{"paper_id":"01ca3ac5-be3e-4dc5-ab10-3bb5aa252d06","body_text":"Reciprocal Relationship Between Intrinsic Capacity and Social Activity Influenced by Gender in Advanced Middle-Aged Adults in South Korea | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Reciprocal Relationship Between Intrinsic Capacity and Social Activity Influenced by Gender in Advanced Middle-Aged Adults in South Korea Kyehyun Kim, Gyeonga Kang This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7782807/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 12 Mar, 2026 Read the published version in BMC Public Health → Version 1 posted 10 You are reading this latest preprint version Abstract Objectives As the population progressively ages, it has become increasingly important to maintain intrinsic capacity (IC) in advanced middle age. Our study aimed to examine the impact of gender on the reciprocal relationship between IC and social activity among advanced middle-aged adults in South Korea. Methods We used data from the 2016 and 2018 waves of KLoSA, including participants aged 55 to 64 years at baseline (N = 2,273). IC was measured in five domains, and social activity by the total number of social group participation. Cross-lagged panel models were applied with gender-stratified analysis. Results We confirmed a correlation between IC and social activity when IC impairment at baseline predicted low social activity at follow-up ( β = − 0.08, p = .002), and higher social activity at baseline predicted subsequent better IC ( β = − 0.03, p = .013). In gender-based analysis, a decline in IC significantly reduced subsequent social activity ( β = − 0.13, p = .006) in males. Among females, enhanced social activity significantly improved subsequent IC ( β = − 0.04, p = .022). Conclusions Our study highlights gender-specific patterns in the reciprocal relationship between IC and social participation in advanced middle age. Interventions for working men should prioritize IC stability. Strategies for females should focus on facilitating sustained social engagement. Early gender-sensitive approaches in advanced middle age may contribute to healthy aging trajectories. Intrinsic capacity social activity advanced middle age gender Figures Figure 1 Figure 2 1. Introduction The World Health Organization (WHO) defines healthy aging as a process of developing and maintaining functional ability to enable well-being in advanced years [ 1 ]. In this context, the development and maintenance of intrinsic capacity (IC) has gained attention [ 2 – 4 ]. IC is a composite of an individual's physical and mental abilities [ 4 , 5 ]. A decline in IC may lead to frailty [ 4 , 5 ]. Frailty contributes to individual as well as societal burden because it is associated not only with numerous adverse outcomes, such as falls, hospitalizations, mortality, and poor quality of life, but also with increased healthcare costs and caregiving demands [ 6 – 9 ] Measures to prevent frailty should focus on enhancing IC levels since frailty can be potentially reversed in the early stages [ 10 ]. Considering the trajectory of IC during the life of an individual, it is essential to build and maintain IC beginning in midlife to promote healthy aging [ 4 ]. Advanced middle age, defined as the transitional stage before old age, is regarded as a critical period to effectively prevent frailty [ 3 , 11 ]. Advanced middle-aged individuals (age range of 55 to 64 years) often experience dual caregiving burdens—caring for both aging parents and dependent children [ 12 ]. They also face various challenges, such as socioeconomic changes, anxiety about an uncertain future linked to preparations for retirement [ 13 ], and functional decline associated with aging [ 14 , 15 ]. According to the WHO’s International Classification of Functioning, Disability and Health framework, healthy aging can be promoted by strengthening the individual’s IC and encouraging participation in social activities that are meaningful to the individual [ 2 ]. From this perspective, social participation can be considered a key environmental factor that contributes to maintaining physical function and mental health [ 16 , 17 ]. Previous studies have shown that social support, derived from social participation, acts as an emotional and material resource to positively contribute to maintain physical and cognitive function [ 17 , 18 ]. Conversely, a decline in IC may hinder social activity, which leads to social isolation and triggers a vicious cycle [ 19 , 20 ]. Thus, the relationship between IC and social activity should be understood as bidirectional rather than unidirectional [ 21 ] With reports that gender differences in health outcomes become more pronounced with age, the relationship between social activity and IC may also be influenced by gender and offers critical insights from a health equity perspective [ 15 , 22 ]. Although females tend to have relatively better health status, they generally demonstrate lower levels of social participation than that of males [ 23 ]. This disparity has been attributed to factors, such as caregiving burdens disproportionately placed on middle-aged females, traditional gender role expectations, and limited access to the labor market [ 24 , 25 ]. Noting these differences, researchers have increasingly emphasized the need for gender-sensitive approaches [ 26 – 28 ]. Therefore, a gender-stratified analysis is necessary to accurately examine the impact on the reciprocal relationship between IC and social participation in middle-aged individuals. IC is a key indicator of healthy aging and the prevention of frailty [ 5 ]. Advanced middle age represents a pivotal period to implement preventive interventions prior to the transition to old age [ 4 ]. Studies have been limited on the interactions between IC and social activity in advanced middle-aged individuals, with most existing research focused on older adults. Research that conducts gender-stratified analyses is even more rare. Therefore, the present study aims to analyze the bidirectional relationship between IC and social activity and to identify the influence of gender on these associations among advanced middle-aged adults using longitudinal data. 2. Methods 2.1. Study participants Our nationwide longitudinal study utilized data from the Korean Longitudinal Study of Aging (KLoSA). Since 2006, KLoSA surveyed and conducted biennial follow-ups on 10, 254 adults aged 45 years or older and residing in 15 metropolitan areas in South Korea. The households were selected based on region and housing type by using a multistage stratified probability sampling method. Trained interviewers collected data through face-to-face interviews. The KLoSA panel survey assessed various social, economic, psychological, demographic, and health-related characteristics of individuals. Our study used data from the 6th wave (T1, 2016) and the 7th wave (T2, 2018). Data from the 8th wave (2020) were not used due to a potential bias introduced by COVID-19 that may have affected the involvement of participants in social activities. Upon registration, the dataset is publicly available through the Employment Survey and Analysis System website ( https://survey.keis.or.kr/index.jsp ) under the “KLoSA” category. For our study, we selected participants based on criteria from previous research on advanced middle age that is defined as individuals aged 55 to 64 years [ 12 ]. A total of 2,464 individuals met this age criterion in T1. We excluded individuals who were fully dependent on conditions known to restrict social participation – activities of daily living (ADL) or instrumental activities of daily living (IADL) [ 18 , 29 ] – on the basis of the following baseline (T1) criteria: (i) those unable to respond to the survey themselves (n = 6), (ii) those diagnosed with a disability (n = 3), (iii) those fully dependent on ADL (n = 7) or IADL (n = 55), and (iv) those with missing data on IC (n = 133) or social activity (n = 133). After applying these exclusion criteria, a final sample of 2,273 participants (male = 1,012; female = 1,261) was included in the analysis (Fig. 1 ). 2.2. Measurements 2.2.1. Intrinsic capacity (IC) IC serves as a potential predictor of negative health outcomes [ 3 ]. On the basis of the WHO definition and previous studies [ 2 , 30 ], IC was measured across five domains: (i) Mobility: requiring partial or complete assistance to get out of bed and to walk out of the room; (ii) Vitality: maximum handgrip strength measured twice for each hand, with the highest value falling below the sex-specific thresholds (males < 26 kg; females < 18 kg) [ 31 ]; (iii) Cognition: needing assistance to manage money or to use medications [ 32 ]; (iv) Psychological well-being: score ≥ 4 out of 10 on the Center for Epidemiological Studies-Depression Scale (CES-D) [ 33 ]; (v) Sensory function: self-reported rating of vision or hearing as \"poor\" or \"very poor.\" Each impaired domain was scored as 1 point, resulting in a total IC score ranging from 0 to 5. Higher scores denoted greater impairment, whereas lower scores indicated better functional status. 2.2.2. Social activity Social activity was assessed on the basis of previous studies that reflect active engagement in various types of activities [ 34 ]. Participants reported their potential involvement in the following seven types of group activities: 1) religious groups, 2) social gatherings (e.g., neighborhood meetings, senior clubs), 3) leisure activities (e.g., cultural or sports groups, seniors colleges), 4) alumni associations (e.g., hometown or clan associations), 5) volunteer work, 6) political or civic organizations, and 7) others. We tallied the total participation in the different groups to provide a score ranging from 0 to 7, with high scores denoting more active social participation. 2.2.3. Covariates Previous studies suggest that changes in immune and metabolic function around age 60 can serve as a turning point to manage health in both IC and social participation [ 26 ]. Perceived economic status predicts functional health and social engagement better than that predicted by educational achievement [ 35 ]. Financial and non-financial support from family have also been found to promote health-enhancing behaviors among advanced middle-aged adults with a positive influence on both physical function and social participation [ 36 ]. Based on previous studies, the following variables were included as covariates for both IC and social activity analyses: gender (female vs. male), age (< 60 vs. ≥ 60), and perceived socioeconomic status (low vs. high). Different covariates were each applied to IC and social activity models to reflect their distinct determinants, with IC linked more to health-related factors and social activity influenced by environmental and structural conditions [ 37 – 39 ]. For IC analysis, the following health-related covariates were included due to their association with physiological decline and deteriorating health: multimorbidity (≥ 2 chronic diseases), current smoking status (yes vs. no), and current alcohol consumption (yes vs. no). On the basis of evidence, the following covariates were added to analyze social activity: 1) regional differences that influence the opportunities for social engagement, 2) economic activity that supports the development of social ties, 3) residential area (urban vs. rural), and 4) current economic activity (yes vs. no) [ 38 , 39 ]. 2.3. Statistical analysis The cross-lagged panel model (CLPM), a type of structural equation modeling, is suitable to examine reciprocal relationships between variables observed at two or more time points. It is also used to compare subgroups [ 40 ]. In our study, the CLPM was used to analyze the gender-associated differences in the relationship between IC and social activity. We examined gender-associated differences on the baseline characteristics of participants using chi-square tests for categorical variables and independent t-tests for continuous variables. To explore the relationship between IC and social activity, Pearson correlation coefficients among IC, social activity, and their covariates were first calculated for both T1 and T2. In structural equation modeling, correlation coefficients greater than 0.8 may indicate multicollinearity and increase the risk of Type II errors, whereas correlations below 0.5 reduce this risk. The CLPM was then applied to examine the reciprocal associations between IC and social activity over time. Separate models were estimated for males and females. Since the assumption of normality was not met for the data, robust maximum likelihood estimation by multiple linear regression (MLR) was used to ensure valid parameter estimates. SPSS/WIN 25.9 (IBM Corp) was used to analyze descriptive statistics, and the CLPM analyses were conducted using Mplus (Muthén & Muthén Corp). Statistical significance was set at p < 0.05. Model fit was evaluated using the Comparative Fit Index (CFI), Tucker-Lewis Index (TLI), Standardized Root Mean Square Residual (SRMR), and Root Mean Square Error of Approximation (RMSEA). A CFI and TLI value of ≥ 0.90 indicates an acceptable-to-good model fit [ 41 ]; an SRMR value < 0.08 indicates a good fit; and an RMSEA value < 0.06 reflects a good fit [ 42 ]. 3. Results 3.1. Descriptive Analysis of General Characteristics of Advanced Middle-Aged Adults Among males, 82.7% were engaged in economic activity when compared to 45.4% of females, which indicates a significantly low participation rate in economic activity among females (χ² = 332.33, p < .001). The proportion of females reporting family support was significantly higher (56.1%) than males (40.8%) (χ² = 52.28, p < .001). Smoking and drinking rates were markedly higher in males (32.4% and 68.4%, respectively) than in females (1.8% and 24.1%, respectively). This difference in rates was statistically significant (Smoking: χ² = 402.26, p < .001; Drinking: χ² = 446.99, p < .001). IC and social activity significantly differed on the basis of gender in their key variables. In T1, the significantly higher IC scores in females than in males (female: 0.30 ± 0.55; male: 0.21 ± 0.47) indicated poor health status ( t = –4.22, p < .001). This trend persisted in T2 (female: 0.33 ± 0.59; male: 0.26 ± 0.53, t = –2.63, p = .009). Social activity levels were significantly high among males at both time points: T1 (female: 1.18 ± 0.78; male: 1.30 ± 0.79, t = 3.55, p < .001) and T2 (female: 1.17 ± 0.74; male: 1.24 ± 0.76, t = 2.09, p = .036) ( Table 1 ). Our results highlight the need for gender-stratified analyses in subsequent modeling. 3.2. Reciprocal Relationship Between Intrinsic Capacity and Social Activity Correlation analyses were conducted among the variables using data from 2,273 participants to assess the reliability of model fit. The Pearson correlation coefficients between all variables were found to be below 0.8, indicating that multicollinearity was not a concern ( Table S1 ). The CLPM analysis demonstrated an overall acceptable-to-good model fit ( Figure 2 ). In the total sample (N = 2273), IC (T1) significantly predicted IC (T2) ( β = 0.40, p < .001), and social activity (T1) significantly predicted social activity (T2) ( β = 0.53, p < .001). Regarding cross-lagged effects, social activity (T1) had a significant negative effect on IC (T2) ( β = –0.03, p = .013), and conversely, IC (T1) significantly and negatively predicted social activity (T2) ( β = –0.08, p = .002) ( Figure 2, Table 2 ). These findings suggest a reciprocal relationship in which worsening IC leads to reduced social activity over time, while more active social participation contributes positively to subsequent improvements in IC. 3.3. Reciprocal Relationship Between IC and Social Activity Influenced by Gender We subsequently analyzed the relationship between IC and social activity in males and females. In males (n = 1012), both the autoregressive effect of IC ( β = 0.35, p < .001) and that of social activity ( β = 0.52, p < .001) were significant. The IC (T1) had a significant negative effect on social activity (T2) ( β = –0.13, p = .006). However, the effect of social activity (T1) on the IC (T2) was not significant ( β = –0.02, p = .286). These findings indicate that a decline in IC clearly led to decreased social activity among males. In females (n = 1261), both the autoregressive effect of social activity ( β = 0.54, p < .001) and that of IC ( β = 0.42, p < .001) were significant. Furthermore, T1 social activity had a significant negative effect on the IC (T2) ( β = –0.04, p = .022). However, the effect of the IC of T1 on T2 social activity was not statistically significant ( β = –0.05, p = .111) ( Figure 2, Table 3 ). These results suggest that among females, active social activity was clearly associated with the subsequent improvement in IC. 4. Discussion Our study examined the bidirectional relationship between social activity and IC among advanced middle-aged adults, with a focus on the impact of gender on the differences observed in the relationship. Descriptive analysis revealed significant gender-based differences in the general characteristics of participants, which underscored the need for gender-stratified analysis. In the overall study cohort, poor health was associated with a decline in subsequent social activity, while increased social activity positively influenced health outcomes in later stages. This suggests a bidirectional relationship. When analyzed separately by gender, males showed a significant effect of initial IC on subsequent reduced social activity, whereas females showed a more pronounced influence of initial social activity on the improvement of IC. Consistent with the observations of previous studies that showed females are more likely to experience biological health disadvantages, our study demonstrated that females had significantly higher IC scores than those of males [43]. Females also showed low levels of social activity than those of males, aligning with the results of a previous study and reflecting the persistent socioeconomic disadvantages faced by advanced middle-aged females [23]. It is essential to develop tailored health strategies for midlife (55 to 64 years) as it is a critical transition period in health management [26]. Previous studies also emphasized the need for gender-specific interventions to enhance health outcomes [23]. In this context, meaningful gender-sensitive strategies for healthy aging can be developed by understanding the biological and social disadvantages of advanced middle-aged females. In all CLPM analyses, the autoregressive effect of IC (T1) on IC (T2) was positive and significant. Similarly, the autoregressive effect of social activity (T1) on social activity (T2) was positive and significant. These findings were consistent in both the overall sample cohort and in the gender-stratified analyses. Previous studies also found that IC and social activity at earlier timepoint was the biggest contributing factor to IC and social activity, respectively [10, 17, 44, 45]. These findings emphasize the importance of early intervention, as both IC and social activity influence their own trajectories over time. As people age, there is a tendency for their functional capacity to decline and for social activity to reduce, which increases the risk of loneliness [37, 45]. Therefore, if stable or low IC is managed in the early years and social participation is encouraged in advanced middle-aged adults, it may help sustain better IC and continued engagement in social activities. The CLPM results supported the reciprocal association between IC and social activity, with notable gender-associated differences. Among advanced middle-aged males, the influence of poor IC on the deterioration of social activity was strong. This suggests that interventions aimed at maintaining or improving IC in advanced middle-aged males could help preserve their social engagement. Previous research showed that the quality of life associated with health is higher among working males in their 50s than among their non-working counterparts with employment playing a pivotal role in men's health than in that of women [46]. In our study, 82.71% of male participants were currently employed. Considering the importance of maintaining IC within the context of continued employment, digital health promotion programs that overcome time and space barriers or worksite-based interventions may be particularly suitable for this population [47, 48]. Male facilitators and gender-responsive designs could improve male engagement in such interventions [27, 49] since social norms around masculinity and face-saving behaviors have been identified as barriers to the use of health services among Korean males [50]. Strategically improving IC in advanced middle-aged males may lead to sustained or increased social activity in later stages of life. For females, the results indicated that social activity played a more significant role in influencing IC in their advanced middle age. This highlights the need for interventions that promote social engagement among advanced middle-aged females. Participants in this study included members of the so-called “sandwich generation,” who are burdened by the dual caregiving demands of supporting both aging parents and children [25]. Despite the well-documented benefits of social activity in improving IC [18-20], many females in this age group face challenges in regular participation. Social participation in females is constrained because caregiving responsibilities often persist in later life, which involves grandchildren or spouses [19, 25, 51]. Proactive outreach and interventions that foster social connections—such as group-based exercise programs—are particularly important for females [25] because social activity tends to decline most rapidly during advanced middle age [45]. Furthermore, supportive policy measures that redistribute caregiving responsibilities may help to reduce the burden on females and facilitate sustainable participation. When social engagement is promoted through active interventions that include multilevel strategies, it may help to improve IC and support healthy aging among advanced middle-aged females. Healthy aging is defined as the process of developing and maintaining functional ability to enable well-being in the advanced stages of life. It is a reflection of the continuous interactions between individuals and their environments [2]. Hence, it is critical to manage IC from middle age onwards [4]. Since advanced middle age is a key period to prevent frailty [3, 11], developing tailored health strategies that consider individual characteristics at this stage could be effective to promote healthy aging [26]. In light of our findings, it is pivotal to give emphasis to early interventions that are gender-associated and focused on improving IC as well as on encouraging social activity from advanced middle age onwards. In males, strategies that include employment status may help to maintain IC and support active social engagement. In females, IC outcomes may be significantly improved by taking into account caregiving burdens and gendered expectations, identifying at-risk individuals, and promoting social connections. Our study expands on the WHO Healthy Aging framework and demonstrates the relationship between IC and social activity in midlife through an emphasis on gender-specific pathways. Our study also underscores the need to reduce health inequalities and support healthy aging in aging societies. Our study has several limitations. First, as a retrospective study, the measurements of IC and social activity were limited by the scope of the original dataset. We did not directly assess cognitive function using standardized instruments. Instead, we indirectly inferred cognitive competence on the basis of whether respondents needed assistance to manage money or medications. Second, our study was based on data from only two timepoints (2016 and 2018) to minimize the effect of time-related confounders. Future studies must use direct cognitive assessments to better reflect IC and employ long-term longitudinal data that spans the transition from advanced middle age to old age. Abbreviations IC Intrinsic capacity SA Social activity KLoSA Korean Longitudinal Study of Aging Declarations Clinical Trial Number Not applicable Consent for publication The authors of this study, GK and KK agree to the publication of this study. Availability of data and materials The dataset is publicly available through the Employment Survey and Analysis System website (https://survey.keis.or.kr/index.jsp) under the “KLoSA” category. Competing interests There were no competing interests. Funding There was no funding. 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The impact of worksite interventions promoting healthier food and/or physical activity habits among employees working 'around the clock' hours: a systematic review. Food Nutr Res 2018, 62. Howell BM, Peterson JR, Corbett S. Where Are All the Men? A Qualitative Review of the Barriers, Facilitators, and Recommendations to Older Male Participation in Health Promotion Interventions. Am J Health Promot. 2023;37(3):386–400. Kim S, Kim D. Mental health help-seeking among Korean men: the influence of stigma, masculine norms, and face. BMC Psychol. 2025;13(1):461. Jang SN, Avendano M, Kawachi I. Informal caregiving patterns in Korea and European countries: a cross-national comparison. Asian Nurs Res (Korean Soc Nurs Sci). 2012;6(1):19–26. Tables Table 1 General characteristics of participants (N = 2,273) Variables Total (N = 2,273) Male (n = 1,012) Female (n = 1,261) χ² or t ( p ) Age < 60 1,204 (52.97) 549 (54.25) 655 (51.94) 1.2 (0.274) ≥ 60 1,069 (47.03) 463 (45.75) 606 (48.06) Region Urban 1,846 (81.21) 836 (82.61) 1,010 (80.1) 2.32 (0.127) Rural 427 (18.79) 176 (17.39) 251 (19.90) Perceived socioeconomic status Low 2,184 (96.08) 965 (95.36) 1,219 (96.67) 2.57 (0.109) High 89 (3.92) 47 (4.64) 42 (3.33) Employment status No 864 (38.01) 175 (17.29) 689 (54.64) 332.33 (< .001) Yes 1,409 (61.99) 837 (82.71) 572 (45.36) Family support No 1,153 (50.73) 599 (59.19) 554 (43.93) 52.28 (< .001) Yes 1,120 (49.27) 413 (40.81) 707 (56.07) Multimorbidity < 2 1,887 (83.02) 856 (84.58) 1,031 (81.76) 3.18 (0.075) ≥ 2 386 (16.98) 156 (15.42) 230 (18.24) Smoking No 1,922 (84.56) 684 (67.59) 1,238 (98.18) 402.26 (< .001) Yes 351 (15.44) 328 (32.41) 23 (1.82) Drinking No 1,277 (56.18) 320 (31.62) 957 (75.89) 446.99 (< .001) Yes 996 (43.82) 692 (68.38) 304 (24.11) Intrinsic capacity (T1) 0.26 ± 0.52 0.21 ± 0.47 0.30 ± 0.55 -4.22 (< .001) Intrinsic capacity (T2) 0.30 ± 0.56 0.26 ± 0.53 0.33 ± 0.59 -2.63 (0.009) Social activity (T1) 1.23 ± 0.78 1.30 ± 0.79 1.18 ± 0.78 3.55 (< .001) Social activity (T2) 1.20 ± 0.75 1.24 ± 0.76 1.17 ± 0.74 2.09 (0.036) Note. T1 refers to data collected in 2016, and T2 refers to data collected in 2018. Table 2 Correlation coefficients of sample characteristics (N = 2,273) Total (N = 2,273) Male (n = 1,012) Female (n = 1,261) IC (T1) IC (T2) SA (T1) SA (T2) IC (T1) IC (T2) SA (T1) SA (T2) IC (T1) IC (T2) SA (T1) SA (T2) IC (T1) 1 1 1 p IC (T2) .39 ** 1 .32 ** 1 .43 ** 1 p < .001 < .001 < .001 SA (T1) − .16 ** − .11 ** 1 − .17 ** − .09 ** 1 − .14 ** − .12 ** 1 p < .001 < .001 < .001 0.005 < .001 < .001 SA (T2) − .14 ** − .14 ** .56 ** 1 − .16 ** − .18 ** .55 ** 1 − .12 ** − .11 ** .57 ** 1 p < .001 < .001 < .001 < .001 < .001 < .001 < .001 < .001 < .001 Note. * p < .05, ** p < .01, *** p < .001. IC - intrinsic capacity; SA - social activity; T1 refers to data collected in 2016, and T2 refers to data collected in 2018. Variables other than the main variables were omitted from this table. Table 3 Cross-lagged panel analysis (N = 2,273) Total (N = 2,273) Male (n = 1,012) Female (n = 1,261) IC (T2) SA (T2) IC (T2) SA (T2) IC (T2) SA (T2) β (SD) p β (SD) p β (SD) p β (SD) p β (SD) p β (SD) p IC (T1) 0.40 (0.03) < .001 -0.08 (0.03) 0.002 0.35 (0.05) < .001 -0.13 (0.05) 0.006 0.42 (0.04) < .001 -0.05 (0.03) 0.111 SA (T1) -0.03 (0.01) 0.013 0.53 (0.02) < .001 -0.02 (0.02) 0.286 0.52 (0.03) < .001 -0.04 (0.02) 0.022 0.54 (0.03) < .001 Gender -0.01 (0.03) 0.821 0.00 (0.03) 0.901 Age 0.02 (0.02) 0.446 0.00 (0.03) 0.923 0.01 (0.03) 0.746 0.06 (0.04) 0.164 0.02 (0.03) 0.549 -0.04 (0.04) 0.248 Region -0.06 (0.03) 0.05 -0.12 (0.05) 0.017 -0.03 (0.04) 0.535 PSS 0.01 (0.06) 0.913 -0.13 (0.08) 0.091 -0.12 (0.06) 0.042 -0.04 (0.09) 0.672 0.15 (0.09) 0.112 -0.24 (0.13) 0.065 ES 0.02 (0.03) 0.489 0.03 (0.05) 0.559 0.01 (0.04) 0.722 FS 0.04 (0.02) 0.047 0.05 (0.03) 0.095 -0.01 (0.03) 0.863 0.09 (0.04) 0.04 0.08 (0.03) 0.005 0.01 (0.04) 0.741 MM 0.09 (0.03) 0.007 0.08 (0.05) 0.103 0.10 (0.04) 0.031 Smoking -0.01 (0.04) 0.696 -0.03 (0.04) 0.4 0.17 (0.19) 0.376 Drinking -0.03 (0.03) 0.218 -0.07 (0.04) 0.087 < .001 (0.03) 0.956 Note. IC - intrinsic capacity; SA - social activity; PSS - perceived socioeconomic status; ES - employment status; FS - family support; MM - multimorbidity; T1 refers to data collected in 2016, and T2 refers to data collected in 2018. Additional Declarations No competing interests reported. Supplementary Files SupplementarymaterialsTableS1Correlationmatrix.docx Cite Share Download PDF Status: Published Journal Publication published 12 Mar, 2026 Read the published version in BMC Public Health → Version 1 posted Editorial decision: Revision requested 26 Dec, 2025 Reviews received at journal 22 Dec, 2025 Reviewers agreed at journal 22 Dec, 2025 Reviews received at journal 24 Oct, 2025 Reviewers agreed at journal 09 Oct, 2025 Reviewers invited by journal 09 Oct, 2025 Editor invited by journal 09 Oct, 2025 Editor assigned by journal 07 Oct, 2025 Submission checks completed at journal 07 Oct, 2025 First submitted to journal 05 Oct, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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15:47:35\",\"extension\":\"png\",\"order_by\":2,\"title\":\"Figure 2\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":90635,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eReciprocal relationship between intrinsic capacity and social activity\\u003c/p\\u003e\\n\\u003cp\\u003eNote. *\\u003cem\\u003ep\\u003c/em\\u003e \\u0026lt; 0.05, **\\u003cem\\u003ep\\u003c/em\\u003e \\u0026lt; 0.01, ***\\u003cem\\u003ep\\u003c/em\\u003e \\u0026lt; 0.001\\u003c/p\\u003e\\n\\u003cp\\u003eCFI – Comparative Fit Index, TLI - Tucker-Lewis Index, SRMR - Standardized Root Mean Square Residual, RMSEA - Root Mean Square Error of Approximation\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"floatimage2.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-7782807/v1/129c1b36d90317e1d20e2d30.png\"},{\"id\":104739916,\"identity\":\"8d7e608b-fd2a-49cb-998b-d847d0e82b0f\",\"added_by\":\"auto\",\"created_at\":\"2026-03-16 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Social Activity Influenced by Gender in Advanced Middle-Aged Adults in South Korea\",\"fulltext\":[{\"header\":\"1. Introduction\",\"content\":\"\\u003cp\\u003eThe World Health Organization (WHO) defines healthy aging as a process of developing and maintaining functional ability to enable well-being in advanced years [\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e]. In this context, the development and maintenance of intrinsic capacity (IC) has gained attention [\\u003cspan additionalcitationids=\\\"CR3\\\" citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e]. IC is a composite of an individual's physical and mental abilities [\\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e]. A decline in IC may lead to frailty [\\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e]. Frailty contributes to individual as well as societal burden because it is associated not only with numerous adverse outcomes, such as falls, hospitalizations, mortality, and poor quality of life, but also with increased healthcare costs and caregiving demands [\\u003cspan additionalcitationids=\\\"CR7 CR8\\\" citationid=\\\"CR6\\\" class=\\\"CitationRef\\\"\\u003e6\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e9\\u003c/span\\u003e] Measures to prevent frailty should focus on enhancing IC levels since frailty can be potentially reversed in the early stages [\\u003cspan citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e].\\u003c/p\\u003e\\u003cp\\u003eConsidering the trajectory of IC during the life of an individual, it is essential to build and maintain IC beginning in midlife to promote healthy aging [\\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e]. Advanced middle age, defined as the transitional stage before old age, is regarded as a critical period to effectively prevent frailty [\\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e]. Advanced middle-aged individuals (age range of 55 to 64 years) often experience dual caregiving burdens\\u0026mdash;caring for both aging parents and dependent children [\\u003cspan citationid=\\\"CR12\\\" class=\\\"CitationRef\\\"\\u003e12\\u003c/span\\u003e]. They also face various challenges, such as socioeconomic changes, anxiety about an uncertain future linked to preparations for retirement [\\u003cspan citationid=\\\"CR13\\\" class=\\\"CitationRef\\\"\\u003e13\\u003c/span\\u003e], and functional decline associated with aging [\\u003cspan citationid=\\\"CR14\\\" class=\\\"CitationRef\\\"\\u003e14\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR15\\\" class=\\\"CitationRef\\\"\\u003e15\\u003c/span\\u003e].\\u003c/p\\u003e\\u003cp\\u003eAccording to the WHO\\u0026rsquo;s International Classification of Functioning, Disability and Health framework, healthy aging can be promoted by strengthening the individual\\u0026rsquo;s IC and encouraging participation in social activities that are meaningful to the individual [\\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e]. From this perspective, social participation can be considered a key environmental factor that contributes to maintaining physical function and mental health [\\u003cspan citationid=\\\"CR16\\\" class=\\\"CitationRef\\\"\\u003e16\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR17\\\" class=\\\"CitationRef\\\"\\u003e17\\u003c/span\\u003e]. Previous studies have shown that social support, derived from social participation, acts as an emotional and material resource to positively contribute to maintain physical and cognitive function [\\u003cspan citationid=\\\"CR17\\\" class=\\\"CitationRef\\\"\\u003e17\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR18\\\" class=\\\"CitationRef\\\"\\u003e18\\u003c/span\\u003e]. Conversely, a decline in IC may hinder social activity, which leads to social isolation and triggers a vicious cycle [\\u003cspan citationid=\\\"CR19\\\" class=\\\"CitationRef\\\"\\u003e19\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR20\\\" class=\\\"CitationRef\\\"\\u003e20\\u003c/span\\u003e]. Thus, the relationship between IC and social activity should be understood as bidirectional rather than unidirectional [\\u003cspan citationid=\\\"CR21\\\" class=\\\"CitationRef\\\"\\u003e21\\u003c/span\\u003e]\\u003c/p\\u003e\\u003cp\\u003eWith reports that gender differences in health outcomes become more pronounced with age, the relationship between social activity and IC may also be influenced by gender and offers critical insights from a health equity perspective [\\u003cspan citationid=\\\"CR15\\\" class=\\\"CitationRef\\\"\\u003e15\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR22\\\" class=\\\"CitationRef\\\"\\u003e22\\u003c/span\\u003e]. Although females tend to have relatively better health status, they generally demonstrate lower levels of social participation than that of males [\\u003cspan citationid=\\\"CR23\\\" class=\\\"CitationRef\\\"\\u003e23\\u003c/span\\u003e]. This disparity has been attributed to factors, such as caregiving burdens disproportionately placed on middle-aged females, traditional gender role expectations, and limited access to the labor market [\\u003cspan citationid=\\\"CR24\\\" class=\\\"CitationRef\\\"\\u003e24\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR25\\\" class=\\\"CitationRef\\\"\\u003e25\\u003c/span\\u003e]. Noting these differences, researchers have increasingly emphasized the need for gender-sensitive approaches [\\u003cspan additionalcitationids=\\\"CR27\\\" citationid=\\\"CR26\\\" class=\\\"CitationRef\\\"\\u003e26\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR28\\\" class=\\\"CitationRef\\\"\\u003e28\\u003c/span\\u003e]. Therefore, a gender-stratified analysis is necessary to accurately examine the impact on the reciprocal relationship between IC and social participation in middle-aged individuals.\\u003c/p\\u003e\\u003cp\\u003eIC is a key indicator of healthy aging and the prevention of frailty [\\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e]. Advanced middle age represents a pivotal period to implement preventive interventions prior to the transition to old age [\\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e]. Studies have been limited on the interactions between IC and social activity in advanced middle-aged individuals, with most existing research focused on older adults. Research that conducts gender-stratified analyses is even more rare. Therefore, the present study aims to analyze the bidirectional relationship between IC and social activity and to identify the influence of gender on these associations among advanced middle-aged adults using longitudinal data.\\u003c/p\\u003e\"},{\"header\":\"2. Methods\",\"content\":\"\\u003cdiv id=\\\"Sec3\\\" class=\\\"Section2\\\"\\u003e\\u003ch2\\u003e2.1. Study participants\\u003c/h2\\u003e\\u003cp\\u003eOur nationwide longitudinal study utilized data from the Korean Longitudinal Study of Aging (KLoSA). Since 2006, KLoSA surveyed and conducted biennial follow-ups on 10, 254 adults aged 45 years or older and residing in 15 metropolitan areas in South Korea. The households were selected based on region and housing type by using a multistage stratified probability sampling method. Trained interviewers collected data through face-to-face interviews. The KLoSA panel survey assessed various social, economic, psychological, demographic, and health-related characteristics of individuals.\\u003c/p\\u003e\\u003cp\\u003eOur study used data from the 6th wave (T1, 2016) and the 7th wave (T2, 2018). Data from the 8th wave (2020) were not used due to a potential bias introduced by COVID-19 that may have affected the involvement of participants in social activities. Upon registration, the dataset is publicly available through the Employment Survey and Analysis System website (\\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://survey.keis.or.kr/index.jsp\\u003c/span\\u003e\\u003cspan address=\\\"https://survey.keis.or.kr/index.jsp\\\" targettype=\\\"URL\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e) under the \\u0026ldquo;KLoSA\\u0026rdquo; category.\\u003c/p\\u003e\\u003cp\\u003eFor our study, we selected participants based on criteria from previous research on advanced middle age that is defined as individuals aged 55 to 64 years [\\u003cspan citationid=\\\"CR12\\\" class=\\\"CitationRef\\\"\\u003e12\\u003c/span\\u003e]. A total of 2,464 individuals met this age criterion in T1. We excluded individuals who were fully dependent on conditions known to restrict social participation \\u0026ndash; activities of daily living (ADL) or instrumental activities of daily living (IADL) [\\u003cspan citationid=\\\"CR18\\\" class=\\\"CitationRef\\\"\\u003e18\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR29\\\" class=\\\"CitationRef\\\"\\u003e29\\u003c/span\\u003e] \\u0026ndash; on the basis of the following baseline (T1) criteria: (i) those unable to respond to the survey themselves (n\\u0026thinsp;=\\u0026thinsp;6), (ii) those diagnosed with a disability (n\\u0026thinsp;=\\u0026thinsp;3), (iii) those fully dependent on ADL (n\\u0026thinsp;=\\u0026thinsp;7) or IADL (n\\u0026thinsp;=\\u0026thinsp;55), and (iv) those with missing data on IC (n\\u0026thinsp;=\\u0026thinsp;133) or social activity (n\\u0026thinsp;=\\u0026thinsp;133). After applying these exclusion criteria, a final sample of 2,273 participants (male\\u0026thinsp;=\\u0026thinsp;1,012; female\\u0026thinsp;=\\u0026thinsp;1,261) was included in the analysis (Fig.\\u0026nbsp;\\u003cspan refid=\\\"Fig1\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e).\\u003c/p\\u003e\\u003cp\\u003e\\u003c/p\\u003e\\u003c/div\\u003e\\u003cdiv id=\\\"Sec4\\\" class=\\\"Section2\\\"\\u003e\\u003ch2\\u003e2.2. Measurements\\u003c/h2\\u003e\\u003cdiv id=\\\"Sec5\\\" class=\\\"Section3\\\"\\u003e\\u003ch2\\u003e2.2.1. Intrinsic capacity (IC)\\u003c/h2\\u003e\\u003cp\\u003eIC serves as a potential predictor of negative health outcomes [\\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e]. On the basis of the WHO definition and previous studies [\\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR30\\\" class=\\\"CitationRef\\\"\\u003e30\\u003c/span\\u003e], IC was measured across five domains: (i) Mobility: requiring partial or complete assistance to get out of bed and to walk out of the room; (ii) Vitality: maximum handgrip strength measured twice for each hand, with the highest value falling below the sex-specific thresholds (males\\u0026thinsp;\\u0026lt;\\u0026thinsp;26 kg; females\\u0026thinsp;\\u0026lt;\\u0026thinsp;18 kg) [\\u003cspan citationid=\\\"CR31\\\" class=\\\"CitationRef\\\"\\u003e31\\u003c/span\\u003e]; (iii) Cognition: needing assistance to manage money or to use medications [\\u003cspan citationid=\\\"CR32\\\" class=\\\"CitationRef\\\"\\u003e32\\u003c/span\\u003e]; (iv) Psychological well-being: score\\u0026thinsp;\\u0026ge;\\u0026thinsp;4 out of 10 on the Center for Epidemiological Studies-Depression Scale (CES-D) [\\u003cspan citationid=\\\"CR33\\\" class=\\\"CitationRef\\\"\\u003e33\\u003c/span\\u003e]; (v) Sensory function: self-reported rating of vision or hearing as \\\"poor\\\" or \\\"very poor.\\\" Each impaired domain was scored as 1 point, resulting in a total IC score ranging from 0 to 5. Higher scores denoted greater impairment, whereas lower scores indicated better functional status.\\u003c/p\\u003e\\u003c/div\\u003e\\u003cdiv id=\\\"Sec6\\\" class=\\\"Section3\\\"\\u003e\\u003ch2\\u003e2.2.2. Social activity\\u003c/h2\\u003e\\u003cp\\u003eSocial activity was assessed on the basis of previous studies that reflect active engagement in various types of activities [\\u003cspan citationid=\\\"CR34\\\" class=\\\"CitationRef\\\"\\u003e34\\u003c/span\\u003e]. Participants reported their potential involvement in the following seven types of group activities: 1) religious groups, 2) social gatherings (e.g., neighborhood meetings, senior clubs), 3) leisure activities (e.g., cultural or sports groups, seniors colleges), 4) alumni associations (e.g., hometown or clan associations), 5) volunteer work, 6) political or civic organizations, and 7) others. We tallied the total participation in the different groups to provide a score ranging from 0 to 7, with high scores denoting more active social participation.\\u003c/p\\u003e\\u003c/div\\u003e\\u003cdiv id=\\\"Sec7\\\" class=\\\"Section3\\\"\\u003e\\u003ch2\\u003e2.2.3. Covariates\\u003c/h2\\u003e\\u003cp\\u003ePrevious studies suggest that changes in immune and metabolic function around age 60 can serve as a turning point to manage health in both IC and social participation [\\u003cspan citationid=\\\"CR26\\\" class=\\\"CitationRef\\\"\\u003e26\\u003c/span\\u003e]. Perceived economic status predicts functional health and social engagement better than that predicted by educational achievement [\\u003cspan citationid=\\\"CR35\\\" class=\\\"CitationRef\\\"\\u003e35\\u003c/span\\u003e]. Financial and non-financial support from family have also been found to promote health-enhancing behaviors among advanced middle-aged adults with a positive influence on both physical function and social participation [\\u003cspan citationid=\\\"CR36\\\" class=\\\"CitationRef\\\"\\u003e36\\u003c/span\\u003e]. Based on previous studies, the following variables were included as covariates for both IC and social activity analyses: gender (female vs. male), age (\\u0026lt;\\u0026thinsp;60 vs. \\u0026ge; 60), and perceived socioeconomic status (low vs. high).\\u003c/p\\u003e\\u003cp\\u003eDifferent covariates were each applied to IC and social activity models to reflect their distinct determinants, with IC linked more to health-related factors and social activity influenced by environmental and structural conditions [\\u003cspan additionalcitationids=\\\"CR38\\\" citationid=\\\"CR37\\\" class=\\\"CitationRef\\\"\\u003e37\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR39\\\" class=\\\"CitationRef\\\"\\u003e39\\u003c/span\\u003e]. For IC analysis, the following health-related covariates were included due to their association with physiological decline and deteriorating health: multimorbidity (\\u0026ge;\\u0026thinsp;2 chronic diseases), current smoking status (yes vs. no), and current alcohol consumption (yes vs. no). On the basis of evidence, the following covariates were added to analyze social activity: 1) regional differences that influence the opportunities for social engagement, 2) economic activity that supports the development of social ties, 3) residential area (urban vs. rural), and 4) current economic activity (yes vs. no) [\\u003cspan citationid=\\\"CR38\\\" class=\\\"CitationRef\\\"\\u003e38\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR39\\\" class=\\\"CitationRef\\\"\\u003e39\\u003c/span\\u003e].\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/div\\u003e\\u003cdiv id=\\\"Sec8\\\" class=\\\"Section2\\\"\\u003e\\u003ch2\\u003e2.3. Statistical analysis\\u003c/h2\\u003e\\u003cp\\u003eThe cross-lagged panel model (CLPM), a type of structural equation modeling, is suitable to examine reciprocal relationships between variables observed at two or more time points. It is also used to compare subgroups [\\u003cspan citationid=\\\"CR40\\\" class=\\\"CitationRef\\\"\\u003e40\\u003c/span\\u003e]. In our study, the CLPM was used to analyze the gender-associated differences in the relationship between IC and social activity.\\u003c/p\\u003e\\u003cp\\u003eWe examined gender-associated differences on the baseline characteristics of participants using chi-square tests for categorical variables and independent t-tests for continuous variables. To explore the relationship between IC and social activity, Pearson correlation coefficients among IC, social activity, and their covariates were first calculated for both T1 and T2. In structural equation modeling, correlation coefficients greater than 0.8 may indicate multicollinearity and increase the risk of Type II errors, whereas correlations below 0.5 reduce this risk.\\u003c/p\\u003e\\u003cp\\u003eThe CLPM was then applied to examine the reciprocal associations between IC and social activity over time. Separate models were estimated for males and females. Since the assumption of normality was not met for the data, robust maximum likelihood estimation by multiple linear regression (MLR) was used to ensure valid parameter estimates.\\u003c/p\\u003e\\u003cp\\u003eSPSS/WIN 25.9 (IBM Corp) was used to analyze descriptive statistics, and the CLPM analyses were conducted using Mplus (Muth\\u0026eacute;n \\u0026amp; Muth\\u0026eacute;n Corp). Statistical significance was set at \\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05. Model fit was evaluated using the Comparative Fit Index (CFI), Tucker-Lewis Index (TLI), Standardized Root Mean Square Residual (SRMR), and Root Mean Square Error of Approximation (RMSEA). A CFI and TLI value of \\u0026ge;\\u0026thinsp;0.90 indicates an acceptable-to-good model fit [\\u003cspan citationid=\\\"CR41\\\" class=\\\"CitationRef\\\"\\u003e41\\u003c/span\\u003e]; an SRMR value\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.08 indicates a good fit; and an RMSEA value\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.06 reflects a good fit [\\u003cspan citationid=\\\"CR42\\\" class=\\\"CitationRef\\\"\\u003e42\\u003c/span\\u003e].\\u003c/p\\u003e\\u003c/div\\u003e\"},{\"header\":\"3. Results\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003e3.1. Descriptive Analysis of General Characteristics of Advanced Middle-Aged Adults\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eAmong males, 82.7% were engaged in economic activity when compared to 45.4% of females, which indicates a significantly low participation rate in economic activity among females (\\u0026chi;\\u0026sup2; = 332.33, \\u003cem\\u003ep\\u003c/em\\u003e \\u0026lt; .001). The proportion of females reporting family support was significantly higher (56.1%) than males (40.8%) (\\u0026chi;\\u0026sup2; = 52.28, \\u003cem\\u003ep\\u003c/em\\u003e \\u0026lt; .001). Smoking and drinking rates were markedly higher in males (32.4% and 68.4%, respectively) than in females (1.8% and 24.1%, respectively). This difference in rates was statistically significant (Smoking: \\u0026chi;\\u0026sup2; = 402.26, \\u003cem\\u003ep\\u003c/em\\u003e \\u0026lt; .001; Drinking: \\u0026chi;\\u0026sup2; = 446.99, \\u003cem\\u003ep\\u003c/em\\u003e \\u0026lt; .001).\\u003c/p\\u003e\\n\\u003cp\\u003eIC and social activity significantly differed on the basis of gender in their key variables. In T1, the significantly higher IC scores in females than in males (female: 0.30 \\u0026plusmn; 0.55; male: 0.21 \\u0026plusmn; 0.47) indicated poor health status (\\u003cem\\u003et\\u003c/em\\u003e = \\u0026ndash;4.22, \\u003cem\\u003ep\\u003c/em\\u003e \\u0026lt; .001). This trend persisted in T2 (female: 0.33 \\u0026plusmn; 0.59; male: 0.26 \\u0026plusmn; 0.53, \\u003cem\\u003et\\u003c/em\\u003e = \\u0026ndash;2.63, \\u003cem\\u003ep\\u003c/em\\u003e = .009). Social activity levels were significantly high among males at both time points: T1 (female: 1.18 \\u0026plusmn; 0.78; male: 1.30 \\u0026plusmn; 0.79, \\u003cem\\u003et\\u003c/em\\u003e = 3.55, \\u003cem\\u003ep\\u003c/em\\u003e \\u0026lt; .001) and T2 (female: 1.17 \\u0026plusmn; 0.74; male: 1.24 \\u0026plusmn; 0.76, \\u003cem\\u003et\\u003c/em\\u003e = 2.09, \\u003cem\\u003ep\\u003c/em\\u003e = .036) (\\u003cstrong\\u003eTable 1\\u003c/strong\\u003e). Our results highlight the need for gender-stratified analyses in subsequent modeling.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003e3.2. Reciprocal Relationship Between Intrinsic Capacity and Social Activity\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eCorrelation analyses were conducted among the variables using data from 2,273 participants to assess the reliability of model fit. The Pearson correlation coefficients between all variables were found to be below 0.8, indicating that multicollinearity was not a concern (\\u003cstrong\\u003eTable S1\\u003c/strong\\u003e).\\u003c/p\\u003e\\n\\u003cp\\u003eThe CLPM analysis demonstrated an overall acceptable-to-good model fit (\\u003cstrong\\u003eFigure 2\\u003c/strong\\u003e). In the total sample (N = 2273), IC (T1) significantly predicted IC (T2) (\\u003cem\\u003e\\u0026beta;\\u003c/em\\u003e = 0.40, \\u003cem\\u003ep\\u003c/em\\u003e \\u0026lt; .001), and social activity (T1) significantly predicted social activity (T2) (\\u003cem\\u003e\\u0026beta;\\u003c/em\\u003e = 0.53, \\u003cem\\u003ep\\u003c/em\\u003e \\u0026lt; .001). Regarding cross-lagged effects, social activity (T1) had a significant negative effect on IC (T2) (\\u003cem\\u003e\\u0026beta;\\u003c/em\\u003e = \\u0026ndash;0.03, \\u003cem\\u003ep\\u0026nbsp;\\u003c/em\\u003e= .013), and conversely, IC (T1) significantly and negatively predicted social activity (T2) (\\u003cem\\u003e\\u0026beta;\\u003c/em\\u003e = \\u0026ndash;0.08, \\u003cem\\u003ep\\u003c/em\\u003e = .002) (\\u003cstrong\\u003eFigure 2, Table 2\\u003c/strong\\u003e). These findings suggest a reciprocal relationship in which worsening IC leads to reduced social activity over time, while more active social participation contributes positively to subsequent improvements in IC.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003e3.3. Reciprocal Relationship Between IC and Social Activity Influenced by Gender\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eWe subsequently analyzed the relationship between IC and social activity in males and females. In males (n = 1012), both the autoregressive effect of IC (\\u003cem\\u003e\\u0026beta;\\u003c/em\\u003e = 0.35, p \\u0026lt; .001) and that of social activity (\\u003cem\\u003e\\u0026beta;\\u003c/em\\u003e = 0.52, \\u003cem\\u003ep\\u003c/em\\u003e \\u0026lt; .001) were significant. The IC (T1) had a significant negative effect on social activity (T2) (\\u003cem\\u003e\\u0026beta;\\u003c/em\\u003e = \\u0026ndash;0.13, \\u003cem\\u003ep\\u003c/em\\u003e = .006). However, the effect of social activity (T1) on the IC (T2) was not significant (\\u003cem\\u003e\\u0026beta;\\u003c/em\\u003e = \\u0026ndash;0.02, \\u003cem\\u003ep\\u003c/em\\u003e = .286). These findings indicate that a decline in IC clearly led to decreased social activity among males.\\u003c/p\\u003e\\n\\u003cp\\u003eIn females (n = 1261), both the autoregressive effect of social activity (\\u003cem\\u003e\\u0026beta;\\u003c/em\\u003e = 0.54, \\u003cem\\u003ep\\u0026nbsp;\\u003c/em\\u003e\\u0026lt; .001) and that of IC (\\u003cem\\u003e\\u0026beta;\\u003c/em\\u003e = 0.42, \\u003cem\\u003ep\\u003c/em\\u003e\\u0026lt; .001) were significant. Furthermore, T1 social activity had a significant negative effect on the IC (T2) (\\u003cem\\u003e\\u0026beta;\\u003c/em\\u003e = \\u0026ndash;0.04, \\u003cem\\u003ep\\u003c/em\\u003e = .022). However, the effect of the IC of T1 on T2 social activity was not statistically significant (\\u003cem\\u003e\\u0026beta;\\u003c/em\\u003e = \\u0026ndash;0.05, \\u003cem\\u003ep\\u003c/em\\u003e = .111) (\\u003cstrong\\u003eFigure 2, Table 3\\u003c/strong\\u003e). These results suggest that among females, active social activity was clearly associated with the subsequent improvement in IC.\\u003c/p\\u003e\"},{\"header\":\"4. Discussion\",\"content\":\"\\u003cp\\u003eOur study examined the bidirectional relationship between social activity and IC among advanced middle-aged adults, with a focus on the impact of gender on the differences observed in the relationship. Descriptive analysis revealed significant gender-based differences in the general characteristics of participants, which underscored the need for gender-stratified analysis. In the overall study cohort, poor health was associated with a decline in subsequent social activity, while increased social activity positively influenced health outcomes in later stages. This suggests a bidirectional relationship. When analyzed separately by gender, males showed a significant effect of initial IC on subsequent reduced social activity, whereas females showed a more pronounced influence of initial social activity on the improvement of IC.\\u003c/p\\u003e\\n\\u003cp\\u003eConsistent with the observations of previous studies that showed females are more likely to experience biological health disadvantages, our study demonstrated that females had significantly higher IC scores than those of males [43]. Females also showed low levels of social activity than those of males, aligning with the results of a previous study and reflecting the persistent socioeconomic disadvantages faced by advanced middle-aged females [23]. It is essential to develop tailored health strategies for midlife (55 to 64 years) as it is a critical transition period in health management [26]. Previous studies also emphasized the need for gender-specific interventions to enhance health outcomes [23]. In this context, meaningful gender-sensitive strategies for healthy aging can be developed by understanding the biological and social disadvantages of advanced middle-aged females.\\u003c/p\\u003e\\n\\u003cp\\u003eIn all CLPM analyses, the autoregressive effect of IC (T1) on IC (T2) was positive and significant. Similarly, the autoregressive effect of social activity (T1) on social activity (T2) was positive and significant. These findings were consistent in both the overall sample cohort and in the gender-stratified analyses. Previous studies also found that IC and social activity at earlier timepoint was the biggest contributing factor to IC and social activity, respectively\\u0026nbsp;[10, 17, 44, 45]. These findings emphasize the importance of early intervention, as both IC and social activity influence their own trajectories over time. As people age, there is a tendency for their functional capacity to decline and for social activity to reduce, which increases the risk of loneliness [37, 45]. Therefore, if stable or low IC is managed in the early years and social participation is encouraged in advanced middle-aged adults, it may help sustain better IC and continued engagement in social activities.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eThe CLPM results supported the reciprocal association between IC and social activity, with notable gender-associated differences. Among advanced middle-aged males, the influence of poor IC on the deterioration of social activity was strong. This suggests that interventions aimed at maintaining or improving IC in advanced middle-aged males could help preserve their social engagement. Previous research showed that the quality of life associated with health is higher among working males in their 50s than among their non-working counterparts with employment playing a pivotal role in men's health than in that of women [46]. In our study, 82.71% of male participants were currently employed. Considering the importance of maintaining IC within the context of continued employment, digital health promotion programs that overcome time and space barriers or worksite-based interventions may be particularly suitable for this population [47, 48]. Male facilitators and gender-responsive designs could improve male engagement in such interventions [27, 49] since social norms around masculinity and face-saving behaviors have been identified as barriers to the use of health services among Korean males [50]. Strategically improving IC in advanced middle-aged males may lead to sustained or increased social activity in later stages of life.\\u003c/p\\u003e\\n\\u003cp\\u003eFor females, the results indicated that social activity played a more significant role in influencing IC in their advanced middle age. This highlights the need for interventions that promote social engagement among advanced middle-aged females. Participants in this study included members of the so-called “sandwich generation,” who are burdened by the dual caregiving demands of supporting both aging parents and children\\u0026nbsp;[25]. Despite the well-documented benefits of social activity in improving IC [18-20], many females in this age group face challenges in regular participation. Social participation in females is constrained because caregiving responsibilities often persist in later life, which involves grandchildren or spouses [19, 25, 51]. Proactive outreach and interventions that foster social connections—such as group-based exercise programs—are particularly important for females [25] because social activity tends to decline most rapidly during advanced middle age [45]. Furthermore, supportive policy measures that redistribute caregiving responsibilities may help to reduce the burden on females and facilitate sustainable participation. When social engagement is promoted through active interventions that include multilevel strategies, it may help to improve IC and support healthy aging among advanced middle-aged females.\\u003c/p\\u003e\\n\\u003cp\\u003eHealthy aging is defined as the process of developing and maintaining functional ability to enable well-being in the advanced stages of life. It is a reflection of the continuous interactions between individuals and their environments [2]. Hence, it is critical to manage IC from middle age onwards [4]. Since advanced middle age is a key period to prevent frailty [3, 11], developing tailored health strategies that consider individual characteristics at this stage could be effective to promote healthy aging [26]. In light of our findings, it is pivotal to give emphasis to early interventions that are gender-associated and focused on improving IC as well as on encouraging social activity from advanced middle age onwards. In males, strategies that include employment status may help to maintain IC and support active social engagement. In females, IC outcomes may be significantly improved by taking into account caregiving burdens and gendered expectations, identifying at-risk individuals, and promoting social connections. Our study expands on the WHO Healthy Aging framework and demonstrates the relationship between IC and social activity in midlife through an emphasis on gender-specific pathways. Our study also underscores the need to reduce health inequalities and support healthy aging in aging societies.\\u003c/p\\u003e\\n\\u003cp\\u003eOur study has several limitations. First, as a retrospective study, the measurements of IC and social activity were limited by the scope of the original dataset. We did not directly assess cognitive function using standardized instruments. Instead, we indirectly inferred cognitive competence on the basis of whether respondents needed assistance to manage money or medications. Second, our study was based on data from only two timepoints (2016 and 2018) to minimize the effect of time-related confounders. Future studies must use direct cognitive assessments to better reflect IC and employ long-term longitudinal data that spans the transition from advanced middle age to old age.\\u003c/p\\u003e\"},{\"header\":\"Abbreviations\",\"content\":\"\\u003cdiv class=\\\"DefinitionList\\\"\\u003e\\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e\\u003cdiv class=\\\"Term\\\"\\u003eIC\\u003c/div\\u003e\\u003cdiv class=\\\"Description\\\"\\u003e\\u003cp\\u003eIntrinsic capacity\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/div\\u003e\\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e\\u003cdiv class=\\\"Term\\\"\\u003eSA\\u003c/div\\u003e\\u003cdiv class=\\\"Description\\\"\\u003e\\u003cp\\u003eSocial activity\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/div\\u003e\\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e\\u003cdiv class=\\\"Term\\\"\\u003eKLoSA\\u003c/div\\u003e\\u003cdiv class=\\\"Description\\\"\\u003e\\u003cp\\u003eKorean Longitudinal Study of Aging\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/div\\u003e\\u003c/div\\u003e\"},{\"header\":\"Declarations\",\"content\":\"\\u003cp\\u003e\\u003cem\\u003eClinical Trial Number\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eNot applicable\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003eConsent for publication\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe authors of this study, GK and KK agree to the publication of this study.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003eAvailability of data and materials\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe dataset is publicly available through the Employment Survey and Analysis System website (https://survey.keis.or.kr/index.jsp) under the “KLoSA” category.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003eCompeting interests\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThere were no competing interests.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003eFunding\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThere was no funding.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003eAuthors’ contributions\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eKyehyun Kim: Conceptualization, Writing – original draft, Writing - review \\u0026amp; editing, Supervision, Project administration, Validation, Visualization.\\u003c/p\\u003e\\n\\u003cp\\u003eGyeonga Kang : Conceptualization, Methodology, Data curation, Formal analysis, Investigation, Writing – original draft, Writing - review \\u0026amp; editing, Supervision, Project administration, Validation.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003eAcknowledgements\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eNone.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003eHuman Ethics and Consent to Participate declarations\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eNot applicable.\\u003c/p\\u003e\\n\"},{\"header\":\"References\",\"content\":\"\\u003col\\u003e\\u003cli\\u003e\\u003cspan\\u003eOrganization WH. 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Asian Nurs Res (Korean Soc Nurs Sci). 2012;6(1):19\\u0026ndash;26.\\u003c/span\\u003e\\u003c/li\\u003e\\u003c/ol\\u003e\"},{\"header\":\"Tables\",\"content\":\"\\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab1\\\" border=\\\"1\\\"\\u003e\\u003ccaption language=\\\"En\\\"\\u003e\\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 1\\u003c/div\\u003e\\u003cdiv class=\\\"CaptionContent\\\"\\u003e\\u003cdiv class=\\\"SimplePara\\\"\\u003eGeneral characteristics of participants (N\\u0026thinsp;=\\u0026thinsp;2,273)\\u003c/div\\u003e\\u003c/div\\u003e\\u003c/caption\\u003e\\u003ccolgroup cols=\\\"6\\\"\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" 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class=\\\"SimplePara\\\"\\u003e0.26\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.52\\u003c/div\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e\\u003cdiv class=\\\"SimplePara\\\"\\u003e0.21\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.47\\u003c/div\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e\\u003cdiv class=\\\"SimplePara\\\"\\u003e0.30\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.55\\u003c/div\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c6\\\"\\u003e\\u003cdiv class=\\\"SimplePara\\\"\\u003e-4.22 (\\u0026lt;\\u0026thinsp;.001)\\u003c/div\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cdiv class=\\\"SimplePara\\\"\\u003eIntrinsic capacity (T2)\\u003c/div\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e\\u003cdiv class=\\\"SimplePara\\\"\\u003e0.30\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.56\\u003c/div\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e\\u003cdiv class=\\\"SimplePara\\\"\\u003e0.26\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.53\\u003c/div\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e\\u003cdiv class=\\\"SimplePara\\\"\\u003e0.33\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.59\\u003c/div\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c6\\\"\\u003e\\u003cdiv class=\\\"SimplePara\\\"\\u003e-2.63 (0.009)\\u003c/div\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cdiv class=\\\"SimplePara\\\"\\u003eSocial activity (T1)\\u003c/div\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e\\u003cdiv class=\\\"SimplePara\\\"\\u003e1.23\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.78\\u003c/div\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e\\u003cdiv class=\\\"SimplePara\\\"\\u003e1.30\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.79\\u003c/div\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e\\u003cdiv class=\\\"SimplePara\\\"\\u003e1.18\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.78\\u003c/div\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c6\\\"\\u003e\\u003cdiv class=\\\"SimplePara\\\"\\u003e3.55 (\\u0026lt;\\u0026thinsp;.001)\\u003c/div\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cdiv class=\\\"SimplePara\\\"\\u003eSocial activity (T2)\\u003c/div\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e\\u003cdiv class=\\\"SimplePara\\\"\\u003e1.20\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.75\\u003c/div\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e\\u003cdiv class=\\\"SimplePara\\\"\\u003e1.24\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.76\\u003c/div\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e\\u003cdiv class=\\\"SimplePara\\\"\\u003e1.17\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.74\\u003c/div\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c6\\\"\\u003e\\u003cdiv class=\\\"SimplePara\\\"\\u003e2.09 (0.036)\\u003c/div\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003c/tbody\\u003e\\u003c/colgroup\\u003e\\u003ctfoot\\u003e\\u003ctr\\u003e\\u003ctd colspan=\\\"6\\\"\\u003e\\u003cspan type=\\\"BoldItalic\\\" class=\\\"BoldItalic\\\" name=\\\"Emphasis\\\"\\u003eNote.\\u003c/span\\u003e T1 refers to data collected in 2016, and T2 refers to data collected in 2018.\\u003c/td\\u003e\\u003c/tr\\u003e\\u003c/tfoot\\u003e\\u003c/table\\u003e\\u003c/div\\u003e\\u003cbr/\\u003e\\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab2\\\" border=\\\"1\\\"\\u003e\\u003ccaption language=\\\"En\\\"\\u003e\\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 2\\u003c/div\\u003e\\u003cdiv class=\\\"CaptionContent\\\"\\u003e\\u003cdiv class=\\\"SimplePara\\\"\\u003eCorrelation coefficients of sample characteristics (N\\u0026thinsp;=\\u0026thinsp;2,273)\\u003c/div\\u003e\\u003c/div\\u003e\\u003c/caption\\u003e\\u003ccolgroup cols=\\\"15\\\"\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c5\\\" colnum=\\\"5\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c6\\\" colnum=\\\"6\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c7\\\" colnum=\\\"7\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c8\\\" colnum=\\\"8\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c9\\\" colnum=\\\"9\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c10\\\" colnum=\\\"10\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c11\\\" colnum=\\\"11\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c12\\\" colnum=\\\"12\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c13\\\" colnum=\\\"13\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c14\\\" colnum=\\\"14\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c15\\\" colnum=\\\"15\\\"\\u003e\\u003c/div\\u003e\\u003cthead\\u003e\\u003ctr\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colspan=\\\"4\\\" nameend=\\\"c5\\\" namest=\\\"c2\\\"\\u003e\\u003cdiv class=\\\"SimplePara\\\"\\u003eTotal (N\\u0026thinsp;=\\u0026thinsp;2,273)\\u003c/div\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colspan=\\\"4\\\" nameend=\\\"c10\\\" namest=\\\"c7\\\"\\u003e\\u003cdiv class=\\\"SimplePara\\\"\\u003eMale (n\\u0026thinsp;=\\u0026thinsp;1,012)\\u003c/div\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c11\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colspan=\\\"4\\\" nameend=\\\"c15\\\" namest=\\\"c12\\\"\\u003e\\u003cdiv class=\\\"SimplePara\\\"\\u003eFemale (n\\u0026thinsp;=\\u0026thinsp;1,261)\\u003c/div\\u003e\\u003c/th\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cdiv class=\\\"SimplePara\\\"\\u003eIC (T1)\\u003c/div\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cdiv class=\\\"SimplePara\\\"\\u003eIC (T2)\\u003c/div\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cdiv class=\\\"SimplePara\\\"\\u003eSA (T1)\\u003c/div\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cdiv class=\\\"SimplePara\\\"\\u003eSA (T2)\\u003c/div\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cdiv class=\\\"SimplePara\\\"\\u003eIC (T1)\\u003c/div\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u003cdiv class=\\\"SimplePara\\\"\\u003eIC (T2)\\u003c/div\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c9\\\"\\u003e\\u003cdiv class=\\\"SimplePara\\\"\\u003eSA (T1)\\u003c/div\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c10\\\"\\u003e\\u003cdiv class=\\\"SimplePara\\\"\\u003eSA (T2)\\u003c/div\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c11\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c12\\\"\\u003e\\u003cdiv class=\\\"SimplePara\\\"\\u003eIC (T1)\\u003c/div\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c13\\\"\\u003e\\u003cdiv class=\\\"SimplePara\\\"\\u003eIC (T2)\\u003c/div\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c14\\\"\\u003e\\u003cdiv class=\\\"SimplePara\\\"\\u003eSA (T1)\\u003c/div\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c15\\\"\\u003e\\u003cdiv class=\\\"SimplePara\\\"\\u003eSA (T2)\\u003c/div\\u003e\\u003c/th\\u003e\\u003c/tr\\u003e\\u003c/thead\\u003e\\u003ctbody\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cdiv class=\\\"SimplePara\\\"\\u003eIC (T1)\\u003c/div\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cdiv class=\\\"SimplePara\\\"\\u003e1\\u003c/div\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cdiv class=\\\"SimplePara\\\"\\u003e1\\u003c/div\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e\\u003cdiv class=\\\"SimplePara\\\"\\u003e1\\u003c/div\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c13\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c14\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c15\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cdiv class=\\\"SimplePara\\\"\\u003e\\u003cspan type=\\\"Italic\\\" class=\\\"Italic\\\" name=\\\"Emphasis\\\"\\u003ep\\u003c/span\\u003e\\u003c/div\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c13\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c14\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c15\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cdiv class=\\\"SimplePara\\\"\\u003eIC (T2)\\u003c/div\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cdiv class=\\\"SimplePara\\\"\\u003e.39\\u003csup\\u003e**\\u003c/sup\\u003e\\u003c/div\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cdiv class=\\\"SimplePara\\\"\\u003e1\\u003c/div\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cdiv class=\\\"SimplePara\\\"\\u003e.32\\u003csup\\u003e**\\u003c/sup\\u003e\\u003c/div\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u003cdiv class=\\\"SimplePara\\\"\\u003e1\\u003c/div\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e\\u003cdiv class=\\\"SimplePara\\\"\\u003e.43\\u003csup\\u003e**\\u003c/sup\\u003e\\u003c/div\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c13\\\"\\u003e\\u003cdiv class=\\\"SimplePara\\\"\\u003e1\\u003c/div\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c14\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c15\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cdiv class=\\\"SimplePara\\\"\\u003e\\u003cspan type=\\\"Italic\\\" class=\\\"Italic\\\" name=\\\"Emphasis\\\"\\u003ep\\u003c/span\\u003e\\u003c/div\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cdiv class=\\\"SimplePara\\\"\\u003e\\u0026lt;\\u0026thinsp;.001\\u003c/div\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cdiv class=\\\"SimplePara\\\"\\u003e\\u0026lt;\\u0026thinsp;.001\\u003c/div\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e\\u003cdiv class=\\\"SimplePara\\\"\\u003e\\u0026lt;\\u0026thinsp;.001\\u003c/div\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c13\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c14\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c15\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cdiv class=\\\"SimplePara\\\"\\u003eSA (T1)\\u003c/div\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cdiv class=\\\"SimplePara\\\"\\u003e\\u0026minus;\\u0026thinsp;.16\\u003csup\\u003e**\\u003c/sup\\u003e\\u003c/div\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cdiv class=\\\"SimplePara\\\"\\u003e\\u0026minus;\\u0026thinsp;.11\\u003csup\\u003e**\\u003c/sup\\u003e\\u003c/div\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cdiv class=\\\"SimplePara\\\"\\u003e1\\u003c/div\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cdiv class=\\\"SimplePara\\\"\\u003e\\u0026minus;\\u0026thinsp;.17\\u003csup\\u003e**\\u003c/sup\\u003e\\u003c/div\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u003cdiv class=\\\"SimplePara\\\"\\u003e\\u0026minus;\\u0026thinsp;.09\\u003csup\\u003e**\\u003c/sup\\u003e\\u003c/div\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e\\u003cdiv class=\\\"SimplePara\\\"\\u003e1\\u003c/div\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e\\u003cdiv class=\\\"SimplePara\\\"\\u003e\\u0026minus;\\u0026thinsp;.14\\u003csup\\u003e**\\u003c/sup\\u003e\\u003c/div\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c13\\\"\\u003e\\u003cdiv class=\\\"SimplePara\\\"\\u003e\\u0026minus;\\u0026thinsp;.12\\u003csup\\u003e**\\u003c/sup\\u003e\\u003c/div\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c14\\\"\\u003e\\u003cdiv class=\\\"SimplePara\\\"\\u003e1\\u003c/div\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c15\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cdiv class=\\\"SimplePara\\\"\\u003e\\u003cspan type=\\\"Italic\\\" class=\\\"Italic\\\" name=\\\"Emphasis\\\"\\u003ep\\u003c/span\\u003e\\u003c/div\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cdiv class=\\\"SimplePara\\\"\\u003e\\u0026lt;\\u0026thinsp;.001\\u003c/div\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cdiv class=\\\"SimplePara\\\"\\u003e\\u0026lt;\\u0026thinsp;.001\\u003c/div\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cdiv class=\\\"SimplePara\\\"\\u003e\\u0026lt;\\u0026thinsp;.001\\u003c/div\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u003cdiv class=\\\"SimplePara\\\"\\u003e0.005\\u003c/div\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e\\u003cdiv class=\\\"SimplePara\\\"\\u003e\\u0026lt;\\u0026thinsp;.001\\u003c/div\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c13\\\"\\u003e\\u003cdiv class=\\\"SimplePara\\\"\\u003e\\u0026lt;\\u0026thinsp;.001\\u003c/div\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c14\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c15\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cdiv class=\\\"SimplePara\\\"\\u003eSA (T2)\\u003c/div\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cdiv class=\\\"SimplePara\\\"\\u003e\\u0026minus;\\u0026thinsp;.14\\u003csup\\u003e**\\u003c/sup\\u003e\\u003c/div\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cdiv class=\\\"SimplePara\\\"\\u003e\\u0026minus;\\u0026thinsp;.14\\u003csup\\u003e**\\u003c/sup\\u003e\\u003c/div\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cdiv class=\\\"SimplePara\\\"\\u003e.56\\u003csup\\u003e**\\u003c/sup\\u003e\\u003c/div\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e\\u003cdiv class=\\\"SimplePara\\\"\\u003e1\\u003c/div\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cdiv class=\\\"SimplePara\\\"\\u003e\\u0026minus;\\u0026thinsp;.16\\u003csup\\u003e**\\u003c/sup\\u003e\\u003c/div\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u003cdiv class=\\\"SimplePara\\\"\\u003e\\u0026minus;\\u0026thinsp;.18\\u003csup\\u003e**\\u003c/sup\\u003e\\u003c/div\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e\\u003cdiv class=\\\"SimplePara\\\"\\u003e.55\\u003csup\\u003e**\\u003c/sup\\u003e\\u003c/div\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c10\\\"\\u003e\\u003cdiv class=\\\"SimplePara\\\"\\u003e1\\u003c/div\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e\\u003cdiv class=\\\"SimplePara\\\"\\u003e\\u0026minus;\\u0026thinsp;.12\\u003csup\\u003e**\\u003c/sup\\u003e\\u003c/div\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c13\\\"\\u003e\\u003cdiv class=\\\"SimplePara\\\"\\u003e\\u0026minus;\\u0026thinsp;.11\\u003csup\\u003e**\\u003c/sup\\u003e\\u003c/div\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c14\\\"\\u003e\\u003cdiv class=\\\"SimplePara\\\"\\u003e.57\\u003csup\\u003e**\\u003c/sup\\u003e\\u003c/div\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c15\\\"\\u003e\\u003cdiv class=\\\"SimplePara\\\"\\u003e1\\u003c/div\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cdiv class=\\\"SimplePara\\\"\\u003e\\u003cspan type=\\\"Italic\\\" class=\\\"Italic\\\" name=\\\"Emphasis\\\"\\u003ep\\u003c/span\\u003e\\u003c/div\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cdiv class=\\\"SimplePara\\\"\\u003e\\u0026lt;\\u0026thinsp;.001\\u003c/div\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cdiv class=\\\"SimplePara\\\"\\u003e\\u0026lt;\\u0026thinsp;.001\\u003c/div\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cdiv class=\\\"SimplePara\\\"\\u003e\\u0026lt;\\u0026thinsp;.001\\u003c/div\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u003cdiv class=\\\"SimplePara\\\"\\u003e\\u0026lt;\\u0026thinsp;.001\\u003c/div\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u003cdiv class=\\\"SimplePara\\\"\\u003e\\u0026lt;\\u0026thinsp;.001\\u003c/div\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e\\u003cdiv class=\\\"SimplePara\\\"\\u003e\\u0026lt;\\u0026thinsp;.001\\u003c/div\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e\\u003cdiv class=\\\"SimplePara\\\"\\u003e\\u0026lt;\\u0026thinsp;.001\\u003c/div\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c13\\\"\\u003e\\u003cdiv class=\\\"SimplePara\\\"\\u003e\\u0026lt;\\u0026thinsp;.001\\u003c/div\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c14\\\"\\u003e\\u003cdiv class=\\\"SimplePara\\\"\\u003e\\u0026lt;\\u0026thinsp;.001\\u003c/div\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c15\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003c/tbody\\u003e\\u003c/colgroup\\u003e\\u003ctfoot\\u003e\\u003ctr\\u003e\\u003ctd colspan=\\\"15\\\"\\u003e\\u003cspan type=\\\"BoldItalic\\\" class=\\\"BoldItalic\\\" name=\\\"Emphasis\\\"\\u003eNote.\\u003c/span\\u003e *\\u003cspan type=\\\"Italic\\\" class=\\\"Italic\\\" name=\\\"Emphasis\\\"\\u003ep\\u003c/span\\u003e\\u0026thinsp;\\u0026lt;\\u0026thinsp;.05, **\\u003cspan type=\\\"Italic\\\" class=\\\"Italic\\\" name=\\\"Emphasis\\\"\\u003ep\\u003c/span\\u003e\\u0026thinsp;\\u0026lt;\\u0026thinsp;.01, ***\\u003cspan type=\\\"Italic\\\" class=\\\"Italic\\\" name=\\\"Emphasis\\\"\\u003ep\\u003c/span\\u003e\\u0026thinsp;\\u0026lt;\\u0026thinsp;.001. IC - intrinsic capacity; SA - social activity; T1 refers to data collected in 2016, and T2 refers to data collected in 2018. Variables other than the main variables were omitted from this table.\\u003c/td\\u003e\\u003c/tr\\u003e\\u003c/tfoot\\u003e\\u003c/table\\u003e\\u003c/div\\u003e\\u003cbr/\\u003e\\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab3\\\" border=\\\"1\\\"\\u003e\\u003ccaption language=\\\"En\\\"\\u003e\\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 3\\u003c/div\\u003e\\u003cdiv class=\\\"CaptionContent\\\"\\u003e\\u003cdiv class=\\\"SimplePara\\\"\\u003eCross-lagged panel analysis (N\\u0026thinsp;=\\u0026thinsp;2,273)\\u003c/div\\u003e\\u003c/div\\u003e\\u003c/caption\\u003e\\u003ccolgroup cols=\\\"18\\\"\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c5\\\" colnum=\\\"5\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c6\\\" colnum=\\\"6\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c7\\\" colnum=\\\"7\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c8\\\" colnum=\\\"8\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c9\\\" colnum=\\\"9\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c10\\\" colnum=\\\"10\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c11\\\" colnum=\\\"11\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c12\\\" colnum=\\\"12\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c13\\\" colnum=\\\"13\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c14\\\" colnum=\\\"14\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c15\\\" colnum=\\\"15\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c16\\\" colnum=\\\"16\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c17\\\" colnum=\\\"17\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c18\\\" colnum=\\\"18\\\"\\u003e\\u003c/div\\u003e\\u003cthead\\u003e\\u003ctr\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colspan=\\\"5\\\" nameend=\\\"c6\\\" namest=\\\"c2\\\"\\u003e\\u003cdiv class=\\\"SimplePara\\\"\\u003eTotal (N\\u0026thinsp;=\\u0026thinsp;2,273)\\u003c/div\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colspan=\\\"5\\\" nameend=\\\"c12\\\" namest=\\\"c8\\\"\\u003e\\u003cdiv class=\\\"SimplePara\\\"\\u003eMale (n\\u0026thinsp;=\\u0026thinsp;1,012)\\u003c/div\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c13\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colspan=\\\"5\\\" nameend=\\\"c18\\\" namest=\\\"c14\\\"\\u003e\\u003cdiv class=\\\"SimplePara\\\"\\u003eFemale (n\\u0026thinsp;=\\u0026thinsp;1,261)\\u003c/div\\u003e\\u003c/th\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c3\\\" namest=\\\"c2\\\"\\u003e\\u003cdiv class=\\\"SimplePara\\\"\\u003eIC (T2)\\u003c/div\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c6\\\" namest=\\\"c5\\\"\\u003e\\u003cdiv class=\\\"SimplePara\\\"\\u003eSA (T2)\\u003c/div\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c9\\\" namest=\\\"c8\\\"\\u003e\\u003cdiv class=\\\"SimplePara\\\"\\u003eIC (T2)\\u003c/div\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c10\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c12\\\" namest=\\\"c11\\\"\\u003e\\u003cdiv class=\\\"SimplePara\\\"\\u003eSA (T2)\\u003c/div\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c13\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c15\\\" namest=\\\"c14\\\"\\u003e\\u003cdiv class=\\\"SimplePara\\\"\\u003eIC (T2)\\u003c/div\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c16\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c18\\\" namest=\\\"c17\\\"\\u003e\\u003cdiv class=\\\"SimplePara\\\"\\u003eSA (T2)\\u003c/div\\u003e\\u003c/th\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cdiv class=\\\"SimplePara\\\"\\u003e\\u003cspan type=\\\"Italic\\\" class=\\\"Italic\\\" name=\\\"Emphasis\\\"\\u003eβ\\u003c/span\\u003e (SD)\\u003c/div\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cdiv class=\\\"SimplePara\\\"\\u003e\\u003cspan type=\\\"Italic\\\" class=\\\"Italic\\\" name=\\\"Emphasis\\\"\\u003ep\\u003c/span\\u003e\\u003c/div\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u003cdiv class=\\\"SimplePara\\\"\\u003e\\u003cspan type=\\\"Italic\\\" class=\\\"Italic\\\" name=\\\"Emphasis\\\"\\u003eβ\\u003c/span\\u003e (SD)\\u003c/div\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u003cdiv class=\\\"SimplePara\\\"\\u003e\\u003cspan type=\\\"Italic\\\" class=\\\"Italic\\\" name=\\\"Emphasis\\\"\\u003ep\\u003c/span\\u003e\\u003c/div\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c8\\\"\\u003e\\u003cdiv class=\\\"SimplePara\\\"\\u003e\\u003cspan type=\\\"Italic\\\" class=\\\"Italic\\\" name=\\\"Emphasis\\\"\\u003eβ\\u003c/span\\u003e (SD)\\u003c/div\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" 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colname=\\\"c14\\\"\\u003e\\u003cdiv class=\\\"SimplePara\\\"\\u003e0.10 (0.04)\\u003c/div\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c15\\\"\\u003e\\u003cdiv class=\\\"SimplePara\\\"\\u003e0.031\\u003c/div\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c16\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c17\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c18\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cdiv class=\\\"SimplePara\\\"\\u003eSmoking\\u003c/div\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e\\u003cdiv class=\\\"SimplePara\\\"\\u003e-0.01 (0.04)\\u003c/div\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cdiv class=\\\"SimplePara\\\"\\u003e0.696\\u003c/div\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c8\\\"\\u003e\\u003cdiv class=\\\"SimplePara\\\"\\u003e-0.03 (0.04)\\u003c/div\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e\\u003cdiv class=\\\"SimplePara\\\"\\u003e0.4\\u003c/div\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c13\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c14\\\"\\u003e\\u003cdiv class=\\\"SimplePara\\\"\\u003e0.17 (0.19)\\u003c/div\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c15\\\"\\u003e\\u003cdiv class=\\\"SimplePara\\\"\\u003e0.376\\u003c/div\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c16\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c17\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c18\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cdiv class=\\\"SimplePara\\\"\\u003eDrinking\\u003c/div\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e\\u003cdiv class=\\\"SimplePara\\\"\\u003e-0.03 (0.03)\\u003c/div\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cdiv class=\\\"SimplePara\\\"\\u003e0.218\\u003c/div\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c8\\\"\\u003e\\u003cdiv class=\\\"SimplePara\\\"\\u003e-0.07 (0.04)\\u003c/div\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e\\u003cdiv class=\\\"SimplePara\\\"\\u003e0.087\\u003c/div\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c10\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c11\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c12\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c13\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c14\\\"\\u003e\\u003cdiv class=\\\"SimplePara\\\"\\u003e\\u0026lt;\\u0026thinsp;.001 (0.03)\\u003c/div\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c15\\\"\\u003e\\u003cdiv class=\\\"SimplePara\\\"\\u003e0.956\\u003c/div\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c16\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c17\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c18\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003c/tbody\\u003e\\u003c/colgroup\\u003e\\u003ctfoot\\u003e\\u003ctr\\u003e\\u003ctd colspan=\\\"18\\\"\\u003e\\u003cspan type=\\\"BoldItalic\\\" class=\\\"BoldItalic\\\" name=\\\"Emphasis\\\"\\u003eNote.\\u003c/span\\u003e IC - intrinsic capacity; SA - social activity; PSS - perceived socioeconomic status; ES - employment status; FS - family support; MM - multimorbidity; T1 refers to data collected in 2016, and T2 refers to data collected in 2018.\\u003c/td\\u003e\\u003c/tr\\u003e\\u003c/tfoot\\u003e\\u003c/table\\u003e\\u003c/div\\u003e\\u003cbr/\\u003e\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":true,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":false,\"hideJournal\":false,\"highlight\":\"\",\"institution\":\"\",\"isAcceptedByJournal\":true,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"bmc-public-health\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"pubh\",\"sideBox\":\"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)\",\"snPcode\":\"\",\"submissionUrl\":\"https://www.editorialmanager.com/pubh/default.aspx\",\"title\":\"BMC Public Health\",\"twitterHandle\":\"@BMC_series\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"em\",\"reportingPortfolio\":\"BMC Series\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":true},\"keywords\":\"Intrinsic capacity, social activity, advanced middle age, gender\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-7782807/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-7782807/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003ch2\\u003eObjectives\\u003c/h2\\u003e\\u003cp\\u003eAs the population progressively ages, it has become increasingly important to maintain intrinsic capacity (IC) in advanced middle age. Our study aimed to examine the impact of gender on the reciprocal relationship between IC and social activity among advanced middle-aged adults in South Korea.\\u003c/p\\u003e\\u003ch2\\u003eMethods\\u003c/h2\\u003e\\u003cp\\u003eWe used data from the 2016 and 2018 waves of KLoSA, including participants aged 55 to 64 years at baseline (N\\u0026thinsp;=\\u0026thinsp;2,273). IC was measured in five domains, and social activity by the total number of social group participation. Cross-lagged panel models were applied with gender-stratified analysis.\\u003c/p\\u003e\\u003ch2\\u003eResults\\u003c/h2\\u003e\\u003cp\\u003eWe confirmed a correlation between IC and social activity when IC impairment at baseline predicted low social activity at follow-up (\\u003cem\\u003eβ\\u003c/em\\u003e = \\u0026minus;\\u0026thinsp;0.08, \\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;.002), and higher social activity at baseline predicted subsequent better IC (\\u003cem\\u003eβ\\u003c/em\\u003e = \\u0026minus;\\u0026thinsp;0.03, \\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;.013). In gender-based analysis, a decline in IC significantly reduced subsequent social activity (\\u003cem\\u003eβ\\u003c/em\\u003e = \\u0026minus;\\u0026thinsp;0.13, \\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;.006) in males. Among females, enhanced social activity significantly improved subsequent IC (\\u003cem\\u003eβ\\u003c/em\\u003e = \\u0026minus;\\u0026thinsp;0.04, \\u003cem\\u003ep\\u003c/em\\u003e\\u0026thinsp;=\\u0026thinsp;.022).\\u003c/p\\u003e\\u003ch2\\u003eConclusions\\u003c/h2\\u003e\\u003cp\\u003e Our study highlights gender-specific patterns in the reciprocal relationship between IC and social participation in advanced middle age. Interventions for working men should prioritize IC stability. Strategies for females should focus on facilitating sustained social engagement. Early gender-sensitive approaches in advanced middle age may contribute to healthy aging trajectories.\\u003c/p\\u003e\",\"manuscriptTitle\":\"Reciprocal Relationship Between Intrinsic Capacity and Social Activity Influenced by Gender in Advanced Middle-Aged Adults in South Korea\",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2025-10-23 15:39:30\",\"doi\":\"10.21203/rs.3.rs-7782807/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0},{\"type\":\"decision\",\"content\":\"Revision requested\",\"date\":\"2025-12-26T11:36:55+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorInvitedReview\",\"content\":\"\",\"date\":\"2025-12-22T14:43:37+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"257146725142801736809765248082138644228\",\"date\":\"2025-12-22T14:01:20+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"editorInvitedReview\",\"content\":\"\",\"date\":\"2025-10-25T01:19:24+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"325329073224783604463210249310217028629\",\"date\":\"2025-10-10T00:27:45+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewersInvited\",\"content\":\"\",\"date\":\"2025-10-09T16:40:42+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorInvited\",\"content\":\"\",\"date\":\"2025-10-09T16:33:39+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorAssigned\",\"content\":\"\",\"date\":\"2025-10-07T04:40:34+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"checksComplete\",\"content\":\"\",\"date\":\"2025-10-07T04:39:37+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"submitted\",\"content\":\"BMC Public Health\",\"date\":\"2025-10-05T04:59:10+00:00\",\"index\":\"\",\"fulltext\":\"\"}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"bmc-public-health\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"pubh\",\"sideBox\":\"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)\",\"snPcode\":\"\",\"submissionUrl\":\"https://www.editorialmanager.com/pubh/default.aspx\",\"title\":\"BMC Public Health\",\"twitterHandle\":\"@BMC_series\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"em\",\"reportingPortfolio\":\"BMC Series\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":true}}],\"origin\":\"\",\"ownerIdentity\":\"aa55b2eb-a87a-4429-b35a-f481d5af46fd\",\"owner\":[],\"postedDate\":\"October 23rd, 2025\",\"published\":true,\"recentEditorialEvents\":[],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"published-in-journal\",\"subjectAreas\":[],\"tags\":[],\"updatedAt\":\"2026-03-16T16:09:05+00:00\",\"versionOfRecord\":{\"articleIdentity\":\"rs-7782807\",\"link\":\"https://doi.org/10.1186/s12889-026-26544-9\",\"journal\":{\"identity\":\"bmc-public-health\",\"isVorOnly\":false,\"title\":\"BMC Public Health\"},\"publishedOn\":\"2026-03-12 15:58:47\",\"publishedOnDateReadable\":\"March 12th, 2026\"},\"versionCreatedAt\":\"2025-10-23 15:39:30\",\"video\":\"\",\"vorDoi\":\"10.1186/s12889-026-26544-9\",\"vorDoiUrl\":\"https://doi.org/10.1186/s12889-026-26544-9\",\"workflowStages\":[]},\"version\":\"v1\",\"identity\":\"rs-7782807\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-7782807\",\"identity\":\"rs-7782807\",\"version\":[\"v1\"]},\"buildId\":\"8U1c8b4HqxoKbykW_rLl7\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC-BY-4.0","license_restricted":false}