其他摘要 | Considering the population aging in China, the mental and physical health of the middle-aged and older adults should receive more attention. As cardiovascular diseaseis one of the most common health issues in this age group, it is much important to investigate possible influence factors of cardiovascular diseases in order to improve the life quality of them and reduce the burdens of their families and the society. Loneliness is one kind of modifiable social connections factor, and its relationships with cardiovascular diseases have not been fully explored. Previous research has found that loneliness could predict a higher risk of cardiovascular diseases, but such
results were not always consistent. A possible reason is that the intra-individual loneliness may change in a longitudinal period, and that different change patterns of loneliness have distinct relationships with health. Thus, it is necessary to investigate the effects of the longitudinal change of loneliness on cardiovascular diseases in the middle-aged and older adults. On the base of that, to explore possible pathways linking the longitudinal change of loneliness to cardiovascular diseases can provide empirical evidence for the theory of how loneliness influences health.
The present study, using a nationally representative longitudinal sample for the middle-aged and older adults from the China Health and Retirement Longitudinal Survey (CHARLS), conducted three studies to investigate the impacts of the longitudinal change of loneliness on cardiovascular diseases and the possible mediation effects in those relationships in the Chinese population aged 45 years and above.
Study 1 explored the patterns of the longitudinal change of loneliness and its correlates. With four waves from 2011 to 2018 from CHARLS, I carried out group-based trajectory modelling (GBTM) to describe possible trajectories of the longitudinal change of loneliness and multinomial logistic regression models to examine the effects of sociodemographic variables, social connections variables, and health status variables in 2011 on the longitudinal change of loneliness. Results showed that the longitudinal change of loneliness can be fitted as three different trajectories, i.e., no loneliness, low loneliness increasing, high loneliness increasing, and that sociodemographic variables, social connections variables, and health status variables in 2011 were significantly associated with the longitudinal change of loneliness.
Study 2 investigated the impacts of the longitudinal change of loneliness on cardiovascular diseases. I carried out binary logistic regression models to examine whether the trajectories of the longitudinal change of loneliness in Study 1 could predict the risk of developing heart diseases and stroke in 2018 independently of social connections variables, sociodemographic variables, and health behaviors and health factors variables in 2011. Results showed that the longitudinal change of loneliness was independently associated with the incidence of heart diseases and stroke in 2018. To be specific, compared with no loneliness, low loneliness increasing was associated with 1.19 times the risk of developing heart diseases and 1.48 times the risk of developing stroke; and high loneliness increasing was associated with 1.38 times the risk of heart diseases and 1.71 times the risk of stroke.
Study 3 explored the mediation effects of behavioral, psychological, and biological factors in 2015 between the longitudinal change of loneliness and cardiovascular diseases in 2018. I carried out multiple mediating analysis based on logistic regression models with Karlson/Holm/Breen (KHB) method. Models were adjusted for gender, age, education, and types of registered residence. Results showed that sleep duration and depressive symptoms partially mediated the association between the longitudinal change of loneliness and heart disease, and that depressive symptoms partially mediated the association between the longitudinal change of loneliness and stroke.
To sum up, the present study described the trajectories of the longitudinal change of loneliness via a person-centered approach, which enriches the theory of the longitudinal change of loneliness from an empirical point of view. Also, this study also confirmed the stable prediction effect of the longitudinal change of loneliness on the risk of developing cardiovascular diseases in the future, and that has important practical significance for identifying the population in risk of cardiovascular diseases and preventing their occurrence. Finally, this study found that psychological and behavioral factors played a partial mediating role between the longitudinal changes of loneliness and cardiovascular diseases, which contributes to elucidating the mechanism of how loneliness influences cardiovascular diseases. |
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