The effect of healthy lifestyles and social determinants on independent life expectancy and sex differences in China: evidence from a 13-year cohort study
Bibliographic record
Abstract
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.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.004 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".