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Lan L, Shao S, Zheng X. Associations between Sarcopenia and trajectories of activities of daily living disability: a nationwide longitudinal study of middle-aged and older adults in China from 2011 to 2018. Arch Public Health 2024; 82:97. [PMID: 38918853 PMCID: PMC11197329 DOI: 10.1186/s13690-024-01329-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 06/18/2024] [Indexed: 06/27/2024] Open
Abstract
BACKGROUND Sarcopenia is an age-related clinical syndrome, which is associated with numerous adverse outcomes among older adults. The relationship between sarcopenia and activities of daily living (ADL) disability has been studied in China, but these findings usually focused on a single time point. The patterns of ADL can change over time and vary among individuals. Therefore, it is necessary to explore the association between sarcopenia and trajectories of ADL disability. METHODS According to Asian Working Group for Sarcopenia (AWGS) 2019 criteria, muscle mass, muscle strength, and physical performance measurements were measured to diagnose sarcopenia. A six-item ADL score was used to measure ADL disability, and trajectories of ADL disability were identified by the latent class trajectory modelling (LCTM). Multiple logistic regression models were performed to examine the association between sarcopenia and trajectories of ADL disability. RESULTS Among 9113 middle-aged and older adults, three trajectories of ADL disability were determined according to changes in ADL score during follow-up, including a mild-high trajectory (n = 648, 7.11%), followed by the low-mild trajectory (n = 3120, 34.24%) and low-low trajectory (n = 5345, 58.65%). After adjustment for covariates, severe sarcopenia was significantly associated with higher risks of being in the mild-high trajectory group (OR = 3.31, 95%CI: 2.10-5.22) and the low-mild trajectory group (OR = 1.44, 95%CI: 1.05-1.98), compared with the low-low trajectory group. This association was still observed when stratified by age and gender. In addition, participants with sarcopenic obesity were associated with a higher risk of ADL disability (OR = 3.99; 95% CI: 2.50-6.09). CONCLUSIONS Among the middle-aged and older Chinese adults, sarcopenia and sarcopenic obesity were both associated with persistent higher trajectories of ADL disability. It suggested that early interventions to sarcopenia and sarcopenic obesity among the middle-aged and older adults may reduce the progression of ADL disability.
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Affiliation(s)
- Lei Lan
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou, Zhejiang Province, 310003, China
| | - ShiMiao Shao
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou, Zhejiang Province, 310003, China
| | - Xiaowei Zheng
- Public Health Research Center, Department of Public Health and Preventive Medicine, Wuxi School of Medicine, Jiangnan University, 1800 Lihu Road, Binhu District, Wuxi, Jiangsu Province, 214122, China.
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He H, Tu R, Chen H, Wang C, Wu S, Wang S. Longitudinal trajectories of disability among Chinese adults: the role of cardiometabolic multimorbidity. Aging Clin Exp Res 2024; 36:79. [PMID: 38520484 PMCID: PMC10960913 DOI: 10.1007/s40520-024-02732-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 03/04/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND Cardiometabolic multimorbidity (CM) has been found to be associated with higher mortality and functional limitations. However, few studies have investigated the longitudinal association between CM and disability in the Chinese population and whether these associations vary by smoking status. METHODS The study included 16,754 participants from four waves (2011, 2013, 2015, and 2018) of China Health and Retirement Longitudinal Study (CHARLS) (mean age: 59, female: 51%). CM was assesed at baseline and defined as having two or more of diabetes, stroke, or heart disease. Disability was repeatedly measured by summing the number of impaired activities of daily living (ADL) and instrumental activities of daily living (IADL) during the 7-year follow-up. Linear mixed-effects model was used to determine the association of CM and trajectories of disability and to assess the modification effect of smoking status in these associations. RESULTS Participants with CM at baseline had a faster progression of disability compared to those without CM (CM: β = 0.13, 95% CI: 0.05 to 0.21). Current smokers with CM developed disability faster than their counterparts (Pinteraction for smoking=0.011). In addition, there was a significant association between CM and the annual change of disability in current smokers (β = 0.34, 95% CI: 0.17 to 0.50) while no such association was observed in current non-smokers (β = 0.08, 95% CI: -0.02 to 0.17). CONCLUSION CM was associated with more a rapid disability progression. Notably, being current smokers may amplify the adverse effects of CM on disability progression.
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Affiliation(s)
- Huihui He
- Department of Nursing, The First Affiliated Hospital of Wannan Medical College, Wuhu, Anhui, China.
| | - Raoping Tu
- School of Health Management, Fujian Medical University, Fuzhou, Fujian, China
| | - Huahua Chen
- Department of Gastrointestinal surgery, The First Affiliated Hospital of Wannan Medical College, Wuhu, Anhui, China
| | - Chao Wang
- Department of Gastrointestinal surgery, The First Affiliated Hospital of Wannan Medical College, Wuhu, Anhui, China
| | - Shengjuan Wu
- Department of Gastrointestinal surgery, The First Affiliated Hospital of Wannan Medical College, Wuhu, Anhui, China
| | - Suhang Wang
- Anesthesia Surgery and Pain Management, Department Zhongda Hospital, School of Medicine Southeast University, Nanjing, Jiangsu, China
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Shi L, Pang T, Zheng Q, Liu G, Zhang W, Leung W. Utilisation of community healthcare services among older adults with disabilities in Luohu district, Shenzhen: a community-based survey. BMJ Open 2024; 14:e076249. [PMID: 38286707 PMCID: PMC10826561 DOI: 10.1136/bmjopen-2023-076249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 01/08/2024] [Indexed: 01/31/2024] Open
Abstract
OBJECTIVE China faces the challenge of an ageing population with disabilities. Community healthcare centres (CHCs) serve as frontline community healthcare providers for older adults with and without disabilities. Despite their significance, there is a lack of literature examining the utilisation of CHC services among older adults. This study aims to examine and compare the utilisation and satisfaction of CHC healthcare services among older adults with and without disabilities. SETTING Data from the 2019 Community Health Diagnosis Questionnaire, which interviewed 259 older adults residing in the Luohu district of Shenzhen, were used in the current study. PRIMARY OUTCOME MEASURES Participants self-reported outcomes including use of CHCs, use of home health services from CHCs and satisfaction with CHCs. Five different disability types and an integrated disability variable were assessed as independent variables. Linear probability models were used to determine the relationship between disability types and outcome variables. RESULTS Among 259 older adults aged 60 years and older, 70.66% self-identified as having a disability. No statistically significant associations were found between the use of CHCs, the use of home health services from CHCs and satisfaction with CHCs, and disability status. However, older adults with mobility and cognitive disabilities were more likely to receive home health services from CHCs. CONCLUSION Community health promotion policies should be implemented to improve access to health services for older adults with and without disabilities. In addition, CHCs should implement effective health management plans to ensure the health needs of older adults with disabilities.
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Affiliation(s)
- Lu Shi
- College of Health, Oregon State University, Corvallis, Oregon, USA
| | | | - Qingming Zheng
- Shenzhen Luohu Disease Prevention and Control Center, Shenzhen, China
| | - Gang Liu
- Shenzhen Luohu Disease Prevention and Control Center, Shenzhen, China
| | - Wei Zhang
- College of Health, Oregon State University, Corvallis, Oregon, USA
| | - Willie Leung
- Health Sciences & Human Performance, The University of Tampa, Tampa, Florida, USA
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Osuna M, Farina M, Ailshire J. Disabled life expectancy among older Colombian men and women. PLoS One 2024; 19:e0296638. [PMID: 38206966 PMCID: PMC10783758 DOI: 10.1371/journal.pone.0296638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 12/15/2023] [Indexed: 01/13/2024] Open
Abstract
Colombia's population is rapidly aging and older adults are living longer, however, we have limited information on the level of disability and number of years older Colombians spend with disability. We estimated age-and-gender specific ADL, IADL and mobility disability prevalence and disabled life expectancy (DLE) and to examined gender differences. Life tables came from the Colombian vital statistics and disability prevalence data came from the cross-sectional 2015 Colombia National Survey of Health, Well-being, and Aging. Disabled life expectancy (DLE) was calculated using Sullivan's method. About one-third to one-half of remaining years will be spent with IADL or mobility disability. The remaining years of life spent with ADL was relatively low at younger ages, but by age 85, about half of remaining life will be spent with disability. Compared to men, women had higher levels of disability and are estimated to spend more years with disability. Gender differences in ADL did not emerge until ages 70 and older. Older Colombians, in particularly women, are estimated to live a significant proportion of their life with disability, particularly IADL and mobility disability. High levels of disability are concerning because the country lacks adequate infrastructure and has limited options for long term care.
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Affiliation(s)
- Margarita Osuna
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, California, United States of America
| | - Mateo Farina
- Department of Human Development and Family Science, Austin, Texas, United States of America
| | - Jennifer Ailshire
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, California, United States of America
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Adam CE, Fitzpatrick AL, Leary CS, Ilango SD, Phelan EA, Semmens EO. The impact of falls on activities of daily living in older adults: A retrospective cohort analysis. PLoS One 2024; 19:e0294017. [PMID: 38170712 PMCID: PMC10763967 DOI: 10.1371/journal.pone.0294017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 10/25/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Falls contribute to impairments in activities of daily living (ADLs), resulting in significant declines in the quality of life, safety, and functioning of older adults. Understanding the magnitude and duration of the effect of falls on ADLs, as well as identifying the characteristics of older adults more likely to have post-fall ADL impairment is critical to inform fall prevention and post-fall intervention. The purpose of this study is to 1) Quantify the association between falls and post-fall ADL impairment and 2) Model trajectories of ADL impairment pre- and post-fall to estimate the long-term impact of falls and identify characteristics of older adults most likely to have impairment. METHOD Study participants were from the Ginkgo Evaluation of Memory Study, a randomized controlled trial in older adults (age 75+) in the United States. Self-reported incident falls and ADL scores were ascertained every 6 months over a 7-year study period. We used Cox proportional hazards analyses (n = 2091) to quantify the association between falls and ADL impairment and latent class trajectory modeling (n = 748) to visualize trajectories of ADL impairment pre-and post-fall. RESULTS Falls reported in the previous 6 months were associated with impairment in ADLs (HR: 1.42; 95% CI 1.32, 1.52) in fully adjusted models. Based on trajectory modeling (n = 748), 19% (n = 139) of participants had increased, persistent ADL impairment after falling. Participants who were female, lived in a neighborhood with higher deprivation, or experienced polypharmacy were more likely to have ADL impairment post-fall. CONCLUSIONS Falls are associated with increased ADL impairment, and this impairment can persist over time. It is crucial that all older adults, and particularly those at higher risk of post-fall ADL impairment have access to comprehensive fall risk assessment and evidence-based fall prevention interventions, to help mitigate the negative impacts on ADL function.
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Affiliation(s)
- Claire E. Adam
- School of Public and Community Health Sciences, University of Montana, Missoula, Montana, United States of America
- Center for Population Health Research, University of Montana, Missoula, Montana, United States of America
| | - Annette L. Fitzpatrick
- Department of Family Medicine, University of Washington, Seattle, Washington, United States of America
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington, United States of America
| | - Cindy S. Leary
- School of Public and Community Health Sciences, University of Montana, Missoula, Montana, United States of America
- Center for Population Health Research, University of Montana, Missoula, Montana, United States of America
| | - Sindana D. Ilango
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington, United States of America
| | - Elizabeth A. Phelan
- Division of Gerontology and Geriatric Medicine, School of Medicine, University of Washington, Seattle, Washington, United States of America
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, Washington, United States of America
| | - Erin O. Semmens
- School of Public and Community Health Sciences, University of Montana, Missoula, Montana, United States of America
- Center for Population Health Research, University of Montana, Missoula, Montana, United States of America
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Li W, Rao Z, Fu Y, Schwebel DC, Li L, Ning P, Huang J, Hu G. Value of the short physical performance battery (SPPB) in predicting fall and fall-induced injury among old Chinese adults. BMC Geriatr 2023; 23:574. [PMID: 37723438 PMCID: PMC10507826 DOI: 10.1186/s12877-023-04290-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 09/07/2023] [Indexed: 09/20/2023] Open
Abstract
BACKGROUND The short physical performance battery (SPPB) is an easy-to-use tool for fall risk prediction, but its predictive value for falls and fall-induced injuries among community dwellers has not been examined through a large-sample longitudinal study. METHODS We analyzed five-round follow-up data (2, 3, 4, 5, 7 years) of the China Health and Retirement Longitudinal Study (CHARLS) (2011-2018). Data concerning falls and fall-induced injuries during multi-round follow-ups were collected through participant self-report. The Cochran-Armitage trend test examined trends in fall incidence rate across SPPB performance levels. Multivariable logistic regression and negative binomial regression models examined associations between SPPB performance and subsequent fall and fall-induced injury. The goodness-of-fit and area under the receiver operating curve (AUC) were used together to quantify the value of the SPPB in predicting fall and fall-induced injury among community-dwelling older adults. RESULTS The CHARLS study included 9279, 6153, 4142, 4148, and 3583 eligible adults aged 60 years and older in the five included follow-up time periods. SPPB performance was associated with fall and fall-induced injury in two and three of the five follow-up time periods, respectively (P < 0.05). The goodness-of-fit for all predictive models was poor, with both Cox-Snell R2 and Nagelkerke R2 under 0.10 and AUCs of 0.53-0.57 when using only SPPB as a predictor and with both Cox-Snell R2 and Nagelkerke R2 lower than 0.12 and AUCs of 0.61-0.67 when using SPPB, demographic variables, and self-reported health conditions as predictors together. Sex and age-specific analyses displayed highly similar results. CONCLUSIONS Neither use of SPPB alone nor SPPB together with demographic variables and self-reported health conditions appears to offer good predictive performance for falls or fall-induced injuries among community-dwelling older Chinese adults.
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Affiliation(s)
- Weiqiang Li
- Department of Epidemiology and Health Statistics, Hunan Provincial Key Laboratory of Clinical Epidemiology, Xiangya School of Public Health, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410078, China
| | - Zhenzhen Rao
- Department of Epidemiology and Health Statistics, Hunan Provincial Key Laboratory of Clinical Epidemiology, Xiangya School of Public Health, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410078, China
| | - Yanhong Fu
- Department of Epidemiology and Health Statistics, Hunan Provincial Key Laboratory of Clinical Epidemiology, Xiangya School of Public Health, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410078, China
| | - David C Schwebel
- Department of Psychology, University of Alabama at Birmingham, Alabama, 35294, United States of America
| | - Li Li
- Department of Epidemiology and Health Statistics, Hunan Provincial Key Laboratory of Clinical Epidemiology, Xiangya School of Public Health, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410078, China
| | - Peishan Ning
- Department of Epidemiology and Health Statistics, Hunan Provincial Key Laboratory of Clinical Epidemiology, Xiangya School of Public Health, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410078, China
| | - Jiaqi Huang
- Department of Epidemiology and Health Statistics, Hunan Provincial Key Laboratory of Clinical Epidemiology, Xiangya School of Public Health, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410078, China
- National Clinical Research Center for Metabolic Diseases, Metabolic Syndrome Research Center, Key Laboratory of Diabetes Immunology, Department of Metabolism and Endocrinology, Ministry of Education, The Second Xiangya Hospital of Central South University, Changsha, Hunan, 410011, China
| | - Guoqing Hu
- Department of Epidemiology and Health Statistics, Hunan Provincial Key Laboratory of Clinical Epidemiology, Xiangya School of Public Health, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410078, China.
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China.
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Wang J, Luo N, Sun Y, Bai R, Li X, Liu L, Wu H, Liu L. Exploring the reciprocal relationship between activities of daily living disability and depressive symptoms among middle-aged and older Chinese people: a four-wave, cross-lagged model. BMC Public Health 2023; 23:1180. [PMID: 37337186 DOI: 10.1186/s12889-023-16100-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 06/11/2023] [Indexed: 06/21/2023] Open
Abstract
BACKGROUND Early studies have shown a relationship between activities of daily living (ADL) disability and depressive symptoms in older people. However, discussions on the direction of this relationship are insufficient. The study's objective was to assess the reciprocal relationship between ADL disability and depressive symptoms among middle-aged and older Chinese people. METHOD Data was collected in four waves of a nationwide survey, the China Health and Retirement Longitudinal Study (CHARLS), which was carried out in 2011, 2013, 2015, and 2018. In total, this study included 4,124 participants aged ≥ 45 years at baseline. A summing score of the eleven items for basic activities of daily living (BADL) and instrumental activities of daily living (IADL) was calculated to indicate the degree of ADL disability. The 10-item Centre for Epidemiological Studies Depression Scale (CESD-10) was adopted to measure depressive symptoms. The reciprocal relationship between ADL disability and depressive symptoms was tested by cross-lagged models. RESULT At baseline, 911 (22.1%) participants were classified as having difficulties with ADL, and the prevalence of depressive symptoms was 34.4% (1,418). Among middle-aged and older people in China, there was a significant reciprocal and longitudinal relationship between ADL disability and depressive symptoms. People who had difficulty with ADL faced a higher risk of depressive symptoms, and those who suffered from depressive symptoms were accompanied by an increase in ADL disability in the following years. The subgroup analysis on age also showed that ADL disability was reciprocally and longitudinally related to depressive symptoms. However, only women showed similar results in the subgroup analysis on gender. CONCLUSION This study shows that ADL disability is bi-directionally related to depressive symptoms in middle-aged and older Chinese people over time. The results suggest we should identify ADL disability and bad psychological conditions in time to prevent subsequent mutual damage among middle-aged and older Chinese people, a vulnerable group rising in the future.
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Affiliation(s)
- Jiayi Wang
- Department of Social Medicine, School of Health Management, China Medical University, No. 77 Puhe Road, Shenyang North New Area, Shenyang, 110122, Liaoning, China
| | - Nansheng Luo
- Department of Social Medicine, School of Health Management, China Medical University, No. 77 Puhe Road, Shenyang North New Area, Shenyang, 110122, Liaoning, China
| | - Yu Sun
- Department of Social Medicine, School of Health Management, China Medical University, No. 77 Puhe Road, Shenyang North New Area, Shenyang, 110122, Liaoning, China
| | - Ru Bai
- Department of Social Medicine, School of Health Management, China Medical University, No. 77 Puhe Road, Shenyang North New Area, Shenyang, 110122, Liaoning, China
| | - Xueying Li
- Department of Social Medicine, School of Health Management, China Medical University, No. 77 Puhe Road, Shenyang North New Area, Shenyang, 110122, Liaoning, China
| | - Libing Liu
- Department of Social Medicine, School of Health Management, China Medical University, No. 77 Puhe Road, Shenyang North New Area, Shenyang, 110122, Liaoning, China
| | - Hui Wu
- Department of Social Medicine, School of Health Management, China Medical University, No. 77 Puhe Road, Shenyang North New Area, Shenyang, 110122, Liaoning, China.
| | - Li Liu
- Department of Social Medicine, School of Health Management, China Medical University, No. 77 Puhe Road, Shenyang North New Area, Shenyang, 110122, Liaoning, China.
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Lin SL. Functional Disability Among Middle-Aged and Older Adults in China: The Intersecting Roles of Ethnicity, Social Class, and Urban/Rural Residency. Int J Aging Hum Dev 2023; 96:350-375. [PMID: 35422130 PMCID: PMC9932620 DOI: 10.1177/00914150221092129] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study explores how ethnicity, family income, and education level differentiate patterns of functional limitations among urban and rural Chinese (aged 45 ≥ years). Based on the 2018 China Family Panel Studies (CFPS) (n = 16,589), this nationwide study employed binary/multinomial logistic regression analyses, stratified by urban/rural residency, to estimate the likelihood of instrumental activities of daily living (IADLs) disability (0/1-2/≥3 limitations) by social determinants of health (SDoH). The estimated overall prevalence of IADLs disability was 14.3%. The multivariable analyses did not find significant ethnic disparity in IADLs disability in urban China, while in rural China, ethnic minorities were 44% more likely to have IADLs disability than Han Chinese. Among rural residents, Mongolians, Tibetans, and Yi minority more than tripled the odds of having ≥3 limitations than Han Chinese; and the intersections of ethnicity and social class were associated with functional limitations. Long-term care and anti-poverty programs should target minority aging populations in rural China.
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Affiliation(s)
- Shen Lamson Lin
- Factor-Inwentash Faculty of Social Work, 152790University of Toronto, Toronto, Canada
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Wang J, Guan J, Wang G. Impact of long-term care insurance on the health status of middle-aged and older adults. HEALTH ECONOMICS 2023; 32:558-573. [PMID: 36403228 DOI: 10.1002/hec.4634] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 11/03/2022] [Accepted: 11/04/2022] [Indexed: 06/16/2023]
Abstract
With the increase of aging population, long-term care insurance (LTCI) systems have become important for improving individuals' health. However, the effect of LTCI on health is unclear, especially in developing countries, owing to the lack of random policy shocks and comprehensive databases. This study investigates the Chinese LTCI pilot program, using four waves of the China Health and Retirement Longitudinal Study database (sample aged ≥45 years) from 2011 to 2018. The recent difference-in-differences approaches for staggered design, which are capable of dealing with the negative weights issue, are used to investigate changes in health status, measured by self-rated health (SRH), (instrumental) activities of daily living, self-rated depression, and cognition, in pilot and non-pilot cities before and after LTCI implementation. Long-term care insurance has a significant average effect on SRH improvement and a long-term positive effect on cognition for middle-aged and older populations. This study provides the first evaluation of LTCI policy on health outcomes using the recent difference-in-differences approaches. It provides evidence for the overall health improvement achieved through the LTCI and offers positive reinforcement and potential areas for improvement in establishing LTCI worldwide.
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Affiliation(s)
- Jingyi Wang
- School of Insurance and Economics, University of International Business and Economics, Beijing, China
| | - Jing Guan
- School of Economics, Beijing Technology and Business University, Beijing, China
| | - Guojun Wang
- School of Insurance and Economics, University of International Business and Economics, Beijing, China
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10
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Zheng X, Jiang M, Ren X, Han L. The longitudinal association of remnant cholesterol with diabetes in middle-aged and elderly Chinese: A nationwide population-based cohort study. J Diabetes Complications 2023; 37:108360. [PMID: 36459863 DOI: 10.1016/j.jdiacomp.2022.108360] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 11/18/2022] [Accepted: 11/21/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND AIMS The association between remnant cholesterol (RC) and diabetes remains unclear in Chinese. METHODS AND RESULTS We used the data of 9464 Chinese adults aged ≥45 years from the China Health and Retirement Longitudinal Study (CHARLS). Estimated RC level was calculated as total cholesterol minus high-density lipoprotein cholesterol minus low-density lipoprotein cholesterol. Cox proportional hazard models and restricted cubic spline models were used to assess the relationships between RC and diabetes. RESULTS After 6 years of follow-up, a total of 777 respondents experienced new-onset diabetes. In multivariable-adjusted analyses, the adjusted hazard ratios (95 % confidence intervals) for the highest versus lowest quartile of RC was 1.45 (1.19-1.75) for risk of diabetes, and each 1-SD increase of RC (19.52 mg/dl) was associated with 9 % (HRs = 1.09; 1.03-1.15) increased risk of diabetes. There were also significant linear associations between RC level and diabetes (P for linearity <0.001). CONCLUSION Elevated RC levels were positively associated with increased risk of diabetes in Chinese adult population, suggesting that RC could be considered as a preferential predictor and treatment target of diabetes in Chinese population. Future prospective studies are needed to verify our findings and to assess the effect of RC-lowering interventions in diabetes prevention.
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Affiliation(s)
- Xiaowei Zheng
- Department of Public Health and Preventive Medicine, Wuxi School of Medicine, Jiangnan University, Wuxi, Jiangsu 214122, China.
| | - Minglan Jiang
- Department of Public Health and Preventive Medicine, Wuxi School of Medicine, Jiangnan University, Wuxi, Jiangsu 214122, China
| | - Xiao Ren
- Department of Public Health and Preventive Medicine, Wuxi School of Medicine, Jiangnan University, Wuxi, Jiangsu 214122, China
| | - Longyang Han
- Department of Public Health and Preventive Medicine, Wuxi School of Medicine, Jiangnan University, Wuxi, Jiangsu 214122, China
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Distinct depressive symptom trajectories are associated with incident diabetes among Chinese middle-aged and older adults: The China Health and Retirement Longitudinal Study. J Psychosom Res 2023; 164:111082. [PMID: 36379076 DOI: 10.1016/j.jpsychores.2022.111082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 11/05/2022] [Accepted: 11/06/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Previous studies have reported that depression and depressive symptom are associated with diabetes incident. However, the association between long-term depressive symptom patterns and risk of diabetes remains unknown. The aim of present study was to evaluate the association between depressive symptom trajectories and risk of diabetes. METHODS We used data of 8806 participants (≥45 years old) from the China Health and Retirement Longitudinal Study (CHARLS). Trajectories of depressive symptom were identified by latent mixture modeling. Multivariable logistic regression model was used to examine the association of depressive symptom trajectories with diabetes. RESULTS Five depressive symptom trajectories were identified, characterizing by maintaining a low CES-D scores throughout the follow-up (low-stable; 3227 participants [36.65%]); maintaining a moderate CES-D scores throughout the follow-up (moderate-stable; 3402 participants [38.63%]); moderate starting CES-D scores then increasing scores (moderate-increasing; 681 participants [7.73%%]); high starting CES-D scores but then decreasing scores (high-decreasing; 1061 participants [12.05%]); and maintained high CES-D scores throughout the follow-up (high-stable; 435 participants [4.94%]). During 2015 to 2018 (Wave 3 to Wave 4), a total of 312 respondents experienced diabetes. Compared with participants in the low-stable depressive symptom trajectory, those following a high-decreasing (ORs = 2.04; 95%CIs 1.48-2.98) and high-stable depressive symptom trajectories (ORs = 3.26; 95%CIs 2.06-5.16) were at substantially higher risk of developing diabetes. CONCLUSIONS Individuals with high-decreasing and high-stable depressive symptom trajectories over time were associated with increased risk of incident diabetes. Long-term depressive symptom may be a strong predictor of having diabetes.
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Zhao Q, Liu X, Liu Z. The impact of air pollution on physical disability in a middle-aged and older Chinese population using regression discontinuity design. Health Place 2023; 79:102958. [PMID: 36565540 DOI: 10.1016/j.healthplace.2022.102958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 12/05/2022] [Accepted: 12/12/2022] [Indexed: 12/24/2022]
Abstract
Emerging evidence has shown the association between ambient air pollution exposure and comorbid chronic diseases, which can subsequently impair physical function. However, less is known about the causal and contextual effect of air pollution on physical disability. Using data from the China Health and Retirement Longitudinal Study (CHARLS), this study employs a geographical regression discontinuity design based on the Huai River Policy to estimate the impact of ambient air pollution on physical disability in activities of daily living (ADL) in China. We find that a 10 μg/m3 increase in particulate matter [particulate matter smaller than 10 μm (PM10)] leads to a 5.4% increase in the incidence of physical disability among middle-aged and older adults. This result is robust to using alternative measurement of key variables, different bandwidths and polynomial functions, and adjustment for a set of sociodemographic covariates. Stroke might be one of the potential pathological pathways linking air pollution and physical disability, with a 10 μg/m3 increase in PM10 leading to a 4.7% increase in the incidence of stroke. In heterogeneity analyses, we find that older adults, males, urban residents, and people with lower socioeconomic status are more vulnerable to air pollution. These results contribute to the limited evidence on the causal and contextual effect of air pollution on physical health, and further provide policy implications for air quality control and health protection for vulnerable populations.
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Affiliation(s)
- Qi Zhao
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Xiaoting Liu
- School of Public Affairs, Zhejiang University, China; Institute of Wenzhou, Zhejiang University, China.
| | - Zuyun Liu
- Department of Big Data in Health Science School of Public Health and Center for Clinical Big Data and Analytics of the Second Affiliated Hospital, School of Medicine, Zhejiang University, China
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13
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Tian YM, Zhang WS, Jiang CQ, Zhu F, Jin YL, Zhu T, Cheng KK, Xu L. Association of alcohol use with memory decline in middle-aged and older Chinese: a longitudinal cohort study. BMC Psychiatry 2022; 22:673. [PMID: 36320000 PMCID: PMC9623936 DOI: 10.1186/s12888-022-04298-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 10/10/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Previous studies on associations of alcohol use with memory decline showed inconclusive results. We examined these associations using longitudinal data from the Guangzhou Biobank Cohort Study (GBCS) and explored whether these associations varied by sex and age group. METHODS Memory function was assessed by delayed 10-word recall test (DWRT) and immediate 10-word recall test (IWRT) at both baseline (2003-2008) and follow-up (2008-2012) examinations, expressed as the mean annual change and mean annual rate of change in scores. Memory cognitive impairment was defined by DWRT scores of less than 4. Multivariable linear regression models and restricted cubic spline were used for data analysis. RESULTS Of 14,827 participants without memory cognitive impairment at baseline, 90.2% were never or occasional drinkers, 5% moderate drinkers, 1.5% excessive drinkers, and 3.3% former drinkers. The mean (standard deviation) age was 60.6 (6.6) years old. During an average of 4.1 years follow-up, 1000 (6.7%) participants developed memory cognitive impairment. After adjusting for confounders, compared with never or occasional drinkers, moderate and excessive drinkers had significant decline in DWRT scores (β, 95% confidence interval (CI) = -0.04 (-0.08 to -0.01), and - 0.07 (-0.14 to 0.01), respectively), and IWRT scores (β, 95% CI = -0.10 (-0.19 to -0.01), and - 0.15 (-0.30 to 0.01), respectively) annually. With respect to the mean annual rate of change, moderate and excessive drinkers also showed greater decline in DWRT scores (β, 95% CI = -1.02% (-1.87% to -0.16%), and - 1.64% (-3.14% to -0.14%), respectively). The associations did not vary by sex and age group (all P values for interaction ≥ 0.10). CONCLUSION Compared to never or occasional alcohol use, moderate and excessive alcohol users had greater memory decline and the associations did not vary by sex and age group.
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Affiliation(s)
- Yu Meng Tian
- grid.12981.330000 0001 2360 039XSchool of Public Health, Sun Yat-sen University, 74 Zhongshan 2nd Road, Guangzhou, Guangdong Province China
| | - Wei Sen Zhang
- Guangzhou Twelfth People's Hospital, 510620, Guangzhou, China.
| | | | - Feng Zhu
- Guangzhou Twelfth People’s Hospital, 510620 Guangzhou, China
| | - Ya Li Jin
- Guangzhou Twelfth People’s Hospital, 510620 Guangzhou, China
| | - Tong Zhu
- Guangzhou Twelfth People’s Hospital, 510620 Guangzhou, China
| | - Kar Keung Cheng
- grid.6572.60000 0004 1936 7486Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Lin Xu
- School of Public Health, Sun Yat-sen University, 74 Zhongshan 2nd Road, Guangzhou, Guangdong Province, China. .,School of Public Health, the University of Hong Kong, Hong Kong, China. .,Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
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Liu Y, Wu Y, Cai J, Huang Y, Chen Y, Venkatraman TM, Lobanov‐Rostovsky S, Bandosz P, Yang Y, Wu Y, Liao J, Hao Y, Brunner EJ. Is there a common latent cognitive construct for dementia estimation across two Chinese cohorts? ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2022; 14:e12356. [PMID: 36177152 PMCID: PMC9473486 DOI: 10.1002/dad2.12356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 07/19/2022] [Accepted: 08/09/2022] [Indexed: 11/09/2022]
Abstract
Introduction It is valuable to identify common latent cognitive constructs for dementia prevalence estimation across Chinese aging cohorts. Methods Based on cognitive measures of 12015 Chinese Longitudinal Healthy Longevity Survey (CLHLS; 13 items) and 6623 China Health and Retirement Longitudinal Study (CHARLS; 9 items) participants aged 65 to 99 in 2018, confirmatory factor analysis was applied to identify latent cognitive constructs, and to estimate dementia prevalence compared to Mini-Mental State Examination (MMSE) and nationwide estimates of the literature. Results A common three-factor cognitive construct of orientation, memory, and executive function and language was found for both cohorts with adequate model fits. Crude dementia prevalence estimated by factor scores was similar to MMSE in CLHLS, and was more reliable in CHARLS. Age-standardized dementia estimates of CLHLS were lower than CHARLS among those aged 70+, which were close to the nationwide prevalence reported by the COAST study and Global Burden of Disease. Discussion We verified common three-factor cognitive constructs for both cohorts, providing an approach to estimate dementia prevalence at the national level. Highlights Common three-factor cognitive constructs were identified in Chinese Longitudinal Healthy Longevity Survey (CLHLS) and China Health and Retirement Longitudinal Study (CHARLS).Crude dementia estimates using factor scores were reliable in both cohorts.Estimates of CHARLS were close to current evidence, but higher than that of CLHLS.
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Affiliation(s)
- Yuyang Liu
- Department of Medical StatisticsSchool of Public HealthSun Yat‐sen UniversityGuangzhouPeople's Republic of China
- Sun Yat‐sen Global Health InstituteSchool of Public Health and Institute of State GovernanceSun Yat‐sen UniversityGuangzhouPeople's Republic of China
| | - Yanjuan Wu
- Department of Medical StatisticsSchool of Public HealthSun Yat‐sen UniversityGuangzhouPeople's Republic of China
- Sun Yat‐sen Global Health InstituteSchool of Public Health and Institute of State GovernanceSun Yat‐sen UniversityGuangzhouPeople's Republic of China
| | - Jingheng Cai
- Department of StatisticsSun Yat‐sen UniversityGuangzhouPeople's Republic of China
| | - Yun Huang
- Guangdong Provincial Center for Disease Control and PreventionGuangzhouPeople's Republic of China
| | - Yuntao Chen
- Department of Epidemiology & Public HealthUniversity College LondonLondonUK
| | | | | | - Piotr Bandosz
- Department of Public Health and PolicyUniversity of LiverpoolLiverpoolUK
- Department of Prevention and Medical EducationMedical University of GdanskGdanskPoland
| | - Yung‐Jen Yang
- Social Research InstituteInstitute of EducationUniversity College LondonLondonUK
| | - Yu‐Tzu Wu
- Population Health Sciences InstituteNewcastle UniversityNewcastleUK
| | - Jing Liao
- Department of Medical StatisticsSchool of Public HealthSun Yat‐sen UniversityGuangzhouPeople's Republic of China
- Sun Yat‐sen Global Health InstituteSchool of Public Health and Institute of State GovernanceSun Yat‐sen UniversityGuangzhouPeople's Republic of China
| | - Yuantao Hao
- Department of Medical StatisticsSchool of Public HealthSun Yat‐sen UniversityGuangzhouPeople's Republic of China
- Sun Yat‐sen Global Health InstituteSchool of Public Health and Institute of State GovernanceSun Yat‐sen UniversityGuangzhouPeople's Republic of China
- Peking University Center for Public Health and Epidemic Preparedness & ResponseBeijingPeople's Republic of China
| | - Eric J. Brunner
- Department of Epidemiology & Public HealthUniversity College LondonLondonUK
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Bai A, Bai W, Ju H, Xu W, Lin Z. Motoric cognitive risk syndrome as a predictor of incident disability: A 7 year follow-up study. Front Aging Neurosci 2022; 14:972843. [PMID: 36158535 PMCID: PMC9493455 DOI: 10.3389/fnagi.2022.972843] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 08/18/2022] [Indexed: 11/15/2022] Open
Abstract
Background Though motoric cognitive risk syndrome (MCR) share risk factors with disability, whether it predict disability remains understudied. Objectives This study aims to examine the association between MCR and incident disability. Design Longitudinal study. Methods MCR was defined as subjective cognitive complaints and objective slow gait speed. Two subtypes of MCR were defined by whether memory impairment (MI) was also present, MCR-MI and MCR-non-MI. Incident activities of daily living (ADL) disability and instrumental activities of daily living (IADL) disability were outcome measures. Multiple logistic regression analysis was used to assess the independent effect of MCR at baseline on the odds of ADL/IADL disability at a 7 year follow-up. Results Among the subjects who were not disabled at baseline and followed for 7 years, 34.66% reported incident ADL disability, and 31.64% reported incident IADL disability. Compared with participants without MCR at baseline, those with MCR had 58% increased odds of incident ADL disability (OR=1.58, 95% CI: 1.19–2.09) and 46% increased odds of incident IADL disability (OR=1.46, 95% CI: 1.13–1.88) after 7 years. MCR-non-MI was associated with a 56.63% increased risk of ADL disability and a 34.73% increased risk of IADL disability. MCR-MI was associated with an even higher risk of IADL disability (OR = 2.14, 95% CI: 1.18–3.88). Conclusions MCR is an independent risk factor for both incident ADL and IADL disability. MCR-MI predicts a higher risk for disability than MCR-non-MI. Early identification of MCR among older adult is recommended and may decrease future risk of disability.
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Affiliation(s)
- Anying Bai
- Department of Epidemiology and Biostatistics, School of Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Weimin Bai
- Department of Emergency, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, People's Hospital of Henan University, Zhengzhou, China
| | - Hepeng Ju
- Center for Disease Control and Prevention of Southern Theatre Command, Guangzhou, China
| | - Weihao Xu
- Department of Geriatrics, Guangdong Provincial Geriatrics Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- *Correspondence: Weihao Xu
| | - Zhanyi Lin
- Department of Geriatrics, Guangdong Provincial Geriatrics Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Zhanyi Lin
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16
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Zhao Y, Duan Y, Feng H, Nan J, Li X, Zhang H, Xiao LD. Trajectories of physical functioning and its predictors in older adults: A 12-year longitudinal study in China. Front Public Health 2022; 10:923767. [PMID: 36111197 PMCID: PMC9469466 DOI: 10.3389/fpubh.2022.923767] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 08/01/2022] [Indexed: 01/24/2023] Open
Abstract
Objective Maintaining and delaying a decline in physical function in older adults is critical for healthy aging. This study aimed to explore trajectories, critical points of the trajectory changes, and predictors among older people in the Chinese community. Design This study was one with a longitudinal design performed in China. Setting and participants The target population was community-dwelling older adults aged over 65 years. A total of 2,503 older adults from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) were included in this study. Methods Physical functioning was measured by instrumental activities of daily living (IADL). Population-based trajectory models were used to identify potential heterogeneity in longitudinal changes over 12 years and to investigate associations between baseline predictors and different trajectories for different cohort members using LASSO regression and logistic regression. Results Four trajectories of physical function were identified: slow decline (33.0%), poor function and moderate decline (8.1%), rapid decline (23.5%), and stable function (35.4%). Older age, male sex, worse self-reported health status, worse vision status, more chronic diseases, worse cognitive function, and a decreased frequency of leisure activity influenced changes in the trajectory of physical function. Having fewer teeth, stronger depressive symptoms, a lack of exercise, and reduced hearing may increase the rate of decline. Conclusion and implications Four trajectories of physical function were identified in the Chinese elderly population. Early prevention or intervention of the determinants of these trajectories can maintain or delay the rate of decline in physical function and improve healthy aging.
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Affiliation(s)
- Yinan Zhao
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Yunzhu Duan
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Hui Feng
- Xiangya School of Nursing, Central South University, Changsha, China,Xiangya-Oceanwide Health Management Research Institute, Central South University, Changsha, China,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, China,*Correspondence: Hui Feng
| | - Jiahui Nan
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Xiaoyang Li
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Hongyu Zhang
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Lily Dongxia Xiao
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia,Lily Dongxia Xiao
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Tu R, He H, Wang S, Ding J, Zeng Q, Guo L, Li Y, Xu T, Lu G. The association between healthy aging index and trajectories of disability: a population-based cohort study. Aging Clin Exp Res 2022; 34:1893-1900. [PMID: 35524107 DOI: 10.1007/s40520-022-02117-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 03/13/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Healthy aging index (HAI) could predict adverse health consequences including mortality and disability independent of age and comorbidity. We investigated the role of HAI on trajectories of disability throughout later life based on a nationally representative sample. METHODS We examined 1733 participants aged over 60 years from the China Health and Retirement Longitudinal Study (CHARLS) followed for 7 years/4 waves repeatedly. Systolic blood pressure [SBP], cognitive function, cystatin C, peak expiratory flow [PEF], and fasting glucose were categorized using tertile or clinical reference range, and scored as 0 (healthiest), 1 (less healthy) and 2 (least healthy) respectively to further generate HAI summary scores (range 0-10). Disability was defined as the sum of impaired activities of daily living (ADL) and instrumental activities of daily living (IADL). We used linear mixed-effects model to study the association between HAI and trajectories of disability. RESULTS A total of 10.5% of participants represented in the healthiest group and 22.5% ended up as the least healthy. After adjusting for all potential confounders, disability progression was significantly faster (β = 0.27, 95% CI 0.11-0.42) in the least healthy group when comparing with the healthiest. CONCLUSION Our findings suggest that HAI is associated with disability progression among adults aged over 60 years old. It might be beneficial for future interventions to specifically target older adults with high HAI scores as a means of reducing disability.
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Li A, Wang D, Lin S, Chu M, Huang S, Lee CY, Chiang YC. Depression and Life Satisfaction Among Middle-Aged and Older Adults: Mediation Effect of Functional Disability. Front Psychol 2021; 12:755220. [PMID: 34899497 PMCID: PMC8656258 DOI: 10.3389/fpsyg.2021.755220] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 10/25/2021] [Indexed: 12/29/2022] Open
Abstract
With increasing age, middle-aged and older persons face a series of physical and mental health problems. This study aimed to explore the latent relationships among age, functional disability, depression, and life satisfaction. The data were obtained from the Wave 2 (in 2013–2014) and Wave 3 (in 2015–2016) surveys of the China Health and Retirement Longitudinal Study. The analytic sample in the present study included 15,950 individuals aged 45 years and over. The participants answered the same questions concerning depression and life satisfaction in both study waves, and functional disability was measured based on the activities of daily living and instrumental activities of daily living. Age was directly associated with functional disability, life satisfaction, and depression. Functional disability was positively correlated with depression and negatively correlated with life satisfaction. Functional disability strongly mediated the relationships among age, depression, and life satisfaction. Depression and life satisfaction were found to have enduring effects and effects on each other. Additionally, the model revealed a gender difference. Depression in middle-aged people should receive closer attention. Avoiding or improving functional disability may be an effective way to improve life satisfaction and reduce the level of depression in middle-aged and older persons. If prevention work successfully decreases depression, the life dissatisfaction of middle-aged and older people could be improved. Additionally, for the prevention of functional disability and depression and improvement in life satisfaction, gender differences need to be considered.
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Affiliation(s)
- An Li
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, China
| | - Dewen Wang
- School of Public Affairs, Xiamen University, Xiamen, China
| | - Shengnan Lin
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, China
| | - Meijie Chu
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, China
| | - Shiling Huang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, China
| | - Chun-Yang Lee
- School of International Business, Xiamen University Tan Kah Kee College, Zhangzhou, China
| | - Yi-Chen Chiang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, China
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Multimorbidity, depressive symptoms and disability in activities of daily living amongst middle-aged and older Chinese: Evidence from the China Health and Retirement Longitudinal Study. J Affect Disord 2021; 295:703-710. [PMID: 34517243 DOI: 10.1016/j.jad.2021.08.072] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 07/09/2021] [Accepted: 08/25/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND Given that multimorbidity is strongly associated with disability in activities of daily living (ADL) and the mechanism still remains unclear, this study sought to investigate the mediating effect of depressive symptoms on such association. METHODS A longitudinal dataset was drawn from the China Health and Retirement Longitudinal Study (CHARLS, 2011-2015), including 3951 adults aged 45 years and above. By sex, logistic regression and mediation analysis (the Karlson, Holm, and Breen Method) were employed. RESULTS The presence of multimorbidity was associated with increased odds of having depressive symptoms and developing ADL disability, and depressive symptoms was significantly associated with ADL disability among middle-aged and older women. Mediation analysis illustrated that depressive symptoms accounted for 6.36% of the effect of multimorbidity on ADL disability in women. LIMITATIONS Results might not generalize to all middle-aged and older Chinese due to missing data on depressive symptoms and ADL. CONCLUSIONS Multimorbidity increased the likelihood of ADL disability onset partially through depressive symptoms in middle-aged and older women, suggesting that emphasizing mental wellness of females with multimorbidity are necessary to prevent impairments in physical function.
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Wang J, Wang Q, Hou XY, Chen S, Guo Z, Du W, Fan L. Spousal Concordance in the Development of Functional Limitations Among Married Adults in China. JAMA Netw Open 2021; 4:e2125577. [PMID: 34581797 PMCID: PMC8479583 DOI: 10.1001/jamanetworkopen.2021.25577] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Functional limitation is increasingly common as people age and is often associated with negative consequences. Evidence of the dynamics of functional limitation within couples in China is still inadequate. OBJECTIVES To examine whether functional limitation was associated within middle-aged and older couples and to explore sex differences in spousal associations. DESIGN, SETTING, AND PARTICIPANTS In this nationwide, population-based cohort study performed from January 1, 2011, to December 31, 2018, participants were selected using multistage probability sampling, and 5207 community-dwelling couples (10 414 individuals) 45 years or older were included in the nationally representative China Health and Retirement Longitudinal Study. Data analysis was performed from January 1 to February 28, 2021. EXPOSURES The exposure variable was the presence of functional limitation in spouses. Functional limitation was measured by the activities of daily living (ADLs) and instrumental activities of daily living (IADLs) scales and was defined as having difficulty in independently performing at least 1 ADL or IADL item. MAIN OUTCOMES AND MEASURES The main outcome was functional limitation in index participants. Multivariable logistic regression with generalized estimating equations was used to estimate the reciprocal association of functional limitation within couples over time. RESULTS A total of 5207 married, different-sex couples (mean [SD] age, 59.1 [8.8] years for husbands and 57.0 [8.2] years for wives) were included in the study. For husbands, the number (percentage) of participants classified with baseline functional limitation was 1140 (21.9%), the number (percentage) with ADL limitation was 684 (13.1%), and the number (percentage) with IADL limitation was 834 (16.0%). For wives, the number (percentage) of participants classified with baseline functional limitation was 1502 (28.8%), the number (percentage) with ADL limitation was 887 (17.0%), and the number (percentage) with IADL limitation was 1183 (22.7%). Longitudinal results demonstrated an association in spouses developing functional limitation (adjusted odds ratio [OR], 2.55; 95% CI, 2.41-2.69; P < .001), ADL limitation (adjusted OR, 2.26; 95% CI, 2.11-2.41; P < .001), and IADL limitation (adjusted OR, 2.58; 95% CI, 2.43-2.73; P < .001). Subgroup analyses by sex revealed similar patterns of spousal health concordance in terms of all studied outcomes, indicating no sex specificity. CONCLUSIONS AND RELEVANCE This population-based cohort study suggests that among Chinese middle-aged and older couples there is significant concordance in the development of functional limitation. This study of spousal functional ability from a dyadic perspective may help in the understanding of health risks within a wider familial context and offers novel insights for prioritizing policy focus from individual centered to couple based.
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Affiliation(s)
- Jingwen Wang
- Department of Medical Insurance, School of Public Health, Southeast University, Nanjing, China
| | - Qian Wang
- Guangdong Provincial Geriatrics Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xiang-Yu Hou
- School of Health and Wellbeing, University of Southern Queensland, Ipswich, Queensland, Australia
| | - Sunan Chen
- Department of Medical Insurance, School of Public Health, Southeast University, Nanjing, China
| | - Zhen Guo
- Department of Epidemiology and Biostatistics, School of Public Health, Southeast University, Nanjing, China
| | - Wei Du
- Department of Epidemiology and Biostatistics, School of Public Health, Southeast University, Nanjing, China
| | - Lijun Fan
- Department of Medical Insurance, School of Public Health, Southeast University, Nanjing, China
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21
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Wu C. The mediating and moderating effects of depressive symptoms on the prospective association between cognitive function and activities of daily living disability in older adults. Arch Gerontol Geriatr 2021; 96:104480. [PMID: 34274875 DOI: 10.1016/j.archger.2021.104480] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 06/25/2021] [Accepted: 07/05/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVES This study aimed to examine to what extent depressive symptoms mediated and moderated the association between cognitive function and activities of daily living (ADL) disability in older adults. METHODS In older participants from the China Health and Longitudinal Retirement Survey (CHARLS), structural equation modeling and multiple regression were performed to examine the mediating and moderating role of depressive symptoms (measured by the 10-item Center for Epidemiologic Studies Depression Scale) in the association between baseline cognitive function (episodic memory, attention, orientation to time, and visuospatial ability) and endpoint disability in basic ADL (BADL) or instrumental ADL (IADL). RESULTS Over a 2-year follow-up, among 1677 participants (67.5 ± 6.0 years old) free of BADL disability and 1194 participants (66.9 ± 5.6 years old) free of IADL disability, 8.3% and 22.9% developed BADL disability and IADL disability, respectively. Good baseline cognitive performance was significantly associated with the reduced incidence of BADL/IADL disability. The indirect effects of baseline depressive symptoms explained 16.9% and 14.5% of the total effect between cognition and BADL and IADL dependency, respectively. The Johnson-Neyman technique identified a threshold of 7.88 for endpoint depressive symptoms, beyond which the protective effect of baseline cognitive function on BADL emerged. CONCLUSIONS In older adults, good cognitive function reduces the risk of BADL/IADL disability. Depressive symptoms downregulate the protective effect of cognitive function on BADL/IADL over time. Intervention techniques focusing on the simultaneous improvement of cognitive dimensions and depression help improve ADL difficulty and prevent disability in older adults.
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Affiliation(s)
- Chao Wu
- Peking University School of Nursing, Beijing, 100191, China.
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彭 顺, 付 茜, 冯 星. [Association between education and the onset of disability in activities of daily living in middle-aged and older Chinese adults: The mediator role of social participation]. BEIJING DA XUE XUE BAO. YI XUE BAN = JOURNAL OF PEKING UNIVERSITY. HEALTH SCIENCES 2021; 53:549-554. [PMID: 34145859 PMCID: PMC8220058 DOI: 10.19723/j.issn.1671-167x.2021.03.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To investigate the association between educational attainment and the onset of disability in activities of daily living (ADL), and to explore the mediating effect of social participation on such association. METHODS A longitudinal dataset was drawn from the China Health and Retirement Longitudinal Study (CHARLS, 2015 to 2018). The measurements of educational attainment, social participation and other covariates were identified from 2015, while the outcome measurement of ADL disability was constructed with data from survey 2018. Descriptive analyses were conducted, and basic characteristics and social engagement of the respondents were compared between illiterates and non-illite-rates using Chi-square test. Logistic regression was used to investigate the associations of educational attainment and social participation on the onset of ADL disability. Mediation analysis was employed to examine the mediator role of the social participation on the linkage from being illiterate to the ADL disability onset. RESULTS A total of 11 359 adults aged 45 years and above were included in the sample, of whom 3 222 were illiterates. The incidence of the onset of ADL disability of illiterates and non-illiterates were 10.4% and 6.2%, respectively. Among these respondents, only half of them were involved in social activities. Of all the 8 social activities, the percentage of interacting with friends (34. 1%) was the highest, and the lowest percentage was observed in participating in an educational or training course (0.6%). Moreover, the percentages of participation in all these 8 social activities among illiterates were significantly lower than that of their educated counterparts (all P < 0.001). The illiterate middle-aged and older adults were less likely to develop ADL disability in the follow-up period [adjusted odds ratio (aOR)=1.22, 95%CI: 1.02-1.45], and social participation was significantly associated with ADL disability onset (aOR=0.73, 95%CI: 0.63-0.85). Findings from mediation analysis illustrated that social participation accounted for 12.22% of the adverse effect of being illiterate on ADL disability onset. CONCLUSION Social participation could buffer the negative effect of being illiterate on ADL disability onset in middle-aged and older adults, suggesting that engagement in social activities might have impact on prevention of impairments in physical function, especially for middle-aged and older illiterates.
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Affiliation(s)
- 顺壮 彭
- />北京大学公共卫生学院卫生政策与管理系,北京 100191Department of Health Policy and Management, Peking University School of Public Health, Beijing 100191, China
| | - 茜茜 付
- />北京大学公共卫生学院卫生政策与管理系,北京 100191Department of Health Policy and Management, Peking University School of Public Health, Beijing 100191, China
| | - 星淋 冯
- />北京大学公共卫生学院卫生政策与管理系,北京 100191Department of Health Policy and Management, Peking University School of Public Health, Beijing 100191, China
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Cuypers M, Tobi H, Naaldenberg J, Leusink GL. Linking national public services data to estimate the prevalence of intellectual disabilities in The Netherlands: results from an explorative population-based study. Public Health 2021; 195:83-88. [PMID: 34062276 DOI: 10.1016/j.puhe.2021.04.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 03/03/2021] [Accepted: 04/05/2021] [Indexed: 12/23/2022]
Abstract
OBJECTIVES Individuals with intellectual disabilities (ID) depend on public services for daily support and medical care; however, this group of individuals can be difficult to identify within population data. This therefore limits the opportunities to accurately estimate the size of the population with ID, monitor trends and tailor public health interventions according to the needs and characteristics of this group. By linking relevant databases, this study sought to identify individuals with ID in national data, to estimate the prevalence of ID based on public service use and to explore how this method can be used to better monitor the population with ID. STUDY DESIGN Explorative data linkage study using the Dutch population register and databases from public services accessible with an ID diagnosis. METHODS The overall prevalence of ID in the Dutch adult population was estimated, specified by age group and sex, and the identified ID groups were also characterised by their support needs. Participants included the entire adult Dutch population who were alive on 1 January 2015. RESULTS After linking databases, 187,149 adults with ID were identified within a population of almost 12.7 million Dutch adults, giving an ID prevalence estimate of 1.45%. Prevalence of ID was higher among males (1.7%) than females (1.2%). Most individuals with ID were identified through the use of residential care services (n = 91,064; 0.7%). Non-residential ID-related care was used by 27,007 individuals (0.2%). Social, employment or income support due to a (mild) ID was received by 69,078 individuals (0.5%); the mean age in these ID groups was between 8 and 10 years which is younger than that in the general Dutch population. ID prevalence declined with increasing age across all ID subgroups. CONCLUSIONS The ID prevalence in The Netherlands, as determined by ID-related public service usage, aligns with international estimates. This suggests that national supportive services are accessible and used by individuals with ID. Moreover, this demonstrated that databases from national supportive services can be a useful resource to identify individuals with ID at the population level and can enable structural monitoring of the ID population through linking national databases.
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Affiliation(s)
- Maarten Cuypers
- Radboud Institute for Health Sciences, Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Hilde Tobi
- Biometris, Wageningen University & Research, Wageningen, The Netherlands
| | - Jenneken Naaldenberg
- Radboud Institute for Health Sciences, Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Geraline L Leusink
- Radboud Institute for Health Sciences, Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
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Yang L, Peng W. Prevalence and Factors Associated With Body Pain: Results of a Nationally Representative Survey of 9,586 Chinese Adults Aged 60 and Over. Front Public Health 2021; 9:634123. [PMID: 33763400 PMCID: PMC7982579 DOI: 10.3389/fpubh.2021.634123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 02/16/2021] [Indexed: 11/21/2022] Open
Abstract
Background: Pain management has become a critical problem worldwide with the aging population. More than half of older people have experienced pain with different severity. The aim of this research is to identify the characteristics of older people with body pain and the associations between pain and characteristics of demographic, health status, and health services use amongst Chinese seniors. Methods: This cross-sectional study was based on the China Health and Retirement Longitudinal Study (CHARLS), using follow-up survey data in 2015. The national survey comprised 20,284 women and men aged 45 years or older who completed questionnaires. Data of older people who were asked whether they had troubles with body pain were extracted and analyzed. Multiple logistic regression modeling was used to determine the important indicators (demographic, health status, and health services use) amongst Chinese elderly with pain. Results: Analyses revealed that 32.5% (n = 9,586) of Chinese people aged over 60 reported having body pain. Pain is positively associated with female gender (OR = 2.08, 95% CI 1.80-2.39, p < 0.001), living in non-urban areas (OR = 1.49, 95% CI 1.25-1.77, p < 0.001), having physical disabilities (OR = 1.45, 95% CI 1.15-1.82, p = 0.002), diagnosed with stomach diseases (OR = 1.40, 95% CI 1.20-1.64, p < 0.001), diagnosed with arthritis (OR = 1.91, 95% CI 1.66-2.20, p < 0.001), self-rating with poor health status (OR = 7.03, 95% CI 5.63-8.78, p < 0.001), self-purchased over-the-counter western medications (OR = 1.50, 95% CI 1.30-1.73, p < 0.001) and self-purchased Chinese herbal medicine (OR = 1.52, 95% CI 1.24-1.85, p < 0.001). Conclusion: Body pain is common amongst the Chinese elderly. This research highlights the need for further nationwide studies exclusively focusing on people with pain including the elder population, and provides evidence-based insights for healthcare providers and policy-makers, to improve the quality of pain management. Future research should also pay attention to the importance of health literacy for health outcomes with regard to pain management.
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Affiliation(s)
- Lu Yang
- Faculty of Sociology and Population Sciences, Nanjing University of Posts and Telecommunications, Nanjing, China
| | - Wenbo Peng
- Faculty of Health, Australian Research Centre in Complementary and Integrative Medicine, School of Public Health, University of Technology Sydney, Sydney, NSW, Australia
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