.01-1.09）。休闲活动增加对过早死亡的保护作用在男性中比在女性中更明显。在亚组分析和敏感性分析中，主要结果保持稳定。
在我们的样本中，保持并增加参与休闲时间活动显著降低了社区居住老年人的全因死亡风险。
