Work

A prospective study of age-related functional impairments, mortality, and life expectancy of Chinese adults aged 50

Year: 2026

Type: article

Abstract: The population distribution of age-related functional impairments (ARFIs) and their associations with mortality and life expectancy (LE) among Chinese adults remain poorly understood. We included 12,906 participants (mean age: 62.6 years) from the China Health and Retirement Longitudinal Study. Visual impairment, hearing impairment, cognitive impairment, sleep disorder, depressive symptoms, and disability in activities of daily living (ADL) were assessed. Cox proportional hazards models were used to estimate the associations of ARFIs with all-cause mortality. Life expectancy at age 50 was estimated by the presence and number of key ARFIs. The six ARFIs exhibit distinct distributions by ages and provinces across China. During the 9-year follow-up, ADL disability, cognitive impairment, and depressive symptoms are independently associated with 64% (95% confidence interval [CI]: 48%–80%), 41% (21%–64%), and 20% (8%–33%) higher risks of mortality, corresponding to LE losses of 4.45, 3.08, and 1.59 years at the age of 50 years. A greater number of key ARFIs is associated with higher mortality risk in a dose-response manner (hazard ratios [95% CI] vs. none: 1.23 [1.11–1.36] for one, 1.42 [1.26–1.61] for two, and 1.86 [1.47–2.36] for three) and greater LE loss (1.63 [1.35–1.90] years for one, 3.37 [3.02–3.71] for two, and 4.96 [4.22–5.71] for three, with three ARFIs accounting for 17% of total LE). The study highlights the important roles of co-existing ARFIs in mortality and LE loss. Integrated prevention strategies and management systems for multiple functional impairments are warranted in the context of rapid population aging. Chen, Wang et al. systematically examine the population distributions of six age-related functional impairments and their associations with mortality risk and life expectancy. The number of key impairments exhibits a dose-response relationship with mortality risk and contributes to an estimated loss of up to 17% in life expectancy at age 50. Age-related functional impairments (ARFIs) are prevalent in aging populations, yet how they relate to death or longevity is uncertain. Global population aging poses major challenges to the public health systems, but the prevalences of ARFIs and their joint associations with life expectancy remained unclear. We studied Chinese adults from age 50 onward and found that inability to carry out normal daily living activities, cognitive impairment, and depressive symptoms are independently associated with an increased risk of death. The number of specific ARFIs was associated with loss in life expectancy in a dose-response manner. Our findings highlight the importance of addressing multiple functional impairments simultaneously. Given the disproportionate burden of ARFIs in socioeconomically disadvantaged regions, integrated and equity-oriented prevention strategies are urgently needed to mitigate health disparities.

Source: Communications Medicine

DOI: 10.1038/s43856-025-01350-3