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Original Article
Mediation analysis of leisure activities on the association between cognitive function and mortality: a longitudinal study of 42,942 Chinese adults 65 years and older
Xingxing Chen, Wenfan Wu, Xian Zhang, Tingxi Long, Wenyu Zhu, Rundong Hu, Xurui Jin, Lijing L. Yan, Yao Yao
Epidemiol Health. 2022;44:e2022112.   Published online November 27, 2022
DOI: https://doi.org/10.4178/epih.e2022112
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AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
Previous studies have established associations of cognitive function and leisure activities with mortality. This study aimed to evaluate whether leisure activities causally mediate these associations.
METHODS
This longitudinal study included 42,246 participants aged over 65 years from the Chinese Longitudinal Healthy Longevity Survey. The Mini-Mental State Examination and a self-reported scale were used to measure cognitive status and leisure activities, respectively. We examined the associations of cognitive function and leisure activities with mortality using Cox proportional hazards models. Causal mediation analysis was used to assess whether leisure activities mediated the association between cognitive function and mortality.
RESULTS
Cognitive function and leisure activities were inversely associated with mortality. Leisure activities accounted for 28.3% (95% confidence interval [CI], 25.6 to 31.1) of the total effect of cognitive function and mortality. A higher mediated proportion (PM) was observed for physical leisure activities (PM, 20.1%; 95% CI, 18.0 to 22.3) than for social leisure activities (PM, 17.7%; 95% CI, 15.7 to 19.7). The mediating effect was higher among participants at younger ages (PM, 41.5%; 95% CI, 21.3 to 65.4), those with higher education levels (PM, 30.5%; 95% CI, 25.3 to 36.2), and residents of rural China (PM, 42.5%; 95% CI, 25.4 to 62.5).
CONCLUSIONS
Cognitive function was associated with inverse mortality. Leisure activities significantly mediated this association. Participation in leisure activities at the early stages of mild cognitive impairment could reduce the risk of mortality, which has a major impact on interventional strategies for healthy aging.
Summary
Key Message
Both cognitive function and leisure activities were associated with inverse mortality. Leisure activities were an important mediator of the association between cognitive function and mortality. A planned intervention for leisure activities, at an early stage of mild cognitive impairment, could promote health outcomes and optimally reduce the risk of mortality.

Citations

Citations to this article as recorded by  
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    Clinical Neurology and Neurosurgery.2024; 236: 108053.     CrossRef
  • Healthy lifestyle in late-life, longevity genes, and life expectancy among older adults: a 20-year, population-based, prospective cohort study
    Jun Wang, Chen Chen, Jinhui Zhou, Lihong Ye, Yang Li, Lanjing Xu, Zinan Xu, Xinwei Li, Yuan Wei, Junxin Liu, Yuebin Lv, Xiaoming Shi
    The Lancet Healthy Longevity.2023; 4(10): e535.     CrossRef
  • Associations of Unhealthy Lifestyle and Nonalcoholic Fatty Liver Disease With Cardiovascular Healthy Outcomes
    Wentao Wu, Wen Ma, Shiqi Yuan, Aozi Feng, Li Li, Haoxiao Zheng, Shuna Li, Ningxia He, Yuli Huang, Jun Lyu
    Journal of the American Heart Association.2023;[Epub]     CrossRef
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