Association between cognitive function and hip fracture among middle-aged and older Chinese adults: A prospective study using the China Health and Retirement Longitudinal Study

Abstract

Background: The relationship between cognitive function and hip fracture risk among middle-aged and older adults in China remains unclear, with limited longitudinal evidence.
Objective: To investigate the association between cognitive function and hip fracture risk among Chinese middle- aged and elderly adults.
Study design: Prospective longitudinal study.
Methods: We analyzed 8257 participants (aged ≥45) from China Health and Retirement Longitudinal Study (CHARLS). The present analysis used Wave 3 (2015) as the study entry and followed participants through Wave 5 (2020). Cognitive function was assessed across four domains: orientation, memory, calculation and drawing. All cognitive z-scores were standardized to the metrics of Wave 3. The calculation formula involved subtracting the Wave 3 average score from each participant’s test score per wave, followed by division using the Wave 3 standard deviation. Hip fracture status served as the outcome measure. Potential confounding effects stemming from demographic attributes and other covariates were controlled for during the analysis. Longitudinal logistic regression was used to analyze the relationship between the cognitive z-scores and their dimensions and hip fracture incidence at two follow-up surveys.
Results: Participants (mean age 56.62 ± 8.92 years; 53.8% male) were followed for up to 5 years. Each standard deviation decrease in global cognitive z-scores was associated with increased hip fracture risk at Wave 4 (odds ratio [OR] = 0.71, 95% CI:0.57-0.89) and Wave 5 (OR = 0.72, 95% CI:0.58-0.87). Decline in orientation demonstrated consistent associations (Wave 4: OR = 0.82, 95% CI:0.70-0.96; Wave 5: OR = 0.82, 95% CI:0.68-0.99). Declines in calculation were associated with hip fracture at Wave 4 only, while declines in memory and drawing showed such an association only at Wave 5.
Conclusion: Independent associations exist between impaired global cognitive function, weakened orientation and increased hip fracture risk in this Chinese middle-aged and older population. These findings highlight the need to integrate cognitive assessments with fracture risk evaluations.

Keywords

CHARLS / Cognitive function / Hip fracture / Longitudinal study

CRediT authorship contribution statement

Yang Shen: Conceptualization, Methodology, Writing - Original Draft; Guishan Wang: Data Curation, Resources; Xiuxiu Shi: Data Curation, Resources; Keshi Zhang: Formal Analysis, Software; Haiyan Sun: Formal Analysis, Validation; Jiedan Mu: Formal Analysis, Visualization; Ying Zhou: Formal Analysis, Visualization; Haibo Wang: Writing - Review and Editing, Supervision, Project Administration; Zhenpeng Guan: Writing - Review and Editing, Supervision; Xiao Li: Writing - Review and Editing, Supervision. All the authors have read and approved the final version of the manuscript.

Ethics approval and consent to participate

Peking University's Institutional Review Board provided full ethical approval for the CHARLS data collection instruments and procedures (IRB00001052-11015). All study procedures involving human partici- pants adhered to the 1964 Declaration of Helsinki and its later amendments. Written informed consent was obtained from all re- spondents at baseline prior to their participation.

Funding

National Key Research and Development Program of China [grant number 2023YFC3604905].

Data availability

Data are available and can be downloaded from https://charl-s.charlsdata.com/.

Declaration of Competing Interest

The authors declare the following financial interests/personal re- lationships which may be considered as potential competing interests: Xiao Li reports financial support was provided by National Key Research and Development Program of China. If there are other au- thors, they declare that they have no known competing financial in- terests or personal relationships that could have appeared to influence the work reported in this paper.

Declaration of Generative AI and AI-assisted technologies in the writing process

The authors declare that no Generative AI or AI-assisted technolo- gies were used in the writing process.

Acknowledgements

We thank the China Health and Retirement Longitudinal Study team for providing data and training in using the datasets.

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