Household mold exposure and arthritis in older Chinese adults: evidence from the Chinese Longitudinal Healthy Longevity Survey (CLHLS).

Association between mold exposure and depressive symptoms among Chinese older adults: Results from the Chinese Longitudinal Healthy Longevity Survey (CLHLS).

The impact of indoor environmental quality on the health of older adults is becoming increasingly evident in the context of an aging population. Mold exposure, a common source of residential environmental hazards, may pose a significant threat to self-rated health in older adults. This study aimed to investigate the relationship between mold exposure and self-rated health in older adults, considering the mediating role of anxiety and the moderating role of indoor ventilation frequency. Data from the 2018 Chinese Longitudinal Healthy Longevity Survey (CLHLS) were used, including 9435 subjects aged 65 and above. These relationships were explored by using Spearman correlation analysis and moderated mediation analysis. Mold exposure has a direct negative impact on the self-rated health of the old adults (β= -0.217, 95%CI= -0.266, -0.167). Anxiety partly mediates this relationship. The frequency of indoor ventilation is a moderating factor for mold exposure and anxiety (β= -0.053, p < 0.01). Mold exposure was found to be significantly negatively associated with self-rated health among older adults. Anxiety plays a mediating role in it, and the indoor ventilation frequency moderates the relationship between mold exposure and anxiety. The findings suggest that a combination of implementing mental health interventions and increasing the frequency of indoor ventilation may be effective in moderating the path of association between mold exposure and self-rated health status in older people.

Hearing loss is a highly prevalent sensory disability in older adults and has been increasingly linked to adverse mental health outcomes. However, longitudinal evidence on its association with depression, particularly in low- and middle-income countries, remains limited. The objective of this study was to examine the prospective association between baseline self-perceived hearing loss and the onset of depression in older Chinese adults and to explore whether this association varies across demographic and clinical subgroups. In this prospective cohort study, we analyzed data from 2,324 community-dwelling adults aged ≥ 65 years who participated in the Chinese Longitudinal Healthy Longevity Survey. Self-perceived hearing status and depressive symptoms were assessed at baseline and during follow-up. The primary outcome was time to depression onset. Kaplan-Meier survival analysis and Cox proportional hazards models were used to estimate hazard ratios (HRs) for incident depression. Models were progressively adjusted for sociodemographic, lifestyle, and health-related covariates. Stratified and interaction analyses were performed to examine potential effect modifiers. Baseline self-perceived hearing loss was significantly associated with an increased risk of incident depression (adjusted HR > 1.00, p < .001). This association remained statistically significant after adjusting for measured sociodemographic, lifestyle, and health-related covariates, although residual confounding from unmeasured factors cannot be excluded. Stratified Cox models showed consistent effects across subgroups defined by age, sex, and other clinical characteristics. No statistically significant interactions were detected. Participants with hearing loss had shorter depression-free survival than those with normal hearing. This study demonstrates that self-perceived hearing loss is independently associated with an increased risk of depression after adjusting for measured covariates. These findings highlight the importance of considering hearing health in care for older adults, though interpretations should account for the subjective nature of the hearing measure used. https://doi.org/10.23641/asha.31580260.

Exposure to mold and solid cooking fuels represents a significant environmental health concern, contributing substantially to indoor air pollution among elderly populations. However, the association between mold exposure, household fuel use, and mental health remains poorly understood. Here we examine individual and joint associations of these exposures on depression, anxiety, and their co-occurrence in older adults. We evaluated 9,243 elderly participants from the eighth survey wave of the Chinese Longitudinal Healthy Longevity Survey (CLHLS) to explore the associations between mold exposure, solid fuel use, and depression, anxiety, and their co-occurrence. Multivariable logistic regression models were employed to quantify these relationships, with adjusted odds ratios (aOR) and 95% confidence intervals (CI) reported. The study identified a depression prevalence of 13.61% and an anxiety prevalence of 11.79%. Participants exposed to mold demonstrated significantly higher odds of depression (OR = 2.26, 95% CI = 1.93-2.63), anxiety (OR = 2.11, 95% CI = 1.80-2.48), and their co-occurrence (OR = 2.58, 95% CI = 2.10-3.16), compared to participants without mold exposure. Moreover, the use of solid fuels for cooking, as opposed to clean fuels, was correlated with higher occurrence of depression (OR = 1.27, 95% CI = 1.10-1.47), anxiety (OR = 1.31, 95% CI = 1.12-1.52), and their co-occurrence (OR = 1.36, 95% CI = 1.10-1.67). Notably, solid fuel use appeared to attenuate the association between mold exposure and anxiety (Relative excess risk due to interaction [RERI] = -0.22, 95% CI = -0.44, -0.01). The study found that exposure to mold and use of solid fuels may be associated with higher prevalence of depression, anxiety, and their co-occurrence. Further prospective studies are warranted to validate our findings.

BackgroundOwing to an increase in life expectancy, it is common for the older adults to suffer from chronic diseases that can result in disability and a low quality of life. This study aimed to explore the influence of chronic diseases and multimorbidities on activities of daily living (ADLs) and instrumental ADLs (IADLs) in an older Chinese population.MethodsBased on the Chinese Longitudinal Healthy Longevity Survey (2018), 9,155 older adults aged 65 years and above were included in the study. A self-administered questionnaire was used to collect information on demographic characteristics, chronic diseases, ADLs, and IADLs. The impact of factors affecting ADL and IADL impairment in older adults was analysed using binary logistic regression.ResultsIn total, 66.3% participants had chronic diseases. Hypertension, heart disease, arthritis, diabetes and cerebrovascular disease were among the top chronic diseases. Of these, 33.7% participants had multimorbidities. The most common combination of the two chronic diseases was hypertension and heart disease (11.2%), whereas the most common combination of the three chronic diseases was hypertension, heart disease, and diabetes (3.18%). After categorising the older adults into four age groups, dementia, visual impairment, and hearing impairment were found to be more prevalent with increasing age. The prevalence of hypertension, heart disease, cerebrovascular disease, gastrointestinal ulcers, arthritis and chronic nephritis gradually increased with age until the age of 75 years, peaked in the 75–84 years age group, and then showed a decreasing trend with age. Multimorbidity prevalence followed a similar pattern. Regression analysis indicated that the increase in age group and the number of chronic diseases independently correlated with impairments in ADL as well as IADL. Additionally, gender, physical activity, educational background, obesity, depressive symptoms, and falls also had an impact on ADLs or IADLs.ConclusionChronic diseases and multimorbidities are common in older adults, and it is important to note that aging, multimorbidity, obesity, and unhealthy lifestyle choices may interfere with ADLs or IADLs in older adults. Therefore, it is imperative that primary healthcare providers pay special attention to older adults and improve screening for multimorbidity and follow-up needs.

BackgroundPrevious studies suggest that frailty increases the risk of mortality, but the risk of cardiovascular disease (CVD) and all-cause mortality in Chinese community-dwelling older adults remains understudied. Our aim was to explore the effect of frailty on cardiovascular and all-cause mortality in older adults based on a large-scale prospective survey of community-dwelling older adults in China.MethodsWe utilized the 2014–2018 cohort of the Chinese Longitudinal Healthy Longevity Survey and constructed a frailty index (FI) to assess frailty status. Propensity score matching was used to equalize the baseline characteristics of participants to strengthen the reliability of the findings. Hazard ratios and 95% confidence intervals (CIs) were estimated using multivariate Cox models, adjusting for potential confounders, to assess the association between frailty and cardiovascular and all-cause mortality. The relationship between frailty and cardiovascular mortality was further explored using a competing risk model considering death as a competing event. The dose–response relationships between them were estimated using restricted cubic spline models.ResultsThe results of the multivariate Cox model found that the frailty group had a higher risk of CVD mortality (1.94, 95% CI: 1.43–2.63) and all-cause mortality (1.87, 95% CI: 1.63–2.14) in compared with the non-frailty group. The multivariate competing risks model suggested a higher risk of CVD mortality in the frailty group (1.94, 95% CI: 1.48–2.53). The analysis found no non-linear relationship between FI and the risk of CVD mortality but a non-linear dose–response relationship with the risk of all-cause mortality.ConclusionsFrail older adults demonstrated a stronger risk of CVD and all-cause mortality. Reversing frailty in older adults is therefore expected to reduce the risk of death in older adults.

Objectives. To comprehensively analyze the prevalence of chronic diseases (hypertension, lung disease, diabetes, stroke, cancer, and heart disease) among older Chinese people. Methods. This study utilized data from 5 waves (2002, 2005, 2008, 2018, and 2022) of the Chinese Longitudinal Healthy Longevity Survey. We estimated prevalence rates using Poisson regression and Bayesian models from the DemoRates R-package and weighted according to the China population censuses. Results. The prevalence of most chronic diseases decreased in the first period and then increased substantially in the second period. Interestingly, the COVID-19 pandemic saw a decrease in the prevalence of most chronic diseases. Notably, hypertension was the most prevalent chronic condition among older adults, with a prevalence rate as high as 45.27% in 2018, and cancer exhibited the most significant increase in prevalence during the second period, with an average annual increase of 11.03%. Conclusions. Chronic disease prevalence among older Chinese adults exhibited dynamic and complex trends, influenced by socioeconomic factors, health care access, and public health emergencies. These findings highlight the importance of targeted interventions tailored to specific diseases, demographics, and regions. (Am J Public Health. 2025;115(12): 2053-2061. https://doi.org/10.2105/AJPH.2025.308245).

Depression and anxiety are prevalent mental health issues among older adult widowed adults. However, the symptom-level relationships between these conditions remain unclear. Due to the high correlations and complex relationships among various symptoms, this study employs network analysis to explore differences in the network structures of depression and anxiety symptoms between widowed and non-widowed older adults. Propensity score matching was used to identify widowed older adults with similar demographic characteristics. Data from 1,736 widowed and 1,736 matched controls were analyzed using the Chinese Longitudinal Healthy Longevity Survey (2017-2018). Depression and anxiety were measured by the Center for Epidemiologic Studies Depression Scale-10 (CESD-10) and the seven-item Generalized Anxiety Disorder Scale (GAD-7), respectively. Central and bridge symptoms were evaluated using expected influence (EI) and bridge expected influence (BEI), respectively. Network analysis revealed similarities in central symptoms between widowed and non-widowed older adults, with both groups exhibiting "Feeling depressed or down" (CESD3), "Feeling tense and having difficulty relaxing" (GAD4), and "Being unable to stop or control worrying" (GAD2) as core symptoms. However, differences emerged in bridge symptoms. In the widowed group, "Feeling anxious, worried, or distressed" (GAD1) was most strongly connected to "Felt lonely" (CESD8); "Worrying too much about various things" (GAD3) was strongly linked to "Feeling increasingly exhausted and useless with age" (CESD4); and "Feeling depressed or down" (CESD3) had a strong association with "Becoming easily annoyed or irritable" (GAD6). In the non-widowed group, "Feeling anxious, worried, or distressed" (GAD1) exhibited the strongest association with "Having good sleep quality" (CESD10); "Getting upset over small matters" (CESD1) was closely connected to "Feeling anxious, worried, or distressed" (GAD1); and "Worrying too much about various things" (GAD3) was most strongly connected to "Feeling depressed or down" (CESD3). Common central and bridge symptoms highlight universal intervention targets. Addressing "Feeling depressed or down" in widowed and "Getting upset over small matters" in non-widowed older adults may help prevent depression-anxiety comorbidity. These findings support targeted interventions to improve mental health outcomes. Future research should evaluate tailored intervention effectiveness.

Background and AimHearing impairment is a commonly reported chronic condition among older adults. Hearing impairment is significantly associated with reduced quality of life and diminished function status. This study aimed to investigate the association between hearing impairment and mental health among Chinese older adults, with a focus on exploring the moderating effects of social participation and exercise on this association.MethodsThe data of this study were obtained from the 2018 wave of Chinese Longitudinal Healthy Longevity Survey (CLHLS). We employed ordinary least squares regression models to analyze the effect of hearing impairment on mental health. Propensity score matching (PSM) and doubly robust estimation were employed to conduct robustness checks.ResultsHearing impairment produced an adverse effect on Mini-Mental State Examination (MMSE) score (coefficient = −1.4073, p < 0.001), while it had a positive effect on depression score (coefficient = 0.8682, p < 0.001). Further analyses using PSM and doubly robust estimation reported similar results. Moreover, social participation (coefficient = 0.9424, p < 0.001) and exercise (coefficient = 0.7001, p < 0.01) moderated the association between hearing impairment and MMSE score. Social participation (coefficient = −0.5991, p > 0.05) and exercise (coefficient = 0.7806, p > 0.05) did not moderate the association between hearing impairment and depression score.ConclusionWe provide robust evidence indicating that hearing impairment had significantly negative effects on the cognitive function and depression status of older adults. Furthermore, we find that social participation and exercise relieved the negative effect of hearing impairment on cognitive function.

China has aimed to establish a universal health care system through a comprehensive health reform since 2009. However, knowledge about the association between basic social insurances and preventive care utilization (PCU) among Chinese older adults, especially as primary coverage, remains limited. This study investigates these associations using data from the 2018 Chinese Longitudinal Healthy Longevity Survey. We analyzed 9,952 older adults with major medical coverage from urban employee/resident insurance (UE/URBMI), cooperative medical programs (New Rural Cooperative Medical System; NCMS), or self-payment (SP). Propensity score matching (PSM) enhanced comparability between UE/URBMI or NCMS and a control group with SP coverage. Subsequent logistic regression examined associations between major medical expense coverage and PCU for older adults with NCMS + SP (n = 6,580) and UE/URBMI + SP (n = 5,248) groups, respectively. NCMS participants had higher odds of reporting PCU compared to SP users (odds ratio: 1.57, 95% CI: 1.40-1.75, P < .001). Conversely, no significant association was observed in the UE/URBMI + SP group (odds ratio: 1.08, 95% CI: 0.93-1.24, P > .05). This study highlights diverse associations between health insurance types and PCU among older adults. Empirical results suggest sustained government-led health insurance reform may need to continue progressing to strengthen financial incentives for PCU within the social insurance framework.

Comparing network structures of depressive and anxiety symptoms between demographically-matched heart disease and heart disease free samples using propensity score matching: Findings from the Chinese Longitudinal Healthy Longevity Survey (CLHLS)

BackgroundThe association of changes in waist circumference (WC), waist-to-height ratio (WHtR) and weight-adjusted-waist index (WWI) with subsequent risk of multimorbidity remains unclear among older Chinese adults. Therefore, we aimed to assess this association by utilizing data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS).MethodsOur study was based on the 2011/2012 wave of the CLHLS whose follow-up surveys were conducted in 2014 and 2017/2018. A total of 2900 participants aged 65 and above at baseline were enrolled. WC, WHtR, and WWI were calculated from measured height, weight, and waist circumference. Multimorbidity refers to the coexistence of two or more of 18 chronic diseases. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (95%CIs) to evaluate the effect of three-year changes in WC, WHtR, and WWI on the risk of multimorbidity.ResultsDuring a mean follow-up time of 4.2 (2.0) years, 906 multimorbidity cases were identified. Compared to participants in the persistently low WC group, those in the WC gain group and the persistently high WC group had a higher multimorbidity risk with adjusted HRs (95%CI) of 1.23 (1.01–1.50) and 1.34(1.14–1.58), respectively. Participants in the WHtR gain group and the persistently high WHtR group also had higher risks of multimorbidity with HRs (95%CI) of 1.35 (1.08–1.67) and 1.27 (1.05–1.53), respectively, relative to the persistently low WHtR group. Compared to the persistently low WWI group, those in the WWI loss group had a lower risk of multimorbidity with HRs (95%CI) of 0.80 (0.66–0.98). For every standard deviation increase in WC, WHtR, and WWI over three years, the risk of multimorbidity was higher by 12% (95%CI: 1.05–1.19), 13% (95%CI: 1.06–1.20), and 12% (95%CI: 1.05–1.20), respectively.ConclusionsAssociations of changes in WC, WHtR and WWI with multimorbidity are significant among older Chinese adults. The findings highlight the importance of evaluating changes in WC, WHtR, and WWI in screening and prevention of multimorbidity in older adults.

Tooth Loss Trajectories and Their Association with Functional Disability among Older Chinese Adults: Results from the Chinese Longitudinal Healthy Longevity Survey

It remains unclear whether limitations in activities of daily living (ADL) increase the risk of stroke in older Chinese adults. This longitudinal study used data from the Chinese Longitudinal Healthy Longevity Survey to investigate the effects of limitations in ADL on the incidence of stroke in older adults. Between 2002 and 2011, 46,728 participants from 22 provinces in China were included in this study. Of participants, 11,241 developed limitations in ADL at baseline. A 3-year follow-up was performed to determine the incidence of stroke. During the 3-year follow-up, 929 participants (8.26%) and 2434 participants (6.86%) experienced stroke in the ADL limitations group and non-ADL limitations group, respectively. Logistic regression was used to analyze the effect of ADL limitations on the risk of stroke. The results showed that after adjusting for the confounding factors gender, age, weight, hypertension, diabetes, heart disease, natural teeth, hearing impairment, visual impairment, smoking, alcohol abuse, exercise, ethnicity, literacy, residential area, and poverty, the ADL limitations group had a 77% higher risk of developing stroke than the non-ADL limitations group. After propensity score matching, the ADL limitations group still had a 33% higher risk of developing stroke than the non-ADL limitations group (OR = 1.326, 95% CI: 1.174-1.497). These findings suggest that limitations in ADL are a stroke risk factor.

Depression and anxiety are global public health challenges among older adults. Square dancing, a popular activity for older Chinese adults, is believed to relieve these disturbances. This study compared the prevalence, severity, and network structures of depression and anxiety among older square dancers versus non-dancers (i.e., those who do not engage in square dancing). Propensity score matching (PSM) created square dancer and non-dancer groups using data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Depressive and anxiety symptoms were assessed with the 10-item Center for Epidemiological Studies Depression Scale (CESD-10) and the 7-item Generalized Anxiety Disorder Scale (GAD-7), respectively. Central symptoms and bridge symptoms were estimated in each group using expected influence (EI) and bridge EI, respectively. The study included 401 square dancers and a matched sample of 1163 non-dancers. The prevalence and severity of depression and anxiety were significantly lower among square dancers compared to non-dancers. In contrast, network structures of depressive and anxiety symptoms were similar between the two groups. "Uncontrollable worrying" and "Felt sadness" were the most central symptoms, and "Nervousness", "Bothered by things" and "Felt nervous/fearful" were key bridge symptoms across both groups. Participation in square dancing is associated with reduced overall prevalence and severity of depression and anxiety among older adults, but is not associated with a unique network structure of these syndromes compared to non-participation. Consequently, psychosocial interventions developed for depression and anxiety based on the network structure of non-dancers may also be applicable for square dancers who experience anxiety and depression.