The effect of healthy lifestyles and social determinants on independent life expectancy and sex differences in China: evidence from a 13-year cohort study
Notice bibliographique
Résumé
BACKGROUND: Functional independence is the basis for healthy ageing and quality of late life. However, evidence on how healthy lifestyle factors and social determinants of health affect longevity in independence remains limited, particularly regarding sex differences. We aimed to examine the associations of these factors with life expectancy with and without dependency, and to assess whether such effects differ by sex. METHODS: This cohort study used data from the nationally representative Chinese Longitudinal Healthy Longevity Study (CLHLS), which collected data from 2008 to 2021. Participants aged 65-100 years were included if they had at least one follow-up or death record. Healthy lifestyle factors (ie, diet, physical activity, smoking, and alcohol use) and social determinants of health (ie, financial status, education, health-care access, built environment, and social context) were assessed at baseline. Functional independence was determined by self-reported need for assistance with activities of daily living and instrumental activities of daily living at each survey wave. A continuous-time three-state Markov model was applied to estimate hazard ratios and 95% CIs between independence, dependence, and death, yielding total and independent life expectancy by sex, adjusted for covariates. FINDINGS: 11 804 participants were included in the study. At age 65 years, females had longer total life expectancy than males (18·18 years [95% CI 17·74-18·49] vs 15·50 years [15·10-15·89]) but shorter independent life expectancy (10·35 years [10·13-10·55] vs 11·29 years [11·05-11·54]). The gain in independent life expectancy was greater for males with 3-4 healthy lifestyle factors versus males with 0-1 healthy lifestyle factors (2·45 years [2·24-2·67]) compared with females with 3-4 healthy lifestyle factors versus females with 0-1 healthy lifestyle factors (2·09 years [1·90-2·29], p=0·015). However, females had greater gains in independent life expectancy from favourable social determinants of health. Those with 4-5 positive social determinants of health indicators lived 1·95 (1·74-2·16) more years independently compared with those with 0-1, surpassing the 1·67 year (1·49-1·85) gain observed in males (p=0·047). The combination of both favourable lifestyle behaviours and supportive social conditions produced the largest improvement in independent life expectancy, with gains of 3·94 (3·73-4·15) years for males and 3·89 (3·68-4·11) years for females. INTERPRETATION: Pathways to healthy ageing differ between sexes in China: males benefit more from lifestyle modifications whereas females gain more from improved social conditions. These results underscore the importance of sex-specific public health strategies that focus on reducing unhealthy behaviours among males and improving social support for females. FUNDING: National Natural Science Foundation of China and Chinese Academy of Medical Sciences Innovation Fund. TRANSLATION: For the Chinese translation of the abstract see Supplementary Materials section.
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,008 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,002 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».