The association between community-level socioeconomic status and cognitive function among Chinese middle-aged and older adults: a study based on the China Health and Retirement Longitudinal Study (CHARLS)

Abstract

Background: Although numerous studies focused on the relationship between area socioeconomic status (SES) and health, only a few of them investigated how community-level SES was linked to late-life cognitive function as well as the potential pathways underlying this association, and very few of them focused on the context of China. This study examined how community-level SES was linked to cognitive function and the potential pathways underlying this association among middle-aged and older adults in China.

Methods: Data was drawn from the waves 1-4 of China Health and Retirement Longitudinal Study. We measured cognitive function with the components of the Telephone Interview of Cognitive Status battery. Community-level SES was derived from a sum of z scores of the percentage of the illiterate and the per-capita net income status within communities. We adopted two-level hierarchical linear regression models to explore the associations between community-level SES and cognitive function. A multilevel mediation analysis with structural equation modeling was undertaken to disaggregate the direct and indirect pathways of the associations.

Results: Higher community-level SES was associated with better cognitive function (β = 0.562, 95% CI = 0.390, 0.734), and this significant association was only present in rural participants, not in urban participants. Furthermore, we discovered the mediating effects of outdoor exercise facilities within communities (β = 0.023, 95% CI = 0.000, 0.056) and individual-level SES (β = 0.108, 95% CI = 0.057, 0.156) to explain the relationship between community SES and cognitive function.

Conclusions: These findings highlight the importance of community environmental interventions in maintaining individuals' cognitive health in China, especially for older adults. Our results provided solid empirical evidence for reducing mental health inequalities in China, and suggested that developing an aging-friendly environment and properly distributing community resources are important to improve cognitive function of older adults.

Keywords: Cognitive function; Community SES; Community environment; Structural equation modeling.

Fig. 1

Flow chart of sampling of this study. Note. CHARLS China Health and Retirement Longitudinal Survey

Fig. 2

Pathways between community-level SES, mediators, and cognitive function (N = 26,065). Note. Multilevel structural equation models adjusted for the percentage of residents with nonagricultural work at the community level, age, sex, residence, occupation, marital status, and ADLs at the individual level. The estimates are omitted for simplicity. Significant pathways (solid lines) and insignificant pathways (dashed lines) between community-level SES, mediators, and cognitive function are presented here. SES socioeconomic status