50岁以上成年人的认知和关节炎：来自CHARLS、HRS和ELSA的证据

摘要(中文译文)

关节炎和认知能力下降是老龄化人口面临的重大健康挑战，但它们在不同社会经济和文化背景下的关联仍然没有得到充分理解。本研究利用来自3个纵向老龄化队列的数据，研究了50岁及以上成年人的认知功能与关节炎患病率之间的关系：中国健康与退休纵向研究（CHARLS）、健康与退休研究（HRS）和英国老龄化纵向研究（ELSA）。该分析包括来自CHARLS的18562名参与者、来自HRS的23238名参与者和来自ELSA的9848名参与者，他们的年龄均为50岁，均接受了医生诊断的关节炎和认知评估。认知功能在记忆、定向和执行功能领域进行了评估，在每个队列中标准化为z评分。广义估计方程（GEE）和广义线性混合模型评估了认知与关节炎之间的纵向关联，并调整了社会人口统计学因素、生活方式变量和合并症。敏感性分析验证了研究结果的稳健性。在完全调整的GEE模型中，执行功能与关节炎显著相关。每1个标准差（SD）较低的执行得分都与较高的关节炎风险相关：CHARLS风险比（OR）1.000（95%置信区间[CI]1.000-1.001，P=0.016），HRS OR 1.13（95%CI 1.01-1.28，P=0.037），ELSA OR 1.07（95%CI 1.02-1.12，P=0.009）。情景记忆和定向均未显示出显著的相关性（均P>0.10），HRS的总体认知具有显著性。混合模型估计是一致的，替代的相关性结构产生了一致的执行关节炎联系。在3个主要的老龄化队列中，执行功能受损与50岁以上成年人患关节炎的几率较高独立相关。针对执行缺陷可能会增强老年人群关节炎和认知健康的早期识别和综合管理。

Abstract

Arthritis and cognitive decline are significant health challenges in ageing populations, yet their association across diverse socioeconomic and cultural contexts remains insufficiently understood. This study examines the relationship between cognitive function and arthritis prevalence among adults aged 50 years and older, utilising data from 3 longitudinal ageing cohorts: the China Health and Retirement Longitudinal Study (CHARLS), the Health and Retirement Study (HRS), and the English Longitudinal Study of Ageing (ELSA). The analysis included 18,562 participants from CHARLS, 23,238 from HRS, and 9848 from ELSA, all aged =50 years with physician-diagnosed arthritis and cognitive assessments. Cognitive function was evaluated across memory, orientation, and executive function domains, standardised as z-scores within each cohort. Generalised Estimating Equations (GEE) and Generalised Linear Mixed Models assessed the longitudinal association between cognition and arthritis, adjusting for sociodemographic factors, lifestyle variables, and comorbidities. Sensitivity analyses validated the findings- robustness. In fully adjusted GEE models, executive function was significantly associated with arthritis. Each 1-standard deviation (SD) lower executive score was associated with higher arthritis odds: CHARLS odds ratio (OR) 1.000 (95% confidence interval [CI] 1.000-1.001, P=0.016), HRS OR 1.13 (95% CI 1.01-1.28, P=0.037), and ELSA OR 1.07 (95% CI 1.02-1.12, P=0.009). Neither episodic memory nor orientation showed significant associations (all P>0.10), and total cognition in HRS was significant. Mixed-model estimates were concordant, and alternative correlation structures yielded consistent executive- arthritis links. Across 3 major ageing cohorts, impaired executive function is independently associated with higher odds of arthritis in adults aged =50 years. Targeting executive deficits may enhance early identification and integrated management of arthritis and cognitive health in ageing populations.

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