Associations between hypertension care cascade, cognitive function, and cardiovascular disease in middle-aged and older adults: the exacerbated role of social isolation.

Although the association between social isolation and the risk of subsequent cardiovascular disease (CVD) is well documented, most studies have only assessed social isolation at a single time point, and few studies have considered the association using repeatedly measured social isolation. This study aimed to examine the association between social isolation trajectories and incident CVD in a large cohort of middle-aged and older adults. This study used data from 4 waves (wave 1, wave 2, wave 3, and wave 4) of the China Health and Retirement Longitudinal Study. We defined the exposure period as from June 2011 to September 2015 (from wave 1 to wave 3) and the follow-up period as from September 2015 to March 2019 (wave 4). On the basis of the inclusion and exclusion criteria, our final analytic sample included 8422 individuals who had no CVD in the China Health and Retirement Longitudinal Study in waves 1 to 3 and were fully followed up in wave 4. Social isolation was ascertained using an extensively used questionnaire at 3 consecutive, biennial time points from waves 1 to 3, and individuals were assigned to 3 predefined social isolation trajectories based on their scores at each wave (consistently low, fluctuating, and consistently high). Incident CVD included self-reported physician-diagnosed heart disease and stroke combined. Cox proportional hazard models estimated the associations of social isolation trajectories with risks of incident CVD, adjusting for demographics, health behaviors, and health conditions. Of the 8422 participants (mean age 59.76, SD 10.33 years at baseline), 4219 (50.09%) were male. Most of the participants (5267/8422, 62.54%) had consistently low social isolation over time and 16.62% (1400/8422) of the participants had consistently high social isolation over the exposure period. During the 4-year follow-up, 746 incident CVDs occurred (heart disease: 450 cases and stroke: 336 cases). Compared with individuals with consistently low social isolation, those with fluctuating social isolation (adjusted hazard ratio 1.27, 95% CI 1.01-1.59) and consistently high social isolation (adjusted hazard ratio 1.45, 95% CI 1.13-1.85) had higher risks for incident CVD after adjusting for demographics (ie, age, sex, residence, and educational level), health behaviors (ie, smoking status and drinking status), and health conditions (ie, BMI; history of diabetes, hypertension, dyslipidemia, chronic kidney disease; use of diabetes medications, hypertension medications, and lipid-lowering therapy; and depressive symptoms scores). In this cohort study, middle-aged and older adults with fluctuating and consistently high social isolation exposure had higher risks of the onset of CVD than those without the exposure. The findings suggest that routine social isolation screenings and efforts to improve social connectedness merit increased attention for preventing CVD among middle-aged and older adults.

Social isolation mediates association between depressive symptoms and cognitive function: Evidence from China health and retirement longitudinal study.

The Relationship Between Sleep Duration and Cardiovascular Disease: A Prospective Cohort Study Based on Charls.

Social isolation is increasingly recognized as a fundamental determinant of health. This study aimed to comprehensively examine the associations between social isolation trajectories spanning from childhood through adulthood and the risk of incident cardiovascular disease (CVD) among middle-aged and older adults in China, while further exploring the potential mediating role of depressive symptoms in these relationships. We analyzed data from 6858 participants using the 2014 life-course survey and 2015-2020 follow-up waves of the China Health and Retirement Longitudinal Study (CHARLS). Trajectories were constructed based on the cross-classification of social isolation status in childhood and adulthood. Exposures were assessed using cumulative composite scores, and incident CVD outcomes were identified via self-reported physician diagnoses. Multivariable logistic regression models were applied to estimate the odds of incident CVD, alongside mediation analyses to quantify potential indirect effects. Subgroup analyses and a comprehensive set of sensitivity analyses were additionally conducted to assess the robustness of the findings. Four distinct life-course social isolation trajectories were identified: no isolation, childhood-only, adulthood-only, and persistent isolation. Persistent social isolation was associated with significantly elevated odds of incident CVD (OR = 1.53, 95% CI: 1.16-2.01). Mediation analyses indicated that depressive symptoms accounted for a meaningful proportion of this association, explaining 16.28% of the relationship with CVD and 14.70% of the association with stroke. Analyses of secondary outcomes further demonstrated that childhood social isolation (OR = 1.44, 95% CI: 1.16-1.79), childhood-only isolation (OR = 1.36, 95% CI: 1.08-1.72), and persistent isolation (OR = 1.79, 95% CI: 1.19-2.71) were each independently associated with increased odds of incident stroke. Persistent social isolation was associated with an increased risk of incident CVD among middle-aged and older adults in China, with this relationship being partially mediated by depressive symptoms. These findings underscore the importance of incorporating long-term psychosocial assessments into CVD risk stratification and management strategies.

BackgroundEpidemiological studies have shown that social isolation, which is prevalent in older adults, is associated with a range of adverse health outcomes, but the prevalence of and trends in regard to social isolation remain ambiguous in China. The aim of this study was to elucidate the trends regarding the prevalence of social isolation among middle-aged and older adults in China from 2011 to 2018 and to further identify associated risk factors.MethodsA repeated cross-sectional study, The data were derived from panel sample data of four waves conducted from May 2011 to August 2018 in the nationally representative China Health and Retirement Longitudinal Study (CHARLS) using multistage probability sampling. Social isolation was ascertained by the five item Steptoe Social Isolation Index. The potential covariates were demographic characteristics, lifestyle factors, and health status. Linear-by-linear association was used to assess the trends in regard to social isolation over time under the influence of the potential covariates. Linear-by-linear association and an age-period-cohort analysis were used to explore the trends, and two-level (time, individual) generalized estimating equation models (GEE) linked multivariate binary logistic regression were performed to identify risk factors.ResultsA high prevalence of social isolation and a moderate upward trend from 2013 to 2018 were observed among a U-shaped trend prevalence of social isolation from 2011 to 2018 across China, with rates of 38.09% (95% CI = 36.73–39.45) in 2011, 33.66% (32.32–35.00) in 2013, 39.13% (37.59–40.67) in 2015, and 39.95% (38.59–41.31) in 2018 (p < 0.001). The prevalence of social isolation increased with age and educational attainment. Females had a higher prevalence than males. The prevalence of social isolation was found to be significantly lower in pensioners than in non-pensioners between 2011 and 2018 (p < 0.001). The prevalence of social isolation was 38.9%, 34.9%, 38.5%, and 44.08% about three times higher among those who doid not use the Internet and 13.44%, 11.64%, 12.93%, and 16.73% than among those who doid in 2011, 2013, 2015 and 2018 respectively. The participants with short (0–5 h) and long sleep (9 or more hours), and poor self-rated health had a higher prevalence of social isolation than the others. Older age, lower educational attainment, living in a rural region, lack of medical insurance or pension, lack of internet use and poor health were risk factors (p < 0.05). ConclusionsWe found a U-shaped prevalence of social isolation trends from 2011 to 2018 and revealed increasing trends from 2013 to 2018 among middle-aged and older adults in China. The findings of the study highlight the urgent need for interventions to reduce social isolation including improving sleep quality and internet skills. Disadvantaged groups in terms of age, economic status, and health status should be the focus of such interventions, especially in the era of COVID-19.

Social isolation and depression onset among middle-aged and older adults in China: Moderating effects of education and gender differences

Adverse childhood experiences (ACEs) are among the factors affecting cognitive function in middle-aged and older adults, but the combined effects of ACEs, social isolation and functional limitations on cognitive function have not been fully explored. This study used data from 6412 middle-aged and older adults from the 2018 China Health and Retirement Longitudinal Study (CHARLS) and the 2014 CHARLS Life Histories Survey. Mplus 8.0 software was used to construct a structural equation model with ACEs as the independent variable, cognitive function as the dependent variable, and social isolation and functional limitations as mediating variables. In this study, ACEs were positively associated with social isolation and functional limitations (r = 0.081, 0.070, P < 0.01) and negatively associated with cognitive function (r = − 0.132, P < 0.01). Social isolation and functional limitations had chain mediating effects on the relationship between ACEs and cognitive function. ACEs lead to impaired cognitive functioning in middle-aged and older adults, and social isolation and functional limitations influence this relationship. These findings suggest that promoting social integration and physical exercise targeting functional limitations may be important approaches for preventing and mitigating the effects ACEs on cognitive function.Supplementary InformationThe online version contains supplementary material available at 10.1038/s41598-025-12822-w.

Social Disconnection in Late Life Mental Illness – Commentary From the National Institute of Mental Health

This study aimed to investigate the independent and interactive associations of social isolation and a healthy lifestyle on intrinsic capacity (IC) among older adults in China. A longitudinal cohort study was conducted using data from the China Health and Retirement Longitudinal Study (CHARLS), spanning three waves (2011, 2013, and 2015) and involving adults aged 60 years and older. A total of 4495 older adults with complete data on IC, social isolation, healthy lifestyle, and relevant covariates at baseline were included in the final analysis. IC was assessed using a composite score across five domains: locomotor, cognitive, sensory, vitality, and psychological. Social isolation was measured using an index based on living arrangements, marital status, contact with children, and social participation. A healthy lifestyle was defined based on five factors: smoking, alcohol consumption, physical activity, sleep duration, and body mass index (BMI). Multiple linear regression and linear mixed-effects models were used to examine cross-sectional and longitudinal associations. Interactive terms between social isolation and a healthy lifestyle were analyzed. Sensitivity analyses were performed by stratifying participants by age and gender. At baseline, 31.0%, 62.3%, and 6.7% of participants had social isolation scores of 0, 1-2, and 3-4, respectively, while 28.5%, 37.0%, and 34.6% had healthy lifestyle scores of 0-2, 3, and 4-5, respectively. Compared to participants with no social isolation (score=0), the IC scores decreased for participants with social isolation scores of 1-2 and 3-4 (β=-0.36, 95% confidence interval [CI]: -0.42 to -0.30) and (β=-0.65, 95% CI: -0.77 to -0.53), respectively. In contrast, adherence to a healthy lifestyle was associated with improved IC (β=0.27, 95% CI: 0.20 to 0.34 for score 3; β=0.54, 95% CI: 0.47 to 0.60 for score 4-5). Interactive analysis showed that a healthy lifestyle mitigated the adverse associations of social isolation on IC, but this protective effect weakened as social isolation increased. Sensitivity analyses confirmed the robustness of these findings. This study identified significant associations between social isolation, healthy lifestyle, and intrinsic capacity in older Chinese adults. Social isolation was negatively associated with IC, while a healthy lifestyle was positively associated with IC. The observed interaction between social isolation and healthy lifestyle highlights the importance of integrated interventions targeting both social engagement and health behaviors in supporting IC during aging.

Background: China’s rapidly aging population presents challenges for cognitive health and mental well-being among the older adults. This study examines how the number of children affects cognitive function in middle-aged and older adults and whether depressive symptoms mediate this relationship. Methods: This study analyzed data from waves 1 to 5 (2011–2020) of the China Health and Retirement Longitudinal Study (CHARLS), involving 5932 participants aged 45 and older. Participants were grouped by the number of children: childless, only child and multiple children. We used Logarithmic Generalized Linear Models (LGLMs) to explore the relationships among the number of children, depressive symptoms, and cognitive function. Indirect effect coefficients and 95% bias-corrected and accelerated confidence intervals (BCaCI) were estimated using Simultaneous Equation Models (SEM) with three-stage least squares (3SLS) and the bootstrap method to assess the mediating effect of depressive symptoms. Results: In middle-aged and older adults, a negative association was observed between the number of children and overall cognitive functioning (all p < 0.01). This association remained significant even after adjusting for covariates in groups with three (β = −0.023, p < 0.05) and four or more children (β = −0.043, p < 0.001). Conversely, the positive association between the number of children and depression also persisted after adjusting for covariates, although it weakened as the number of children increased (all p < 0.01). Depressive symptoms consistently correlated negatively with overall cognitive function (p < 0.001) and partially mediated the relationship between the number of children and cognitive function (pMe = 20.36%, p < 0.05). The proportion of the mediating effect attributed to depression was more pronounced in middle-aged and older adults who had experienced the loss of children (pMe = 24.31%) or had two children (pMe = 25.39%), with stronger mediating effects observed in males (pMe = 48.84%) and urban residents (pMe = 64.58%). Conclusions: The findings indicate that depressive symptoms partially mediate the relationship between the number of children and cognitive function in middle-aged and older adults in China. These results highlight the significance of considering mental health factors when studying cognitive function in this demographic. Notably, in families without children and those with two children, depressive symptoms play a crucial role in explaining the decline in cognitive function.

older adults have increased risk of social isolation, loneliness and cognitive functioning impairment, but the relationships among these factors are not conclusive. We investigated the potential mediation mechanism of loneliness on the association between social isolation and cognitive functioning among Chinese older adults within their cultural context. secondary analysis of the baseline wave (2011-12) of the harmonised China Health and Retirement Longitudinal Study. community-dwelling older adults in China (N= 7,410 participants aged 60-101years). we applied a multiple indicator multiple cause approach to determine whether the construct of social isolation is well defined by four indicators (social activity engagement, weekly adult children contact, caregiving for grandchildren and living alone) and used structural equation modelling to examine the direct and indirect effects among variables of interest. the results demonstrated that social activity engagement, weekly adult children contact and caregiving for grandchildren were significantly related to social isolation (β = -0.26 to -0.28) (Living alone was fixed to 1 for model identification.) The indirect effect of social isolation on cognitive functioning through loneliness was significant (β = -0.15), indicating loneliness was an important mediator. However, the direct effect of social isolation on cognitive functioning also remained significant (β = -0.83), suggesting a partial mediation effect. our study highlights the mediation role of loneliness in the relationship between social isolation and cognitive functioning among Chinese older adults. The findings support the beneficial effects of maintaining social relations and coping with feelings of loneliness on older adults' cognitive functioning.

Estimating the joint effect of household solid fuel use and social isolation on depression among middle-aged and older adults in China

Given that there is limited research examining the specific role social isolation plays in stroke risk, we aimed to estimate the controlled direct effect of social isolation on stroke risk in China. A nationally representative sample (n = 12,662) of persons aged 45 years or more at baseline (2011), with corresponding follow-ups in 2013 and 2015, was taken from the China Health and Retirement Longitudinal Study. Stroke was assessed through a self- or proxy-reported physician's diagnosis. Social isolation was measured by incorporating marital status, frequency of contact with friends, family, and children, and participation in social activities. A marginal structural model with stabilized inverse probability weights was applied to examine the controlled direct effect of social isolation on stroke risk. Overall, 245 persons had a stroke within the 4-year timeline under study. The total effect model indicated that persons experiencing social isolation had a 64% increased risk of stroke (odds ratio (OR) = 1.64, 95% confidence interval (CI): 1.26, 2.13). Results from the marginal structural model also indicated that socially isolated persons had an increased risk of stroke (OR = 2.39, 95% CI: 1.49, 3.82) after adjustment for depression. Interventions to reduce social isolation may be particularly beneficial in preventing the occurrence of stroke among middle-aged and older adults in China.

This study investigates the bidirectional relationship between social isolation and cognitive function among older adults in China, utilizing data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS). The baseline survey, which commenced in 2008, tracked 1,662 participants over four waves of data collection spanning a decade. We employed Cross-Lagged Panel Models (CLPM) and Random Intercept Cross-Lagged Panel Models (RI-CLPM) to analyze these relationships at both the between-person and within-person levels. CLPM results indicated significant cross-lagged effects between social isolation (β = − 0.119, p < 0.001; β = − 0.162, p < 0.001) and cognitive function (β = − 0.073, p < 0.001; β = − 0.091, p < 0.001) at the between-person level over the last three waves. Specifically, higher prior levels of social isolation were associated with a significant decline in subsequent cognitive function, and vice versa. Furthermore, RI-CLPM results showed that, after controlling for random intercepts and covariates, only social isolation had a significant negative impact on cognitive function across all waves (β = − 0.051, p < 0.05; β = − 0.047, p < 0.05; β = − 0.028, p < 0.05). Overall, this study demonstrates that, when considering both between-person and within-person effects, social isolation exerts a stronger lag effect on cognitive function among older adults in China. This suggests that, over a specific timeframe, reducing social isolation is crucial for promoting healthy aging in this population.

This study examined the association between childhood conditions and cognitive function among middle-aged and older adults in China. We analyzed data from the 2011 China Health and Retirement Longitudinal Study ( N = 11,868). Cognitive function was measured by word recall, a test of episodic memory. We examined the association between childhood conditions and cognitive function among the middle-aged (45-59 years) and the older (60 years and older) adults separately, using multilevel linear regressions. Indicators of childhood socioeconomic status (SES) and nutrition were significantly associated with memory performance among the middle-aged and the older adults in China. Adulthood SES, education in particular, accounted for some but not all the associations. The protective effect of childhood urban residence was stronger for middle-aged women than for middle-aged men. Childhood conditions are significantly associated with mid- to late-life cognitive function in China. The strengths of the associations may vary by gender and cohort.