Stronger Minds Together: How Resilience and Social Support Associate with Cognitive Function during Aging

Stronger Minds Together: How Resilience and Social Support Associate with Cognitive Function during Aging | 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 Stronger Minds Together: How Resilience and Social Support Associate with Cognitive Function during Aging Xiaoxia Wei, Fangqin Tan, Weihao Shao, Enying Gong, Jean-Pierre Michel, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7557045/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 13 Apr, 2026 Read the published version in Aging Clinical and Experimental Research → Version 1 posted 7 You are reading this latest preprint version Abstract Background Cognitive impairment poses a major public health concern in ageing societies. This study investigated the independent and joint associations of resilience and social support with cognitive function among community-dwelling middle-aged and older Chinese adults, and explored gender-specific differences. Methods A total of 3,058 Chinese adults aged ≥ 50 years from both urban and rural communities were included. Cognitive function was evaluated using the Mini-Mental State Examination (MMSE). Resilience was assessed using the 10-item Connor-Davidson Resilience Scale (CD-RISC-10), and social support by the 6-item Lubben Social Network Scale (LSNS-6). Logistic regression models stratified by gender were applied with adjustment for demographic, behavioral, and health-related variables. Generalized additive models were used to test non-linear associations, and joint effects were examined with combined categories. Results Overall, 18.4% of participants (20.1% women, 16.3% men) had cognitive impairment. Higher resilience and social support were independently associated with lower odds of impairment. Curvilinear associations were observed in generalized additive models. Compared with low resilience and low support, participants with moderate resilience and high support had the lowest risk (OR = 0.25, 95% CI: 0.11–0.51). Conclusions Resilience and social support were independently and jointly associated with better cognitive function. Promoting psychosocial resources, especially among women, may represent an important gender-sensitive strategy for cognitive health promotion in ageing populations. Cognitive function Cognitive impairment Psychological resilience Social support Psycho-social factors Joint association Figures Figure 1 Figure 2 Figure 3 Introduction Cognitive impairment and dementia are growing global public health challenges, particularly in the context of rapidly ageing populations[ 1 ]. The World Health Organization estimates that over 55 million people are currently living with dementia worldwide, with nearly 10 million new cases each year[ 1 ]. These figures are expected to increase substantially in the coming decades, placing immense pressure on healthcare systems and long-term care services. China faces one of the highest burdens globally, with over 15 million older adults estimated to be affected by dementia[ 2 ]. The rapid pace of population ageing, combined with increasing life expectancy and urbanization, further intensifies the challenge. Despite progress in pharmacological treatments, no cure currently exists, and available therapies offer limited efficacy in halting disease progression[ 3 ]. There is thus an urgent need to identify modifiable risk and protective factors that could inform early prevention and intervention strategies. Psycho-social factors have been recognized as important influences on cognitive ageing. Psychological resilience—broadly defined as the ability to maintain or regain mental health despite adversity[ 4 , 5 ], has emerged as a promising protective factor[ 6 – 9 ]. Resilient individuals may better manage stress, maintain emotional stability, and adapt to age-related changes, potentially preserving cognitive function. However, evidence on the association between resilience and cognitive outcomes remains limited. Importantly, the influence of resilience may vary across demographic groups, including by gender, however, only a few studies have explored these variations in depth, and findings have been inconsistent[ 6 , 10 , 11 ]. Social support, defined as the emotional, informational, or practical assistance derived from social relationships[ 12 ], is another key determinant of healthy ageing. Higher levels of social support have been linked to reduced risk of cognitive decline and dementia[ 13 ]. Mechanisms may include enhanced cognitive stimulation, reduced loneliness and depression, and promotion of healthier behaviors. However, as with resilience, the strength and direction of associations between social support and cognitive health may depend on contextual and individual factors, including gender roles and broader social contexts. While previous research has examined psychological resilience and social support separately in relation to cognitive outcomes, few studies have considered their joint effects or potential interactions. Moreover, gender differences in these associations remain under-explored, despite known disparities in psycho-social exposures and cognitive ageing trajectories. This study aims to investigate the independent and combined associations of psychological resilience and social support with cognitive impairment in middle-aged and older adults, and to examine whether these associations differ by gender. Methods Participants This cross-sectional study was conducted between July and September 2023 among community-dwelling adults aged 50 and older in China. A multi-stage purposive sampling strategy was employed to select 45 communities from urban (Fangshan District, Beijing) and rural (Wuyuan County, Jiangxi Province) settings. Participants were recruited through local administrative channels and invited to designated survey sites on pre-specified dates. Eligibility criteria included: (1) age ≥50 years; (2) permanent residency in the selected area, defined as residing there for at least six months per year; and (3) provision of written informed consent. Individuals with severe physical disabilities or cognitive impairments that precluded independent participation were excluded. Ethical approval was obtained from the Ethics Committee of the Chinese Academy of Medical Sciences and Peking Union Medical College (CAMS&PUMC-IEC-2022-076). Measures Psychological resilience Psychological resilience was assessed using the 10-item version of the Connor–Davidson Resilience Scale (CD-RISC-10)[14, 15], a widely validated instrument with robust psychometric properties. Participants rated each item based on their experiences over the past month using a 5-point Likert scale (0 = “not true at all” to 4 = “true nearly all of the time”). Example items include “I think of myself as a strong person when dealing with life’s challenges” and “Having to cope with stress can make me stronger.” Total scores range from 0 to 40, with higher scores indicating greater resilience. For analytical purposes, resilience scores were divided into tertiles: low, moderate, and high resilience. Social support Perceived social support was measured using the 6-item Lubben Social Network Scale (LSNS-6), which evaluates social engagement with family and friends, including network size, contact frequency, and availability of emotional support[16, 17]. Each item was scored from 0 (“none”) to 5 (“nine or more”), yielding a total score from 0 to 30. Higher scores reflect greater social support. Social support levels were categorized as low (0–11), moderate (12–23), and high (24–30). Cognitive function Cognitive function was assessed using the Mini-Mental State Examination (MMSE), a 30-point scale evaluating orientation, registration, attention, and calculation, recall, and language. Scores range from 0 to 30, with higher scores denoting better cognitive performance. Education-adjusted cut-off values were applied to define cognitive impairment: ≤17 for individuals with no formal education, ≤20 for those with primary education, and ≤24 for those with middle school education or above[18]. Other Variables Sociodemographic variables included age (50–59, 60–69, ≥70 years), gender (male, female), marital status (married vs never married/divorced/widowed), highest level of educational attainment (primary school and below, secondary school, higher school), and occupation (unskilled, skilled, professional or managerial). Lifestyle factors included smoking status (current vs non/former smoker) [19], alcohol consumption (frequent [>1 time/month] vs non-frequent)[19], and physical activity (active [>600 Metabolic Equivalent Task (MET) minutes per week, approximately equivalent to 150 minutes of moderate-intensity activity such as brisk walking] vs inactive)[20]. Dietary intake was defined as sufficient if participants reported daily consumption of ≥300 g of vegetables and ≥200 g of fruits[21]. Sleep quality was evaluated using the Pittsburgh Sleep Quality Index (PSQI), with scores classified into four categories: poor (0-5), fair (6-10), good (11-15), and very good (16-21)[22]. Body mass index (BMI) was calculated from self-reported height and weight. Participants were also asked to report physician-diagnosed chronic conditions from a standardized list of 39 diseases; the total number of chronic conditions was categorized as 0, 1, 2, or ≥3. Statistical Analysis All analyses were performed using R version 4.4.1. Descriptive statistics were used to summarize participant characteristics. Continuous variables were expressed as means with standard deviations (SD) or medians with inter quartile ranges (IQR), while categorical variables were presented as frequencies and percentages. Multiple logistic regression models were used to assess the associations of psychological resilience and social support with cognitive impairment, adjusting for all covariates. Results are reported as odds ratios (OR) with 95% confidence intervals (CI). Gender-stratified analyses were conducted to explore potential sex-specific associations. To assess potential non-linear relationships between resilience, social support, and cognitive performance (as measured by MMSE scores), generalized additive model (GAM) with smoothing splines were applied[23]. For joint analysis, participants were classified into nine groups based on tertiles of both psychological resilience and social support. The group with low resilience and low social support served as the reference category. Two-sided p-values <0.05 were considered statistically significant. Results Sample characteristics A total of 3,058 participants (mean age 61.3 ± 8.1 years; 45.2% male) were included in the analysis (Table 1). Compared to females, males were more likely to have higher educational attainment (secondary school or above: 66.4% vs 49.3%) and be in skilled or professional occupations (77.9% vs 60.5%). Men also reported substantially higher rates of current smoking (76.0% vs 6.6%) and frequent alcohol consumption (55.0% vs 8.3%). The prevalence of cognitive impairment was higher in females than in males (20.1% vs 16.3%). Poor psychological resilience was more common in women (38.3% vs 29.6%), while poor social support was similarly distributed between genders (36.9% in women vs 33.9% in men). Table 1. Characteristics of participants grouped by gender Characteristics Total (3058) N (%) Male (1381) N (%) Female (1677) N (%) Age (years), mean (SD 61.3 (8.1) 61.6 (8.2) 61.0 (8.0) The highest education level Primary school and below 1314 (43.0) 464 (33.6) 850 (50.7) Secondary school 1606 (52.5) 835 (60.5) 771 (46.0) Higher school 138 ( 4.5) 82 ( 5.9) 56 ( 3.3) Marital status Married 2677 (87.5) 1268 (91.8) 1409 (84.0) Single a 381 (12.5) 113 ( 8.2) 268 (16.0) Occupation b Unskilled 968 (31.7) 305 (22.1) 663 (39.5) Skilled 1735 (56.7) 853 (61.8) 882 (52.6) Professional or managerial 355 (11.6) 223 (16.1) 132 ( 7.9) Smoking Non-smoker or past smoker 1898 (62.1) 331 (24.0) 1567 (93.4) Current smoker 1160 (37.9) 1050 (76.0) 110 ( 6.6) Alcohol use Non-frequent 2158 (70.6) 621 (45.0) 1537 (91.7) Frequent 900 (29.4) 760 (55.0) 140 ( 8.3) Physical activity Inactive 1433 (46.9) 638 (46.2) 795 (47.4) Active 1625 (53.1) 743 (53.8) 882 (52.6) Diet (vegetable and fruit intake) Insufficient 2803 (91.7) 1281 (92.8) 1522 (90.8) Sufficient 255 ( 8.3) 100 ( 7.2) 155 ( 9.2) sleep quality Poor 36 ( 1.2) 9 ( 0.7) 27 ( 1.6) Fair 280 ( 9.2) 89 ( 6.4) 191 (11.4) Good 1007 (32.9) 410 (29.7) 597 (35.6) Very good 1735 (56.7) 873 (63.2) 862 (51.4) BMI Underweight 102 ( 3.3) 50 ( 3.6) 52 ( 3.1) Normal 1241 (40.6) 589 (42.7) 652 (38.9) Overweight 1187 (38.8) 538 (39.0) 649 (38.7) Obese 528 (17.3) 204 (14.8) 324 (19.3) Number of major chronic diseases 0 738 (24.1) 338 (24.5) 400 (23.9) 1 900 (29.4) 447 (32.4) 453 (27.0) 2 656 (21.5) 279 (20.2) 377 (22.5) 3+ 764 (25.0) 317 (23.0) 447 (26.7) Psychological resilience Poor 1052 (34.4) 409 (29.6) 643 (38.3) Fair 1132 (37.0) 544 (39.4) 588 (35.1) Good 874 (28.6) 428 (31.0) 446 (26.6) Social support Poor 1087 (35.5) 468 (33.9) 619 (36.9) Fair 1737 (56.8) 791 (57.3) 946 (56.4) Good 234 ( 7.7) 122 ( 8.8) 112 ( 6.7) Cognitive function Normal 2496 (81.6) 1156 (83.7) 1340 (79.9) Cognitive impairment 562 (18.4) 225 (16.3) 337 (20.1) Notes: Data were expressed as mean (standard deviation) or n (%). a: Single: never married, divorced, widowed b: Occupation encompasses the current or pre-retirement status of participant. Association between psychological resilience and cognitive function Table 2 presents the results of gender-stratified logistic regression analyses. Among males, both fair (OR = 0.56, 95% CI: 0.39–0.81, p = 0.002) and good (OR = 0.65, 95% CI: 0.44–0.96, p = 0.032) psychological resilience were associated with reduced odds of cognitive impairment compared to poor resilience. Similar associations were observed in females, with stronger effect sizes: OR = 0.55 (95% CI: 0.41–0.74, p < 0.001) for fair resilience and OR = 0.39 (95% CI: 0.26–0.56, p < 0.001) for good resilience. Age was a significant predictor in both sexes. Compared to participants aged 50–59, those aged 60–69 and ≥70 years had significantly higher odds of cognitive impairment (e.g., in women: OR = 2.64 and 3.23, both p < 0.001). Being single was associated with increased odds of cognitive impairment in men (OR = 1.75, p = 0.024), but not in women. Among women, higher education (secondary school vs primary: OR = 0.72, p = 0.035) and professional/managerial occupation (OR = 0.21, p = 0.003) showed significant associations with lower odds of cognitive impairment. Physical activity was inversely associated with cognitive impairment in women only (OR = 0.67, p = 0.003). BMI was significantly associated with cognitive impairment in men, with lower odds among normal weight (OR = 0.47, p = 0.026) and obese participants (OR = 0.35, p = 0.009) compared to underweight. Table 2. Multiple logistic regression of the association between psychological resilience and cognitive impairment Male Female Variable OR p OR p Psychological resilience Poor 1.0 (Ref) Fair 0.56（0.39-0.81） 0.002 0.55（0.41-0.74） 0.000 Good 0.65（0.44-0.96） 0.032 0.39（0.26-0.56） ＜0.001 Age 50-59 1.0 (Ref) 60-69 2.6（1.85-3.67） ＜0.001 2.64（1.96-3.56） ＜0.001 70+ 2.11（1.35-3.30） 0.001 3.23（2.19-4.76） ＜0.001 Marital status Married 1.0 (Ref) Single a 1.75（1.06-2.81） 0.024 0.93（0.65-1.32） 0.696 The highest education level Primary school and below 1.0 (Ref) Secondary school 1.72（1.21-2.45） 0.003 0.72（0.54-0.98） 0.035 Higer school 0.52（0.15-1.39） 0.243 0.19（0.01-0.92） 0.106 Occupation b Unskilled 1.0 (Ref) Skilled 0.90（0.63-1.29） 0.562 0.94（0.73-1.22） 0.657 Professional or managerial 0.70（0.41-1.19） 0.194 0.21（0.06-0.52） 0.003 Smoking Non-smoker or past smoker 1.0 (Ref) Current smoker 1.12（0.78-1.62） 0.554 1.65（1.05-2.58） 0.028 drinking Non-frequent 1.0 (Ref) Frequent 0.77（0.57-1.04） 0.084 1.05（0.66-1.63） 0.844 Physical activity Inactive 1.0 (Ref) Active 0.77（0.57-1.05） 0.102 0.67（0.52-0.88） 0.003 Diet (vegetable and fruit intake) Insufficient 1.0 (Ref) Sufficient 1.18（0.64-2.07） 0.573 0.8（0.46-1.32） 0.392 sleep quality Poor 1.0 (Ref) Fair 0.94（0.19-7.09） 0.946 0.94（0.35-2.84） 0.911 Good 0.77（0.16-5.56） 0.758 1.14（0.45-3.30） 0.799 very good 0.84（0.18-6.08） 0.842 1.23（0.49-3.57） 0.676 BMI Underweight 1.0 (Ref) Normal 0.47（0.25-0.93） 0.026 0.66（0.35-1.30） 0.216 Overweight 0.55（0.28-1.10） 0.080 0.64（0.33-1.27） 0.190 Obese 0.35（0.16-0.78） 0.009 0.81（0.41-1.65） 0.559 Number of major chronic diseases 0 1.0 (Ref) 1 1.08（0.73-1.61） 0.701 0.76（0.53-1.09） 0.142 2 0.93（0.59-1.45） 0.739 0.57（0.39-0.85） 0.005 3+ 0.83（0.53-1.30） 0.424 0.66（0.46-0.96） 0.029 a: Single: never married, divorced, widowed b: Occupation encompasses the current or pre-retirement status of participant. Association between social support and cognitive function Results from the models examining social support are shown in Table 3. Among males, fair (OR = 0.54, 95% CI: 0.39–0.73, p < 0.001) and good (OR = 0.54, 95% CI: 0.28–0.97, p = 0.050) levels of support were both associated with reduced odds of cognitive impairment. In females, similar associations with lower odds of cognitive impairment were observed (fair: OR = 0.72, p = 0.013; good: OR = 0.52, p = 0.034). Age remained strongly associated with cognitive impairment in both sexes. In women, higher education and professional occupations were again associated with lower odds of cognitive impairment. Additionally, being physically active (OR = 0.65, p = 0.001) were associated with lower odds of cognitive impairment. Smoking was positively associated with cognitive impairment among females (OR = 1.57, p = 0.047), but not among males. Table 3. Multiple logistic regression of the association between social support and cognitive impairment Male Female Variable OR p OR p (Intercept) 0.40（0.05-2.24） 0.325 0.5（0.14-1.62） 0.263 Social support Poor Fair 0.54（0.39-0.73) ＜0.001 0.72（0.55-0.93） 0.013 Good 0.54（0.28-0.97） 0.050 0.52（0.28-0.93） 0.034 Age 50-59 60-69 2.50（1.78-3.55） ＜0.001 2.57（1.91-3.46） ＜0.001 70+ 1.97（1.25-3.08） 0.003 2.96（2.02-4.35） ＜0.001 Marital status Married Single a 1.67（1.01-2.68） 0.039 0.90（0.64-1.27） 0.563 The highest education level Primary school and below Secondary school 1.68（1.20-2.38） 0.003 0.60（0.45-0.80） 0.001 Higer school 0.54（0.16-1.44） 0.265 0.16（0.01-0.78） 0.075 Occupation b Unskilled Skilled 0.86（0.60-1.24） 0.405 0.94（0.73-1.22） 0.635 Professional or managerial 0.69（0.40-1.16） 0.169 0.21（0.06-0.52） 0.003 Smoking Non-smoker or past smoker Current smoker 1.12（0.78-1.64） 0.533 1.57（1.00-2.44） 0.047 drinking Non-frequent Frequent 0.80（0.59-1.08） 0.142 1.06（0.67-1.64） 0.806 Physical activity Inactive Active 0.79（0.58-1.07） 0.129 0.65（0.50-0.84） 0.001 Diet (vegetable and fruit intake) Insufficient Sufficient 1.14（0.62-2.00） 0.658 0.71（0.41-1.16） 0.192 sleep quality Poor Fair 0.92（0.18-6.83） 0.921 0.95（0.36-2.84） 0.918 Good 0.76（0.16-5.43） 0.746 1.11（0.44-3.20） 0.833 very good 0.81（0.18-5.80） 0.808 1.19（0.47-3.42） 0.725 BMI Underweight Normal 0.49（0.26-0.98） 0.038 0.67（0.35-1.31） 0.228 Overweight 0.55（0.28-1.11） 0.088 0.63（0.33-1.24） 0.170 Obese 0.35（0.16-0.77） 0.009 0.76（0.39-1.55） 0.447 Number of major chronic diseases 0 1 1.12（0.76-1.66） 0.576 0.81（0.57-1.15） 0.242 2 0.94（0.59-1.47） 0.777 0.60（0.40-0.88） 0.009 3+ 0.84（0.53-1.31） 0.439 0.72（0.50-1.04） 0.079 a: Single: never married, divorced, widowed b: Occupation encompasses the current or pre-retirement status of participant. Non-linear associations of psychological resilience and social support with cognitive function To explore potential non-linear relationships, we conducted generalized additive model (GAM) adjusting for relevant covariates. As shown in Figure 1, the association between psychological resilience and predicted cognitive function was non-linear. Cognitive function increased with psychological resilience in a curvilinear pattern, with a steeper increase observed at lower to moderate levels of resilience, plateauing at higher levels. The confidence band (shaded area) suggests this trend is statistically robust. A similar non-linear relationship was observed between social support and cognitive function (Figure 2). The cognitive function score rose sharply from low to moderate levels of social support and then plateaued with further increases. Joint effects of psychological resilience and social support on cognitive function To assess potential synergistic effects, we conducted a joint analysis stratifying participants by psychological resilience and social support (Figure 3). Using the group with low psychological resilience and low social support as the reference, all other combinations showed reduced odds of cognitive impairment, though effect sizes varied by combination. Among participants with moderate social support, a dose-response pattern was evident: compared to the reference group, moderate psychological resilience was associated with 56% reduced odds (OR = 0.44, 95% CI: 0.33–0.60), and high resilience with a 72% reduction (OR = 0.28, 95% CI: 0.19–0.40). In the high social support group, those with moderate (OR = 0.25, 95% CI: 0.11–0.51) and high resilience (OR = 0.37, 95% CI: 0.16–0.76) also showed significantly lower odds of cognitive impairment, though estimates were less precise due to smaller sample sizes. In contrast, within the low social support group, only those with moderate resilience had significantly lower odds of impairment (OR = 0.55, 95% CI: 0.39–0.77), while the association between high resilience and cognitive impairment was not statistically significant (OR = 0.73, 95% CI: 0.50–1.05). These findings suggest an interaction whereby the beneficial associations between psychological resilience and cognitive function may be stronger in the presence of greater social support. Discussion In this community-based study of middle-aged and older Chinese adults, we found that psychological resilience and social support were significantly associated with lower odds of cognitive impairment. Specifically, compared to participants with poor psychological resilience, those with fair and reasonable resilience had 44% (OR = 0.56, 95% CI: 0.39–0.81) and 35% (OR = 0.65, 95% CI: 0.44–0.96) lower odds of cognitive impairment among men, and 45% (OR = 0.55, 95% CI: 0.41–0.74) and 61% (OR = 0.39, 95% CI: 0.26–0.56) lower odds among women, respectively. Similarly, good social support was associated with a 46% (OR = 0.54, 95% CI: 0.28–0.97) lower risk of cognitive impairment in men and a 48% (OR = 0.52, 95% CI: 0.28–0.93) lower risk in women. Importantly, we observed a synergistic interaction between psychological resilience and social support. Individuals with moderate resilience and high support exhibited the lowest likelihood of cognitive impairment (OR = 0.25, 95% CI: 0.11–0.51). These findings suggest that the co-presence of internal (resilience) and external (support) psycho-social resources may offer enhanced protection for cognitive health. Generalized additive models further revealed non-linear, dose–response relationships, indicating that cognitive function improves steeply from low to moderate levels of resilience and support but plateaus at higher levels. This suggests diminishing marginal gains, highlighting the importance of targeted but not excessive psycho-social interventions. These findings offer several important insights into the psycho-social determinants of cognitive aging. Psychological resilience reflects an individual’s capacity to adapt positively to stress and adversity[24], encompassing emotional regulation, self-efficacy, and problem-solving strategies. Resilient individuals may better manage chronic stress, maintain engagement in cognitively stimulating activities, and adopt health-promoting behaviors that preserve cognitive function. Beyond behavioral pathways, resilience may exert biological influences through several mechanisms. First, resilience has been associated with enhanced brain plasticity, including greater synaptic density and neurogenesis in key regions such as the hippocampus, which are crucial for memory and cognition[25, 26]. Second, psychological resilience may reduce chronic systemic inflammation and lower levels of pro-inflammatory cytokines, thereby mitigating neuroinflammation, a known contributor to cognitive decline. Third, resilience may regulate neuroendocrine responses to stress, such as attenuating hypothalamic-pituitary-adrenal (HPA) axis over-activation and reducing cortisol levels, which otherwise have neurotoxic effects on brain structures involved in cognition[25, 26]. Social support, defined as the perceived and actual availability of emotional or practical assistance, has also been consistently associated with better cognitive outcomes[27]. Mechanistically, social support may reduce loneliness, depressive symptoms, and chronic stress, all of which are recognized risk factors for cognitive decline[28-31]. Furthermore, social support may directly influence biological processes, including promoting healthier inflammatory profiles, buffering HPA axis dysregulation, and enhancing structural brain integrity, particularly in regions implicated in memory and executive function[27]. In addition, socially integrated individuals are more likely to remain physically active and cognitively engaged, both linked to preserved cognitive function. Our findings align with prior evidence suggesting that reduced social isolation is associated with a lower risk of dementia and cognitive decline[32-36]. Our study adds to the literature by examining gender-specific patterns in these associations. Although psychological resilience and social support were favorably associated with cognitive function in both sexes, the magnitude of the association for resilience appeared to be greater in women. This observation may reflect gender differences in emotional coping, stress reactivity, and help-seeking behaviour, as well as sociocultural norms regarding vulnerability and independence. Few previous studies have assessed the joint effects of resilience and social support; our findings suggest that these factors may act synergistically rather than independently, offering a more comprehensive buffer against cognitive deterioration. The implications of these findings are both theoretical and practical. Theoretically, they support the biopsychosocial model of cognitive aging and reinforce the cognitive reserve hypothesis. Practically, they point to the value of psycho-social interventions in dementia prevention strategies. Initiatives that enhance psychological resilience, such as cognitive behavioral therapy, mindfulness-based stress reduction, positive psychology programs, and community-based efforts to improve social connectivity, may be especially beneficial. These interventions may yield the greatest returns if implemented before onset of significant cognitive decline. Strengths and Limitations This study has several notable strengths. We employed validated instruments to measure psychological resilience and social support, applied robust analytic methods including gender-stratified logistic regression and non-linear modelling, and accounted for a comprehensive set of potential confounders. The large sample size enhances the statistical power and generalizability to similar ageing populations in East Asia. However, limitations must be acknowledged. The cross-sectional design limits our ability to infer causality or temporal direction. Self-reported measures of psycho-social factors may be subject to recall or social desirability bias. Finally, despite adjusting for a wide range of covariates, residual confounding due to unmeasured factors, such as early-life adversity, chronic inflammation, or genetic susceptibility, cannot be ruled out. Future research should build upon these findings using longitudinal designs to examine how resilience and social support trajectories influence cognitive ageing over time. Interventional studies are warranted to test whether enhancing these psycho-social factors can delay or prevent cognitive impairment. Additionally, integration of biological measures (e.g., neuroimaging, inflammatory markers) may help clarify the mechanisms underlying the observed associations. Conclusions This study provides robust evidence that psychological resilience and social support are independently and synergistically associated with a reduced risk of cognitive impairment among middle-aged and older Chinese adults. These associations were observed across sexes but were particularly pronounced in women. Non-linear patterns suggest that even moderate levels of resilience and support may confer meaningful cognitive benefits. The joint analysis underscores that the presence of these psycho-social factors together is associated with lower odds of cognitive impairment. These findings reinforce the relevance of psycho-social resources in cognitive ageing and support incorporating resilience-building and social engagement strategies into dementia prevention frameworks. Longitudinal and interventional studies are warranted to establish causality and inform the development of effective, scalable interventions to promote cognitive health in ageing populations. Abbreviations OR, Odds ratio; CI, Confidence interval; IQR, Inter quartile ranges; GAM, Generalized additive model; BMI, Body mass index; MMSE, the Mini-Mental State Examination; CD-RISC-10, the 10-item version of the Connor-Davidson Resilience Scale; LSNS-6, the 6-item Lubben Social Network Scale; MET, Metabolic equivalent task; PSQI, Pittsburgh sleep quality index. Declarations Data availability The data that support the findings of this study are available from the corresponding author upon reasonable request. Acknowledgments We gratefully acknowledge the support from the Chinese Academy of Medical Sciences & Peking Union Medical College (Grant Nos. 2021-RC330-004, 2022-ZHCH330-01, and WH10022022010) and the Chinese Academy of Engineering (Grant No. 2024-GJ-04). Funding This study was supported by Chinese Academy of Engineering (Grant No. 2024-GJ-04);the non-profit Central Research Institute Fund of Chinese Academy of Medical Sciences (Grant No. 2021-RC330-004；Grant No. 2022-ZHCH330-01); the Disciplines Construction Project:Population Medicine(Grant No. WH10022022010). Author information Authors and Affiliations Authors and Affiliations: School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China 100730 Xiaoxia Wei, Fangqin Tan, Weihao Shao, Enying Gong & Ruitai Shao State Key Laboratory of Respiratory Health and Multimorbidity, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China 100730 Enying Gong & Ruitai Shao University of Geneva, Geneva, Switzerland Jean-Pierre Michel French Academy of Medicine, Paris, France Jean-Pierre Michel IHU HealthAge, Toulouse, France Philipe de Souto Barreto CERPOP UMR 1295, Inserm, Université Paul Sabatier, Toulouse, France Philipe de Souto Barreto Contributions Xiaoxia Wei contributed to the study design, data collection, data management, data analysis and manuscript drafting. Fangqin Tan contributed to data collection and data management. Weihao Shao, Enying Gong, Jean-Pierre Michel and Philipe de Souto Barreto contributed to manuscript revision. Ruitai Shao was responsible for project supervision and financial support. All authors approved this manuscript for publication. Corresponding authors Correspondence to Philipe de Souto Barreto or Ruitai Shao. Ethics declarations Ethics approval and consent to participate This study was received approval from the Ethics Committee of Chinese Academy of Medical Sciences & Peking Union Medical College (CAMS&PUMC-IEC-2022-076). Written informed consent was obtained from all participants. Competing interests The authors declare no competing interests. References Organization WH: Global status report on the public health response to dementia . 2021. Jia L, Du Y, Chu L, Zhang Z, Li F, Lyu D, Li Y, Zhu M, Jiao H, Song YJTLph: Prevalence, risk factors, and management of dementia and mild cognitive impairment in adults aged 60 years or older in China: a cross-sectional study . 2020, 5 (12):e661-e671. Reuben DB, Kremen S, Maust DTJJIM: Dementia prevention and treatment: a narrative review . 2024, 184 (5):563-572. Fletcher D, Sarkar MJEp: Psychological resilience . 2013. Windle GJRicg: What is resilience? A review and concept analysis . 2011, 21 (2):152-169. Yang JS, Jeon YJ, Lee GB, Kim HC, Jung SJ: The association between psychological resilience and cognitive function in longitudinal data: Results from the community follow-up survey . Journal of affective disorders 2021, 290 :109-116. Wang P, Li R, Chen Y: Longitudinal trajectories of psychological resilience and cognitive impairment among older adults: Evidence from a national cohort study . The journals of gerontology Series B, Psychological sciences and social sciences 2025. Jiang GQ, He YK, Li TF, Qin QR, Wang DN, Huang F, Sun YH, Li J: Association of psychological resilience and cognitive function in older adults: Based on the Ma' anshan Healthy Aging Cohort Study . Archives of gerontology and geriatrics 2024, 116 :105166. Du C, Katz B, Li M, Pernice FM, Rickertsen K, Gu F, Hori K, Ding X, Xu H: Longitudinal Associations Between Psychological Resilience and Cognitive Function: Evidence From the U.S. Health and Retirement Study . The journals of gerontology Series B, Psychological sciences and social sciences 2025, 80 (2). Scambray KA, Morris EP, Palms JD, Lee JH, Sol K, Zahodne LB: Psychological resilience and cognitive functioning in Black and White men and women . The Gerontologist 2025. Jung SJ, Lee GB, Nishimi K, Chibnik L, Koenen KC, Kim HC: Association between psychological resilience and cognitive function in older adults: effect modification by inflammatory status . GeroScience 2021, 43 (6):2749-2760. Albrecht TL, Goldsmith DJ: Social support, social networks, and health . In: The Routledge handbook of health communication. Routledge; 2003: 277-298. Poey JL, Burr JA, Roberts JSJTG: Social connectedness, perceived isolation, and dementia: Does the social environment moderate the relationship between genetic risk and cognitive well-being? 2017, 57 (6):1031-1040. Campbell‐Sills L, Stein MBJJoTSOPoTISfTSS: Psychometric analysis and refinement of the connor–davidson resilience scale (CD‐RISC): Validation of a 10‐item measure of resilience . 2007, 20 (6):1019-1028. Connor KM, Davidson JRJD, anxiety: Development of a new resilience scale: The Connor‐Davidson resilience scale (CD‐RISC) . 2003, 18 (2):76-82. Lubben J, Blozik E, Gillmann G, Iliffe S, von Renteln Kruse W, Beck JC, Stuck AEJTG: Performance of an abbreviated version of the Lubben Social Network Scale among three European community-dwelling older adult populations . 2006, 46 (4):503-513. Chang Q, Sha F, Chan CH, Yip PSJPo: Validation of an abbreviated version of the Lubben Social Network Scale (“LSNS-6”) and its associations with suicidality among older adults in China . 2018, 13 (8):e0201612. !!! INVALID CITATION !!! [16]. Ni Y, Zhou Y, Kivimäki M, Cai Y, Carrillo-Larco RM, Xu X, Dai X, Xu X: Socioeconomic inequalities in physical, psychological, and cognitive multimorbidity in middle-aged and older adults in 33 countries: a cross-sectional study . The lancet Healthy longevity 2023, 4 (11):e618-e628. Organization WH: Global recommendations on physical activity for health . 2010. Wang T, Zhao Z, Wang G, Li Q, Xu Y, Li M, Hu R, Chen G, Su Q, Mu Y et al : Age-related disparities in diabetes risk attributable to modifiable risk factor profiles in Chinese adults: a nationwide, population-based, cohort study . The lancet Healthy longevity 2021, 2 (10):e618-e628. Buysse DJ, Reynolds III CF, Monk TH, Berman SR, Kupfer DJJPr: The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research . 1989, 28 (2):193-213. Hastie TJJSmiS: Generalized additive models . 2017:249-307. Vella S-LC, Pai NBJAoM, Sciences H: A theoretical review of psychological resilience: Defining resilience and resilience research over the decades . 2019, 7 (2):233-239. Gu Y, Wong NML, Chan CCH, Wu J, Lee TMC: The negative relationship between brain-age gap and psychological resilience defines the age-related neurocognitive status in older people . GeroScience 2025. Chen M, Gao M, Ma J, Lee TMC: Intrinsic brain functional connectivity mediates the relationship between psychological resilience and cognitive decline in ageing . GeroScience 2025. Kelly ME, Duff H, Kelly S, McHugh Power JE, Brennan S, Lawlor BA, Loughrey DGJSr: The impact of social activities, social networks, social support and social relationships on the cognitive functioning of healthy older adults: a systematic review . 2017, 6 :1-18. Schnittger RI, Wherton J, Prendergast D, Lawlor BAJA, health m: Risk factors and mediating pathways of loneliness and social support in community-dwelling older adults . 2012, 16 (3):335-346. Ellwardt L, Aartsen M, Deeg D, Steverink NJSs, medicine: Does loneliness mediate the relation between social support and cognitive functioning in later life? 2013, 98 :116-124. Xu J, Zhang L, Sun H, Gao Z, Wang M, Hu M, Ji Q, Guo L: Psychological resilience and quality of life among middle-aged and older adults hospitalized with chronic diseases: multiple mediating effects through sleep quality and depression . BMC geriatrics 2023, 23 (1):752. Zheng K, Chu J, Zhang X, Ding Z, Song Q, Liu Z, Peng W, Cao W, Zou T, Yi J: Psychological resilience and daily stress mediate the effect of childhood trauma on depression . Child abuse & neglect 2022, 125 :105485. Ng TKS, Beck T, Dennis KR, Desai P, Krueger K, Dhana K, Wilson RS, Evans DA, Rajan KB: Social isolation, loneliness, and their joint effects on cognitive decline and incident Alzheimer's disease: Findings from the Chicago health and aging project . The journal of prevention of Alzheimer's disease 2025, 12 (3):100046. Goldberg TE, Choi J, Lee S, Gurland B, Devanand DP: Effects of restriction of activities and social isolation on risk of dementia in the community . International psychogeriatrics 2021, 33 (11):1207-1215. Franks KH, Bransby L, Cribb L, Buckley R, Yassi N, Chong TT, Saling MM, Lim YY, Pase MP: Associations of Perceived Stress and Psychological Resilience With Cognition and a Modifiable Dementia Risk Score in Middle-Aged Adults . The journals of gerontology Series B, Psychological sciences and social sciences 2023, 78 (12):1992-2000. Kim S, Won CW, Kim S, Park JH, Kim M, Kim B, Ryu J: The Effect of Psychological Resilience on Cognitive Decline in Community-Dwelling Older Adults: The Korean Frailty and Aging Cohort Study . Korean journal of family medicine 2024, 45 (6):331-336. Wan R, Tu J, Gao J, Cao L, Zhang L, Huang J, Liu Z: Mediation effect of neuropsychological factors on the relationship between social networks and mild cognitive impairment in older adults . Journal of Alzheimer's disease : JAD 2025, 103 (1):208-217. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 13 Apr, 2026 Read the published version in Aging Clinical and Experimental Research → Version 1 posted Editorial decision: Revision requested 25 Oct, 2025 Reviews received at journal 14 Oct, 2025 Reviewers agreed at journal 22 Sep, 2025 Reviewers invited by journal 21 Sep, 2025 Editor assigned by journal 12 Sep, 2025 Submission checks completed at journal 08 Sep, 2025 First submitted to journal 07 Sep, 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. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7557045","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":518604335,"identity":"0dcdd596-0963-42b6-8a6b-86739a54d209","order_by":0,"name":"Xiaoxia Wei","email":"","orcid":"","institution":"School of Population Medicine and Public Health, Chinese Academy of Medical Sciences \u0026 Peking Union Medical College","correspondingAuthor":false,"prefix":"","firstName":"Xiaoxia","middleName":"","lastName":"Wei","suffix":""},{"id":518604336,"identity":"77415634-ffe2-478b-90be-3d019baeec48","order_by":1,"name":"Fangqin Tan","email":"","orcid":"","institution":"School of Population Medicine and Public Health, Chinese Academy of Medical Sciences \u0026 Peking Union Medical College","correspondingAuthor":false,"prefix":"","firstName":"Fangqin","middleName":"","lastName":"Tan","suffix":""},{"id":518604337,"identity":"9af6e2fe-09cf-40d5-b393-6910540e1b19","order_by":2,"name":"Weihao Shao","email":"","orcid":"","institution":"School of Population Medicine and Public Health, Chinese Academy of Medical Sciences \u0026 Peking Union Medical College","correspondingAuthor":false,"prefix":"","firstName":"Weihao","middleName":"","lastName":"Shao","suffix":""},{"id":518604338,"identity":"5ea6bc93-ef5a-4285-872c-f2dc498ff375","order_by":3,"name":"Enying Gong","email":"","orcid":"","institution":"School of Population Medicine and Public Health, Chinese Academy of Medical Sciences \u0026 Peking Union Medical College","correspondingAuthor":false,"prefix":"","firstName":"Enying","middleName":"","lastName":"Gong","suffix":""},{"id":518604339,"identity":"805aab4c-3f64-448b-a169-824f22a34de9","order_by":4,"name":"Jean-Pierre Michel","email":"","orcid":"","institution":"University of Geneva","correspondingAuthor":false,"prefix":"","firstName":"Jean-Pierre","middleName":"","lastName":"Michel","suffix":""},{"id":518604340,"identity":"556c5660-670f-4da3-9577-2f3af4d2ed29","order_by":5,"name":"Philipe de Souto Barreto","email":"","orcid":"","institution":"IHU HealthAge","correspondingAuthor":false,"prefix":"","firstName":"Philipe","middleName":"de Souto","lastName":"Barreto","suffix":""},{"id":518604341,"identity":"1915c908-51e2-4223-9ec7-9778bc92cae1","order_by":6,"name":"Ruitai Shao","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAxElEQVRIiWNgGAWjYDACCRjJzHyANC0SDMxsCSRpAVE8BsTpkJ/d/PBxZZtFHX87z8cPP3PqGPhnN+DXYnDnmLHh2TYJCYnDvJsle7cdZpC4c4CAFokEM8lGoBaGw7zbGHi3HQCJEHDYjPRvYC3yh3meMf7dVkdYC8ONHIgtBod52Jh5tzET1mJwI6fYsOGchOTGw2zG0rLbDvNI3CDssI0PG8rq+OXOH3748e22Ojn+GYQchg54SFQ/CkbBKBgFowAbAABLBzwKaLDBMAAAAABJRU5ErkJggg==","orcid":"","institution":"School of Population Medicine and Public Health, Chinese Academy of Medical Sciences \u0026 Peking Union Medical College","correspondingAuthor":true,"prefix":"","firstName":"Ruitai","middleName":"","lastName":"Shao","suffix":""}],"badges":[],"createdAt":"2025-09-07 14:53:15","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7557045/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7557045/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s40520-026-03348-w","type":"published","date":"2026-04-13T15:58:06+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":92736151,"identity":"7c2f93d8-7f62-44fa-8228-f70b7e678fc3","added_by":"auto","created_at":"2025-10-03 16:35:18","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":353163,"visible":true,"origin":"","legend":"","description":"","filename":"Manuscript.docx","url":"https://assets-eu.researchsquare.com/files/rs-7557045/v1/7ba3a6fe151e39b36df6f709.docx"},{"id":92733250,"identity":"07fa8863-05f9-4b24-beb9-a2feecbb2940","added_by":"auto","created_at":"2025-10-03 16:19:18","extension":"json","order_by":1,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":8443,"visible":true,"origin":"","legend":"","description":"","filename":"9226a8843ccc4e9985a6e188fc851f51.json","url":"https://assets-eu.researchsquare.com/files/rs-7557045/v1/f2230405101caceea55859c6.json"},{"id":92734890,"identity":"945d07d2-8041-4430-a441-a9abf673f602","added_by":"auto","created_at":"2025-10-03 16:27:18","extension":"xml","order_by":2,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":142615,"visible":true,"origin":"","legend":"","description":"","filename":"9226a8843ccc4e9985a6e188fc851f511enriched.xml","url":"https://assets-eu.researchsquare.com/files/rs-7557045/v1/943db51da3d13d9a0fd212e1.xml"},{"id":92733248,"identity":"18e24ec5-6fef-4150-8bb1-39cef9891acc","added_by":"auto","created_at":"2025-10-03 16:19:18","extension":"jpeg","order_by":3,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":48473,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7557045/v1/a059e13e34c7e6cd9b7c43e8.jpeg"},{"id":92734889,"identity":"c16900af-e70c-410f-8947-85f01b32a8c5","added_by":"auto","created_at":"2025-10-03 16:27:18","extension":"jpeg","order_by":4,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":43535,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7557045/v1/afab85dad8655706ef215314.jpeg"},{"id":92734887,"identity":"828def03-7a97-43e2-907c-ec3395470e7b","added_by":"auto","created_at":"2025-10-03 16:27:18","extension":"png","order_by":5,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":141195,"visible":true,"origin":"","legend":"","description":"","filename":"floatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-7557045/v1/f69ec648753fb5c9d5db9f96.png"},{"id":92733253,"identity":"af9b5c09-4bef-42f2-a581-e34c87eaa5fb","added_by":"auto","created_at":"2025-10-03 16:19:18","extension":"png","order_by":6,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":19485,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7557045/v1/6775d21b75d980773e4e1caf.png"},{"id":92733256,"identity":"0b5cdac3-7887-4822-97ab-ead596c3b7ab","added_by":"auto","created_at":"2025-10-03 16:19:18","extension":"png","order_by":7,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":16676,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-7557045/v1/9fcb6fed0f761b1ebb7563ef.png"},{"id":92733255,"identity":"6658859d-3c3c-41a8-a833-3bc3cd65738a","added_by":"auto","created_at":"2025-10-03 16:19:18","extension":"png","order_by":8,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":34347,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-7557045/v1/e664af3d3d19e44c94806c38.png"},{"id":92733258,"identity":"5535e8a7-890b-44c5-a7fa-dff629b64b27","added_by":"auto","created_at":"2025-10-03 16:19:18","extension":"xml","order_by":9,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":140529,"visible":true,"origin":"","legend":"","description":"","filename":"9226a8843ccc4e9985a6e188fc851f511structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7557045/v1/7bb08a03e6dd8cf10e15d0f2.xml"},{"id":92733259,"identity":"1a83f180-0277-4676-bc28-fa74418016e2","added_by":"auto","created_at":"2025-10-03 16:19:18","extension":"html","order_by":10,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":148583,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7557045/v1/32937da38fc116464648a466.html"},{"id":92733246,"identity":"d10706ac-cbe0-4ecc-9f3c-aac1fc8f7625","added_by":"auto","created_at":"2025-10-03 16:19:18","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":48473,"visible":true,"origin":"","legend":"\u003cp\u003eNon-linear Relationship between Psychological Resilience and Cognitive Function\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7557045/v1/7ec83a0eb0349d23cf66fd43.jpeg"},{"id":92733247,"identity":"014a385c-0a86-4a41-88f5-9167503e21ff","added_by":"auto","created_at":"2025-10-03 16:19:18","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":43535,"visible":true,"origin":"","legend":"\u003cp\u003eNon-linear Relationship between Social Support and Cognitive Function\u003c/p\u003e","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7557045/v1/7eec2c158eb435390407cd67.jpeg"},{"id":92733251,"identity":"4bb45b62-f488-488b-931d-c4b0c77245cd","added_by":"auto","created_at":"2025-10-03 16:19:18","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":141195,"visible":true,"origin":"","legend":"\u003cp\u003eJoint analysis of cognitive impairment according to psychological resilience and social support\u003c/p\u003e","description":"","filename":"floatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-7557045/v1/5818442283c67a9e1cca5474.png"},{"id":107350754,"identity":"b1257d49-6a10-489f-8e8d-9136de631e72","added_by":"auto","created_at":"2026-04-20 16:03:15","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2157758,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7557045/v1/6195d83e-3a6e-46fa-bed4-36e4ce07b53f.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Stronger Minds Together: How Resilience and Social Support Associate with Cognitive Function during Aging","fulltext":[{"header":"Introduction","content":"\u003cp\u003eCognitive impairment and dementia are growing global public health challenges, particularly in the context of rapidly ageing populations[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. The World Health Organization estimates that over 55\u0026nbsp;million people are currently living with dementia worldwide, with nearly 10\u0026nbsp;million new cases each year[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. These figures are expected to increase substantially in the coming decades, placing immense pressure on healthcare systems and long-term care services.\u003c/p\u003e\u003cp\u003eChina faces one of the highest burdens globally, with over 15\u0026nbsp;million older adults estimated to be affected by dementia[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. The rapid pace of population ageing, combined with increasing life expectancy and urbanization, further intensifies the challenge. Despite progress in pharmacological treatments, no cure currently exists, and available therapies offer limited efficacy in halting disease progression[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. There is thus an urgent need to identify modifiable risk and protective factors that could inform early prevention and intervention strategies.\u003c/p\u003e\u003cp\u003ePsycho-social factors have been recognized as important influences on cognitive ageing. Psychological resilience\u0026mdash;broadly defined as the ability to maintain or regain mental health despite adversity[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e], has emerged as a promising protective factor[\u003cspan additionalcitationids=\"CR7 CR8\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Resilient individuals may better manage stress, maintain emotional stability, and adapt to age-related changes, potentially preserving cognitive function. However, evidence on the association between resilience and cognitive outcomes remains limited. Importantly, the influence of resilience may vary across demographic groups, including by gender, however, only a few studies have explored these variations in depth, and findings have been inconsistent[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eSocial support, defined as the emotional, informational, or practical assistance derived from social relationships[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e], is another key determinant of healthy ageing. Higher levels of social support have been linked to reduced risk of cognitive decline and dementia[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Mechanisms may include enhanced cognitive stimulation, reduced loneliness and depression, and promotion of healthier behaviors. However, as with resilience, the strength and direction of associations between social support and cognitive health may depend on contextual and individual factors, including gender roles and broader social contexts.\u003c/p\u003e\u003cp\u003eWhile previous research has examined psychological resilience and social support separately in relation to cognitive outcomes, few studies have considered their joint effects or potential interactions. Moreover, gender differences in these associations remain under-explored, despite known disparities in psycho-social exposures and cognitive ageing trajectories.\u003c/p\u003e\u003cp\u003eThis study aims to investigate the independent and combined associations of psychological resilience and social support with cognitive impairment in middle-aged and older adults, and to examine whether these associations differ by gender.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eParticipants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis cross-sectional study was conducted between July and September 2023 among community-dwelling adults aged 50 and older in China. A multi-stage purposive sampling strategy was employed to select 45 communities from urban (Fangshan District, Beijing) and rural (Wuyuan County, Jiangxi Province) settings. Participants were recruited through local administrative channels and invited to designated survey sites on pre-specified dates.\u003c/p\u003e\n\u003cp\u003eEligibility criteria included: (1) age \u0026ge;50 years; (2) permanent residency in the selected area, defined as residing there for at least six months per year; and (3) provision of written informed consent. Individuals with severe physical disabilities or cognitive impairments that precluded independent participation were excluded.\u003c/p\u003e\n\u003cp\u003eEthical approval was obtained from the Ethics Committee of the Chinese Academy of Medical Sciences and Peking Union Medical College (CAMS\u0026amp;PUMC-IEC-2022-076).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMeasures\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePsychological resilience\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePsychological resilience was assessed using the 10-item version of the Connor\u0026ndash;Davidson Resilience Scale (CD-RISC-10)[14, 15], a widely validated instrument with robust psychometric properties. Participants rated each item based on their experiences over the past month using a 5-point Likert scale (0 = \u0026ldquo;not true at all\u0026rdquo; to 4 = \u0026ldquo;true nearly all of the time\u0026rdquo;). Example items include \u0026ldquo;I think of myself as a strong person when dealing with life\u0026rsquo;s challenges\u0026rdquo; and \u0026ldquo;Having to cope with stress can make me stronger.\u0026rdquo; Total scores range from 0 to 40, with higher scores indicating greater resilience. For analytical purposes, resilience scores were divided into tertiles: low, moderate, and high resilience.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSocial support\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePerceived social support was measured using the 6-item Lubben Social Network Scale (LSNS-6), which evaluates social engagement with family and friends, including network size, contact frequency, and availability of emotional support[16, 17]. Each item was scored from 0 (\u0026ldquo;none\u0026rdquo;) to 5 (\u0026ldquo;nine or more\u0026rdquo;), yielding a total score from 0 to 30. Higher scores reflect greater social support. Social support levels were categorized as low (0\u0026ndash;11), moderate (12\u0026ndash;23), and high (24\u0026ndash;30).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCognitive function\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCognitive function was assessed using the Mini-Mental State Examination (MMSE), a 30-point scale evaluating orientation, registration, attention, and calculation, recall, and language. Scores range from 0 to 30, with higher scores denoting better cognitive performance. Education-adjusted cut-off values were applied to define cognitive impairment: \u0026le;17 for individuals with no formal education, \u0026le;20 for those with primary education, and \u0026le;24 for those with middle school education or above[18].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOther Variables\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSociodemographic variables included age (50\u0026ndash;59, 60\u0026ndash;69, \u0026ge;70 years), gender (male, female), marital status (married vs never married/divorced/widowed), highest level of educational attainment (primary school and below, secondary school, higher school), and occupation (unskilled, skilled, professional or managerial). Lifestyle factors included smoking status (current vs non/former smoker) [19], alcohol consumption (frequent [\u0026gt;1 time/month] vs non-frequent)[19], and physical activity (active [\u0026gt;600 Metabolic Equivalent Task (MET) minutes per week, approximately equivalent to 150 minutes of moderate-intensity activity such as brisk walking] vs inactive)[20]. Dietary intake was defined as sufficient if participants reported daily consumption of \u0026ge;300 g of vegetables and \u0026ge;200 g of fruits[21]. Sleep quality was evaluated using the Pittsburgh Sleep Quality Index (PSQI), with scores classified into four categories: poor (0-5), fair (6-10), good (11-15), and very good (16-21)[22]. Body mass index (BMI) was calculated from self-reported height and weight. Participants were also asked to report physician-diagnosed chronic conditions from a standardized list of 39 diseases; the total number of chronic conditions was categorized as 0, 1, 2, or \u0026ge;3.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll analyses were performed using R version 4.4.1. Descriptive statistics were used to summarize participant characteristics. Continuous variables were expressed as means with standard deviations (SD) or medians with inter quartile ranges (IQR), while categorical variables were presented as frequencies and percentages.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMultiple logistic regression models were used to assess the associations of psychological resilience and social support with cognitive impairment, adjusting for all covariates. Results are reported as odds ratios (OR) with 95% confidence intervals (CI). Gender-stratified analyses were conducted to explore potential sex-specific associations. To assess potential non-linear relationships between resilience, social support, and cognitive performance (as measured by MMSE scores), generalized additive model (GAM) with smoothing splines were applied[23].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFor joint analysis, participants were classified into nine groups based on tertiles of both psychological resilience and social support. The group with low resilience and low social support served as the reference category. Two-sided p-values \u0026lt;0.05 were considered statistically significant.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eSample characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 3,058 participants (mean age 61.3 \u0026plusmn; 8.1 years; 45.2% male) were included in the analysis (Table 1). Compared to females, males were more likely to have higher educational attainment (secondary school or above: 66.4% vs 49.3%) and be in skilled or professional occupations (77.9% vs 60.5%). Men also reported substantially higher rates of current smoking (76.0% vs 6.6%) and frequent alcohol consumption (55.0% vs 8.3%). The prevalence of cognitive impairment was higher in females than in males (20.1% vs 16.3%). Poor psychological resilience was more common in women (38.3% vs 29.6%), while poor social support was similarly distributed between genders (36.9% in women vs 33.9% in men).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 1. Characteristics of participants grouped by gender\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"586\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 256px;\"\u003e\n \u003cp\u003eCharacteristics\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003eTotal (3058)\u0026nbsp;\u003cbr\u003e\u0026nbsp;N (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003eMale (1381)\u0026nbsp;\u003cbr\u003e\u0026nbsp;N (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003eFemale (1677)\u0026nbsp;\u003cbr\u003e\u0026nbsp;N (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eAge (years), mean (SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e61.3 (8.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e61.6 (8.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e61.0 (8.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eThe highest education level\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003ePrimary school and below\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1314 (43.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e464 (33.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e850 (50.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eSecondary school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1606 (52.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e835 (60.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e771 (46.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eHigher school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e138 ( 4.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e82 ( 5.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e56 ( 3.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eMarital status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2677 (87.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1268 (91.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1409 (84.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eSingle\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e381 (12.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e113 ( 8.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e268 (16.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eOccupation\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eUnskilled\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e968 (31.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e305 (22.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e663 (39.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eSkilled\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1735 (56.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e853 (61.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e882 (52.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eProfessional or managerial\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e355 (11.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e223 (16.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e132 ( 7.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eSmoking\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eNon-smoker or past smoker\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1898 (62.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e331 (24.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1567 (93.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eCurrent smoker\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1160 (37.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1050 (76.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e110 ( 6.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eAlcohol use\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eNon-frequent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2158 (70.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e621 (45.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1537 (91.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eFrequent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e900 (29.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e760 (55.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e140 ( 8.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003ePhysical activity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eInactive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1433 (46.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e638 (46.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e795 (47.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eActive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1625 (53.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e743 (53.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e882 (52.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eDiet (vegetable and fruit intake)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eInsufficient\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2803 (91.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1281 (92.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1522 (90.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eSufficient\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e255 ( 8.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e100 ( 7.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e155 ( 9.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003esleep quality\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003ePoor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e36 ( 1.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e9 ( 0.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e27 ( 1.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eFair\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e280 ( 9.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e89 ( 6.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e191 (11.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eGood\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1007 (32.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e410 (29.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e597 (35.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eVery good\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1735 (56.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e873 (63.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e862 (51.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eBMI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eUnderweight\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e102 ( 3.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e50 ( 3.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e52 ( 3.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eNormal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1241 (40.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e589 (42.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e652 (38.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eOverweight\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1187 (38.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e538 (39.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e649 (38.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eObese\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e528 (17.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e204 (14.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e324 (19.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eNumber of major chronic diseases\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e738 (24.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e338 (24.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e400 (23.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e900 (29.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e447 (32.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e453 (27.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e656 (21.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e279 (20.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e377 (22.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e3+\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e764 (25.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e317 (23.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e447 (26.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003ePsychological resilience\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003ePoor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1052 (34.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e409 (29.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e643 (38.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eFair\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1132 (37.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e544 (39.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e588 (35.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eGood\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e874 (28.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e428 (31.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e446 (26.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;Social support\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003ePoor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1087 (35.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e468 (33.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e619 (36.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eFair\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1737 (56.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e791 (57.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e946 (56.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eGood\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e234 ( 7.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e122 ( 8.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e112 ( 6.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eCognitive function\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;Normal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2496 (81.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1156 (83.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1340 (79.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;Cognitive impairment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e562 (18.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e225 (16.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e337 (20.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003eNotes:\u003c/em\u003e Data were expressed as mean (standard deviation) or n (%).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ea: Single: never married, divorced, widowed\u003c/p\u003e\n\u003cp\u003eb: Occupation encompasses the current or pre-retirement status of participant.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAssociation between psychological resilience and cognitive function\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTable 2 presents the results of gender-stratified logistic regression analyses. Among males, both fair (OR = 0.56, 95% CI: 0.39\u0026ndash;0.81, p = 0.002) and good (OR = 0.65, 95% CI: 0.44\u0026ndash;0.96, p = 0.032) psychological resilience were associated with reduced odds of cognitive impairment compared to poor resilience. Similar associations were observed in females, with stronger effect sizes: OR = 0.55 (95% CI: 0.41\u0026ndash;0.74, p \u0026lt; 0.001) for fair resilience and OR = 0.39 (95% CI: 0.26\u0026ndash;0.56, p \u0026lt; 0.001) for good resilience.\u003c/p\u003e\n\u003cp\u003eAge was a significant predictor in both sexes. Compared to participants aged 50\u0026ndash;59, those aged 60\u0026ndash;69 and \u0026ge;70 years had significantly higher odds of cognitive impairment (e.g., in women: OR = 2.64 and 3.23, both p \u0026lt; 0.001). Being single was associated with increased odds of cognitive impairment in men (OR = 1.75, p = 0.024), but not in women.\u003c/p\u003e\n\u003cp\u003eAmong women, higher education (secondary school vs primary: OR = 0.72, p = 0.035) and professional/managerial occupation (OR = 0.21, p = 0.003) showed significant associations with lower odds of cognitive impairment. Physical activity was inversely associated with cognitive impairment in women only (OR = 0.67, p = 0.003). BMI was significantly associated with cognitive impairment in men, with lower odds among normal weight (OR = 0.47, p = 0.026) and obese participants (OR = 0.35, p = 0.009) compared to underweight.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 2. Multiple logistic regression of the association between psychological resilience and cognitive impairment\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" align=\"left\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 32px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 33px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 34px;\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20px;\"\u003e\n \u003cp\u003eOR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003eOR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 34px;\"\u003e\n \u003cp\u003ePsychological resilience\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 34px;\"\u003e\n \u003cp\u003ePoor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20px;\"\u003e\n \u003cp\u003e1.0 (Ref)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 34px;\"\u003e\n \u003cp\u003eFair\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20px;\"\u003e\n \u003cp\u003e0.56（0.39-0.81）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e0.002\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e0.55（0.41-0.74）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e0.000\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 34px;\"\u003e\n \u003cp\u003eGood\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20px;\"\u003e\n \u003cp\u003e0.65（0.44-0.96）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e0.032\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e0.39（0.26-0.56）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 34px;\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 34px;\"\u003e\n \u003cp\u003e50-59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20px;\"\u003e\n \u003cp\u003e1.0 (Ref)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 34px;\"\u003e\n \u003cp\u003e60-69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20px;\"\u003e\n \u003cp\u003e2.6（1.85-3.67）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e2.64（1.96-3.56）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 34px;\"\u003e\n \u003cp\u003e70+\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20px;\"\u003e\n \u003cp\u003e2.11（1.35-3.30）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e0.001\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e3.23（2.19-4.76）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003eMarital status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20px;\"\u003e\n \u003cp\u003e1.0 (Ref)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003eSingle\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20px;\"\u003e\n \u003cp\u003e1.75（1.06-2.81）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e0.024\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e0.93（0.65-1.32）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e0.696\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003eThe highest education level\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003ePrimary school and below\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20px;\"\u003e\n \u003cp\u003e1.0 (Ref)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003eSecondary school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20px;\"\u003e\n \u003cp\u003e1.72（1.21-2.45）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e0.003\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e0.72（0.54-0.98）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e0.035\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003eHiger school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20px;\"\u003e\n \u003cp\u003e0.52（0.15-1.39）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e0.243\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e0.19（0.01-0.92）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e0.106\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003eOccupation\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003eUnskilled\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20px;\"\u003e\n \u003cp\u003e1.0 (Ref)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003eSkilled\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20px;\"\u003e\n \u003cp\u003e0.90（0.63-1.29）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e0.562\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e0.94（0.73-1.22）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e0.657\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003eProfessional or managerial\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20px;\"\u003e\n \u003cp\u003e0.70（0.41-1.19）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e0.194\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e0.21（0.06-0.52）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e0.003\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003eSmoking\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003eNon-smoker or past smoker\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20px;\"\u003e\n \u003cp\u003e1.0 (Ref)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003eCurrent smoker\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20px;\"\u003e\n \u003cp\u003e1.12（0.78-1.62）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e0.554\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e1.65（1.05-2.58）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e0.028\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003edrinking\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003eNon-frequent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20px;\"\u003e\n \u003cp\u003e1.0 (Ref)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003eFrequent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20px;\"\u003e\n \u003cp\u003e0.77（0.57-1.04）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e0.084\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e1.05（0.66-1.63）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e0.844\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003ePhysical activity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003eInactive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20px;\"\u003e\n \u003cp\u003e1.0 (Ref)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003eActive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20px;\"\u003e\n \u003cp\u003e0.77（0.57-1.05）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e0.102\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e0.67（0.52-0.88）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e0.003\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003eDiet (vegetable and fruit intake)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003eInsufficient\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20px;\"\u003e\n \u003cp\u003e1.0 (Ref)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003eSufficient\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20px;\"\u003e\n \u003cp\u003e1.18（0.64-2.07）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e0.573\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e0.8（0.46-1.32）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e0.392\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003esleep quality\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003ePoor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20px;\"\u003e\n \u003cp\u003e1.0 (Ref)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003eFair\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20px;\"\u003e\n \u003cp\u003e0.94（0.19-7.09）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e0.946\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e0.94（0.35-2.84）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e0.911\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003eGood\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20px;\"\u003e\n \u003cp\u003e0.77（0.16-5.56）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e0.758\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e1.14（0.45-3.30）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e0.799\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003every good\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20px;\"\u003e\n \u003cp\u003e0.84（0.18-6.08）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e0.842\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e1.23（0.49-3.57）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e0.676\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003eBMI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003eUnderweight\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20px;\"\u003e\n \u003cp\u003e1.0 (Ref)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003eNormal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20px;\"\u003e\n \u003cp\u003e0.47（0.25-0.93）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e0.026\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e0.66（0.35-1.30）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e0.216\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003eOverweight\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20px;\"\u003e\n \u003cp\u003e0.55（0.28-1.10）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e0.080\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e0.64（0.33-1.27）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e0.190\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003eObese\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20px;\"\u003e\n \u003cp\u003e0.35（0.16-0.78）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e0.009\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e0.81（0.41-1.65）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e0.559\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003eNumber of major chronic diseases\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20px;\"\u003e\n \u003cp\u003e1.0 (Ref)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20px;\"\u003e\n \u003cp\u003e1.08（0.73-1.61）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e0.701\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e0.76（0.53-1.09）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e0.142\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20px;\"\u003e\n \u003cp\u003e0.93（0.59-1.45）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e0.739\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e0.57（0.39-0.85）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e0.005\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003e3+\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20px;\"\u003e\n \u003cp\u003e0.83（0.53-1.30）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e0.424\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e0.66（0.46-0.96）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e0.029\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003ea: Single: \u0026nbsp;never married, divorced, widowed\u003c/p\u003e\n\u003cp\u003eb: Occupation encompasses the current or pre-retirement status of participant.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAssociation between social support and cognitive function\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eResults from the models examining social support are shown in Table 3. Among males, fair (OR = 0.54, 95% CI: 0.39\u0026ndash;0.73, p \u0026lt; 0.001) and good (OR = 0.54, 95% CI: 0.28\u0026ndash;0.97, p = 0.050) levels of support were both associated with reduced odds of cognitive impairment. In females, similar associations with lower odds of cognitive impairment were observed (fair: OR = 0.72, p = 0.013; good: OR = 0.52, p = 0.034).\u003c/p\u003e\n\u003cp\u003eAge remained strongly associated with cognitive impairment in both sexes. In women, higher education and professional occupations were again associated with lower odds of cognitive impairment. Additionally, being physically active (OR = 0.65, p = 0.001) were associated with lower odds of cognitive impairment. Smoking was positively associated with cognitive impairment among females (OR = 1.57, p = 0.047), but not among males.\u003c/p\u003e\n\u003cp\u003eTable 3. Multiple logistic regression of the association between social support and cognitive impairment\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 34px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 32px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 33px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 34px;\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20px;\"\u003e\n \u003cp\u003eOR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003eOR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 34px;\"\u003e\n \u003cp\u003e(Intercept)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20px;\"\u003e\n \u003cp\u003e0.40（0.05-2.24）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e0.325\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e0.5（0.14-1.62）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e0.263\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 34px;\"\u003e\n \u003cp\u003eSocial support\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 34px;\"\u003e\n \u003cp\u003ePoor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 34px;\"\u003e\n \u003cp\u003eFair\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20px;\"\u003e\n \u003cp\u003e0.54（0.39-0.73)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e0.72（0.55-0.93）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e0.013\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 34px;\"\u003e\n \u003cp\u003eGood\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20px;\"\u003e\n \u003cp\u003e0.54（0.28-0.97）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e0.050\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e0.52（0.28-0.93）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e0.034\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 34px;\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 34px;\"\u003e\n \u003cp\u003e50-59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 34px;\"\u003e\n \u003cp\u003e60-69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20px;\"\u003e\n \u003cp\u003e2.50（1.78-3.55）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e2.57（1.91-3.46）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 34px;\"\u003e\n \u003cp\u003e70+\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20px;\"\u003e\n \u003cp\u003e1.97（1.25-3.08）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e0.003\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e2.96（2.02-4.35）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003eMarital status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003eSingle\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20px;\"\u003e\n \u003cp\u003e1.67（1.01-2.68）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e0.039\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e0.90（0.64-1.27）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e0.563\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003eThe highest education level\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003ePrimary school and below\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003eSecondary school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20px;\"\u003e\n \u003cp\u003e1.68（1.20-2.38）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e0.003\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e0.60（0.45-0.80）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e0.001\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003eHiger school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20px;\"\u003e\n \u003cp\u003e0.54（0.16-1.44）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e0.265\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e0.16（0.01-0.78）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e0.075\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003eOccupation\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003eUnskilled\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003eSkilled\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20px;\"\u003e\n \u003cp\u003e0.86（0.60-1.24）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e0.405\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e0.94（0.73-1.22）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e0.635\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003eProfessional or managerial\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20px;\"\u003e\n \u003cp\u003e0.69（0.40-1.16）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e0.169\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e0.21（0.06-0.52）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e0.003\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003eSmoking\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003eNon-smoker or past smoker\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003eCurrent smoker\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20px;\"\u003e\n \u003cp\u003e1.12（0.78-1.64）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e0.533\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e1.57（1.00-2.44）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e0.047\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003edrinking\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003eNon-frequent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003eFrequent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20px;\"\u003e\n \u003cp\u003e0.80（0.59-1.08）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e0.142\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e1.06（0.67-1.64）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e0.806\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003ePhysical activity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003eInactive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003eActive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20px;\"\u003e\n \u003cp\u003e0.79（0.58-1.07）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e0.129\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e0.65（0.50-0.84）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e0.001\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003eDiet (vegetable and fruit intake)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003eInsufficient\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003eSufficient\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20px;\"\u003e\n \u003cp\u003e1.14（0.62-2.00）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e0.658\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e0.71（0.41-1.16）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e0.192\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003esleep quality\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003ePoor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003eFair\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20px;\"\u003e\n \u003cp\u003e0.92（0.18-6.83）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e0.921\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e0.95（0.36-2.84）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e0.918\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003eGood\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20px;\"\u003e\n \u003cp\u003e0.76（0.16-5.43）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e0.746\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e1.11（0.44-3.20）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e0.833\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003every good\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20px;\"\u003e\n \u003cp\u003e0.81（0.18-5.80）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e0.808\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e1.19（0.47-3.42）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e0.725\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003eBMI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003eUnderweight\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003eNormal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20px;\"\u003e\n \u003cp\u003e0.49（0.26-0.98）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e0.038\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e0.67（0.35-1.31）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e0.228\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003eOverweight\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20px;\"\u003e\n \u003cp\u003e0.55（0.28-1.11）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e0.088\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e0.63（0.33-1.24）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e0.170\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003eObese\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20px;\"\u003e\n \u003cp\u003e0.35（0.16-0.77）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e0.009\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e0.76（0.39-1.55）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e0.447\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003eNumber of major chronic diseases\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20px;\"\u003e\n \u003cp\u003e1.12（0.76-1.66）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e0.576\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e0.81（0.57-1.15）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e0.242\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20px;\"\u003e\n \u003cp\u003e0.94（0.59-1.47）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e0.777\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e0.60（0.40-0.88）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e0.009\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 34px;\"\u003e\n \u003cp\u003e3+\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 20px;\"\u003e\n \u003cp\u003e0.84（0.53-1.31）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e0.439\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 21px;\"\u003e\n \u003cp\u003e0.72（0.50-1.04）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e0.079\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003ea: Single: never married, divorced, widowed\u003c/p\u003e\n\u003cp\u003eb: Occupation encompasses the current or pre-retirement status of participant.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNon-linear associations of psychological resilience and social support with cognitive function\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTo explore potential non-linear relationships, we conducted generalized additive model (GAM) adjusting for relevant covariates. As shown in Figure 1, the association between psychological resilience and predicted cognitive function was non-linear. Cognitive function increased with psychological resilience in a curvilinear pattern, with a steeper increase observed at lower to moderate levels of resilience, plateauing at higher levels. The confidence band (shaded area) suggests this trend is statistically robust.\u003c/p\u003e\n\u003cp\u003eA similar non-linear relationship was observed between social support and cognitive function (Figure 2). The cognitive function score rose sharply from low to moderate levels of social support and then plateaued with further increases.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eJoint effects of psychological resilience and social support on cognitive function\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTo assess potential synergistic effects, we conducted a joint analysis stratifying participants by psychological resilience and social support (Figure 3). Using the group with low psychological resilience and low social support as the reference, all other combinations showed reduced odds of cognitive impairment, though effect sizes varied by combination.\u003c/p\u003e\n\u003cp\u003eAmong participants with moderate social support, a dose-response pattern was evident: compared to the reference group, moderate psychological resilience was associated with 56% reduced odds (OR = 0.44, 95% CI: 0.33\u0026ndash;0.60), and high resilience with a 72% reduction (OR = 0.28, 95% CI: 0.19\u0026ndash;0.40).\u003c/p\u003e\n\u003cp\u003eIn the high social support group, those with moderate (OR = 0.25, 95% CI: 0.11\u0026ndash;0.51) and high resilience (OR = 0.37, 95% CI: 0.16\u0026ndash;0.76) also showed significantly lower odds of cognitive impairment, though estimates were less precise due to smaller sample sizes.\u003c/p\u003e\n\u003cp\u003eIn contrast, within the low social support group, only those with moderate resilience had significantly lower odds of impairment (OR = 0.55, 95% CI: 0.39\u0026ndash;0.77), while the association between high resilience and cognitive impairment was not statistically significant (OR = 0.73, 95% CI: 0.50\u0026ndash;1.05).\u003c/p\u003e\n\u003cp\u003eThese findings suggest an interaction whereby the beneficial associations between psychological resilience and cognitive function may be stronger in the presence of greater social support.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn this community-based study of middle-aged and older Chinese adults, we found that psychological resilience and social support were significantly associated with lower odds of cognitive impairment. Specifically, compared to participants with poor psychological resilience, those with fair and reasonable resilience had 44% (OR = 0.56, 95% CI: 0.39\u0026ndash;0.81) and 35% (OR = 0.65, 95% CI: 0.44\u0026ndash;0.96) lower odds of cognitive impairment among men, and 45% (OR = 0.55, 95% CI: 0.41\u0026ndash;0.74) and 61% (OR = 0.39, 95% CI: 0.26\u0026ndash;0.56) lower odds among women, respectively. Similarly, good social support was associated with a 46% (OR = 0.54, 95% CI: 0.28\u0026ndash;0.97) lower risk of cognitive impairment in men and a 48% (OR = 0.52, 95% CI: 0.28\u0026ndash;0.93) lower risk in women.\u003c/p\u003e\n\u003cp\u003eImportantly, we observed a synergistic interaction between psychological resilience and social support. Individuals with moderate resilience and high support exhibited the lowest likelihood of cognitive impairment (OR = 0.25, 95% CI: 0.11\u0026ndash;0.51). These findings suggest that the co-presence of internal (resilience) and external (support) psycho-social resources may offer enhanced protection for cognitive health. Generalized additive models further revealed non-linear, dose\u0026ndash;response relationships, indicating that cognitive function improves steeply from low to moderate levels of resilience and support but plateaus at higher levels. This suggests diminishing marginal gains, highlighting the importance of targeted but not excessive psycho-social interventions.\u003c/p\u003e\n\u003cp\u003eThese findings offer several important insights into the psycho-social determinants of cognitive aging. Psychological resilience reflects an individual\u0026rsquo;s capacity to adapt positively to stress and adversity[24], encompassing emotional regulation, self-efficacy, and problem-solving strategies. Resilient individuals may better manage chronic stress, maintain engagement in cognitively stimulating activities, and adopt health-promoting behaviors that preserve cognitive function. Beyond behavioral pathways, resilience may exert biological influences through several mechanisms. First, resilience has been associated with enhanced brain plasticity, including greater synaptic density and neurogenesis in key regions such as the hippocampus, which are crucial for memory and cognition[25, 26]. Second, psychological resilience may reduce chronic systemic inflammation and lower levels of pro-inflammatory cytokines, thereby mitigating neuroinflammation, a known contributor to cognitive decline. Third, resilience may regulate neuroendocrine responses to stress, such as attenuating hypothalamic-pituitary-adrenal (HPA) axis over-activation and reducing cortisol levels, which otherwise have neurotoxic effects on brain structures involved in cognition[25, 26].\u003c/p\u003e\n\u003cp\u003eSocial support, defined as the perceived and actual availability of emotional or practical assistance, has also been consistently associated with better cognitive outcomes[27]. Mechanistically, social support may reduce loneliness, depressive symptoms, and chronic stress, all of which are recognized risk factors for cognitive decline[28-31]. Furthermore, social support may directly influence biological processes, including promoting healthier inflammatory profiles, buffering HPA axis dysregulation, and enhancing structural brain integrity, particularly in regions implicated in memory and executive function[27]. \u0026nbsp;In addition, socially integrated individuals are more likely to remain physically active and cognitively engaged, both linked to preserved cognitive function. Our findings align with prior evidence suggesting that reduced social isolation is associated with a lower risk of dementia and cognitive decline[32-36].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOur study adds to the literature by examining gender-specific patterns in these associations. Although psychological resilience and social support were favorably associated with cognitive function in both sexes, the magnitude of the association for resilience appeared to be greater in women. This observation may reflect gender differences in emotional coping, stress reactivity, and help-seeking behaviour, as well as sociocultural norms regarding vulnerability and independence. Few previous studies have assessed the joint effects of resilience and social support; our findings suggest that these factors may act synergistically rather than independently, offering a more comprehensive buffer against cognitive deterioration.\u003c/p\u003e\n\u003cp\u003eThe implications of these findings are both theoretical and practical. Theoretically, they support the biopsychosocial model of cognitive aging and reinforce the cognitive reserve hypothesis. Practically, they point to the value of psycho-social interventions in dementia prevention strategies. Initiatives that enhance psychological resilience, such as cognitive behavioral therapy, mindfulness-based stress reduction, positive psychology programs, and community-based efforts to improve social connectivity, may be especially beneficial. These interventions may yield the greatest returns if implemented before onset of significant cognitive decline.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStrengths and Limitations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study has several notable strengths. We employed validated instruments to measure psychological resilience and social support, applied robust analytic methods including gender-stratified logistic regression and non-linear modelling, and accounted for a comprehensive set of potential confounders. The large sample size enhances the statistical power and generalizability to similar ageing populations in East Asia. However, limitations must be acknowledged. The cross-sectional design limits our ability to infer causality or temporal direction. Self-reported measures of psycho-social factors may be subject to recall or social desirability bias. Finally, despite adjusting for a wide range of covariates, residual confounding due to unmeasured factors, such as early-life adversity, chronic inflammation, or genetic susceptibility, cannot be ruled out.\u003c/p\u003e\n\u003cp\u003eFuture research should build upon these findings using longitudinal designs to examine how resilience and social support trajectories influence cognitive ageing over time. Interventional studies are warranted to test whether enhancing these psycho-social factors can delay or prevent cognitive impairment. Additionally, integration of biological measures (e.g., neuroimaging, inflammatory markers) may help clarify the mechanisms underlying the observed associations.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThis study provides robust evidence that\u0026nbsp;psychological resilience and social support are independently and synergistically associated with a reduced risk of cognitive impairment among middle-aged and older Chinese adults. These associations were observed across sexes but were particularly pronounced in women. Non-linear patterns suggest that even moderate levels of resilience and support may confer meaningful cognitive benefits. The joint analysis underscores that the presence of these psycho-social factors together is associated with lower odds of cognitive impairment. These findings reinforce the relevance of psycho-social resources in cognitive ageing and support incorporating resilience-building and social engagement strategies into dementia prevention frameworks. Longitudinal and interventional studies are warranted to establish causality and inform the development of effective, scalable interventions to promote cognitive health in ageing populations.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eOR, Odds ratio; CI, Confidence interval; IQR, Inter quartile ranges; GAM, Generalized additive model; BMI, Body mass index; MMSE, the Mini-Mental State Examination; CD-RISC-10, the 10-item version of the Connor-Davidson Resilience Scale; LSNS-6, the 6-item Lubben Social Network Scale; MET, Metabolic equivalent task; PSQI, Pittsburgh sleep quality index.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data that support the findings of this study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe gratefully acknowledge the support from the Chinese Academy of Medical Sciences \u0026amp; Peking Union Medical College (Grant Nos. 2021-RC330-004, 2022-ZHCH330-01, and WH10022022010) and the Chinese Academy of Engineering (Grant No. 2024-GJ-04).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was supported by Chinese Academy of Engineering (Grant No. 2024-GJ-04);the non-profit Central Research Institute Fund of Chinese Academy of Medical Sciences (Grant No. 2021-RC330-004；Grant No. 2022-ZHCH330-01); the Disciplines Construction Project:Population Medicine(Grant No. WH10022022010).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAuthors and Affiliations\u003c/p\u003e\n\u003cp\u003eAuthors and Affiliations:\u003c/p\u003e\n\u003cp\u003eSchool of Population Medicine and Public Health, Chinese Academy of Medical Sciences \u0026amp; Peking Union Medical College, Beijing, China 100730\u003c/p\u003e\n\u003cp\u003eXiaoxia Wei, Fangqin Tan, Weihao Shao, Enying Gong \u0026amp; Ruitai Shao\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eState Key Laboratory of Respiratory Health and Multimorbidity, Chinese Academy of Medical Sciences \u0026amp; Peking Union Medical College, Beijing, China 100730\u003c/p\u003e\n\u003cp\u003eEnying Gong \u0026amp; Ruitai Shao\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eUniversity of Geneva, Geneva, Switzerland\u003c/p\u003e\n\u003cp\u003eJean-Pierre Michel\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFrench Academy of Medicine, Paris, France\u003c/p\u003e\n\u003cp\u003eJean-Pierre Michel\u003c/p\u003e\n\u003cp\u003eIHU HealthAge, Toulouse, France\u003c/p\u003e\n\u003cp\u003ePhilipe de Souto Barreto\u003c/p\u003e\n\u003cp\u003eCERPOP UMR 1295, Inserm, Universit\u0026eacute; Paul Sabatier, Toulouse, France\u003c/p\u003e\n\u003cp\u003ePhilipe de Souto Barreto\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eContributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eXiaoxia Wei contributed to the study design, data collection, data management, data analysis and manuscript drafting. Fangqin Tan contributed to data collection and data management. Weihao Shao, Enying Gong, Jean-Pierre Michel and Philipe de Souto Barreto contributed to manuscript revision. Ruitai Shao was responsible for project supervision and financial support. All authors approved this manuscript for publication.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCorresponding authors\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCorrespondence to\u0026nbsp;Philipe de Souto Barreto\u0026nbsp;or Ruitai Shao.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics declarations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was received approval from the Ethics Committee of Chinese Academy of Medical Sciences \u0026amp; Peking Union Medical College (CAMS\u0026amp;PUMC-IEC-2022-076). Written informed consent was obtained from all participants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eOrganization WH: \u003cstrong\u003eGlobal status report on the public health response to dementia\u003c/strong\u003e. 2021.\u003c/li\u003e\n\u003cli\u003eJia L, Du Y, Chu L, Zhang Z, Li F, Lyu D, Li Y, Zhu M, Jiao H, Song YJTLph: \u003cstrong\u003ePrevalence, risk factors, and management of dementia and mild cognitive impairment in adults aged 60 years or older in China: a cross-sectional study\u003c/strong\u003e. 2020, \u003cstrong\u003e5\u003c/strong\u003e(12):e661-e671.\u003c/li\u003e\n\u003cli\u003eReuben DB, Kremen S, Maust DTJJIM: \u003cstrong\u003eDementia prevention and treatment: a narrative review\u003c/strong\u003e. 2024, \u003cstrong\u003e184\u003c/strong\u003e(5):563-572.\u003c/li\u003e\n\u003cli\u003eFletcher D, Sarkar MJEp: \u003cstrong\u003ePsychological resilience\u003c/strong\u003e. 2013.\u003c/li\u003e\n\u003cli\u003eWindle GJRicg: \u003cstrong\u003eWhat is resilience? A review and concept analysis\u003c/strong\u003e. 2011, \u003cstrong\u003e21\u003c/strong\u003e(2):152-169.\u003c/li\u003e\n\u003cli\u003eYang JS, Jeon YJ, Lee GB, Kim HC, Jung SJ: \u003cstrong\u003eThe association between psychological resilience and cognitive function in longitudinal data: Results from the community follow-up survey\u003c/strong\u003e. \u003cem\u003eJournal of affective disorders \u003c/em\u003e2021, \u003cstrong\u003e290\u003c/strong\u003e:109-116.\u003c/li\u003e\n\u003cli\u003eWang P, Li R, Chen Y: \u003cstrong\u003eLongitudinal trajectories of psychological resilience and cognitive impairment among older adults: Evidence from a national cohort study\u003c/strong\u003e. \u003cem\u003eThe journals of gerontology Series B, Psychological sciences and social sciences \u003c/em\u003e2025.\u003c/li\u003e\n\u003cli\u003eJiang GQ, He YK, Li TF, Qin QR, Wang DN, Huang F, Sun YH, Li J: \u003cstrong\u003eAssociation of psychological resilience and cognitive function in older adults: Based on the Ma\u0026apos; anshan Healthy Aging Cohort Study\u003c/strong\u003e. \u003cem\u003eArchives of gerontology and geriatrics \u003c/em\u003e2024, \u003cstrong\u003e116\u003c/strong\u003e:105166.\u003c/li\u003e\n\u003cli\u003eDu C, Katz B, Li M, Pernice FM, Rickertsen K, Gu F, Hori K, Ding X, Xu H: \u003cstrong\u003eLongitudinal Associations Between Psychological Resilience and Cognitive Function: Evidence From the U.S. Health and Retirement Study\u003c/strong\u003e. \u003cem\u003eThe journals of gerontology Series B, Psychological sciences and social sciences \u003c/em\u003e2025, \u003cstrong\u003e80\u003c/strong\u003e(2).\u003c/li\u003e\n\u003cli\u003eScambray KA, Morris EP, Palms JD, Lee JH, Sol K, Zahodne LB: \u003cstrong\u003ePsychological resilience and cognitive functioning in Black and White men and women\u003c/strong\u003e. \u003cem\u003eThe Gerontologist \u003c/em\u003e2025.\u003c/li\u003e\n\u003cli\u003eJung SJ, Lee GB, Nishimi K, Chibnik L, Koenen KC, Kim HC: \u003cstrong\u003eAssociation between psychological resilience and cognitive function in older adults: effect modification by inflammatory status\u003c/strong\u003e. \u003cem\u003eGeroScience \u003c/em\u003e2021, \u003cstrong\u003e43\u003c/strong\u003e(6):2749-2760.\u003c/li\u003e\n\u003cli\u003eAlbrecht TL, Goldsmith DJ: \u003cstrong\u003eSocial support, social networks, and health\u003c/strong\u003e. In: \u003cem\u003eThe Routledge handbook of health communication.\u003c/em\u003e Routledge; 2003: 277-298.\u003c/li\u003e\n\u003cli\u003ePoey JL, Burr JA, Roberts JSJTG: \u003cstrong\u003eSocial connectedness, perceived isolation, and dementia: Does the social environment moderate the relationship between genetic risk and cognitive well-being?\u003c/strong\u003e 2017, \u003cstrong\u003e57\u003c/strong\u003e(6):1031-1040.\u003c/li\u003e\n\u003cli\u003eCampbell‐Sills L, Stein MBJJoTSOPoTISfTSS: \u003cstrong\u003ePsychometric analysis and refinement of the connor\u0026ndash;davidson resilience scale (CD‐RISC): Validation of a 10‐item measure of resilience\u003c/strong\u003e. 2007, \u003cstrong\u003e20\u003c/strong\u003e(6):1019-1028.\u003c/li\u003e\n\u003cli\u003eConnor KM, Davidson JRJD, anxiety: \u003cstrong\u003eDevelopment of a new resilience scale: The Connor‐Davidson resilience scale (CD‐RISC)\u003c/strong\u003e. 2003, \u003cstrong\u003e18\u003c/strong\u003e(2):76-82.\u003c/li\u003e\n\u003cli\u003eLubben J, Blozik E, Gillmann G, Iliffe S, von Renteln Kruse W, Beck JC, Stuck AEJTG: \u003cstrong\u003ePerformance of an abbreviated version of the Lubben Social Network Scale among three European community-dwelling older adult populations\u003c/strong\u003e. 2006, \u003cstrong\u003e46\u003c/strong\u003e(4):503-513.\u003c/li\u003e\n\u003cli\u003eChang Q, Sha F, Chan CH, Yip PSJPo: \u003cstrong\u003eValidation of an abbreviated version of the Lubben Social Network Scale (\u0026ldquo;LSNS-6\u0026rdquo;) and its associations with suicidality among older adults in China\u003c/strong\u003e. 2018, \u003cstrong\u003e13\u003c/strong\u003e(8):e0201612.\u003c/li\u003e\n\u003cli\u003e!!! INVALID CITATION !!! [16].\u003c/li\u003e\n\u003cli\u003eNi Y, Zhou Y, Kivim\u0026auml;ki M, Cai Y, Carrillo-Larco RM, Xu X, Dai X, Xu X: \u003cstrong\u003eSocioeconomic inequalities in physical, psychological, and cognitive multimorbidity in middle-aged and older adults in 33 countries: a cross-sectional study\u003c/strong\u003e. \u003cem\u003eThe lancet Healthy longevity \u003c/em\u003e2023, \u003cstrong\u003e4\u003c/strong\u003e(11):e618-e628.\u003c/li\u003e\n\u003cli\u003eOrganization WH: \u003cstrong\u003eGlobal recommendations on physical activity for health\u003c/strong\u003e. 2010.\u003c/li\u003e\n\u003cli\u003eWang T, Zhao Z, Wang G, Li Q, Xu Y, Li M, Hu R, Chen G, Su Q, Mu Y\u003cem\u003e et al\u003c/em\u003e: \u003cstrong\u003eAge-related disparities in diabetes risk attributable to modifiable risk factor profiles in Chinese adults: a nationwide, population-based, cohort study\u003c/strong\u003e. \u003cem\u003eThe lancet Healthy longevity \u003c/em\u003e2021, \u003cstrong\u003e2\u003c/strong\u003e(10):e618-e628.\u003c/li\u003e\n\u003cli\u003eBuysse DJ, Reynolds III CF, Monk TH, Berman SR, Kupfer DJJPr: \u003cstrong\u003eThe Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research\u003c/strong\u003e. 1989, \u003cstrong\u003e28\u003c/strong\u003e(2):193-213.\u003c/li\u003e\n\u003cli\u003eHastie TJJSmiS: \u003cstrong\u003eGeneralized additive models\u003c/strong\u003e. 2017:249-307.\u003c/li\u003e\n\u003cli\u003eVella S-LC, Pai NBJAoM, Sciences H: \u003cstrong\u003eA theoretical review of psychological resilience: Defining resilience and resilience research over the decades\u003c/strong\u003e. 2019, \u003cstrong\u003e7\u003c/strong\u003e(2):233-239.\u003c/li\u003e\n\u003cli\u003eGu Y, Wong NML, Chan CCH, Wu J, Lee TMC: \u003cstrong\u003eThe negative relationship between brain-age gap and psychological resilience defines the age-related neurocognitive status in older people\u003c/strong\u003e. \u003cem\u003eGeroScience \u003c/em\u003e2025.\u003c/li\u003e\n\u003cli\u003eChen M, Gao M, Ma J, Lee TMC: \u003cstrong\u003eIntrinsic brain functional connectivity mediates the relationship between psychological resilience and cognitive decline in ageing\u003c/strong\u003e. \u003cem\u003eGeroScience \u003c/em\u003e2025.\u003c/li\u003e\n\u003cli\u003eKelly ME, Duff H, Kelly S, McHugh Power JE, Brennan S, Lawlor BA, Loughrey DGJSr: \u003cstrong\u003eThe impact of social activities, social networks, social support and social relationships on the cognitive functioning of healthy older adults: a systematic review\u003c/strong\u003e. 2017, \u003cstrong\u003e6\u003c/strong\u003e:1-18.\u003c/li\u003e\n\u003cli\u003eSchnittger RI, Wherton J, Prendergast D, Lawlor BAJA, health m: \u003cstrong\u003eRisk factors and mediating pathways of loneliness and social support in community-dwelling older adults\u003c/strong\u003e. 2012, \u003cstrong\u003e16\u003c/strong\u003e(3):335-346.\u003c/li\u003e\n\u003cli\u003eEllwardt L, Aartsen M, Deeg D, Steverink NJSs, medicine: \u003cstrong\u003eDoes loneliness mediate the relation between social support and cognitive functioning in later life?\u003c/strong\u003e 2013, \u003cstrong\u003e98\u003c/strong\u003e:116-124.\u003c/li\u003e\n\u003cli\u003eXu J, Zhang L, Sun H, Gao Z, Wang M, Hu M, Ji Q, Guo L: \u003cstrong\u003ePsychological resilience and quality of life among middle-aged and older adults hospitalized with chronic diseases: multiple mediating effects through sleep quality and depression\u003c/strong\u003e. \u003cem\u003eBMC geriatrics \u003c/em\u003e2023, \u003cstrong\u003e23\u003c/strong\u003e(1):752.\u003c/li\u003e\n\u003cli\u003eZheng K, Chu J, Zhang X, Ding Z, Song Q, Liu Z, Peng W, Cao W, Zou T, Yi J: \u003cstrong\u003ePsychological resilience and daily stress mediate the effect of childhood trauma on depression\u003c/strong\u003e. \u003cem\u003eChild abuse \u0026amp; neglect \u003c/em\u003e2022, \u003cstrong\u003e125\u003c/strong\u003e:105485.\u003c/li\u003e\n\u003cli\u003eNg TKS, Beck T, Dennis KR, Desai P, Krueger K, Dhana K, Wilson RS, Evans DA, Rajan KB: \u003cstrong\u003eSocial isolation, loneliness, and their joint effects on cognitive decline and incident Alzheimer\u0026apos;s disease: Findings from the Chicago health and aging project\u003c/strong\u003e. \u003cem\u003eThe journal of prevention of Alzheimer\u0026apos;s disease \u003c/em\u003e2025, \u003cstrong\u003e12\u003c/strong\u003e(3):100046.\u003c/li\u003e\n\u003cli\u003eGoldberg TE, Choi J, Lee S, Gurland B, Devanand DP: \u003cstrong\u003eEffects of restriction of activities and social isolation on risk of dementia in the community\u003c/strong\u003e. \u003cem\u003eInternational psychogeriatrics \u003c/em\u003e2021, \u003cstrong\u003e33\u003c/strong\u003e(11):1207-1215.\u003c/li\u003e\n\u003cli\u003eFranks KH, Bransby L, Cribb L, Buckley R, Yassi N, Chong TT, Saling MM, Lim YY, Pase MP: \u003cstrong\u003eAssociations of Perceived Stress and Psychological Resilience With Cognition and a Modifiable Dementia Risk Score in Middle-Aged Adults\u003c/strong\u003e. \u003cem\u003eThe journals of gerontology Series B, Psychological sciences and social sciences \u003c/em\u003e2023, \u003cstrong\u003e78\u003c/strong\u003e(12):1992-2000.\u003c/li\u003e\n\u003cli\u003eKim S, Won CW, Kim S, Park JH, Kim M, Kim B, Ryu J: \u003cstrong\u003eThe Effect of Psychological Resilience on Cognitive Decline in Community-Dwelling Older Adults: The Korean Frailty and Aging Cohort Study\u003c/strong\u003e. \u003cem\u003eKorean journal of family medicine \u003c/em\u003e2024, \u003cstrong\u003e45\u003c/strong\u003e(6):331-336.\u003c/li\u003e\n\u003cli\u003eWan R, Tu J, Gao J, Cao L, Zhang L, Huang J, Liu Z: \u003cstrong\u003eMediation effect of neuropsychological factors on the relationship between social networks and mild cognitive impairment in older adults\u003c/strong\u003e. \u003cem\u003eJournal of Alzheimer\u0026apos;s disease : JAD \u003c/em\u003e2025, \u003cstrong\u003e103\u003c/strong\u003e(1):208-217. \u003c/li\u003e\n\u003c/ol\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":"[email protected]","identity":"aging-clinical-and-experimental-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"acer","sideBox":"Learn more about [Aging Clinical and Experimental Research](http://link.springer.com/journal/40520)","snPcode":"40520","submissionUrl":"https://submission.nature.com/new-submission/40520/3","title":"Aging Clinical and Experimental Research","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Cognitive function, Cognitive impairment, Psychological resilience, Social support, Psycho-social factors, Joint association","lastPublishedDoi":"10.21203/rs.3.rs-7557045/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7557045/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eCognitive impairment poses a major public health concern in ageing societies. This study investigated the independent and joint associations of resilience and social support with cognitive function among community-dwelling middle-aged and older Chinese adults, and explored gender-specific differences.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eA total of 3,058 Chinese adults aged\u0026thinsp;\u0026ge;\u0026thinsp;50 years from both urban and rural communities were included. Cognitive function was evaluated using the Mini-Mental State Examination (MMSE). Resilience was assessed using the 10-item Connor-Davidson Resilience Scale (CD-RISC-10), and social support by the 6-item Lubben Social Network Scale (LSNS-6). Logistic regression models stratified by gender were applied with adjustment for demographic, behavioral, and health-related variables. Generalized additive models were used to test non-linear associations, and joint effects were examined with combined categories.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eOverall, 18.4% of participants (20.1% women, 16.3% men) had cognitive impairment. Higher resilience and social support were independently associated with lower odds of impairment. Curvilinear associations were observed in generalized additive models. Compared with low resilience and low support, participants with moderate resilience and high support had the lowest risk (OR\u0026thinsp;=\u0026thinsp;0.25, 95% CI: 0.11\u0026ndash;0.51).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eResilience and social support were independently and jointly associated with better cognitive function. Promoting psychosocial resources, especially among women, may represent an important gender-sensitive strategy for cognitive health promotion in ageing populations.\u003c/p\u003e","manuscriptTitle":"Stronger Minds Together: How Resilience and Social Support Associate with Cognitive Function during Aging","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-03 16:19:13","doi":"10.21203/rs.3.rs-7557045/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-10-25T07:24:27+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-14T13:08:12+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"243307765672224153543232585008149694032","date":"2025-09-22T09:13:55+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-09-21T17:09:03+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-09-12T19:51:04+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-09-08T06:06:14+00:00","index":"","fulltext":""},{"type":"submitted","content":"Aging Clinical and Experimental Research","date":"2025-09-07T14:42:41+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"aging-clinical-and-experimental-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"acer","sideBox":"Learn more about [Aging Clinical and Experimental Research](http://link.springer.com/journal/40520)","snPcode":"40520","submissionUrl":"https://submission.nature.com/new-submission/40520/3","title":"Aging Clinical and Experimental Research","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"d9e84ae5-2b51-401c-9d76-29a253fd3654","owner":[],"postedDate":"October 3rd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-04-20T16:01:16+00:00","versionOfRecord":{"articleIdentity":"rs-7557045","link":"https://doi.org/10.1007/s40520-026-03348-w","journal":{"identity":"aging-clinical-and-experimental-research","isVorOnly":false,"title":"Aging Clinical and Experimental Research"},"publishedOn":"2026-04-13 15:58:06","publishedOnDateReadable":"April 13th, 2026"},"versionCreatedAt":"2025-10-03 16:19:13","video":"","vorDoi":"10.1007/s40520-026-03348-w","vorDoiUrl":"https://doi.org/10.1007/s40520-026-03348-w","workflowStages":[]},"version":"v1","identity":"rs-7557045","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7557045","identity":"rs-7557045","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}