Presentation (CTI)

OBJECTIVES: Cognitive decline and dementia pose a significant global disease burden. The primary objective of this study is to comprehensively explore the contributions of various life-course circumstances to the cognitive function of Chinese older adults aged 60 years and above, and to provide insights for formulating policies to mitigate health inequities.
METHODS: The research utilized data from 12,394 older adults who participated in at least one wave of the China Health and Retirement Longitudinal Study (CHARLS). A total of 65 life-course circumstances were identified, covering childhood and adulthood, including demographics, socioeconomic status, health, trauma, and relationships. Fixed-effects multivariable linear regression models were employed to analyze the data. The Blinder-Oaxaca decomposition was used to disentangle the differences in cognitive performance among different populations, and heterogeneity analysis was conducted to examine the relationships in different subgroups.
RESULTS: The results indicated that participants with more favorable early-life and adulthood environments had significantly higher cognitive function scores in later life. Early-life factors directly accounted for 28.36% of cognitive function, and their marginal effect on cognitive function, episodic memory, and executive function generally increased when considering cumulative effects. Adulthood socioeconomic status (SES) accounted for the largest proportion (36.05%) of cognitive function. Moreover, significant differences in cognitive performance were observed between males and females, the pre-old (60-69 years old) and older (70+ years old) population, and those living in urban and rural areas. For example, males had higher cognitive scores than females, with adulthood SES contributing the most to this difference.
CONCLUSIONS: Unfavorable life-course factors were found to be associated with a decrease in late-life cognitive function in China. The cumulative socioeconomic inequalities over the life course further aggravated these effects. The findings can inform future research and policy initiatives aimed at promoting cognitive well-being and reducing health disparities among the older adults in China.