Association of changes in overall and specific leisure activities with long-term all-cause mortality in older adults: a nationwide cohort study

Abstract

Background: Leisure activities (LAs) are vital for healthy ageing and are linked to lower mortality risk in older adults. However, most previous longitudinal studies have assessed LAs at only one time point. We aimed to explore the impact of dynamic changes in LAs on subsequent all-cause mortality among older adults.

Methods: We enrolled 21 262 older adults who had participated in the six waves of the Chinese Longitudinal Healthy Longevity Survey (CLHLS) in 1998, 2000, 2002, 2005, 2008, and 2011. All participants completed two consecutive assessments of LAs (including seven typical activities) during the first two waves (mean interval = 2.72 years (standard deviation = 0.08)); we further followed them up until 2018, i.e. beyond the 2011 CLHLS. We divided them into five categories according to the change pattern of LAs: stable low (low-low), stable moderate (moderate-moderate), stable high (high-high), LAs increase (low-moderate, low-high, moderate-high), and LAs decrease (high-moderate, high-low, moderate-low). We used a Cox proportional hazard model to test the association between changes in LAs and all-cause mortality, including demographic characteristics, health behaviours, and disease history as covariates.

Results: We documented 15 065 death events during 80 045.39 person-years of follow-up. Compared with the stable moderate group, the adjusted hazard ratios (aHRs) of mortality for the stable low group and stable high group were 1.27 (95% confidence interval (CI) = 1.21-1.35) and 0.66 (95% CI = 0.62-0.71), respectively. An increase in LAs was associated with a lower risk of mortality (aHR = 0.83; 95% CI = 0.78-0.88), while a decrease in LAs was associated with a higher risk of mortality (aHR = 1.05; 95% CI = 1.01-1.09). The protective effect of LAs increase on premature death was more pronounced in men than in women. The main results remained stable in subgroup and sensitivity analyses.

Conclusions: Maintaining and increasing participation in leisure time activities significantly reduced the risk of all-cause mortality in community-dwelling older individuals in our sample.

Figure 1

Changing patterns of overall and specific LAs in the total sample. Panel A. Changing patterns of the overall LAs. Panels B–H. Changing patterns of specific types of LAs.

Figure 2

Kaplan-Meier survival curves across changing patterns of leisure activities.

Figure 3

Associations of change in specific activity with mortality risk. All analyses were adjusted for age, sex, ethnicity, household registration, financial support, family income, living arrangement, education level, marital status, smoking, alcohol consumption, body mass index, dietary diversity, psychological distress, disability, cognitive impairment, hypertension, diabetes, heart disease, cerebrovascular disease, and respiratory disease.