Multilevel model analysis of factors influencing cognitive impairment in middle-aged and elderly adults in rural areas

BI Shengxian; WANG Qianwen; YANG Qijiao; PENG Xinyi; CHEN Yingchun

doi:10.16462/j.cnki.zhjbkz.2025.08.007

Volume 29 Issue 8

Aug. 2025

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BI Shengxian, WANG Qianwen, YANG Qijiao, PENG Xinyi, CHEN Yingchun. Multilevel model analysis of factors influencing cognitive impairment in middle-aged and elderly adults in rural areas[J]. CHINESE JOURNAL OF DISEASE CONTROL & PREVENTION, 2025, 29(8): 906-912. doi: 10.16462/j.cnki.zhjbkz.2025.08.007

Citation:

BI Shengxian, WANG Qianwen, YANG Qijiao, PENG Xinyi, CHEN Yingchun. Multilevel model analysis of factors influencing cognitive impairment in middle-aged and elderly adults in rural areas[J]. CHINESE JOURNAL OF DISEASE CONTROL & PREVENTION, 2025, 29(8): 906-912. doi: 10.16462/j.cnki.zhjbkz.2025.08.007

Citation:

BI Shengxian, WANG Qianwen, YANG Qijiao, PENG Xinyi, CHEN Yingchun. Multilevel model analysis of factors influencing cognitive impairment in middle-aged and elderly adults in rural areas[J]. CHINESE JOURNAL OF DISEASE CONTROL & PREVENTION, 2025, 29(8): 906-912. doi: 10.16462/j.cnki.zhjbkz.2025.08.007

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Multilevel model analysis of factors influencing cognitive impairment in middle-aged and elderly adults in rural areas

doi: 10.16462/j.cnki.zhjbkz.2025.08.007

1.
Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
2.
Tingzhou Town Community Health Service Center, Changting County, Longyan City, Longyan 366300, China
3.
Research Center for Rural Health Services Hubei Province Key Research Institute of Humanities and Social Sciences, Wuhan 430030, China

Funds:

The Fundamental Research Funds for the Central Universities 2022WKYXZD003

More Information

Corresponding author: CHEN Yingchun, E-mail: chenyingchunhust@163.com
Received Date: 2025-03-12
Rev Recd Date: 2025-06-09
Publish Date: 2025-08-10

Abstract

Abstract

Objective To investigate factors that influence cognitive impairment among middle-aged and elderly adults in rural areas and provide a scientific basis for targeted interventions. Methods A total of 5 927 middle-aged and elderly adults from rural areas were selected from five waves (2011-2020) of the China Health and Retirement Longitudinal Study. A three-level logistic regression model was used to analyze the effects of time, individual characteristics, and regional factors on cognitive impairment. Results Variation at the individual level was the primary contributor, standard deviation (s)=1.481, and regional-level clustering was also observed (s=0.444, P < 0.001). The risk of cognitive impairment in 2018 (OR=3.755, 95% CI: 3.131-4.502) and 2020 (OR=1.279, 95% CI: 1.040-1.572) was higher than in 2011. A lower risk was associated with being male (OR=0.432, 95% CI: 0.375-0.496), younger elderly (OR=0.481, 95% CI: 0.431-0.536), older elderly (OR=0.252, 95% CI: 0.203-0.312), participating in social activities (OR=0.597, 95% CI: 0.548-0.650), and higher annual sunshine duration (OR=0.809, 95% CI: 0.702-0.933). A higher risk was associated with primary education (OR=10.842, 95% CI: 2.119-55.490), being divorced/widowed/unmarried (OR=1.551, 95% CI: 1.333-1.803), lacking pension insurance (OR=2.126, 95% CI: 1.495-3.025), lacking health insurance (OR=1.528, 95% CI: 1.011-2.310), infrequent communication with children (OR=1.440, 95% CI: 1.130-1.836), insomnia (OR=1.124, 95% CI: 1.010-1.250), impaired instrumental activities of daily living (OR=1.691, 95% CI: 1.531-1.868), pain (OR=1.179, 95% CI: 1.073-1.296), and depression (OR=1.201, 95% CI: 1.099-1.313). Conclusions Cognitive impairment among rural middle-aged and elderly adults is influenced by factors at the temporal, individual, and regional levels. Comprehensive interventions should target individual-level determinants such as health behaviors, education, and social security, while also addressing community-level social engagement and mental health services, and policy-level resource allocation.
- Rural middle-aged and elderly adults,
- Cognitive impairment,
- Three-level model

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References(18)

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