Sex differences in the association between latent class of lifestyle and disability among older adults in China

Abstract

Background: A healthy lifestyle may prevent disability for older adults. But research to date is limited to a single lifestyle behavior and ignore sex difference in the lifestyle-disability association. This study aimed at identifying sex-specific latent classes of lifestyle and their relationship with disability among older Chinese adults.

Methods: Data were obtained from adults aged 65 years or above in the 2018 Chinese Longitudinal Healthy Longevity Survey, a nationally representative sample of older adults in China. We used latent class analysis to categorize participants into subgroups based on three dimensions of lifestyle factors: health behaviors, psychological wellbeing, and social engagement. Disability was assessed by the activities of daily living (ADL). Multivariable logistic regression was used to evaluate the associations between the latent lifestyle classes and disability.

Results: A total of 15,771 older adults were included in this analysis, of whom 56% were women and 66% aged 80 years or above. We identified four latent lifestyle classes among older women: "Health Promoting" (28%), "Isolated and Health Harming" (34%), "Restless and Dismal" (21%), and "Restless" (17%). A different set of four lifestyle classes were identified in older men: "Health Promoting" (21%), "Isolated and Health Harming" (26%), "Restless and Dismal" (20%), and "Discordant" (33%). Compared with the "Health Promoting" class, the "Isolated and Health Harming" class (OR = 1.88, 95% CI: 1.46-2.43) and the "Restless and Dismal" class (OR = 1.67, 95% CI: 1.27-2.20) had higher risk of disability in women. The "Discordant" class had lower risk of disability in men (OR = 0.52, 95% CI: 0.37-0.72).

Conclusions: Our analyses revealed different lifestyle patterns for older women and men in China. Sex differences in the associations between lifestyle and disability need to be considered when formulating interventions to prevent disability.

Keywords: Aging; Disability; Latent class analysis; Lifestyle; Sex differences.

Fig. 1

The distribution of latent classes and conditional probability for men. For sleep quality: response 1 = bad, response 2 = moderate, response 3 = good. For sleep time: response 1 = less than 7 h, response 2 = 7 to 8 h, response 3 = more than 8 h. For consumption of fruits and vegetable: response 1 = insufficient, response 2 = sufficient. For hypertension, diabetes, and dyslipidemia, response 1 = not diagnosed, response 2 = diagnosed but not taking medicine, response 3 = diagnosed and taking medicine. For other binary variables, response 1 = no and response 2 = yes

Fig. 2

The distribution of latent classes and conditional probability for women. For sleep quality: response 1 = bad, response 2 = moderate, response 3 = good. For sleep time: response 1 = less than 7 h, response 2 = 7 to 8 h, response 3 = more than 8 h. For consumption of fruits and vegetable: response 1 = insufficient, response 2 = sufficient. For hypertension, diabetes, and dyslipidemia, response 1 = not diagnosed, response 2 = diagnosed but not taking medicine, response 3 = diagnosed and taking medicine. For other binary variables, response 1 = no and response 2 = yes