Relationship between Cardiovascular Risk and ADLs' Disability among Middle-aged and Older Adults in China: Evidence from a Longitudinal Study

Relationship between Cardiovascular Risk and ADLs' Disability among Middle-aged and Older Adults in China: Evidence from a Longitudinal Study | 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 Relationship between Cardiovascular Risk and ADLs' Disability among Middle-aged and Older Adults in China: Evidence from a Longitudinal Study Yihao Zhao, Chen Chen, Yu Wu, Ruitai Shao, Xiaoying Zheng This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-2799628/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Backgrounds: The effect of FGCRS on disability will not be immediate and may have a lag time between the experienced cardiovascular risk and the ultimate health outcome. However, how this effect changes over time is not known. Based on data from China Health and Retirement Longitudinal Study, we aimed to investigate the association between cardiovascular risk and activities of daily living disability among Chinese middle-aged and older adults and to examine the lag effect of cardiovascular risk on individual ADLs’ disability. Methods: Means ± standard deviation were used to describe continuous variables and numbers (percentages) to categorical variables. Logistic regression analysis and a distributed-lag model were used to estimate the correlations and lag effect between FGCRS and ADLs disability (BADL and IADL). All statistical analyses were performed using STATA 17.0, and p < 0.05 was considered statistically significant. Results: In 2018, Out of 6,123 participants, 23.54% reported at least one difficulty in basic activities of daily living and 28.04% had at least one difficulty in instrumental activities of daily living. After adjusting for all the covariates, a positive correlation was identified between FGCRS and ADL disability (BADL: OR = 1.023, IADL: OR = 1.028), and the correlation varied by age, gender, living regions, and income. In the longitudinal research, baseline CVD risk was significantly associated with the risk of ADL disability in 2 to 7 years. Conclusions: Elevated cardiovascular risk was significantly associated with subsequent functional limitations in middle-aged and older Chinese adults. cardiovascular risk FGCRS activities of daily living disability middle-aged and older adults Figures Figure 1 Background Disability is universal and closely linked to ageing. In the face of global population ageing, the risk of disability will increase dramatically [ 1 ]. It is estimated that about 1.3 billion people experience disabilities globally. Disability in activities of daily living (ADLs) will inevitably have negative impacts on the quality of life of older adults [ 2 , 3 ], increasing healthcare costs [ 4 ] for both families and the country as well as the burden on family caregivers [ 5 ]. According to the framework of the International Classification of Functioning, Disability, and Health (ICF) [ 6 ] issued by the World Health Organization, disability is a multi-dimensional status as the result of dynamic interaction between health conditions, individual factors, and other external factors such as the individual living environment. Many factors may be related to disability progress, and early identification and control of risk factors may provide significant benefits. Cardiovascular Disease (CVD) is a common cardiac disease and circulatory system disorder among middle-aged and older adults, placing a tremendous burden on both families and the whole society. The increase in life expectancy has increased the years people lived with CVD. One of the most important contributors to the disability burden is cardiovascular disease [ 7 ]. A previous study reported that the rate of disability was significantly higher among people with CVD experience [ 8 ]. In addition to the immutable factors such as age, sex, and heredity, CVD could be also influenced by factors such as smoking, alcohol consumption, elevated blood pressure, type 2 diabetes, and obesity [ 9 ]. Given that these factors are aggregated and interact in individuals [ 10 ], we need to examine their overall impacts. Comprehensive and validated tools exist to evaluate cardiovascular risk at present such as the Framingham general cardiovascular risk score (FGCRS), the SCORE charts, and the Progetto CUORE score. The FGCRS is a widely used and comprehensive tool that predicts the risk of cardiovascular disease over 10 years by combining demographic factors such as age and gender with some traditional cardiovascular risk factors. Previous studies have shown that higher FGCRS was a significant risk factor for cognitive decline [ 11 , 12 ] such as dementia and Alzheimer's disease dementia, which leads to neurodegenerative changes in the brain [ 13 ] that accelerates the progression of disability, especially in older adults [ 1 ]. The effect of FGCRS on disability will not be immediate and may have a lag time between the experienced cardiovascular risk and the ultimate health outcome. However, how this effect changes over time is not known. In this study, we aimed to examine the hypothesis that higher FGCRS was related to the increased risk of disability in ADLs and to estimate the lag effect using 4 different lag times between 0 and 7 years to better describe and address the healthcare needs of middle-aged and older adults. Methods Study design and participates The study population was derived from China Health and Retirement Longitudinal Study (CHARLS, 2011–2018), an ongoing longitudinal national survey of a representative population aged at least 45 years old and their spouses in China. CHARLS was conducted in 2011 and covered 17,708 respondents in 10,257 households from 150 countries or districts and 450 villages in 28 provinces, through a multistage stratified probability proportional to size (PPS) sampling. Three follow-up interviews were conducted in 2013, 2015, and 2018. More detailed information about the study design has been reported previously [ 14 ]. In this study, we analyzed data from CHARLS from 2011 to 2018. The inclusion criteria for this study were: 1) individuals completely followed from 2011 to 2018, and 2) individuals aged at least 45 years old in CHARLS 2011. Exclusion criteria were: 1) individuals with missing data on relevant variables, such as FGCRS, ADLs, gender, age, marital status, educational status, working status, medical insurance, body mass index (BMI), and alcohol consumption, and 2) individuals with CVD in 2011. From CHARLS 2011 to 2018, a total of 11,988 participants were followed up and 5,865 individuals were excluded due to the criteria mentioned above. Our analytic sample ultimately included 6,123 individuals, and the detailed selection process is presented in Fig. 1 . Assessment of Cardiovascular Risk The Framingham General Cardiovascular Risk Score (FGCRS) was used to assess cardiovascular disease risk. The FGCRS was calculated for each participant in CHARLS 2011 based on age, gender, high-density lipoprotein (HDL), total cholesterol (TC), systolic blood pressure (SBP), and SBP (if having medication for hypertension, smoking, and diabetes) [ 15 ]. We summarized the key points of these risk factors to obtain the FGCRS. A higher FGCRS means a higher risk of a cardiovascular event in the future. Assessment of ADLs disability The study outcome was ADLs disability, including two indicators: disability in basic activities of daily living (BADL) [ 16 ] and disability in instrumental activities of daily living (IADL) [ 17 ]. Both were measured by valid scales. The BADLs were measured by the Katz Activities of Daily Living Scale [ 18 ] and included six self-report items: dressing, bathing, eating, getting in/out of bed, using the toilet, and controlling urination or defecation. The IADLs included managing money, taking medications, shopping for groceries, preparing meals, cleaning the house, and making phone calls. The answers to each question were the same: “no difficulty”, “have difficulty but can still do it”, “have difficulty and need help”, and “cannot do it”. We defined the BADL disability or IADL disability as the respondent who reported difficulty with any activity or was unable to do the activity. Covariates Information on sociodemographic characteristics, anthropometric measurements, health-related lifestyle factors, and new CVD incidence was also used in the present study. The covariates included age (constant in description analysis and classified as 45 to 54, 55 to 64, 65 and above in the regression model), gender (male or female), living region (urban or rural), marital status (married and partnered or without a spouse), educational status (elementary school and below, middle school or high school and above), per household income (lowest, middle or highest), working status (no job, have job or retirement), medical insurance (no or yes), drinking status (never, former, or current drinking), and new CVD incidence from 2011 to 2018 (no or yes). Body mass index (BMI) equaled weight (kg) divided by height (m) squared. Statistical analysis Data were shown as means ± standard deviation (SD) for continuous variables and numbers (percentages) for categorical variables. First, categorical variables were compared in the different FGCRS groups using chi-square analysis, and constant variables were compared by Spearman's rank correlation coefficient. Second, logistic regression analysis was used to estimate the correlations between FGCRS and ADLs disability (BADL and IADL) in cross-sectional data and stratified analysis. Third, in the longitudinal analysis, a distributed-lag model was used to estimate the relationships at 0-, 2-, 4-, and 7-year lag times. Both cross-sectional and longitudinal analyses were controlled for individuals' age, gender, living region, marital status, educational status, per household income, working status, medical insurance, BMI, drinking, and new CVD incidence. Finally, considering the possible differences due to socio-demographic characteristics, we also evaluated correlations using stratified analysis for all subgroups. All statistical analyses were performed using STATA 17.0, and p < 0.05 was considered statistically significant in all models. Results Basic information on the study population Table 1 presents the general and grouped characteristics of participants. Among the 6,132 middle-aged and older adults (mean age: 58.13±8.68 years old) in China, the FGCRS ranged from 0 to 29, with a mean score of 12.40±5.24. In our study, most participants were female (53.90%), lived in rural areas (68.12%), were married and partnered (86.20%), had a lower education level (elementary school and below: 70.47%), employed (71.75%), had medical insurance (94.79%), and never drank (58.24%); the mean BMI was 23.55±6.99 kg/m2; 23.54% of the study population had difficulty in BADL and 28.04% had difficulty in IADL in 2018. During the follow-up from 2013 to 2018, 14.21% of the patients experienced a new CVD incidence. Age, gender, marital status, education level, per household income, working status, BMI, drinking, CVD incidences, difficulty in BADL, and difficulty in IADL were significantly different in tertile FGCRS as lowest, middle, and highest (p<0.05). Cross-sectional relationship between FGCRS and ADLs disability In the logistic regression model with FGCRS as a continuous variable, the risk of disability for BADL and IADL was associated with higher scores even after adjusting for gender, age, living region, educational status, marital status, per household income, working status, medical insurance, BMI, alcohol consumption, and new CVD incidence. Each point increase in FGCRS was associated with an increase in the risk of BADL disability by 2.3% and the risk of IADL disability by 2.8% ( Table 2 ). In the stratified analysis, FGCRS could be found to be partially related to the risk of ADLs disability by gender, age group, famine cohort, living region, and per household income ( Table 3 ). Compared to the counterpart in subgroups, the increasing FGCRS was associated with the highest risk of BADL disability in males (OR: 1.030, 95% CI:1.014-1.046), 65 years old, and above (OR: 1.0219, 95% CI:1.006-1.038), people experienced famine in adolescence (OR: 1.021, 95% CI:1.009-1.034), living in urban (OR: 1.023, 95% CI:1.008-1.040), with highest per household income (OR: 1.021, 95% CI:1.003-1.038), and the highest risk of IADL disability in male (OR: 1.052, 95% CI:1.037-1.068), 65 years old and above (OR: 1.038, 95% CI:1.023-1.054), people experienced famine in infancy and child (OR: 1.033, 95% CI:1.014-1.052), living in rural (OR: 1.016, 95% CI:1.006-1.026), and lowest per household income (OR: 1.033, 95% CI:1.020-1.046). Longitudinal relationship between FGCRS and ADLs disability A distributed-lag model was used to examine the correlation between FGCRS and ADLs disability in the longitudinal data from 2011 to 2018, and continuous FGCRS was dose-dependently associated with the risk of ADL disability. As shown in Table 4 , the odds ratio for BADL limitations increased steadily at 2-, 4- and 7-year lag times, with each point increase in FGCRS related to a 1.5%, 1.9%, and 2.3% increase in the risk of BADL disability, respectively. This trend was also evident in the relationship between FGCRS and IADL, where the risk of disability was 1.8%, 2.2%, and 2.8% higher with a one-point increase in FGCRS at the 2-, 4- and 7-year lag times ( Table 4 ). There was no statistical relationship between FGCRS and BADL at baseline, and we did not explore the relationship between FGCRS and IADL at baseline due to a lack of data. Detailed information can be found in Appendix A ( Table A1 and Table A2 ). Discussion In this national prospective cohort study of middle-aged and older adults, we used the logistic regression model and distributed-lag model to investigate the association between CVD risk and ADL disability. Our findings suggested that a higher CVD risk burden evaluated by the FGCRS is significantly related to the higher risk of disability in both basic and instrumental activities of daily living. Significant differences remained when examining the effects between sub-groups of gender, age, living region, per household income, and famine experience. Furthermore, the longitudinal research also indicates that the baseline CVD risk is associated with the risk of ADL disability at 2 to 7 years. Thus, FGCRS screeners may identify the potential risk for late-life disability. CVD has become a major global public health concern as it is the main cause of increased death and disability. The relationship between CVD and disability has been well documented, but the association between FGCRS and disability risk and the overall trends need further study. Consistent with previous studies, individuals with higher FGCRS, which means a higher risk of CVD, will experience significantly higher rates of disability than those with lower FGCRS. Most directly, CVD leads to damage to the heart and systemic vascular system, resulting in decreased aerobic capacity; thus, the physical ability and mobility activities will be limited over time, eventually leading to the disability experience [ 19 ]. To our knowledge, no studies have examined the lag effect of FGCRS on disabilities in BADL and IADL and its progression. Based on the results of this study, we also found that the FGCRS could be considered a predictor of activities of daily living over at least 7 years because of the stable associations across different years, and the effect of FGCRS was enhanced by its duration. This suggests that there may be a cumulative effect. This study also revealed that there were age and gender disparities between FGCRS and disability risks. Previous studies have shown that age and gender were significantly associated with disability in ADL, especially for chronic patients [ 19 – 21 ]. Our findings were consistent with previous studies that the risk of disability for BADL and IADL related to high FGCRS increased with age, as this was usually the result of the ageing progress. To further investigate age-related differences, we examined this association after taking into account their famine experiences. It indicated that there were more significant associations between FGCRS and disability risks among people who experienced famine, especially early in life. This may be caused by the higher risk of CVD associated with the famine experience. Some famine cohort studies from the Netherlands [ 22 ], China [ 23 , 24 ], and Nigeria [ 25 ] have shown that exposure to famine during the fetal period and early life could increase the risk of CVD and CVD-related factors such as higher levels of total cholesterol, systolic blood pressure [ 26 ] in late life. In terms of the cumulative disadvantage theory, the effects of risk factors would accumulate throughout the life course, thereby increasing the variability in later life [ 27 ]. We also found that men with a higher risk of CVD were at higher risk of disability than women in both BADL and IADL. The previous study showed that males tended to suffer from multiple chronic diseases, resulting in higher impairment of ADL, especially on the IADL [ 28 ]. However, this finding was different from Keeney’s study [ 8 ], which indicated that gender was not significantly associated with community disability when combined with environmental factors such as transportation, household modification, and other external supports. The results also suggested the residential gap in the association. As age increased, urban residents were related to more BADL limitations [ 29 ]. However, given the actual gap between urban and rural in China, we had an adverse result of IADL disability that needed further study. In addition, there were also differences in high- and low-income groups. The different trends shown in BADL and IADL disability may be associated with the complex relationship between social-economic factors and cardiovascular risk factors [ 30 , 31 ]. This study had some limitations. The disabilities in both BADL and IADL were self-reported indicators rather than objective function tests. In future work, objective indicators such as grip strength or the chair stand test could be used to draw more definitive conclusions about the association between FGCRS and disabilities. In addition, as mentioned earlier, disability is a comprehensive concept. We have examined the contribution of individual risk factors and living experiences, but still lack other relative factors such as transportation [ 32 ], home modification [ 33 ], use of assistive devices [ 34 ], and the relationship among neighbors [ 35 ]. Future studies should further examine the impact of environmental and other additional individual factors on disability development. Despite these limitations, this study still has several strengths that distinguished it from previous studies in that we examined the lagged effects as well as the associations in subgroups, especially in the famine-related cohort. In addition, the results could be more objective using CVD risk rather than self-reported disease. Conclusions FGCRS is known as a comprehensive measure of multiple cardiovascular risk factors and a valid predictor of future CVD [ 15 ]. This study suggests at least a 7-year lag between FGCRS and BADL and IADL outcomes. FGCRS is significantly associated with an accumulative risk rate of ADL disability. The findings also suggest that effective strategies need to focus more on managing multiple risk factors for CVD and preventing disability. Abbreviations CVD cardiovascular disease FGCRS Framingham General Cardiovascular Risk Score ADLs activities of daily living BADL basic activities of daily living IADL instrumental activities of daily living ICF international Classification of Functioning, Disability and Health BMI body mass index HDL high-density lipoprotein TC total cholesterol SBP systolic blood pressure OR odds ratio CI confidential interval Declarations Ethics approval and consent to participate: This study is a secondary analysis of the publicly available de-identified China Health and Retirement Longitudinal Study (CHARLS) data. CHARLS was approved by the Biomedical Ethics Review Committee of Peking University (approval number: IRB00001052-11,015), and Informed consent was obtained from all the study participants involved in the study. Since all participants are adults, the guardian consent is not involved in this study. Consent for publication: Not applicable.. Availability of data and materials: All data generated or analysed during this study are included in this published article and its supplementary information files. The original datasets analyzed during the current study are publicly available in the CHARLS repository at http://charls.pku.edu.cn/en. Competing interests: The authors declare that they have no competing interests. Funding: This research was funded by the Major Project of the National Social Science Fund of China, grant number 21ZDA107. Authors’ Contributions: Conceptualization, Yihao Zhao and Chen Chen; methodology, Yihao Zhao and Chen Chen; formal analysis, Yihao Zhao and Chen Chen; writing—original draft preparation, Yihao Zhao; writing—review and editing, Chen Chen, and Yu Wu; Yihao Zhao drafted the article. Ruitai Shao and Xiaoying Zheng obtained the funding and editing. All authors read and approved the final manuscript. Acknowledgements: Not applicable. References Cui K, et al. 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Tables Tables 1 to 4 are available in the Supplementary Files section Additional Declarations No competing interests reported. Supplementary Files Supplementarytable.docx Tables.docx Cite Share Download PDF Status: Posted Version 1 posted 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. 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13:25:01","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":22742,"visible":true,"origin":"","legend":"","description":"","filename":"Supplementarytable.docx","url":"https://assets-eu.researchsquare.com/files/rs-2799628/v1/0896934b03651115a8a09918.docx"},{"id":36375935,"identity":"515f1d77-9aad-474a-9ef7-d1df5a0fc928","added_by":"auto","created_at":"2023-04-27 13:25:01","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":74124,"visible":true,"origin":"","legend":"","description":"","filename":"Tables.docx","url":"https://assets-eu.researchsquare.com/files/rs-2799628/v1/2422d10c74e5f34e7ea5c2a8.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Relationship between Cardiovascular Risk and ADLs' Disability among Middle-aged and Older Adults in China: Evidence from a Longitudinal Study","fulltext":[{"header":"Background","content":"\u003cp\u003eDisability is universal and closely linked to ageing. In the face of global population ageing, the risk of disability will increase dramatically [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. It is estimated that about 1.3\u0026nbsp;billion people experience disabilities globally. Disability in activities of daily living (ADLs) will inevitably have negative impacts on the quality of life of older adults [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e], increasing healthcare costs [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e] for both families and the country as well as the burden on family caregivers [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. According to the framework of the International Classification of Functioning, Disability, and Health (ICF) [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] issued by the World Health Organization, disability is a multi-dimensional status as the result of dynamic interaction between health conditions, individual factors, and other external factors such as the individual living environment. Many factors may be related to disability progress, and early identification and control of risk factors may provide significant benefits.\u003c/p\u003e \u003cp\u003eCardiovascular Disease (CVD) is a common cardiac disease and circulatory system disorder among middle-aged and older adults, placing a tremendous burden on both families and the whole society. The increase in life expectancy has increased the years people lived with CVD. One of the most important contributors to the disability burden is cardiovascular disease [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. A previous study reported that the rate of disability was significantly higher among people with CVD experience [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. In addition to the immutable factors such as age, sex, and heredity, CVD could be also influenced by factors such as smoking, alcohol consumption, elevated blood pressure, type 2 diabetes, and obesity [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Given that these factors are aggregated and interact in individuals [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e], we need to examine their overall impacts. Comprehensive and validated tools exist to evaluate cardiovascular risk at present such as the Framingham general cardiovascular risk score (FGCRS), the SCORE charts, and the Progetto CUORE score. The FGCRS is a widely used and comprehensive tool that predicts the risk of cardiovascular disease over 10 years by combining demographic factors such as age and gender with some traditional cardiovascular risk factors.\u003c/p\u003e \u003cp\u003ePrevious studies have shown that higher FGCRS was a significant risk factor for cognitive decline [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] such as dementia and Alzheimer's disease dementia, which leads to neurodegenerative changes in the brain [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] that accelerates the progression of disability, especially in older adults [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. The effect of FGCRS on disability will not be immediate and may have a lag time between the experienced cardiovascular risk and the ultimate health outcome. However, how this effect changes over time is not known. In this study, we aimed to examine the hypothesis that higher FGCRS was related to the increased risk of disability in ADLs and to estimate the lag effect using 4 different lag times between 0 and 7 years to better describe and address the healthcare needs of middle-aged and older adults.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design and participates\u003c/h2\u003e \u003cp\u003eThe study population was derived from China Health and Retirement Longitudinal Study (CHARLS, 2011\u0026ndash;2018), an ongoing longitudinal national survey of a representative population aged at least 45 years old and their spouses in China. CHARLS was conducted in 2011 and covered 17,708 respondents in 10,257 households from 150 countries or districts and 450 villages in 28 provinces, through a multistage stratified probability proportional to size (PPS) sampling. Three follow-up interviews were conducted in 2013, 2015, and 2018. More detailed information about the study design has been reported previously [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn this study, we analyzed data from CHARLS from 2011 to 2018. The inclusion criteria for this study were: 1) individuals completely followed from 2011 to 2018, and 2) individuals aged at least 45 years old in CHARLS 2011. Exclusion criteria were: 1) individuals with missing data on relevant variables, such as FGCRS, ADLs, gender, age, marital status, educational status, working status, medical insurance, body mass index (BMI), and alcohol consumption, and 2) individuals with CVD in 2011. From CHARLS 2011 to 2018, a total of 11,988 participants were followed up and 5,865 individuals were excluded due to the criteria mentioned above. Our analytic sample ultimately included 6,123 individuals, and the detailed selection process is presented in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eAssessment of Cardiovascular Risk\u003c/h2\u003e \u003cp\u003eThe Framingham General Cardiovascular Risk Score (FGCRS) was used to assess cardiovascular disease risk. The FGCRS was calculated for each participant in CHARLS 2011 based on age, gender, high-density lipoprotein (HDL), total cholesterol (TC), systolic blood pressure (SBP), and SBP (if having medication for hypertension, smoking, and diabetes) [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. We summarized the key points of these risk factors to obtain the FGCRS. A higher FGCRS means a higher risk of a cardiovascular event in the future.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eAssessment of ADLs disability\u003c/h2\u003e \u003cp\u003eThe study outcome was ADLs disability, including two indicators: disability in basic activities of daily living (BADL) [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e] and disability in instrumental activities of daily living (IADL) [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Both were measured by valid scales. The BADLs were measured by the Katz Activities of Daily Living Scale [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] and included six self-report items: dressing, bathing, eating, getting in/out of bed, using the toilet, and controlling urination or defecation. The IADLs included managing money, taking medications, shopping for groceries, preparing meals, cleaning the house, and making phone calls. The answers to each question were the same: \u0026ldquo;no difficulty\u0026rdquo;, \u0026ldquo;have difficulty but can still do it\u0026rdquo;, \u0026ldquo;have difficulty and need help\u0026rdquo;, and \u0026ldquo;cannot do it\u0026rdquo;. We defined the BADL disability or IADL disability as the respondent who reported difficulty with any activity or was unable to do the activity.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eCovariates\u003c/h2\u003e \u003cp\u003eInformation on sociodemographic characteristics, anthropometric measurements, health-related lifestyle factors, and new CVD incidence was also used in the present study. The covariates included age (constant in description analysis and classified as 45 to 54, 55 to 64, 65 and above in the regression model), gender (male or female), living region (urban or rural), marital status (married and partnered or without a spouse), educational status (elementary school and below, middle school or high school and above), per household income (lowest, middle or highest), working status (no job, have job or retirement), medical insurance (no or yes), drinking status (never, former, or current drinking), and new CVD incidence from 2011 to 2018 (no or yes). Body mass index (BMI) equaled weight (kg) divided by height (m) squared.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eData were shown as means\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (SD) for continuous variables and numbers (percentages) for categorical variables. First, categorical variables were compared in the different FGCRS groups using chi-square analysis, and constant variables were compared by Spearman's rank correlation coefficient. Second, logistic regression analysis was used to estimate the correlations between FGCRS and ADLs disability (BADL and IADL) in cross-sectional data and stratified analysis. Third, in the longitudinal analysis, a distributed-lag model was used to estimate the relationships at 0-, 2-, 4-, and 7-year lag times. Both cross-sectional and longitudinal analyses were controlled for individuals' age, gender, living region, marital status, educational status, per household income, working status, medical insurance, BMI, drinking, and new CVD incidence. Finally, considering the possible differences due to socio-demographic characteristics, we also evaluated correlations using stratified analysis for all subgroups. All statistical analyses were performed using STATA 17.0, and p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant in all models.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003e\u003cem\u003eBasic information on the study population\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1\u003c/strong\u003e presents the general and grouped characteristics of participants. Among the 6,132 middle-aged and older adults (mean age: 58.13\u0026plusmn;8.68 years old) in China, the FGCRS ranged from 0 to 29, with a mean score of 12.40\u0026plusmn;5.24. In our study, most participants were female (53.90%), lived in rural areas (68.12%), were married and partnered (86.20%), had a lower education level (elementary school and below: 70.47%), employed (71.75%), had medical insurance (94.79%), and never drank (58.24%); the mean BMI was 23.55\u0026plusmn;6.99 kg/m2; 23.54% of the study population had difficulty in BADL and 28.04% had difficulty in IADL in 2018. During the follow-up from 2013 to 2018, 14.21% of the patients experienced a new CVD incidence. Age, gender, marital status, education level, per household income, working status, BMI, drinking, CVD incidences, difficulty in BADL, and difficulty in IADL were significantly different in tertile FGCRS as lowest, middle, and highest (p\u0026lt;0.05).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eCross-sectional relationship between\u003c/em\u003e\u003c/strong\u003e \u003cstrong\u003e\u003cem\u003eFGCRS and ADLs disability\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn the logistic regression model with FGCRS as a continuous variable, the risk of disability for BADL and IADL was associated with higher scores even after adjusting for gender, age, living region, educational status, marital status, per household income, working status, medical insurance, BMI, alcohol consumption, and new CVD incidence. Each point increase in FGCRS was associated with an increase in the risk of BADL disability by 2.3% and the risk of IADL disability by 2.8% (\u003cstrong\u003eTable 2\u003c/strong\u003e).\u003c/p\u003e\n\u003cp\u003eIn the stratified analysis, FGCRS could be found to be partially related to the risk of ADLs disability by gender, age group, famine cohort, living region, and per household income (\u003cstrong\u003eTable 3\u003c/strong\u003e). Compared to the counterpart in subgroups, the increasing FGCRS was associated with the highest risk of BADL disability in males (OR: 1.030, 95% CI:1.014-1.046), 65 years old, and above (OR: 1.0219, 95% CI:1.006-1.038), people experienced famine in adolescence (OR: 1.021, 95% CI:1.009-1.034), living in urban (OR: 1.023, 95% CI:1.008-1.040), with\u0026nbsp;highest per household income (OR: 1.021, 95% CI:1.003-1.038), and the highest risk of IADL disability in male (OR: 1.052, 95% CI:1.037-1.068), 65 years old and above (OR: 1.038, 95% CI:1.023-1.054), people experienced famine in infancy and child (OR: 1.033, 95% CI:1.014-1.052), living in rural (OR: 1.016, 95% CI:1.006-1.026), and\u0026nbsp;lowest per household income\u0026nbsp;(OR: 1.033, 95% CI:1.020-1.046).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eLongitudinal relationship between\u003c/em\u003e\u003c/strong\u003e \u003cstrong\u003e\u003cem\u003eFGCRS and ADLs disability\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA distributed-lag model was used to examine the correlation between FGCRS and ADLs disability in the longitudinal data from 2011 to 2018, and continuous FGCRS was dose-dependently associated with the risk of ADL disability. As shown in\u0026nbsp;\u003cstrong\u003eTable 4\u003c/strong\u003e, the odds ratio for BADL limitations increased steadily at 2-, 4- and 7-year lag times, with each point increase in FGCRS related to a 1.5%, 1.9%, and 2.3% increase in the risk of BADL disability, respectively. This trend was also evident in the relationship between FGCRS and IADL, where the risk of disability was 1.8%, 2.2%, and 2.8% higher with a one-point increase in FGCRS at the 2-, 4- and 7-year lag times (\u003cstrong\u003eTable 4\u003c/strong\u003e). There was no\u0026nbsp;statistical relationship between FGCRS and BADL at baseline, and we did not explore the\u0026nbsp;relationship between FGCRS and IADL at baseline due to a lack of data. Detailed information can be found in\u0026nbsp;\u003cstrong\u003eAppendix A (\u003c/strong\u003e\u003cstrong\u003eTable A1\u003c/strong\u003e and\u0026nbsp;\u003cstrong\u003eTable A2\u003c/strong\u003e).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn this national prospective cohort study of middle-aged and older adults, we used the logistic regression model and distributed-lag model to investigate the association between CVD risk and ADL disability. Our findings suggested that a higher CVD risk burden evaluated by the FGCRS is significantly related to the higher risk of disability in both basic and instrumental activities of daily living. Significant differences remained when examining the effects between sub-groups of gender, age, living region, per household income, and famine experience. Furthermore, the longitudinal research also indicates that the baseline CVD risk is associated with the risk of ADL disability at 2 to 7 years. Thus, FGCRS screeners may identify the potential risk for late-life disability.\u003c/p\u003e \u003cp\u003eCVD has become a major global public health concern as it is the main cause of increased death and disability. The relationship between CVD and disability has been well documented, but the association between FGCRS and disability risk and the overall trends need further study. Consistent with previous studies, individuals with higher FGCRS, which means a higher risk of CVD, will experience significantly higher rates of disability than those with lower FGCRS. Most directly, CVD leads to damage to the heart and systemic vascular system, resulting in decreased aerobic capacity; thus, the physical ability and mobility activities will be limited over time, eventually leading to the disability experience [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eTo our knowledge, no studies have examined the lag effect of FGCRS on disabilities in BADL and IADL and its progression. Based on the results of this study, we also found that the FGCRS could be considered a predictor of activities of daily living over at least 7 years because of the stable associations across different years, and the effect of FGCRS was enhanced by its duration. This suggests that there may be a cumulative effect.\u003c/p\u003e \u003cp\u003eThis study also revealed that there were age and gender disparities between FGCRS and disability risks. Previous studies have shown that age and gender were significantly associated with disability in ADL, especially for chronic patients [\u003cspan additionalcitationids=\"CR20\" citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Our findings were consistent with previous studies that the risk of disability for BADL and IADL related to high FGCRS increased with age, as this was usually the result of the ageing progress. To further investigate age-related differences, we examined this association after taking into account their famine experiences. It indicated that there were more significant associations between FGCRS and disability risks among people who experienced famine, especially early in life. This may be caused by the higher risk of CVD associated with the famine experience. Some famine cohort studies from the Netherlands [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e], China [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e], and Nigeria [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e] have shown that exposure to famine during the fetal period and early life could increase the risk of CVD and CVD-related factors such as higher levels of total cholesterol, systolic blood pressure [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e] in late life. In terms of the cumulative disadvantage theory, the effects of risk factors would accumulate throughout the life course, thereby increasing the variability in later life [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWe also found that men with a higher risk of CVD were at higher risk of disability than women in both BADL and IADL. The previous study showed that males tended to suffer from multiple chronic diseases, resulting in higher impairment of ADL, especially on the IADL [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. However, this finding was different from Keeney\u0026rsquo;s study [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e], which indicated that gender was not significantly associated with community disability when combined with environmental factors such as transportation, household modification, and other external supports. The results also suggested the residential gap in the association. As age increased, urban residents were related to more BADL limitations [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. However, given the actual gap between urban and rural in China, we had an adverse result of IADL disability that needed further study. In addition, there were also differences in high- and low-income groups. The different trends shown in BADL and IADL disability may be associated with the complex relationship between social-economic factors and cardiovascular risk factors [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThis study had some limitations. The disabilities in both BADL and IADL were self-reported indicators rather than objective function tests. In future work, objective indicators such as grip strength or the chair stand test could be used to draw more definitive conclusions about the association between FGCRS and disabilities. In addition, as mentioned earlier, disability is a comprehensive concept. We have examined the contribution of individual risk factors and living experiences, but still lack other relative factors such as transportation [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e], home modification [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e], use of assistive devices [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e], and the relationship among neighbors [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. Future studies should further examine the impact of environmental and other additional individual factors on disability development.\u003c/p\u003e \u003cp\u003eDespite these limitations, this study still has several strengths that distinguished it from previous studies in that we examined the lagged effects as well as the associations in subgroups, especially in the famine-related cohort. In addition, the results could be more objective using CVD risk rather than self-reported disease.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eFGCRS is known as a comprehensive measure of multiple cardiovascular risk factors and a valid predictor of future CVD [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. This study suggests at least a 7-year lag between FGCRS and BADL and IADL outcomes. FGCRS is significantly associated with an accumulative risk rate of ADL disability. The findings also suggest that effective strategies need to focus more on managing multiple risk factors for CVD and preventing disability.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.370705244122966%\"\u003e\n \u003cp\u003eCVD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"84.62929475587704%\"\u003e\n \u003cp\u003ecardiovascular disease\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.370705244122966%\"\u003e\n \u003cp\u003eFGCRS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"84.62929475587704%\"\u003e\n \u003cp\u003eFramingham General Cardiovascular Risk Score\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.370705244122966%\"\u003e\n \u003cp\u003eADLs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"84.62929475587704%\"\u003e\n \u003cp\u003eactivities of daily living\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.370705244122966%\"\u003e\n \u003cp\u003eBADL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"84.62929475587704%\"\u003e\n \u003cp\u003ebasic activities of daily living\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.370705244122966%\"\u003e\n \u003cp\u003eIADL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"84.62929475587704%\"\u003e\n \u003cp\u003einstrumental activities of daily living\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.370705244122966%\"\u003e\n \u003cp\u003eICF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"84.62929475587704%\"\u003e\n \u003cp\u003einternational Classification of Functioning, Disability and Health\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.370705244122966%\"\u003e\n \u003cp\u003eBMI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"84.62929475587704%\"\u003e\n \u003cp\u003ebody mass index\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.370705244122966%\"\u003e\n \u003cp\u003eHDL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"84.62929475587704%\"\u003e\n \u003cp\u003ehigh-density lipoprotein\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.370705244122966%\"\u003e\n \u003cp\u003eTC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"84.62929475587704%\"\u003e\n \u003cp\u003etotal cholesterol\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.370705244122966%\"\u003e\n \u003cp\u003eSBP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"84.62929475587704%\"\u003e\n \u003cp\u003esystolic blood pressure\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.370705244122966%\"\u003e\n \u003cp\u003eOR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"84.62929475587704%\"\u003e\n \u003cp\u003eodds ratio\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.370705244122966%\"\u003e\n \u003cp\u003eCI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"84.62929475587704%\"\u003e\n \u003cp\u003econfidential interval\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u003c/strong\u003e This study is a secondary analysis of the publicly available de-identified China Health and Retirement Longitudinal Study (CHARLS) data. CHARLS was approved by the Biomedical Ethics Review Committee of Peking University (approval number: IRB00001052-11,015), and Informed consent was obtained from all the study participants involved in the study. Since all participants are adults, the guardian consent is not involved in this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u0026nbsp;\u003c/strong\u003eNot applicable..\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u0026nbsp;\u003c/strong\u003eAll data generated or analysed during this study are included in this published article and its supplementary information files. The original datasets analyzed during the current study are publicly available in the CHARLS repository at\u0026nbsp;http://charls.pku.edu.cn/en.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u0026nbsp;\u003c/strong\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e This research was funded by the Major Project of the National Social Science Fund of China, grant number 21ZDA107.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; Contributions:\u0026nbsp;\u003c/strong\u003eConceptualization, Yihao Zhao and Chen Chen; methodology, Yihao Zhao and Chen Chen; formal analysis, Yihao Zhao and Chen Chen; writing\u0026mdash;original draft preparation, Yihao Zhao; writing\u0026mdash;review and editing, Chen Chen, and Yu Wu; Yihao Zhao drafted the article. Ruitai Shao and Xiaoying Zheng obtained the funding and editing. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u003c/strong\u003e Not applicable.\u003cbr\u003e\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003e\u003cspan\u003eCui K, et al. Association of Cardiovascular Risk Burden With Risk and Progression of Disability: Mediating Role of Cardiovascular Disease and Cognitive Decline. J Am Heart Assoc. 2020;9(18):e017346.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eBalzi D, et al. Risk factors for disability in older persons over 3-year follow-up. Age Ageing. 2010;39(1):92\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eGroessl EJ, et al. Health-related quality of life in older adults at risk for disability. Am J Prev Med. 2007;33(3):214\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eChan L, et al. Disability and health care costs in the Medicare population. Arch Phys Med Rehabil. 2002;83(9):1196\u0026ndash;201.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eWolff JL, et al. Family Caregivers of Older Adults, 1999\u0026ndash;2015: Trends in Characteristics, Circumstances, and Role-Related Appraisal. Gerontologist. 2018;58(6):1021\u0026ndash;32.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eUst\u0026uuml;n TB, et al. The International Classification of Functioning, Disability and Health: a new tool for understanding disability and health. Disabil Rehabil. 2003;25(11\u0026ndash;12):565\u0026ndash;71.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eYokota RT, et al. Impact of Chronic Conditions and Multimorbidity on the Disability Burden in the Older Population in Belgium. J Gerontol A Biol Sci Med Sci. 2016;71(7):903\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eKeeney T, Jette AM. Individual and Environmental Determinants of Late-Life Community Disability for Persons Aging With Cardiovascular Disease. Am J Phys Med Rehabil. 2019;98(1):30\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eReiner Z, et al. ESC/EAS Guidelines for the management of dyslipidaemias: the Task Force for the management of dyslipidaemias of the European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS). Eur Heart J. 2011;32(14):1769\u0026ndash;818.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003ePoortinga W. The prevalence and clustering of four major lifestyle risk factors in an English adult population. Prev Med. 2007;44(2):124\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eRafnsson SB, et al. Cardiovascular diseases and decline in cognitive function in an elderly community population: the Edinburgh Artery Study. Psychosom Med. 2007;69(5):425\u0026ndash;34.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eSong R, et al. Associations Between Cardiovascular Risk, Structural Brain Changes, and Cognitive Decline. J Am Coll Cardiol. 2020;75(20):2525\u0026ndash;34.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eSong R, et al. Association of cardiovascular risk burden with risk of dementia and brain pathologies: A population-based cohort study. Alzheimers Dement. 2021;17(12):1914\u0026ndash;22.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eZhao Y, et al. Cohort profile: the China Health and Retirement Longitudinal Study (CHARLS). Int J Epidemiol. 2014;43(1):61\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eD\u0026apos;Agostino RB, Sr, et al. General cardiovascular risk profile for use in primary care: the Framingham Heart Study. Circulation. 2008;117(6):743\u0026ndash;53.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eKatz S, et al. STUDIES OF ILLNESS IN THE AGED. THE INDEX OF ADL: A STANDARDIZED MEASURE OF BIOLOGICAL AND PSYCHOSOCIAL FUNCTION. JAMA. 1963;185:914\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eLawton MP, Brody EM. Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist. 1969;9(3):179\u0026ndash;86.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eKatz S, Akpom CA. A measure of primary sociobiological functions. Int J Health Serv. 1976;6(3):493\u0026ndash;508.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eSpiers NA, et al. Diseases and impairments as risk factors for onset of disability in the older population in England and Wales: findings from the Medical Research Council Cognitive Function and Ageing Study. J Gerontol A Biol Sci Med Sci. 2005;60(2):248\u0026ndash;54.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eFreedman VA, et al. Chronic conditions and the decline in late-life disability. Demography. 2007;44(3):459\u0026ndash;77.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eLin SF, Beck AN, Finch BK. The Dynamic contribution of chronic conditions to temporal trends in disability among U.S. adults. Disabil Health J. 2016;9(2):332\u0026ndash;40.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eRoseboom T, de Rooij S, Painter R. The Dutch famine and its long-term consequences for adult health. Early Hum Dev. 2006;82(8):485\u0026ndash;91.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eLiu L, et al. Increase in the prevalence of hypertension among adults exposed to the Great Chinese Famine during early life. Environ Health Prev Med. 2017;22(1):64.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eChen H, Nembhard WN, Stockwell HG. Sex-specific effects of fetal exposure to the 1959\u0026ndash;1961 Chinese famine on risk of adult hypertension. Matern Child Health J. 2014;18(3):527\u0026ndash;33.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eHult M, et al. Hypertension, diabetes and overweight: looming legacies of the Biafran famine. PLoS ONE. 2010;5(10):e13582.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eChen C, et al. Prenatal exposure to the Chinese famine of 1959-62 and risk of cardiovascular diseases in adulthood: findings from the China PEACE million persons project. Eur J Prev Cardiol. 2022;29(16):2111\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eFerraro KF, Kelley-Moore JA. Cumulative Disadvantage and Health: Long-Term Consequences of Obesity? Am Sociol Rev. 2003;68(5):707\u0026ndash;29.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eLi JQ, et al. Prevalence of chronic diseases and associate factors on daily activities in male oldest-olds. Zhonghua Liu Xing Bing Xue Za Zhi. 2019;40(5):537\u0026ndash;41.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eHu X, et al. Trends in activities of daily living disability among Chinese older adults from 1998 to 2018: an age-period-cohort analysis. Eur J Ageing. 2022;19(4):1167\u0026ndash;79.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eSubramanian SV, et al. Jumping the gun: the problematic discourse on socioeconomic status and cardiovascular health in India. Int J Epidemiol. 2013;42(5):1410\u0026ndash;26.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eGreiser KH, et al. P2-104 Association of neighbourhood socioeconomic status and individual socioeconomic status with cardiovascular risk factors in an Eastern German population - the CARLA Study 2002\u0026ndash;2006. J Epidemiol Commun Health. 2011;65(Suppl 1):A249.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eWhite DK, et al. Are features of the neighborhood environment associated with disability in older adults? Disabil Rehabil. 2010;32(8):639\u0026ndash;45.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eWahl HW, et al. The home environment and disability-related outcomes in aging individuals: what is the empirical evidence? Gerontologist. 2009;49(3):355\u0026ndash;67.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eFreedman VA, Kasper JD, Spillman BC. Successful Aging Through Successful Accommodation With Assistive Devices. J Gerontol B Psychol Sci Soc Sci. 2017;72(2):300\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eLevasseur M, et al. Importance of proximity to resources, social support, transportation and neighborhood security for mobility and social participation in older adults: results from a scoping study. BMC Public Health. 2015;15:503.\u003c/span\u003e\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTables 1 to 4 are available in the Supplementary Files section\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"cardiovascular risk, FGCRS, activities of daily living, disability, middle-aged and older adults ","lastPublishedDoi":"10.21203/rs.3.rs-2799628/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-2799628/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackgrounds: \u003c/strong\u003eThe effect of FGCRS on disability will not be immediate and may have a lag time between the experienced cardiovascular risk and the ultimate health outcome. However, how this effect changes over time is not known. Based on data from China Health and Retirement Longitudinal Study, we aimed to investigate the association between cardiovascular risk and activities of daily living disability among Chinese middle-aged and older adults and to examine the lag effect of cardiovascular risk on individual ADLs’ disability.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e Means ± standard deviation were used to describe continuous variables and numbers (percentages) to categorical variables. Logistic regression analysis and a distributed-lag model were used to estimate the correlations and lag effect between FGCRS and ADLs disability (BADL and IADL). All statistical analyses were performed using STATA 17.0, and p \u0026lt; 0.05 was considered statistically significant.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e In 2018, Out of 6,123 participants, 23.54% reported at least one difficulty in basic activities of daily living and 28.04% had at least one difficulty in instrumental activities of daily living. After adjusting for all the covariates, a positive correlation was identified between FGCRS and ADL disability (BADL: OR = 1.023, IADL: OR = 1.028), and the correlation varied by age, gender, living regions, and income. In the longitudinal research, baseline CVD risk was significantly associated with the risk of ADL disability in 2 to 7 years.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e Elevated cardiovascular risk was significantly associated with subsequent functional limitations in middle-aged and older Chinese adults.\u003c/p\u003e","manuscriptTitle":"Relationship between Cardiovascular Risk and ADLs' Disability among Middle-aged and Older Adults in China: Evidence from a Longitudinal Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2023-04-27 13:24:56","doi":"10.21203/rs.3.rs-2799628/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"df6bb7fc-8dbc-414c-9837-dac551adcc6f","owner":[],"postedDate":"April 27th, 2023","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2023-08-14T02:59:18+00:00","versionOfRecord":[],"versionCreatedAt":"2023-04-27 13:24:56","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-2799628","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-2799628","identity":"rs-2799628","version":["v1"]},"buildId":"7rjqhiLT3MXkJMwkYKINL","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}