| ObjectiveWith the intensification of China’s aging,the rapid increase in dementia risk to become China’s focus on issues to be concerned about.Few studies about the association of social engagement,loneliness and dementia risk and the conclusions are inconsistent.In addition,the previous studies using the traditional regression method,which is not take the deviation by the time-dependent confounding factors into account.The study intended to analyze the dementia risk in aged 65 years older and over by using the marginal structural model(MSM)method,explore the causal relationship between social engagement,loneliness and dementia risk,and detect gender,age,and education level differences.To provide a reference for reducing the incidence of dementia,improving the quality of life of the older adults and alleviating the aging situation.Methods].Data used were from 2002 to 2011/2012 waves of the Chinese Longitudinal Healthy Longevity Survey(CLHLS).In this study,the 2002 survey as the baseline,and the 2005.2008/2009 and 2011/2012 were three follow-ups.The study population was older adults aged 65 or over.The total sample size was 7346.2.The diagnosis of dementia was based on self-report and doctoral diagnosis:1)Are you suffering from dementia?2)Was it diagnosed by a hospital or not?We considered the participants to be suffering from dementia only when they responded"yes" to both items,vice versa.The measurement of social engagement consists of five aspects of marital status,whether to live alone,the availability of help when required,the availability of a confidant,and participation in social activities.The measurement of loneliness was based on one item "Do you often feel lonely".Other covariates include general demographic characteristics(gender,age,education level),lifestyle(smoking,drinking,physical exercise),health status(hypertension,diabetes,stoke and cardiovascular diseases,cognitive function,activities of daily living disability).3.Distributive proportions,and mean and deviation were employed to describe the sample.The causal relationship between social engagement,loneliness and dementia risk was analyzed by MSM.The weight of the sample population was weighted by the inverse probability weighting method,and the generalized estimation model was used to analyze the causal relationship between social engagement,loneliness and the risk of dementia,and the joint effects of social engagement and loneliness on dementia risk were analyzed by joint MSM.All analyses were stratified by gender,age,and education level.Results1.Of the 7346 subjects,225 were developed dementia,with an average age of 80.20(10.51).ranging from 65 to 116 years old,and 55.94%of participants aged 85 year and over.the proportion of the men(43.55%)were lower than women(56.45%).The proportion of illiterate was 57.23%.Older adults who had low social engagement.high loneliness,less physical exercise and suffered from high blood pressure,stroke or cerebrovascular disease.cognition decline or activities of daily living disability are more likely to develop dementia(P<0.05).the elderly with low social engagement and high loneliness compared to high social engagement and high loneliness.low social engagement and low loneliness,high social engagement and low loneliness has a higher dementia risk(P<0.05)2.The results of MSM showed that lower social engagement increased dementia risk(rate ratio(RR)=1.86.95%confidence interval(CI):1.28,2.72).Under gender stratification,social engagement was associated with dementia risk among women(RR= 2.07.95%CI:1.22,3.50).but this relationship is not statistically significant in men(RR= 1.61.95%CI:0.95,2.73).The results of age stratification.65 to 74 years old adults with a lower social engagement had a high risk of dementia(RR = 2.61,95%CI:1.16,5.89),in the older adults had 75～84 and 85～years old,this relationship was not statistically significant.Under the education level,it was found that lower social engagement increased the risk of dementia in the non-illiterate older adults(RR = 2.54,95%CI:1.41,4.57),but in the illiterate elderly no statistically significant.The results of MSM showed that loneliness increased the risk of dementia(RR = 1.87,95%CI:1.39,2.52),and gender stratification revealed an increased risk of dementia in men(RR=2.83,95%CI:1.66,4.82),but the relationship between loneliness and dementia was not statistically significant in women(RR=1.35,95%CI:0.94,1.95).Loneliness is always a risk factor for dementia under the stratification of age and educational level.3.Combined MSM results show that control of confounders,with the high social engagement and low loneliness as a reference,low social engagement and low loneliness,high social engagement and high loneliness,low social engagement and high loneliness(RR = 2.19.95%CI:1.27.3.79;RR = 2.02.95%CI:1.16.3.54:RR =3.38,95%CI:2.15,5.31,respectively),with the risk of dementia(P<0.05).after adjusting the confounding factors.Conclusions1.Older adults who had low social engagement,high loneliness have a higher dementia risk;low social engagement and high loneliness compared to high social engagement and high loneliness.low social engagement and low loneliness,high social engagement and low loneliness has a higher dementia risk;less physical exercise and older people who suffered from high blood pressure,stroke or cerebrovascular disease.cognition decline or activities of daily living disability are more likely to develop dementia.2.Low social engagement or high loneliness may increase the risk of dementia.In women or non-illiterate older adults,social engagement is a protective factor of dementia;in men,loneliness is a risk factor of dementia.3.The joint effect between social engagement and loneliness may associate with dementia risk,and older adults with a lower social engagement and higher loneliness have the greatest effect. |
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