Independent and joint associations of social participation and depressive symptoms with incident stroke risk in older adults: a prospective cohort study based on CHARLS and ELSA

BMC Public Health

卷:26

Research

Liangze Ma^1,2,3  Yukun Ma³  Zixun Huang⁴  Lincui Wang^1,2  Kaixuan Ma^1,2  Ze Lin^1,2  Jianhong Li^1,2  Lingbin He^1,2  Chunhong Ren⁵  Xin Zhang^1,2,3 

[1] Laboratory of Molecular Cadology, Department of Cardiology, The First Affiliated Hospital of Shantou University Medical College, 515041, Shantou, China

[2] The First Affiliated Hospital of Shantou University Medical College, 515041, Shantou, China

[3] International Medical Service Center, The First Affiliated Hospital of Shantou University Medical College, 515041, Shantou, China

[4] Shantou University Medical College, 515041, Shantou, China

[5] Cancer Hospital of Shantou University Medical College, 515041, Shantou, China

关键词: Social participation;    Depressive symptoms;    Incident stroke;    Older adults;    CHARLS;    ELSA;   

DOI  :  10.1186/s12889-026-28217-z

 received in 2026-02-02, accepted in 2026-06-15,  发布年份 2026

来源: Springer

【 摘 要 】

BackgroundStroke remains a leading cause of death and disability among older adults. Depressive symptoms and low social participation have been linked to stroke risk via behavioral and biological pathways. This study examined the independent and joint associations of social participation (SP) and depressive symptoms (DS) with incident stroke in two nationally representative cohorts.MethodsData were derived from two nationally representative cohorts: the China Health and Retirement Longitudinal Study (CHARLS; 2011–2018) and the English Longitudinal Study of Ageing (ELSA; 2012–2019). SP and DS were assessed at baseline and categorized into four phenotypic subgroups (SP+/DS−, SP−/DS−, SP+/DS+, SP−/DS+). Cox proportional hazards models were fitted within each cohort with sequential covariate adjustment. To address missing data, sensitivity analyses were performed using the multiple imputation method (MICE).ResultsIn CHARLS (n = 10,555; mean age 58.3 years), DS + was associated with elevated stroke risk (Model 3 h = 1.40, 95% CI 1.18–1.65, p < 0.001), whereas SP− showed no significant association (HR = 1.14, 95% CI 0.96–1.34, p = 0.13). Compared with the SP+/DS− reference phenotype, the SP−/DS+ joint phenotype was associated with an increased stroke risk (HR = 1.56, 95% CI 1.27–1.93, p < 0.001). In ELSA (n = 5,321; mean age 65.1 years), SP − was not associated with stroke risk (HR = 1.05, 95% CI 0.74–1.51, p = 0.78), and DS+ exhibited a similar but non-significant association (HR = 1.54, 95% CI 0.95–2.51, p = 0.08); the SP−/DS + was associated with elevated stroke risk (HR = 1.87, 95% CI 1.04–3.37, p = 0.04).ConclusionsDepressive symptoms were associated with incident stroke, whereas low social participation alone showed no consistent association with incident stroke. Notably, the joint phenotype SP−/DS+ identified a subgroup with the highest incident stroke risk, although such associations exhibited some heterogeneity between cohorts.

【 授权许可】

CC BY   
© The Author(s) 2026

【 图 表 】

Fig. 21