Sensory Impairment and Subjective Cognitive Decline in Older Adults: A Cross-Sectional Study of Depression as Mediators in Southern China

Sensory Impairment and Subjective Cognitive Decline in Older Adults: A Cross-Sectional Study of Depression as Mediators in Southern China | 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 Sensory Impairment and Subjective Cognitive Decline in Older Adults: A Cross-Sectional Study of Depression as Mediators in Southern China Shengwei Wang, Jinjun Li, Miaohong Chen, Ling Zhang, Qiaochao Chen, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8432557/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 Objective Subjective cognitive decline (SCD), the self-experienced onset of cognitive deterioration before deficits are measurable, is an early Alzheimer’s marker. Little is known about whether vision (VI), hearing (HI) or dual sensory impairment (DI) predicts SCD in Chinese older adults, or whether depressive symptoms mediate such links. Materials and Methods Cross-sectional community survey in Guangdong, January–October 2024. 1,162 participants aged 65–98 (mean 73.7 ± 6.8; 52.7% female). SCD was quantified with the 9-item Subjective Cognitive Decline Questionnaire; depression with PHQ-9; VI/HI by self-report. Multiple linear regression, subgroup and sensitivity analyses tested sensory–SCD associations; bias-corrected bootstrapping assessed mediation by depression. Results Overall SCD prevalence 42.9%. Relative to no impairment, severity of SCD was higher in HI (β = 0.589, 95% CI 0.229–0.949), VI (β = 1.597, 1.159–2.036) and DI (β = 2.072, 1.678–2.466) after full adjustment (p < 0.001). Effects were consistent across sex, residence, physical activity, nutrition, hypertension and diabetes; excluding smokers or individuals with hypertension/diabetes did not alter results. Depression mediated 6.8% of the VI–SCD effect and 4.7% of the DI–SCD effect (1,000 bootstrap samples), but mediation was non-significant for HI alone. Conclusion Sensory impairments, particularly concurrent VI and HI, are strongly associated with SCD in southern Chinese elders. Depressive symptoms partially explain these links, indicating a modifiable psychosocial pathway. Early detection and management of sensory loss and depression may help forestall subsequent Subjective cognitive decline (SCD) Sensory impairment Depression Older adults Cross-sectional study 1. Introduction With the rapid aging of the global population, the issue of cognitive health in older adults has attracted increasing attention from the academic community and public health sectors. Subjective Cognitive Decline (SCD), defined as an individual's self-perceived decline in cognitive function without objective evidence of cognitive impairment through neuropsychological tests, is widely regarded as the earliest stage of cognitive deterioration. 1 It is not only a potential precursor to Alzheimer's Disease (AD) but also occurs before the emergence of measurable cognitive deficits and other clinical symptoms of AD. 2 Therefore, identifying the risk factors associated with SCD and exploring the underlying mechanisms is of great significance for the early prevention and intervention of cognitive decline in older adults. 3 Sensory function, including vision and hearing, is an important channel for older adults to interact with the external environment. In recent years, a growing number of studies have focused on the relationship between sensory impairment and cognitive function. Vision Impairment (VI) and Hearing Impairment (HI) are common health problems in older adults. 4 Previous studies have shown that sensory impairment may be associated with cognitive decline, 4, 5 but the specific relationship between different types of sensory impairments (such as single VI, single HI, and Dual Impairment (DI) of vision and hearing) and SCD remains unclear, especially in the Chinese elderly population. 6 , 7 A study conducted in 10 Asian countries found that the prevalence of sensory impairment in older adults over 65 years old reached 45.2%, and the comorbidity rate of DI was 12.8%, which further indicates the urgency of studying the relationship between sensory impairment and cognitive health in the elderly population. 8 Depression is another common mental health problem in older adults. Existing research has found that depressive symptoms are not only associated with sensory impairment but also with cognitive decline. 9 Some scholars have proposed that depression may play a mediating role in the relationship between sensory impairment and cognitive decline. 10 However, there is a lack of in-depth research on whether depressive symptoms mediate the association between different types of sensory impairments and SCD in the Chinese elderly population. 11 A meta-analysis involving 28 studies in East Asia showed that the pooled prevalence of depressive symptoms in Chinese older adults was 23.1%, which is higher than the average level in developed countries, suggesting that the mediating effect of depression in the Chinese elderly population may have unique characteristics. 12 This study aims to explore the associations between different types of sensory impairments (VI, HI, DI) and SCD in Chinese older adults and to examine the mediating role of depressive symptoms in these relationships. 10 , 13 – 15 The results of this study are expected to provide a theoretical basis for formulating targeted cognitive health intervention strategies for the elderly in southern China and enrich the global evidence on the relationship between sensory impairment and cognitive decline. 16 2. Materials and Methods This study adopted a cross-sectional design. The study population was community-dwelling adults aged 65 years and older in Guangdong Province, Southern China. The inclusion criteria were: (1) aged 65 years or older; (2) living in the community for more than 6 months; (3) able to communicate normally and complete the face-to-face interview; (4) voluntary participation in the study and signing the informed consent form. The exclusion criteria were: (1) having severe mental illness (such as schizophrenia) or cognitive impairment diagnosed by a professional doctor; (2) having severe physical diseases that affect cognitive function (such as severe stroke, Parkinson's disease); (3) unable to complete the questionnaire due to language or other reasons. 17 This sampling strategy is consistent with the design of most community-based elderly cognitive research in China, which can effectively ensure the representativeness of the sample. 18 The data collection was conducted between January and October 2024. Community-dwelling older adults who met the inclusion criteria were randomly selected from each district for face-to-face interviews. A total of 1,200 questionnaires were distributed, and 1,162 valid questionnaires were collected, with an effective response rate of 96.8%. 19 The effective response rate of this study is higher than the average level of similar cross-sectional studies in China (about 85%-90%), which may be due to the fact that the investigators were trained uniformly and the community health service centers provided assistance, which improved the cooperation degree of the elderly. 20 Data were collected through structured face-to-face interviews by trained investigators. The interview content included demographic characteristics (such as age, gender, city of residence, educational level), lifestyle factors (such as smoking history, physical activity level), nutritional status, chronic diseases (such as hypertension, diabetes), sensory function (vision and hearing), depressive symptoms, and SCD. 21 Structured interviews can reduce information bias caused by differences in investigation methods, which is a commonly used and effective data collection method in elderly health research. 22 Sensory impairments were assessed via self-reported vision and hearing function. For vision impairment, the participants were asked: "Do you have difficulty seeing even with glasses (if you wear them) in daily life?" The answer options were "yes" and "no". Those who answered "yes" were considered to have vision impairment. For hearing impairment, the participants were asked: "Do you have difficulty hearing even with a hearing aid (if you use one) in daily life?" The answer options were "yes" and "no". Those who answered "yes" were considered to have hearing impairment. Dual sensory impairment was defined as having both vision impairment and hearing impairment. 23 Although self-reported assessment may have certain limitations, it is widely used in large-scale epidemiological surveys due to its simplicity and high efficiency. A study comparing self-reported and objective sensory function assessment showed that the consistency rate between self-reported and objective assessment of vision and hearing impairment in the elderly was 78.3% and 72.5% respectively, which proved the reliability of self-reported assessment. 24 Depressive symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9). The PHQ-9 is a widely used self-report scale for assessing depressive symptoms in adults. 25 , 26 It consists of 9 items, each scored on a 4-point scale (0 = not at all, 1 = several days, 2 = more than half the days, 3 = nearly every day). The total score ranges from 0 to 27, with higher scores indicating more severe depressive symptoms. A total score of ≥ 10 is considered to have significant depressive symptoms. The PHQ-9 has good reliability and validity in the Chinese population. 27 A recent study in southern China confirmed that the Cronbach's α coefficient of the PHQ-9 in the elderly population is 0.86, and the split-half reliability is 0.82, which further verifies its applicability in the study population of this paper. 28 Subjective Cognitive Decline was assessed using the validated Subjective Cognitive Decline Questionnaire-9 (SCD-Q9). The SCD-Q9 is a self-report scale designed to assess SCD in older adults. 29 It includes 9 items, each scored on a 5-point scale (1 = no decline, 2 = slight decline, 3 = moderate decline, 4 = severe decline, 5 = very severe decline). The total score ranges from 9 to 45, with higher scores indicating more severe SCD. The SCD-Q9 has been validated in the Chinese population and has good reliability and validity . 30 A validation study involving 1,500 elderly people in 5 provinces of China showed that the SCD-Q9 has good discriminant validity, and the area under the ROC curve for distinguishing elderly people with and without SCD is 0.83. 31 Demographic characteristics such as age, gender, city of residence, and educational level were collected through direct inquiry. Lifestyle factors: smoking history was divided into "never smoked" and "ever smoked" (including current smokers and former smokers). Physical activity level was assessed using the International Physical Activity Questionnaire (IPAQ) short version. 32 , 33 Participants were classified into low, moderate, and high physical activity levels based on the total metabolic equivalent (MET) minutes per week. Nutritional status was assessed using the Mini Nutritional Assessment-Short Form (MNA-SF). The MNA-SF consists of 6 items, with a total score ranging from 0 to 14. A score of ≥ 12 indicates normal nutritional status, 8–11 indicates at risk of malnutrition, and ≤ 7 indicates malnutrition. Chronic diseases such as hypertension and diabetes were determined by asking the participants whether they had been diagnosed by a doctor and were taking relevant medications. 34 The MNA-SF is a commonly used nutritional assessment tool for the elderly, and its validity in the Chinese elderly population has been confirmed by multiple studies. The Cronbach's α coefficient in the Chinese elderly population is 0.79–0.85. 35 Chronic diseases such as hypertension and diabetes were determined by asking the participants whether they had been diagnosed by a doctor and were taking relevant medications. 36 This method of determining chronic diseases is in line with the standards of the Chinese National Health Survey, which can ensure the accuracy of chronic disease diagnosis information. 37 All statistical analyses were performed using SPSS 26.0 software and Mplus 8.3 software. The significance level was set at α = 0.05 (two-tailed). Continuous variables (such as age, PHQ-9 score, SCD-Q9 score) were expressed as mean ± standard deviation (SD), and categorical variables (such as gender, sensory impairment, smoking history, chronic diseases) were expressed as frequency and percentage. 38 The choice of statistical software and variable expression methods in this study is consistent with the norms of medical statistics, which is conducive to the comparability of research results with similar studies. 39 Independent samples t-tests or one-way analysis of variance (ANOVA) were used to compare the differences in SCD-Q9 scores between participants with and without sensory impairments. Then, multiple linear regression analysis was used to assess the association between sensory impairments and SCD. In the multiple linear regression model, SCD-Q9 score was the dependent variable, and sensory impairment (no sensory impairment, only HI, only VI, DI) was the independent variable. Demographic characteristics (age, gender, city of residence, educational level), lifestyle factors (smoking history, physical activity level), nutritional status, and chronic diseases (hypertension, diabetes) were included as confounding variables. 40 Including these confounding variables in the regression model can effectively control the interference of other factors on the relationship between sensory impairment and SCD, which is a necessary step to ensure the authenticity of the research results. 41 Subgroup analyses were conducted to explore whether the association between sensory impairments and SCD varied across different subgroups. The subgroups were divided based on residence (rural vs. urban), gender (male, female), physical activity level (low, moderate, high), nutritional status (normal, at risk of malnutrition, malnutrition), and the presence of chronic conditions (hypertension: yes, no; diabetes: yes, no). Multiple linear regression analysis was performed in each subgroup to assess the association between sensory impairments and SCD. 42 Subgroup analysis can help to find the differences in the relationship between sensory impairment and SCD in different populations, which is of great significance for formulating personalized intervention strategies. 43 Sensitivity analyses were conducted to test the robustness of the association between sensory impairments and SCD. We excluded individuals with a history of smoking, hypertension, or diabetes respectively, and then performed multiple linear regression analysis again to assess the association between sensory impairments and SCD. 44 Sensitivity analysis is an important part of epidemiological research, which can test whether the research results are affected by specific factors and improve the reliability of the results. 45 Mediation analysis was employed to examine the indirect effects of depressive symptoms (assessed by PHQ-9 score) on the relationship between sensory impairments and SCD. The mediation model was established using the bias-corrected bootstrapping method with 5,000 resamples. In the mediation model, sensory impairment was the independent variable, SCD-Q9 score was the dependent variable, PHQ-9 score was the mediating variable, and the same confounding variables as in the multiple linear regression model were included. The mediating effect was considered significant if the 95% confidence interval (CI) of the indirect effect did not include 0. The proportion of the mediating effect to the total effect was calculated to evaluate the mediating role of depressive symptoms. 46 , 47 The bias-corrected bootstrapping method is a commonly used method in mediation analysis, which has higher statistical power than the traditional Sobel test, especially in small sample sizes. 48 3. Results 3.1 Demographic Characteristics of the Participants A total of 1,162 community-dwelling older adults aged 65–98 years were enrolled in this cross-sectional analysis, with a mean age of 73.7 ± 6.8 years. The cohort had a slight female predominance, as 52.7% (n = 613) of participants were female, and 47.3% (n = 549) were male. The overall prevalence of subjective cognitive decline (SCD) in this elderly population was 42.94% (n = 499), meaning nearly half of the participants reported experiencing symptoms of cognitive decline. As presented in Table 1 , participants with SCD were significantly older (mean age: 74.87 ± 7.27 years vs. 72.88 ± 6.33 years, p < 0.001) and more likely to be divorced/separated/widowed (19.84% vs. 13.27%, p = 0.003) compared to those without SCD. Financial stress was more prevalent in the SCD group: 40.28% of participants with SCD reported moderate financial stress, and 6.41% reported severe financial stress, whereas only 32.13% and 1.21% of non-SCD participants reported moderate and severe financial stress, respectively (p < 0.001). In terms of physical health and functional status, participants with SCD had a higher prevalence of chewing function impairment (74.55% vs. 41.84%, p < 0.001), hearing impairment (47.29% vs. 35.90%, p < 0.001), and vision impairment (48.90% vs. 18.55%, p < 0.001) than those without SCD. Chronic conditions, including hypertension (45.89% vs. 26.24%, p < 0.001), coronary artery disease (9.82% vs. 5.88%, p = 0.012), diabetes (14.83% vs. 9.05%, p = 0.002), cataract (2.61% vs. 0.60%, p = 0.005), osteoporosis (11.22% vs. 3.17%, p < 0.001), lumbar disc herniation (4.01% vs. 1.36%, p = 0.004), rheumatoid arthritis (2.20% vs. 0.60%, p = 0.017), low back and leg pain (6.81% vs. 1.21%, p < 0.001), urinary incontinence (11.62% vs. 0.90%, p < 0.001), and a history of choking episodes within 3 months (16.83% vs. 5.13%, p < 0.001), were also more common in the SCD group. Additionally, participants with SCD were more likely to have unexplained weight loss (8.22% vs. 5.28%, p = 0.045), gastrointestinal symptoms such as constipation/anal fissure (13.43% vs. 4.37%, p < 0.001) and diarrhea within 1 year(11.82% vs. 3.47%, p < 0.001), a history of falls (10.62% vs. 6.03%, p = 0.004) and fractures within 1 year(6.81% vs. 3.17%, p = 0.004), and polypharmacy (11.02% vs. 3.02%, p < 0.001). Dietary patterns also differed between groups: the SCD group had a higher proportion of high-salt diets (21.84% vs. 11.61%, p < 0.001) and high-meat diets (7.82% vs. 3.92%, p = 0.004). Sleep duration was less optimal in the SCD group, with 12.63% reporting < 5 hours of nightly sleep and 57.72% reporting 5–7 hours, compared to 7.69% and 47.96% in the non-SCD group, respectively (p < 0.001). Finally, psychological well-being metrics indicated higher levels of depression (Patient Health Questionnaire-9 [PHQ-9] score: 5.10 ± 4.75 vs. 2.42 ± 3.70, p < 0.001) and anxiety (Generalized Anxiety Disorder-7 [GAD-7] score: 2.82 ± 3.99 vs. 1.35 ± 2.98, p < 0.001) in participants with SCD. Table 1 Sample characteristics, stratified by SCD (n = 1162) Variables SCD P-value Overall (N = 1162) Yes (N = 499) No (N = 663) Age, Mean ± SD 73.74 ± 6.82 74.87 ± 7.27 72.88 ± 6.33 < 0.001 Sex, n (%) 0.422 Male 549 (47.25%) 229 (45.89%) 320 (48.27%) Female 613 (52.75%) 270 (54.11%) 343 (51.73%) Education level, n (%) 0.138 Illiterate/Semi-illiterate 269 (23.15%) 116 (23.25%) 153 (23.08%) Primary school 481 (41.39%) 223 (44.69%) 258 (38.91%) Junior high school 224 (19.28%) 82 (16.43%) 142 (21.42%) High school/Vocational secondary school 133 (11.45%) 58 (11.62%) 75 (11.31%) College graduate or above 55 (4.73%) 20 (4.01%) 35 (5.28%) Marital status, n (%) 0.003 Married/Living with a partner 975 (83.91%) 400 (80.16%) 575 (86.73%) Divorced/Separated/Widowed 187 (16.09%) 99 (19.84%) 88 (13.27%) Residence, n (%) 0.189 Rural 510 (43.89%) 230 (46.09%) 280 (42.23%) Urban 652 (56.11%) 269 (53.91%) 383 (57.77%) Financial stress, n (%) < 0.001 No financial stress 708 (60.93%) 266 (53.31%) 442 (66.67%) Moderate financial stress 414 (35.63%) 201 (40.28%) 213 (32.13%) Severe financial stress 40 (3.44%) 32 (6.41%) 8 (1.21%) Drinking, n (%) 0.918 Non-drinker 1,127 (96.99%) 483 (96.79%) 644 (97.13%) Ex-drinker 8 (0.69%) 4 (0.80%) 4 (0.60%) Current drinker 27 (2.32%) 12 (2.40%) 15 (2.26%) Smoking, n (%) 0.075 Non-smoker 1,057 (90.96%) 444 (88.98%) 613 (92.46%) Ex-smoker 21 (1.81%) 13 (2.61%) 8 (1.21%) Current smoker 84 (7.23%) 42 (8.42%) 42 (6.33%) Chewing function impairment, n (%) < 0.001 None 508 (43.72%) 127 (25.45%) 381 (57.47%) Mild 468 (40.28%) 236 (47.29%) 232 (34.99%) Moderate 148 (12.74%) 111 (22.24%) 37 (5.58%) Severe 38 (3.27%) 25 (5.01%) 13 (1.96%) Hearing impairment, n (%) < 0.001 No 688 (59.21%) 263 (52.71%) 425 (64.10%) Yes 474 (40.79%) 236 (47.29%) 238 (35.90%) Visual impairment, n (%) < 0.001 No 795 (68.42%) 255 (51.10%) 540 (81.45%) Yes 367 (31.58%) 244 (48.90%) 123 (18.55%) Hypertension, n (%) < 0.001 No 759 (65.32%) 270 (54.11%) 489 (73.76%) Yes 403 (34.68%) 229 (45.89%) 174 (26.24%) Coronary Artery Disease, n (%) 0.012 No 1,074 (92.43%) 450 (90.18%) 624 (94.12%) Yes 88 (7.57%) 49 (9.82%) 39 (5.88%) Diabetes, n (%) 0.002 No 1,028 (88.47%) 425 (85.17%) 603 (90.95%) Yes 134 (11.53%) 74 (14.83%) 60 (9.05%) Cataract, n (%) 0.005 No 1,145 (98.54%) 486 (97.39%) 659 (99.40%) Yes 17 (1.46%) 13 (2.61%) 4 (0.60%) Osteoporosis, n (%) < 0.001 No 1,085 (93.37%) 443 (88.78%) 642 (96.83%) Yes 77 (6.63%) 56 (11.22%) 21 (3.17%) Lumbar Disc Herniation, n (%) 0.004 No 1,133 (97.50%) 479 (95.99%) 654 (98.64%) Yes 29 (2.50%) 20 (4.01%) 9 (1.36%) Rheumatoid Arthritis, n (%) 0.017 No 1,147 (98.71%) 488 (97.80%) 659 (99.40%) Yes 15 (1.29%) 11 (2.20%) 4 (0.60%) Low Back and Leg Pain, n (%) < 0.001 No 1,120 (96.39%) 465 (93.19%) 655 (98.79%) Yes 42 (3.61%) 34 (6.81%) 8 (1.21%) Urinary incontinence, n (%) < 0.001 No 1,098 (94.49%) 441 (88.38%) 657 (99.10%) Yes 64 (5.51%) 58 (11.62%) 6 (0.90%) Choking episodes within past 3 months, n (%) < 0.001 No 1,044 (89.85%) 415 (83.17%) 629 (94.87%) Yes 118 (10.15%) 84 (16.83%) 34 (5.13%) Unexplained weight loss ≥ 4.5 kg or ≥ 5% body weight within 1 year, n (%) 0.045 No 1,086 (93.46%) 458 (91.78%) 628 (94.72%) Yes 76 (6.54%) 41 (8.22%) 35 (5.28%) Constipation or anal fissure within 1 year, n (%) < 0.001 No 1,066 (91.74%) 432 (86.57%) 634 (95.63%) Yes 96 (8.26%) 67 (13.43%) 29 (4.37%) Diarrhea within 1 year, n (%) < 0.001 No 1,080 (92.94%) 440 (88.18%) 640 (96.53%) Yes 82 (7.06%) 59 (11.82%) 23 (3.47%) Fall within 1 year, n (%) 0.004 No 1,069 (92.00%) 446 (89.38%) 623 (93.97%) Yes 93 (8.00%) 53 (10.62%) 40 (6.03%) Fracture within 1 year, n (%) 0.004 No 1,107 (95.27%) 465 (93.19%) 642 (96.83%) Yes 55 (4.73%) 34 (6.81%) 21 (3.17%) Polypharmacy, n (%) < 0.001 No 1087 (93.55%) 444 (88.98%) 643 (96.98%) Yes 75 (6.45%) 55 (11.02%) 20 (3.02%) Average nightly sleep duration, n (%) < 0.001 < 5 h 114 (9.81%) 63 (12.63%) 51 (7.69%) 5–7 h 606 (52.15%) 288 (57.72%) 318 (47.96%) 7–9 h 417 (35.89%) 133 (26.65%) 284 (42.84%) ≥ 9 25 (2.15%) 15 (3.01%) 10 (1.51%) Difficulty/psychological discomfort in social activities, n (%) 0.008 No 1,065 (91.65%) 445 (89.18%) 620 (93.51%) Yes 97 (8.35%) 54 (10.82%) 43 (6.49%) High Salt Diet, n (%) < 0.001 No 976 (83.99%) 390 (78.16%) 586 (88.39%) Yes 186 (16.01%) 109 (21.84%) 77 (11.61%) High Meat Diet, n (%) 0.004 No 1,097 (94.41%) 460 (92.18%) 637 (96.08%) Yes 65 (5.59%) 39 (7.82%) 26 (3.92%) BMI, Mean ± SD 22.99 ± 3.36 23.07 ± 3.34 22.93 ± 3.38 0.476 PASE Score, Mean ± SD 154.31 ± 168.32 146.50 ± 177.05 160.19 ± 161.33 0.170 MNA Score, Mean ± SD 22.52 ± 3.13 22.39 ± 3.30 22.62 ± 3.00 0.212 PHQ-9 Score, Mean ± SD 3.57 ± 4.38 5.10 ± 4.75 2.42 ± 3.70 < 0.001 GAD-7 Score, Mean ± SD 1.98 ± 3.53 2.82 ± 3.99 1.35 ± 2.98 < 0.001 3.2 Association Between Sensory Impairments and Subjective Cognitive Decline 3.2.1 Univariate and Multivariate Linear Regression Analyses The uivariate linear regression analysis (Table 2 ) revealed significant positive associations between sensory impairments and the severity of SCD. Compared to participants with no sensory impairment, those with hearing impairment only (β = 0.530, 95% confidence interval [CI]: 0.151–0.909, p = 0.006), vision impairment only (β = 2.150, 95% CI: 1.692–2.608, p < 0.001), and dual sensory impairment (β = 2.544, 95% CI: 2.135–2.953, p < 0.001) had significantly higher SCD severity scores. After adjusting for potential confounding variables—including age, sex, marital status, education level, residence, financial stress, drinking status, smoking status, hypertension, diabetes, polypharmacy, PASE score, MNA score, and GAD-7 score—the associations between sensory impairments and SCD remained statistically significant (Table 2 ). The adjusted regression coefficients indicated that: Hearing impairment only was associated with a 0.589-point increase in SCD severity (95% CI: 0.229–0.949, p = 0.001); Vision impairment only was associated with a 1.597-point increase in SCD severity (95% CI: 1.159–2.036, p < 0.001); Dual sensory impairment was associated with the largest increase in SCD severity, at 2.072 points (95% CI: 1.678–2.466, p < 0.001). Among the confounding variables included in the adjusted model, age (β = 0.042, 95% CI: 0.020–0.064, p < 0.001), marital status (divorced/separated/widowed vs. married/living with a partner: β = 0.491, 95% CI: 0.097–0.885, p = 0.015), severe financial stress (vs. no financial stress: β = 2.315, 95% CI: 1.551–3.080, p < 0.001), hypertension (β = 0.779, 95% CI: 0.475–1.083, p < 0.001), polypharmacy (β = 0.617, 95% CI: 0.016–1.218, p = 0.044), and GAD-7 score (β = 0.179, 95% CI: 0.139–0.219, p < 0.001) were also independently associated with SCD severity. 3.2.2 Subgroup and Sensitivity Analyses To assess the robustness of the association between sensory impairments and SCD, we conducted subgroup analyses stratified by key variables: residence (rural vs. urban), sex (male vs. female), physical activity level (low vs. medium vs. high, based on tertiles of PASE score), nutritional status (normal vs. at risk of malnutrition vs. malnourished, based on MNA score), and the presence of chronic conditions (hypertension vs. no hypertension, diabetes vs. no diabetes). In all subgroups, the positive associations between hearing impairment only, vision impairment only, dual sensory impairment, and SCD severity remained consistent and statistically significant (all p for interaction > 0.05), indicating that these associations were not modified by the stratified variables. Sensitivity analyses were further performed by excluding participants with a history of smoking (n = 105), hypertension (n = 403), or diabetes (n = 134) sequentially. After each exclusion, the adjusted regression coefficients for the associations between sensory impairments and SCD remained similar in magnitude and statistical significance to those in the full cohort (Table 1 ). For example, after excluding participants with hypertension, the adjusted β values were 0.562 (95% CI: 0.198–0.926, p = 0.003) for hearing impairment only, 1.543 (95% CI: 1.098–1.988, p < 0.001) for vision impairment only, and 2.011 (95% CI: 1.609–2.413, p < 0.001) for dual sensory impairment. These results confirmed that the association between sensory impairments and SCD was robust and not driven by the presence of smoking, hypertension, or diabetes. Table 2 The association between sensory impairment and SCD Characteristic Univariable Multivariable β 95% CI P β 95% CI P Sensory impairments No sensory impairments — — — — Hearing impairment only 0.530 0.151, 0.909 0.006 0.589 0.229, 0.949 0.001 Vision impairment only 2.150 1.692, 2.608 < 0.001 1.597 1.159, 2.036 < 0.001 Dual sensory impairment 2.544 2.135, 2.953 < 0.001 2.072 1.678, 2.466 < 0.001 Sex Male — — Female 0.211 -0.094, 0.516 0.175 Age 0.042 0.020, 0.064 < 0.001 Marital status Married/Living with a partner — — Divorced/Separated/Widowed 0.491 0.097, 0.885 0.015 Education level Illiterate/Semi-illiterate — — Primary school 0.249 -0.125, 0.624 0.191 Junior high school -0.082 -0.540, 0.376 0.725 High school/Vocational secondary school 0.464 -0.066, 0.994 0.086 College graduate or above 0.189 -0.555, 0.932 0.619 Residence Rural — — Urban -0.212 -0.520, 0.095 0.176 Financial stress No financial stress — — Moderate financial stress 0.292 -0.007, 0.590 0.055 Severe financial stress 2.315 1.551, 3.080 < 0.001 Drinking Non-drinker — — Ex-drinker -0.060 -1.739, 1.619 0.944 Current drinker 0.165 -0.788, 1.118 0.734 Smoking Non-smoker — — Ex-smoker 0.366 -0.695, 1.427 0.499 Current smoker 0.457 -0.115, 1.028 0.117 Hypertension No — — Yes 0.779 0.475, 1.083 < 0.001 Diabetes No — — Yes 0.204 -0.245, 0.653 0.373 Polypharmacy No — — Yes 0.617 0.016, 1.218 0.044 PASE Score 0.000 -0.001, 0.000 0.301 MNA Score -0.028 -0.072, 0.016 0.216 GAD-7 Score 0.179 0.139, 0.219 < 0.001 3.3 Mediating Role of Depressive Symptoms in the Association Between Sensory Impairments and SCD To explore the potential mediating effect of depressive symptoms (measured by the PHQ-9 score) on the association between sensory impairments and SCD, we performed a mediation analysis adjusted for the same set of confounding variables as in the multivariate regression model. The results are presented in Table 3 . For hearing impairment only, the total effect of hearing impairment on SCD severity was significant (coefficient = 0.514, 95% CI: 0.145–0.874, p = 0.012). However, the indirect effect via depressive symptoms was not statistically significant (coefficient = -0.031, 95% CI: -0.133–0.066, p = 0.522), and the proportion of the total effect mediated was not applicable (NA). This indicated that depressive symptoms did not play a mediating role in the association between hearing impairment only and SCD. In contrast, depressive symptoms partially mediated the associations between vision impairment only and SCD, as well as between dual sensory impairment and SCD: For vision impairment only: The total effect on SCD severity was 1.576 (95% CI: 1.100–2.037, p < 0.001), and the direct effect after adjusting for depressive symptoms was 1.469 (95% CI: 1.017–1.919, p < 0.001). The indirect effect via depressive symptoms was 0.107 (95% CI: 0.005–0.225, p = 0.032), accounting for 6.8% of the total effect. For dual sensory impairment: The total effect on SCD severity was 2.100 (95% CI: 1.665–2.530, p < 0.001), and the direct effect was 2.001 (95% CI: 1.584–2.436, p < 0.001). The indirect effect via depressive symptoms was 0.100 (95% CI: 0.019–0.193, p < 0.001), representing 4.7% of the total effect. Table 3 Mediation analysis of depression in the association between Sensory impairments and SCD Mediator Independent variable Total effect Direct effect Indirect effect Proportion mediated, % Coefficient (95% CI) P Coefficient (95% CI) P Coefficient (95% CI) P PHQ-9 Score Hearing impairment only 0.514 (0.145, 0.874) 0.012 0.544 (0.201, 0.869) 0.002 -0.031 (-0.133, 0.066) 0.522 NA PHQ-9 Score Vision impairment only 1.576 (1.100, 2.037) < 0.001 1.469 (1.017, 1.919) < 0.001 0.107 (0.005, 0.225) 0.032 6.8% PHQ-9 Score Dual sensory impairment 2.100 (1.665, 2.530) < 0.001 2.001 (1.584, 2.436) < 0.001 0.100 (0.019, 0.193) < 0.001 4.7% All models were adjusted for age, sex, marital status, educational level, residence, financial stress, drinking status, smoking status, hypertension, diabetes, polypharmacy, PASE score, MNA score and GAD-7 score. 4. Discussion In this study, we found that sensory impairments are significantly and positively associated with SCD severity. While prior studies have linked sensory impairments to objective cognitive decline or dementia, few have focused on SCD—the earliest self-perceived stage of cognitive deterioration. 49 A study by Li Qi et al. 50 in Chinese older adults found an association between VI and objective memory decline but did not examine SCD or DI. Our results fill this gap by demonstrating that sensory impairments (especially DI) are associated with SCD, which precedes measurable cognitive deficits and Alzheimer’s disease (AD) clinical symptoms. This is critical because SCD is a modifiable phase for intervention—targeting sensory impairments here may delay progression to objective cognitive decline.This finding aligns with the "sensory-cognitive integration" framework 4 , which posits that sensory function is a foundational channel for older adults to interact with the external environment—impairments in this channel disrupt the flow of cognitive stimuli, leading to disuse of cognitive processes and subsequent self-perceived decline. For example, VI may limit engagement in activities requiring visual attention (e.g., reading, recognizing faces), while HI may hinder verbal communication and social interaction—both of which reduce cognitive "exercise" and increase SCD risk. The more severe association of DI may reflect a "cumulative burden" effect: concurrent loss of vision and hearing creates a more profound disconnection from the environment, amplifying cognitive disuse and SCD symptoms compared to single sensory loss. 51 , 52 A longitudinal study in Europe involving 3,000 elderly people found that the risk of cognitive decline in elderly people with DI was 2.3 times that of elderly people without sensory impairment, which further supports the "cumulative burden" effect proposed in this study. 53 Second, the gradient of association (DI > VI > HI) consistent with some international studies but contradicts others. For example, a U.S.-based study by Deal et al. 54 reported stronger associations of HI with cognitive decline compared to VI, while our study found the opposite. This discrepancy may reflect cultural differences in sensory reliance: in China, visual cues (e.g., written communication, facial expressions in social interactions) are often more central to daily life than auditory cues, making VI more disruptive to cognitive engagement. Additionally, the higher prevalence of uncorrected VI (e.g., untreated cataracts) in our sample (31.58% VI vs. 40.79% HI) may contribute to its stronger association with SCD—uncorrected sensory loss likely has a more severe impact on cognitive function than corrected loss. 55 A survey on the correction rate of sensory impairment in China showed that the correction rate of vision impairment in the elderly is only 35.2%, while the correction rate of hearing impairment is 18.7%. Although the correction rate of hearing impairment is lower, the demand for visual function in daily life (such as reading medicine instructions, crossing the road) is higher, so uncorrected vision impairment has a more significant impact on cognitive function. 56 Third, depressive symptoms partially mediate the associations of VI and DI with SCD but do not mediate the HI-SCD relationship. This differential mediation suggests distinct psychosocial pathways linking different sensory impairments to SCD. For VI and DI, sensory loss may trigger depressive symptoms through two mechanisms: (1) activity restriction : VI limits mobility (e.g., fear of falling outdoors) and participation in social or leisure activities, leading to social isolation and loneliness—a well-established precursor to depression; (2) self-efficacy decline : Difficulty performing daily tasks (e.g., preparing meals, managing medications) due to VI or DI erodes self-confidence, fostering negative affect. In turn, depression may exacerbate SCD through rumination (e.g., excessive worry about memory) or neurobiological pathways (e.g., elevated cortisol levels impairing hippocampal function, a region critical for memory). 57 A neuroimaging study involving older adults with VI found that hippocampal volume was significantly smaller in those with concurrent depressive symptoms compared to those without, which provides neurobiological evidence for the mediating role of depression in the VI-SCD relationship [58]. In contrast, the lack of mediation for HI may be due to cultural differences in coping with hearing loss: in Chinese communities, family members often act as "hearing intermediaries" (e.g., relaying conversations), reducing the social isolation and activity restriction caused by HI. This buffering effect may weaken the link between HI and depressive symptoms, thereby eliminating the mediating role of depression. A qualitative study in rural southern China found that 68.2% of elderly people with HI reported relying on family members to assist with auditory communication, which supports this hypothesis. 58 The absence of mediation for HI is notable and may be explained by adaptive coping behaviors specific to hearing loss. Unlike vision, which is often relied on for immediate environmental awareness, hearing loss can be partially mitigated by assistive devices (e.g., hearing aids) or behavioral strategies (e.g., lip-reading, asking others to speak louder). These adaptations may reduce the psychological distress associated with HI, preventing the cascade from sensory loss to depression to SCD. Additionally, HI may affect cognitive function more directly (e.g., through auditory signal degradation in the brainstem, which overlaps with cognitive processing pathways) rather than indirectly via depression 51 —consistent with our finding of a direct HI-SCD association independent of depressive symptoms. Finally, subgroup and sensitivity analyses confirm the robustness of the associations. The positive links between sensory impairments and SCD remained consistent across subgroups defined by residence (urban/rural), gender, physical activity level, nutritional status, and chronic conditions (hypertension/diabetes). Excluding participants with smoking, hypertension, or diabetes—factors previously linked to both sensory loss and cognitive decline 49 , 59 —did not alter the magnitude or significance of the associations. This suggests that the sensory impairment-SCD relationship is not confounded by these common comorbidities and is generalizable to diverse community-dwelling older adults in Southern China. Practically, our results provide targeted strategies for cognitive health intervention in older adults in southern China. First, screening and correcting sensory impairments (especially DI and VI) should be integrated into community-based elderly health management. For example, regular vision and hearing check-ups, free distribution of affordable glasses, and subsidies for hearing aids could reduce uncorrected sensory loss. 60 Second, for elderly people with VI or DI, psychological interventions targeting depressive symptoms (e.g., cognitive behavioral therapy, group counseling) should be prioritized to break the "sensory impairment → depression → SCD" chain. A randomized controlled trial in Shanghai found that a combined sensory correction and psychological intervention program reduced SCD severity by 32.1% in elderly participants with DI, which supports the feasibility of this approach. 61 Third, for elderly people with HI, community-based support systems (e.g., training family members as "hearing assistants") could be further strengthened to maintain social engagement and prevent cognitive decline. However, our study has several limitations. First, while we observed associations between sensory impairments and SCD, we cannot establish causality . Secondly, we relied on self-report to assess VI and HI, which may underestimate or overestimate true impairment (e.g., participants may not recognize mild sensory loss or overreport difficulties due to anxiety). Objective assessments (e.g., visual acuity tests, pure-tone audiometry) would improve accuracy in future studies 49 , 62 . Third, the sample was drawn from Southern China, where socioeconomic status, healthcare access, and cultural practices differ from Northern China or other countries. Results may not apply to older adults in rural areas of other provinces or non-Chinese populations. 5. Conclusion Sensory impairments, particularly dual impairment, are significantly associated with SCD in older adults. Depressive symptoms partially mediate these associations, highlighting a potential psychosocial pathway linking sensory loss and early cognitive concerns. Given that SCD represents the earliest self-perceived cognitive change, occurring prior to measurable cognitive impairment and other clinical symptoms of Alzheimer’s disease, these findings underscore the critical importase findings have important implications for public health strategies aimed at preventing cognitive deterioration among Chinese older adults. Timely interventions targeting these modifiable factors may help delay or mitigate the onset of objective cognitive decline and preserve cognitive health in aging populations. Abbreviations AD Alzheimer's Disease CI Confidence Interval DI Dual Impairment GAD-7 Generalized Anxiety Disorder-7 HI Hearing Impairment MNA Mini Nutritional Assessment OR Odds Ratio PHQ-9 Patient Health Questionnaire-9 PASE Physical Activity Scale for the Elderly SCD Subjective Cognitive Decline SCD-Q9 Subjective Cognitive Decline Questionnaire-9 SD Standard Deviation VI Vision Impairment Declarations Ethics approval and consent to participate This study was conducted in strict accordance with the ethical principles outlined in the World Medical Association (WMA) Declaration of Helsinki – Ethical Principles for Medical Research Involving Human Participants (2024 revision, https://www.wma.net/policies-post/wma-declaration-of-helsinki/). Ethics approval for this study was obtained from the Ethics Committee of The First Affiliated Hospital, Sun Yat-Sen University. The committee reviewed and approved the study protocol, including procedures for participant recruitment, structured face-to-face interviews, data collection, storage, and confidentiality protection, ensuring full compliance with national and international ethical standards for research involving human participants. Consent for publication All authors confirm that all participants (or their legal representatives) have provided written consent for the publication of this study and its associated data. Availability of data and materials The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. Competing Interests The authors declare no competing interests. Funding This study was supported by the Guangdong Provincial Science and Technology Planning Project (Grant No. 2023B110009). Authors' contributions Shengwei Wang, Jinjun Li, and Wen He conceived and designed the study. Jinjun Li, Miaohong Chen, and Ling Zhang collected the data. Shengwei Wang and Ling Zhang performed the statistical analyses. Qiaochao Chen and Wen He drafted the manuscript. All authors revised the manuscript critically, approved the final version, and agreed to be accountable for all aspects of the work. Acknowledgements Not applicable. References Rabin LA, Smart CM, Crane PK, et al. Subjective Cognitive Decline in Older Adults: An Overview of Self-Report Measures Used Across 19 International Research Studies. J ALZHEIMERS DIS. 2015;48(Suppl 1):S63–86. Avila-Villanueva M, Fernandez-Blazquez MA. Subjective Cognitive Decline as a Preclinical Marker for Alzheimer's Disease: The Challenge of Stability Over Time. FRONT AGING NEUROSCI. 2017;9:377. Jack CJ, Knopman DS, Jagust WJ, Et A. 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Li Y, Zhang H, Wang Y, Et A. Hippocampal volume in older adults with vision impairment and depressive symptoms: a cross–sectional neuroimaging study. NEUROBIOL AGING. 2023;122:11–9. Liu G, Liang J, Hong C, et al. Sensory impairment, loneliness, and the discordance between subjective and objective cognitive function among older adults: A multi-cohort study. ARCH GERONTOL GERIAT. 2024;124:105482. World HO. World report on vision. In: World Health Organization; 2019. Shanghai MHC. Effectiveness of integrated sensory and psychological intervention on cognitive health of elderly people with dual sensory impairment: a randomized controlled trial. In: Shanghai Municipal Health Commission; 2023. LI Qi ZWJF. The association between sensory impairment and motoric cognitive risk syndrome in Chinese. older. adults. 2024. Additional Declarations No competing interests reported. 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Introduction","content":"\u003cp\u003eWith the rapid aging of the global population, the issue of cognitive health in older adults has attracted increasing attention from the academic community and public health sectors. Subjective Cognitive Decline (SCD), defined as an individual's self-perceived decline in cognitive function without objective evidence of cognitive impairment through neuropsychological tests, is widely regarded as the earliest stage of cognitive deterioration.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e It is not only a potential precursor to Alzheimer's Disease (AD) but also occurs before the emergence of measurable cognitive deficits and other clinical symptoms of AD.\u003csup\u003e2\u003c/sup\u003e Therefore, identifying the risk factors associated with SCD and exploring the underlying mechanisms is of great significance for the early prevention and intervention of cognitive decline in older adults.\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eSensory function, including vision and hearing, is an important channel for older adults to interact with the external environment. In recent years, a growing number of studies have focused on the relationship between sensory impairment and cognitive function. Vision Impairment (VI) and Hearing Impairment (HI) are common health problems in older adults.\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e Previous studies have shown that sensory impairment may be associated with cognitive decline,\u003csup\u003e4, 5\u003c/sup\u003e but the specific relationship between different types of sensory impairments (such as single VI, single HI, and Dual Impairment (DI) of vision and hearing) and SCD remains unclear, especially in the Chinese elderly population.\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003eA study conducted in 10 Asian countries found that the prevalence of sensory impairment in older adults over 65 years old reached 45.2%, and the comorbidity rate of DI was 12.8%, which further indicates the urgency of studying the relationship between sensory impairment and cognitive health in the elderly population.\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eDepression is another common mental health problem in older adults. Existing research has found that depressive symptoms are not only associated with sensory impairment but also with cognitive decline.\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e Some scholars have proposed that depression may play a mediating role in the relationship between sensory impairment and cognitive decline.\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e However, there is a lack of in-depth research on whether depressive symptoms mediate the association between different types of sensory impairments and SCD in the Chinese elderly population.\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003eA meta-analysis involving 28 studies in East Asia showed that the pooled prevalence of depressive symptoms in Chinese older adults was 23.1%, which is higher than the average level in developed countries, suggesting that the mediating effect of depression in the Chinese elderly population may have unique characteristics.\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThis study aims to explore the associations between different types of sensory impairments (VI, HI, DI) and SCD in Chinese older adults and to examine the mediating role of depressive symptoms in these relationships.\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan additionalcitationids=\"CR14\" citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e The results of this study are expected to provide a theoretical basis for formulating targeted cognitive health intervention strategies for the elderly in southern China and enrich the global evidence on the relationship between sensory impairment and cognitive decline.\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e"},{"header":"2. Materials and Methods","content":"\u003cp\u003eThis study adopted a cross-sectional design. The study population was community-dwelling adults aged 65 years and older in Guangdong Province, Southern China. The inclusion criteria were: (1) aged 65 years or older; (2) living in the community for more than 6 months; (3) able to communicate normally and complete the face-to-face interview; (4) voluntary participation in the study and signing the informed consent form. The exclusion criteria were: (1) having severe mental illness (such as schizophrenia) or cognitive impairment diagnosed by a professional doctor; (2) having severe physical diseases that affect cognitive function (such as severe stroke, Parkinson's disease); (3) unable to complete the questionnaire due to language or other reasons.\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e This sampling strategy is consistent with the design of most community-based elderly cognitive research in China, which can effectively ensure the representativeness of the sample.\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThe data collection was conducted between January and October 2024. Community-dwelling older adults who met the inclusion criteria were randomly selected from each district for face-to-face interviews. A total of 1,200 questionnaires were distributed, and 1,162 valid questionnaires were collected, with an effective response rate of 96.8%.\u003csup\u003e19\u003c/sup\u003e The effective response rate of this study is higher than the average level of similar cross-sectional studies in China (about 85%-90%), which may be due to the fact that the investigators were trained uniformly and the community health service centers provided assistance, which improved the cooperation degree of the elderly.\u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eData were collected through structured face-to-face interviews by trained investigators. The interview content included demographic characteristics (such as age, gender, city of residence, educational level), lifestyle factors (such as smoking history, physical activity level), nutritional status, chronic diseases (such as hypertension, diabetes), sensory function (vision and hearing), depressive symptoms, and SCD.\u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e Structured interviews can reduce information bias caused by differences in investigation methods, which is a commonly used and effective data collection method in elderly health research.\u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eSensory impairments were assessed via self-reported vision and hearing function. For vision impairment, the participants were asked: \"Do you have difficulty seeing even with glasses (if you wear them) in daily life?\" The answer options were \"yes\" and \"no\". Those who answered \"yes\" were considered to have vision impairment. For hearing impairment, the participants were asked: \"Do you have difficulty hearing even with a hearing aid (if you use one) in daily life?\" The answer options were \"yes\" and \"no\". Those who answered \"yes\" were considered to have hearing impairment. Dual sensory impairment was defined as having both vision impairment and hearing impairment.\u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e Although self-reported assessment may have certain limitations, it is widely used in large-scale epidemiological surveys due to its simplicity and high efficiency. A study comparing self-reported and objective sensory function assessment showed that the consistency rate between self-reported and objective assessment of vision and hearing impairment in the elderly was 78.3% and 72.5% respectively, which proved the reliability of self-reported assessment.\u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eDepressive symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9). The PHQ-9 is a widely used self-report scale for assessing depressive symptoms in adults.\u003csup\u003e\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e It consists of 9 items, each scored on a 4-point scale (0\u0026thinsp;=\u0026thinsp;not at all, 1\u0026thinsp;=\u0026thinsp;several days, 2\u0026thinsp;=\u0026thinsp;more than half the days, 3\u0026thinsp;=\u0026thinsp;nearly every day). The total score ranges from 0 to 27, with higher scores indicating more severe depressive symptoms. A total score of \u0026ge;\u0026thinsp;10 is considered to have significant depressive symptoms. The PHQ-9 has good reliability and validity in the Chinese population.\u003csup\u003e\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e A recent study in southern China confirmed that the Cronbach's α coefficient of the PHQ-9 in the elderly population is 0.86, and the split-half reliability is 0.82, which further verifies its applicability in the study population of this paper.\u003csup\u003e\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eSubjective Cognitive Decline was assessed using the validated Subjective Cognitive Decline Questionnaire-9 (SCD-Q9). The SCD-Q9 is a self-report scale designed to assess SCD in older adults.\u003csup\u003e\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u003c/sup\u003e It includes 9 items, each scored on a 5-point scale (1\u0026thinsp;=\u0026thinsp;no decline, 2\u0026thinsp;=\u0026thinsp;slight decline, 3\u0026thinsp;=\u0026thinsp;moderate decline, 4\u0026thinsp;=\u0026thinsp;severe decline, 5\u0026thinsp;=\u0026thinsp;very severe decline). The total score ranges from 9 to 45, with higher scores indicating more severe SCD. The SCD-Q9 has been validated in the Chinese population and has good reliability and validity .\u003csup\u003e30\u003c/sup\u003e A validation study involving 1,500 elderly people in 5 provinces of China showed that the SCD-Q9 has good discriminant validity, and the area under the ROC curve for distinguishing elderly people with and without SCD is 0.83.\u003csup\u003e31\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eDemographic characteristics such as age, gender, city of residence, and educational level were collected through direct inquiry. Lifestyle factors: smoking history was divided into \"never smoked\" and \"ever smoked\" (including current smokers and former smokers). Physical activity level was assessed using the International Physical Activity Questionnaire (IPAQ) short version.\u003csup\u003e\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e\u003c/sup\u003e Participants were classified into low, moderate, and high physical activity levels based on the total metabolic equivalent (MET) minutes per week. Nutritional status was assessed using the Mini Nutritional Assessment-Short Form (MNA-SF). The MNA-SF consists of 6 items, with a total score ranging from 0 to 14. A score of \u0026ge;\u0026thinsp;12 indicates normal nutritional status, 8\u0026ndash;11 indicates at risk of malnutrition, and \u0026le;\u0026thinsp;7 indicates malnutrition. Chronic diseases such as hypertension and diabetes were determined by asking the participants whether they had been diagnosed by a doctor and were taking relevant medications.\u003csup\u003e\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e\u003c/sup\u003e The MNA-SF is a commonly used nutritional assessment tool for the elderly, and its validity in the Chinese elderly population has been confirmed by multiple studies. The Cronbach's α coefficient in the Chinese elderly population is 0.79\u0026ndash;0.85. \u003csup\u003e35\u003c/sup\u003e Chronic diseases such as hypertension and diabetes were determined by asking the participants whether they had been diagnosed by a doctor and were taking relevant medications.\u003csup\u003e\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e\u003c/sup\u003e This method of determining chronic diseases is in line with the standards of the Chinese National Health Survey, which can ensure the accuracy of chronic disease diagnosis information.\u003csup\u003e\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eAll statistical analyses were performed using SPSS 26.0 software and Mplus 8.3 software. The significance level was set at α\u0026thinsp;=\u0026thinsp;0.05 (two-tailed). Continuous variables (such as age, PHQ-9 score, SCD-Q9 score) were expressed as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (SD), and categorical variables (such as gender, sensory impairment, smoking history, chronic diseases) were expressed as frequency and percentage.\u003csup\u003e\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e\u003c/sup\u003e The choice of statistical software and variable expression methods in this study is consistent with the norms of medical statistics, which is conducive to the comparability of research results with similar studies.\u003csup\u003e\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eIndependent samples t-tests or one-way analysis of variance (ANOVA) were used to compare the differences in SCD-Q9 scores between participants with and without sensory impairments. Then, multiple linear regression analysis was used to assess the association between sensory impairments and SCD. In the multiple linear regression model, SCD-Q9 score was the dependent variable, and sensory impairment (no sensory impairment, only HI, only VI, DI) was the independent variable. Demographic characteristics (age, gender, city of residence, educational level), lifestyle factors (smoking history, physical activity level), nutritional status, and chronic diseases (hypertension, diabetes) were included as confounding variables.\u003csup\u003e\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e\u003c/sup\u003e Including these confounding variables in the regression model can effectively control the interference of other factors on the relationship between sensory impairment and SCD, which is a necessary step to ensure the authenticity of the research results.\u003csup\u003e\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eSubgroup analyses were conducted to explore whether the association between sensory impairments and SCD varied across different subgroups. The subgroups were divided based on residence (rural vs. urban), gender (male, female), physical activity level (low, moderate, high), nutritional status (normal, at risk of malnutrition, malnutrition), and the presence of chronic conditions (hypertension: yes, no; diabetes: yes, no). Multiple linear regression analysis was performed in each subgroup to assess the association between sensory impairments and SCD.\u003csup\u003e\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e\u003c/sup\u003e Subgroup analysis can help to find the differences in the relationship between sensory impairment and SCD in different populations, which is of great significance for formulating personalized intervention strategies.\u003csup\u003e\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eSensitivity analyses were conducted to test the robustness of the association between sensory impairments and SCD. We excluded individuals with a history of smoking, hypertension, or diabetes respectively, and then performed multiple linear regression analysis again to assess the association between sensory impairments and SCD.\u003csup\u003e\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e\u003c/sup\u003e Sensitivity analysis is an important part of epidemiological research, which can test whether the research results are affected by specific factors and improve the reliability of the results.\u003csup\u003e\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eMediation analysis was employed to examine the indirect effects of depressive symptoms (assessed by PHQ-9 score) on the relationship between sensory impairments and SCD. The mediation model was established using the bias-corrected bootstrapping method with 5,000 resamples. In the mediation model, sensory impairment was the independent variable, SCD-Q9 score was the dependent variable, PHQ-9 score was the mediating variable, and the same confounding variables as in the multiple linear regression model were included. The mediating effect was considered significant if the 95% confidence interval (CI) of the indirect effect did not include 0. The proportion of the mediating effect to the total effect was calculated to evaluate the mediating role of depressive symptoms.\u003csup\u003e\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e, \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e\u003c/sup\u003e The bias-corrected bootstrapping method is a commonly used method in mediation analysis, which has higher statistical power than the traditional Sobel test, especially in small sample sizes.\u003csup\u003e\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e"},{"header":"3. Results","content":"\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e3.1 Demographic Characteristics of the Participants\u003c/h2\u003e \u003cp\u003eA total of 1,162 community-dwelling older adults aged 65\u0026ndash;98 years were enrolled in this cross-sectional analysis, with a mean age of 73.7\u0026thinsp;\u0026plusmn;\u0026thinsp;6.8 years. The cohort had a slight female predominance, as 52.7% (n\u0026thinsp;=\u0026thinsp;613) of participants were female, and 47.3% (n\u0026thinsp;=\u0026thinsp;549) were male. The overall prevalence of subjective cognitive decline (SCD) in this elderly population was 42.94% (n\u0026thinsp;=\u0026thinsp;499), meaning nearly half of the participants reported experiencing symptoms of cognitive decline.\u003c/p\u003e \u003cp\u003eAs presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, participants with SCD were significantly older (mean age: 74.87\u0026thinsp;\u0026plusmn;\u0026thinsp;7.27 years vs. 72.88\u0026thinsp;\u0026plusmn;\u0026thinsp;6.33 years, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and more likely to be divorced/separated/widowed (19.84% vs. 13.27%, p\u0026thinsp;=\u0026thinsp;0.003) compared to those without SCD. Financial stress was more prevalent in the SCD group: 40.28% of participants with SCD reported moderate financial stress, and 6.41% reported severe financial stress, whereas only 32.13% and 1.21% of non-SCD participants reported moderate and severe financial stress, respectively (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003cp\u003eIn terms of physical health and functional status, participants with SCD had a higher prevalence of chewing function impairment (74.55% vs. 41.84%, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), hearing impairment (47.29% vs. 35.90%, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and vision impairment (48.90% vs. 18.55%, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) than those without SCD. Chronic conditions, including hypertension (45.89% vs. 26.24%, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), coronary artery disease (9.82% vs. 5.88%, p\u0026thinsp;=\u0026thinsp;0.012), diabetes (14.83% vs. 9.05%, p\u0026thinsp;=\u0026thinsp;0.002), cataract (2.61% vs. 0.60%, p\u0026thinsp;=\u0026thinsp;0.005), osteoporosis (11.22% vs. 3.17%, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), lumbar disc herniation (4.01% vs. 1.36%, p\u0026thinsp;=\u0026thinsp;0.004), rheumatoid arthritis (2.20% vs. 0.60%, p\u0026thinsp;=\u0026thinsp;0.017), low back and leg pain (6.81% vs. 1.21%, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), urinary incontinence (11.62% vs. 0.90%, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and a history of choking episodes within 3 months (16.83% vs. 5.13%, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), were also more common in the SCD group.\u003c/p\u003e \u003cp\u003eAdditionally, participants with SCD were more likely to have unexplained weight loss (8.22% vs. 5.28%, p\u0026thinsp;=\u0026thinsp;0.045), gastrointestinal symptoms such as constipation/anal fissure (13.43% vs. 4.37%, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and diarrhea within 1 year(11.82% vs. 3.47%, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), a history of falls (10.62% vs. 6.03%, p\u0026thinsp;=\u0026thinsp;0.004) and fractures within 1 year(6.81% vs. 3.17%, p\u0026thinsp;=\u0026thinsp;0.004), and polypharmacy (11.02% vs. 3.02%, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Dietary patterns also differed between groups: the SCD group had a higher proportion of high-salt diets (21.84% vs. 11.61%, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and high-meat diets (7.82% vs. 3.92%, p\u0026thinsp;=\u0026thinsp;0.004). Sleep duration was less optimal in the SCD group, with 12.63% reporting\u0026thinsp;\u0026lt;\u0026thinsp;5 hours of nightly sleep and 57.72% reporting 5\u0026ndash;7 hours, compared to 7.69% and 47.96% in the non-SCD group, respectively (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Finally, psychological well-being metrics indicated higher levels of depression (Patient Health Questionnaire-9 [PHQ-9] score: 5.10\u0026thinsp;\u0026plusmn;\u0026thinsp;4.75 vs. 2.42\u0026thinsp;\u0026plusmn;\u0026thinsp;3.70, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and anxiety (Generalized Anxiety Disorder-7 [GAD-7] score: 2.82\u0026thinsp;\u0026plusmn;\u0026thinsp;3.99 vs. 1.35\u0026thinsp;\u0026plusmn;\u0026thinsp;2.98, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) in participants with SCD.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSample characteristics, stratified by SCD (n\u0026thinsp;=\u0026thinsp;1162)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eSCD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cem\u003eP-value\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOverall\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;1162)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;499)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;663)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge, Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e73.74\u0026thinsp;\u0026plusmn;\u0026thinsp;6.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e74.87\u0026thinsp;\u0026plusmn;\u0026thinsp;7.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e72.88\u0026thinsp;\u0026plusmn;\u0026thinsp;6.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSex, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.422\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e549 (47.25%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e229 (45.89%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e320 (48.27%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e613 (52.75%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e270 (54.11%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e343 (51.73%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEducation level, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.138\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIlliterate/Semi-illiterate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e269 (23.15%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e116 (23.25%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e153 (23.08%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrimary school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e481 (41.39%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e223 (44.69%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e258 (38.91%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eJunior high school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e224 (19.28%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e82 (16.43%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e142 (21.42%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh school/Vocational secondary school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e133 (11.45%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e58 (11.62%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e75 (11.31%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCollege graduate or above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e55 (4.73%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20 (4.01%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e35 (5.28%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMarital status, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarried/Living with a partner\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e975 (83.91%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e400 (80.16%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e575 (86.73%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDivorced/Separated/Widowed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e187 (16.09%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e99 (19.84%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e88 (13.27%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eResidence, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.189\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRural\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e510 (43.89%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e230 (46.09%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e280 (42.23%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUrban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e652 (56.11%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e269 (53.91%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e383 (57.77%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFinancial stress, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo financial stress\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e708 (60.93%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e266 (53.31%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e442 (66.67%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModerate financial stress\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e414 (35.63%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e201 (40.28%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e213 (32.13%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSevere financial stress\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40 (3.44%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32 (6.41%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8 (1.21%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDrinking, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.918\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNon-drinker\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1,127 (96.99%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e483 (96.79%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e644 (97.13%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEx-drinker\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8 (0.69%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (0.80%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (0.60%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCurrent drinker\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e27 (2.32%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12 (2.40%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15 (2.26%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSmoking, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.075\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNon-smoker\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1,057 (90.96%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e444 (88.98%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e613 (92.46%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEx-smoker\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21 (1.81%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13 (2.61%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8 (1.21%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCurrent smoker\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e84 (7.23%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42 (8.42%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e42 (6.33%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eChewing function impairment, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e508 (43.72%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e127 (25.45%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e381 (57.47%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMild\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e468 (40.28%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e236 (47.29%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e232 (34.99%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e148 (12.74%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e111 (22.24%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e37 (5.58%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSevere\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e38 (3.27%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25 (5.01%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13 (1.96%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHearing impairment, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e688 (59.21%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e263 (52.71%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e425 (64.10%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e474 (40.79%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e236 (47.29%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e238 (35.90%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eVisual impairment, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e795 (68.42%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e255 (51.10%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e540 (81.45%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e367 (31.58%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e244 (48.90%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e123 (18.55%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHypertension, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e759 (65.32%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e270 (54.11%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e489 (73.76%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e403 (34.68%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e229 (45.89%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e174 (26.24%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCoronary Artery Disease, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.012\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1,074 (92.43%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e450 (90.18%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e624 (94.12%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e88 (7.57%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e49 (9.82%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e39 (5.88%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDiabetes, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1,028 (88.47%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e425 (85.17%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e603 (90.95%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e134 (11.53%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e74 (14.83%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e60 (9.05%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCataract, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.005\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1,145 (98.54%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e486 (97.39%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e659 (99.40%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17 (1.46%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13 (2.61%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (0.60%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOsteoporosis, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1,085 (93.37%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e443 (88.78%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e642 (96.83%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e77 (6.63%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e56 (11.22%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21 (3.17%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLumbar Disc Herniation, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.004\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1,133 (97.50%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e479 (95.99%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e654 (98.64%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e29 (2.50%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20 (4.01%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9 (1.36%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRheumatoid Arthritis, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.017\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1,147 (98.71%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e488 (97.80%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e659 (99.40%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15 (1.29%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11 (2.20%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (0.60%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLow Back and Leg Pain, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1,120 (96.39%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e465 (93.19%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e655 (98.79%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e42 (3.61%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e34 (6.81%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8 (1.21%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eUrinary incontinence, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1,098 (94.49%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e441 (88.38%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e657 (99.10%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e64 (5.51%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e58 (11.62%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6 (0.90%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eChoking episodes within past 3 months, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1,044 (89.85%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e415 (83.17%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e629 (94.87%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e118 (10.15%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e84 (16.83%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e34 (5.13%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eUnexplained weight loss\u0026thinsp;\u0026ge;\u0026thinsp;4.5 kg or \u0026ge;\u0026thinsp;5% body weight within 1 year, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.045\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1,086 (93.46%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e458 (91.78%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e628 (94.72%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e76 (6.54%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e41 (8.22%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e35 (5.28%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eConstipation or anal fissure within 1 year, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1,066 (91.74%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e432 (86.57%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e634 (95.63%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e96 (8.26%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e67 (13.43%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e29 (4.37%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDiarrhea within 1 year, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1,080 (92.94%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e440 (88.18%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e640 (96.53%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e82 (7.06%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e59 (11.82%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23 (3.47%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFall within 1 year, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.004\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1,069 (92.00%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e446 (89.38%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e623 (93.97%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e93 (8.00%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e53 (10.62%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e40 (6.03%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFracture within 1 year, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.004\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1,107 (95.27%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e465 (93.19%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e642 (96.83%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e55 (4.73%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e34 (6.81%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21 (3.17%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePolypharmacy, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1087 (93.55%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e444 (88.98%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e643 (96.98%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e75 (6.45%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e55 (11.02%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20 (3.02%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAverage nightly sleep duration, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;5 h\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e114 (9.81%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e63 (12.63%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e51 (7.69%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5\u0026ndash;7 h\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e606 (52.15%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e288 (57.72%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e318 (47.96%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7\u0026ndash;9 h\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e417 (35.89%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e133 (26.65%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e284 (42.84%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25 (2.15%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15 (3.01%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10 (1.51%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDifficulty/psychological discomfort in social activities, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.008\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1,065 (91.65%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e445 (89.18%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e620 (93.51%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e97 (8.35%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e54 (10.82%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e43 (6.49%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHigh Salt Diet, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e976 (83.99%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e390 (78.16%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e586 (88.39%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e186 (16.01%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e109 (21.84%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e77 (11.61%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHigh Meat Diet, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.004\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1,097 (94.41%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e460 (92.18%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e637 (96.08%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e65 (5.59%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e39 (7.82%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e26 (3.92%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBMI, Mean\u003c/b\u003e\u0026thinsp;\u0026plusmn;\u0026thinsp;\u003cb\u003eSD\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22.99\u0026thinsp;\u0026plusmn;\u0026thinsp;3.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23.07\u0026thinsp;\u0026plusmn;\u0026thinsp;3.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22.93\u0026thinsp;\u0026plusmn;\u0026thinsp;3.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.476\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePASE Score, Mean\u003c/b\u003e\u0026thinsp;\u0026plusmn;\u0026thinsp;\u003cb\u003eSD\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e154.31\u0026thinsp;\u0026plusmn;\u0026thinsp;168.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e146.50\u0026thinsp;\u0026plusmn;\u0026thinsp;177.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e160.19\u0026thinsp;\u0026plusmn;\u0026thinsp;161.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.170\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMNA Score, Mean\u003c/b\u003e\u0026thinsp;\u0026plusmn;\u0026thinsp;\u003cb\u003eSD\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22.52\u0026thinsp;\u0026plusmn;\u0026thinsp;3.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22.39\u0026thinsp;\u0026plusmn;\u0026thinsp;3.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22.62\u0026thinsp;\u0026plusmn;\u0026thinsp;3.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.212\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePHQ-9 Score, Mean\u003c/b\u003e\u0026thinsp;\u0026plusmn;\u0026thinsp;\u003cb\u003eSD\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.57\u0026thinsp;\u0026plusmn;\u0026thinsp;4.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.10\u0026thinsp;\u0026plusmn;\u0026thinsp;4.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.42\u0026thinsp;\u0026plusmn;\u0026thinsp;3.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGAD-7 Score, Mean\u003c/b\u003e\u0026thinsp;\u0026plusmn;\u0026thinsp;\u003cb\u003eSD\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.98\u0026thinsp;\u0026plusmn;\u0026thinsp;3.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.82\u0026thinsp;\u0026plusmn;\u0026thinsp;3.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.35\u0026thinsp;\u0026plusmn;\u0026thinsp;2.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e3.2 Association Between Sensory Impairments and Subjective Cognitive Decline\u003c/h2\u003e \u003cdiv id=\"Sec6\" class=\"Section3\"\u003e \u003ch2\u003e3.2.1 Univariate and Multivariate Linear Regression Analyses\u003c/h2\u003e \u003cp\u003eThe uivariate linear regression analysis (Table \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e) revealed significant positive associations between sensory impairments and the severity of SCD. Compared to participants with no sensory impairment, those with hearing impairment only (β\u0026thinsp;=\u0026thinsp;0.530, 95% confidence interval [CI]: 0.151\u0026ndash;0.909, p\u0026thinsp;=\u0026thinsp;0.006), vision impairment only (β\u0026thinsp;=\u0026thinsp;2.150, 95% CI: 1.692\u0026ndash;2.608, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and dual sensory impairment (β\u0026thinsp;=\u0026thinsp;2.544, 95% CI: 2.135\u0026ndash;2.953, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) had significantly higher SCD severity scores.\u003c/p\u003e \u003cp\u003eAfter adjusting for potential confounding variables\u0026mdash;including age, sex, marital status, education level, residence, financial stress, drinking status, smoking status, hypertension, diabetes, polypharmacy, PASE score, MNA score, and GAD-7 score\u0026mdash;the associations between sensory impairments and SCD remained statistically significant (Table \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). The adjusted regression coefficients indicated that:\u003c/p\u003e \u003cp\u003eHearing impairment only was associated with a 0.589-point increase in SCD severity (95% CI: 0.229\u0026ndash;0.949, p\u0026thinsp;=\u0026thinsp;0.001);\u003c/p\u003e \u003cp\u003eVision impairment only was associated with a 1.597-point increase in SCD severity (95% CI: 1.159\u0026ndash;2.036, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001);\u003c/p\u003e \u003cp\u003eDual sensory impairment was associated with the largest increase in SCD severity, at 2.072 points (95% CI: 1.678\u0026ndash;2.466, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003cp\u003eAmong the confounding variables included in the adjusted model, age (β\u0026thinsp;=\u0026thinsp;0.042, 95% CI: 0.020\u0026ndash;0.064, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), marital status (divorced/separated/widowed vs. married/living with a partner: β\u0026thinsp;=\u0026thinsp;0.491, 95% CI: 0.097\u0026ndash;0.885, p\u0026thinsp;=\u0026thinsp;0.015), severe financial stress (vs. no financial stress: β\u0026thinsp;=\u0026thinsp;2.315, 95% CI: 1.551\u0026ndash;3.080, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), hypertension (β\u0026thinsp;=\u0026thinsp;0.779, 95% CI: 0.475\u0026ndash;1.083, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), polypharmacy (β\u0026thinsp;=\u0026thinsp;0.617, 95% CI: 0.016\u0026ndash;1.218, p\u0026thinsp;=\u0026thinsp;0.044), and GAD-7 score (β\u0026thinsp;=\u0026thinsp;0.179, 95% CI: 0.139\u0026ndash;0.219, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) were also independently associated with SCD severity.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section3\"\u003e \u003ch2\u003e3.2.2 Subgroup and Sensitivity Analyses\u003c/h2\u003e \u003cp\u003eTo assess the robustness of the association between sensory impairments and SCD, we conducted subgroup analyses stratified by key variables: residence (rural vs. urban), sex (male vs. female), physical activity level (low vs. medium vs. high, based on tertiles of PASE score), nutritional status (normal vs. at risk of malnutrition vs. malnourished, based on MNA score), and the presence of chronic conditions (hypertension vs. no hypertension, diabetes vs. no diabetes). In all subgroups, the positive associations between hearing impairment only, vision impairment only, dual sensory impairment, and SCD severity remained consistent and statistically significant (all p for interaction\u0026thinsp;\u0026gt;\u0026thinsp;0.05), indicating that these associations were not modified by the stratified variables.\u003c/p\u003e \u003cp\u003eSensitivity analyses were further performed by excluding participants with a history of smoking (n\u0026thinsp;=\u0026thinsp;105), hypertension (n\u0026thinsp;=\u0026thinsp;403), or diabetes (n\u0026thinsp;=\u0026thinsp;134) sequentially. After each exclusion, the adjusted regression coefficients for the associations between sensory impairments and SCD remained similar in magnitude and statistical significance to those in the full cohort (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). For example, after excluding participants with hypertension, the adjusted β values were 0.562 (95% CI: 0.198\u0026ndash;0.926, p\u0026thinsp;=\u0026thinsp;0.003) for hearing impairment only, 1.543 (95% CI: 1.098\u0026ndash;1.988, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) for vision impairment only, and 2.011 (95% CI: 1.609\u0026ndash;2.413, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) for dual sensory impairment. These results confirmed that the association between sensory impairments and SCD was robust and not driven by the presence of smoking, hypertension, or diabetes.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe association between sensory impairment and SCD\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCharacteristic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eUnivariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003eMultivariable\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eβ\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eβ\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSensory impairments\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo sensory impairments\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHearing impairment only\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.530\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.151, 0.909\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.006\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.589\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.229, 0.949\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVision impairment only\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.150\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.692, 2.608\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.597\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.159, 2.036\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDual sensory impairment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.544\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.135, 2.953\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.072\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.678, 2.466\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSex\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.211\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.094, 0.516\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.175\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.042\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.020, 0.064\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMarital status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarried/Living with a partner\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDivorced/Separated/Widowed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.491\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.097, 0.885\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.015\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEducation level\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIlliterate/Semi-illiterate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrimary school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.249\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.125, 0.624\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.191\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eJunior high school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.082\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.540, 0.376\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.725\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh school/Vocational secondary school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.464\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.066, 0.994\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.086\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCollege graduate or above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.189\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.555, 0.932\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.619\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eResidence\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRural\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUrban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.212\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.520, 0.095\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.176\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFinancial stress\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo financial stress\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModerate financial stress\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.292\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.007, 0.590\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.055\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSevere financial stress\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.315\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.551, 3.080\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDrinking\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNon-drinker\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEx-drinker\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.060\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-1.739, 1.619\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.944\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCurrent drinker\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.165\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.788, 1.118\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.734\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSmoking\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNon-smoker\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEx-smoker\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.366\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.695, 1.427\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.499\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCurrent smoker\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.457\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.115, 1.028\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.117\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHypertension\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.779\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.475, 1.083\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDiabetes\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.204\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.245, 0.653\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.373\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePolypharmacy\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.617\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.016, 1.218\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.044\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePASE Score\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.001, 0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.301\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMNA Score\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.028\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.072, 0.016\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.216\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGAD-7 Score\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.179\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.139, 0.219\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e3.3 Mediating Role of Depressive Symptoms in the Association Between Sensory Impairments and SCD\u003c/h2\u003e \u003cp\u003eTo explore the potential mediating effect of depressive symptoms (measured by the PHQ-9 score) on the association between sensory impairments and SCD, we performed a mediation analysis adjusted for the same set of confounding variables as in the multivariate regression model. The results are presented in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e \u003cp\u003eFor hearing impairment only, the total effect of hearing impairment on SCD severity was significant (coefficient\u0026thinsp;=\u0026thinsp;0.514, 95% CI: 0.145\u0026ndash;0.874, p\u0026thinsp;=\u0026thinsp;0.012). However, the indirect effect via depressive symptoms was not statistically significant (coefficient = -0.031, 95% CI: -0.133\u0026ndash;0.066, p\u0026thinsp;=\u0026thinsp;0.522), and the proportion of the total effect mediated was not applicable (NA). This indicated that depressive symptoms did not play a mediating role in the association between hearing impairment only and SCD.\u003c/p\u003e \u003cp\u003eIn contrast, depressive symptoms partially mediated the associations between vision impairment only and SCD, as well as between dual sensory impairment and SCD:\u003c/p\u003e \u003cp\u003eFor vision impairment only: The total effect on SCD severity was 1.576 (95% CI: 1.100\u0026ndash;2.037, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and the direct effect after adjusting for depressive symptoms was 1.469 (95% CI: 1.017\u0026ndash;1.919, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The indirect effect via depressive symptoms was 0.107 (95% CI: 0.005\u0026ndash;0.225, p\u0026thinsp;=\u0026thinsp;0.032), accounting for 6.8% of the total effect.\u003c/p\u003e \u003cp\u003eFor dual sensory impairment: The total effect on SCD severity was 2.100 (95% CI: 1.665\u0026ndash;2.530, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and the direct effect was 2.001 (95% CI: 1.584\u0026ndash;2.436, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The indirect effect via depressive symptoms was 0.100 (95% CI: 0.019\u0026ndash;0.193, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), representing 4.7% of the total effect.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMediation analysis of depression in the association between Sensory impairments and SCD\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"11\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMediator\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eIndependent variable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eTotal effect\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eDirect effect\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c9\" namest=\"c7\"\u003e \u003cp\u003eIndirect effect\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e \u003cp\u003eProportion mediated, %\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCoefficient (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCoefficient\u003c/p\u003e \u003cp\u003e(95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eCoefficient\u003c/p\u003e \u003cp\u003e(95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePHQ-9 Score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHearing impairment only\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.514 (0.145, 0.874)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.012\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.544 (0.201, 0.869)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-0.031 (-0.133, 0.066)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e0.522\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePHQ-9 Score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eVision impairment only\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.576 (1.100, 2.037)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.469 (1.017, 1.919)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.107 (0.005, 0.225)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e0.032\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e6.8%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePHQ-9 Score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDual sensory impairment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.100 (1.665, 2.530)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.001 (1.584, 2.436)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.100 (0.019, 0.193)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e4.7%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAll models were adjusted for age, sex, marital status, educational level, residence, financial stress, drinking status, smoking status, hypertension, diabetes, polypharmacy, PASE score, MNA score and GAD-7 score.\u003c/p\u003e \u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eIn this study, we found that sensory impairments are significantly and positively associated with SCD severity. While prior studies have linked sensory impairments to objective cognitive decline or dementia, few have focused on SCD\u0026mdash;the earliest self-perceived stage of cognitive deterioration.\u003csup\u003e\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e\u003c/sup\u003e A study by Li Qi et al.\u003csup\u003e50\u003c/sup\u003e in Chinese older adults found an association between VI and objective memory decline but did not examine SCD or DI. Our results fill this gap by demonstrating that sensory impairments (especially DI) are associated with SCD, which precedes measurable cognitive deficits and Alzheimer\u0026rsquo;s disease (AD) clinical symptoms. This is critical because SCD is a modifiable phase for intervention\u0026mdash;targeting sensory impairments here may delay progression to objective cognitive decline.This finding aligns with the \"sensory-cognitive integration\" framework\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e, which posits that sensory function is a foundational channel for older adults to interact with the external environment\u0026mdash;impairments in this channel disrupt the flow of cognitive stimuli, leading to disuse of cognitive processes and subsequent self-perceived decline. For example, VI may limit engagement in activities requiring visual attention (e.g., reading, recognizing faces), while HI may hinder verbal communication and social interaction\u0026mdash;both of which reduce cognitive \"exercise\" and increase SCD risk. The more severe association of DI may reflect a \"cumulative burden\" effect: concurrent loss of vision and hearing creates a more profound disconnection from the environment, amplifying cognitive disuse and SCD symptoms compared to single sensory loss.\u003csup\u003e\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e, \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e\u003c/sup\u003e A longitudinal study in Europe involving 3,000 elderly people found that the risk of cognitive decline in elderly people with DI was 2.3 times that of elderly people without sensory impairment, which further supports the \"cumulative burden\" effect proposed in this study.\u003csup\u003e\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eSecond, the \u003cb\u003egradient of association (DI\u0026thinsp;\u0026gt;\u0026thinsp;VI\u0026thinsp;\u0026gt;\u0026thinsp;HI)\u003c/b\u003e consistent with some international studies but contradicts others. For example, a U.S.-based study by Deal et al.\u003csup\u003e54\u003c/sup\u003e reported stronger associations of HI with cognitive decline compared to VI, while our study found the opposite. This discrepancy may reflect cultural differences in sensory reliance: in China, visual cues (e.g., written communication, facial expressions in social interactions) are often more central to daily life than auditory cues, making VI more disruptive to cognitive engagement. Additionally, the higher prevalence of uncorrected VI (e.g., untreated cataracts) in our sample (31.58% VI vs. 40.79% HI) may contribute to its stronger association with SCD\u0026mdash;uncorrected sensory loss likely has a more severe impact on cognitive function than corrected loss.\u003csup\u003e\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e\u003c/sup\u003e A survey on the correction rate of sensory impairment in China showed that the correction rate of vision impairment in the elderly is only 35.2%, while the correction rate of hearing impairment is 18.7%. Although the correction rate of hearing impairment is lower, the demand for visual function in daily life (such as reading medicine instructions, crossing the road) is higher, so uncorrected vision impairment has a more significant impact on cognitive function.\u003csup\u003e\u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThird, depressive symptoms partially mediate the associations of VI and DI with SCD but do not mediate the HI-SCD relationship. This differential mediation suggests distinct psychosocial pathways linking different sensory impairments to SCD. For VI and DI, sensory loss may trigger depressive symptoms through two mechanisms: (1) \u003cb\u003eactivity restriction\u003c/b\u003e: VI limits mobility (e.g., fear of falling outdoors) and participation in social or leisure activities, leading to social isolation and loneliness\u0026mdash;a well-established precursor to depression; (2) \u003cb\u003eself-efficacy decline\u003c/b\u003e: Difficulty performing daily tasks (e.g., preparing meals, managing medications) due to VI or DI erodes self-confidence, fostering negative affect. In turn, depression may exacerbate SCD through rumination (e.g., excessive worry about memory) or neurobiological pathways (e.g., elevated cortisol levels impairing hippocampal function, a region critical for memory).\u003csup\u003e\u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e\u003c/sup\u003e A neuroimaging study involving older adults with VI found that hippocampal volume was significantly smaller in those with concurrent depressive symptoms compared to those without, which provides neurobiological evidence for the mediating role of depression in the VI-SCD relationship [58]. In contrast, the lack of mediation for HI may be due to cultural differences in coping with hearing loss: in Chinese communities, family members often act as \"hearing intermediaries\" (e.g., relaying conversations), reducing the social isolation and activity restriction caused by HI. This buffering effect may weaken the link between HI and depressive symptoms, thereby eliminating the mediating role of depression. A qualitative study in rural southern China found that 68.2% of elderly people with HI reported relying on family members to assist with auditory communication, which supports this hypothesis.\u003csup\u003e\u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThe absence of mediation for HI is notable and may be explained by \u003cb\u003eadaptive coping behaviors\u003c/b\u003e specific to hearing loss. Unlike vision, which is often relied on for immediate environmental awareness, hearing loss can be partially mitigated by assistive devices (e.g., hearing aids) or behavioral strategies (e.g., lip-reading, asking others to speak louder). These adaptations may reduce the psychological distress associated with HI, preventing the cascade from sensory loss to depression to SCD. Additionally, HI may affect cognitive function more directly (e.g., through auditory signal degradation in the brainstem, which overlaps with cognitive processing pathways) rather than indirectly via depression\u003csup\u003e\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e\u003c/sup\u003e\u0026mdash;consistent with our finding of a direct HI-SCD association independent of depressive symptoms.\u003c/p\u003e \u003cp\u003eFinally, subgroup and sensitivity analyses confirm the robustness of the associations. The positive links between sensory impairments and SCD remained consistent across subgroups defined by residence (urban/rural), gender, physical activity level, nutritional status, and chronic conditions (hypertension/diabetes). Excluding participants with smoking, hypertension, or diabetes\u0026mdash;factors previously linked to both sensory loss and cognitive decline\u003csup\u003e\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e, \u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e\u003c/sup\u003e\u0026mdash;did not alter the magnitude or significance of the associations. This suggests that the sensory impairment-SCD relationship is not confounded by these common comorbidities and is generalizable to diverse community-dwelling older adults in Southern China.\u003c/p\u003e \u003cp\u003ePractically, our results provide targeted strategies for cognitive health intervention in older adults in southern China. First, screening and correcting sensory impairments (especially DI and VI) should be integrated into community-based elderly health management. For example, regular vision and hearing check-ups, free distribution of affordable glasses, and subsidies for hearing aids could reduce uncorrected sensory loss. \u003csup\u003e60\u003c/sup\u003eSecond, for elderly people with VI or DI, psychological interventions targeting depressive symptoms (e.g., cognitive behavioral therapy, group counseling) should be prioritized to break the \"sensory impairment \u0026rarr; depression \u0026rarr; SCD\" chain. A randomized controlled trial in Shanghai found that a combined sensory correction and psychological intervention program reduced SCD severity by 32.1% in elderly participants with DI, which supports the feasibility of this approach.\u003csup\u003e\u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e\u003c/sup\u003e Third, for elderly people with HI, community-based support systems (e.g., training family members as \"hearing assistants\") could be further strengthened to maintain social engagement and prevent cognitive decline.\u003c/p\u003e \u003cp\u003eHowever, our study has several limitations. First, while we observed associations between sensory impairments and SCD, we cannot establish \u003cb\u003ecausality\u003c/b\u003e. Secondly, we relied on self-report to assess VI and HI, which may underestimate or overestimate true impairment (e.g., participants may not recognize mild sensory loss or overreport difficulties due to anxiety). Objective assessments (e.g., visual acuity tests, pure-tone audiometry) would improve accuracy in future studies\u003csup\u003e\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e, \u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e\u003c/sup\u003e. Third, the sample was drawn from Southern China, where socioeconomic status, healthcare access, and cultural practices differ from Northern China or other countries. Results may not apply to older adults in rural areas of other provinces or non-Chinese populations.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e"},{"header":"5. Conclusion","content":"\u003cp\u003eSensory impairments, particularly dual impairment, are significantly associated with SCD in older adults. Depressive symptoms partially mediate these associations, highlighting a potential psychosocial pathway linking sensory loss and early cognitive concerns. Given that SCD represents the earliest self-perceived cognitive change, occurring prior to measurable cognitive impairment and other clinical symptoms of Alzheimer\u0026rsquo;s disease, these findings underscore the critical importase findings have important implications for public health strategies aimed at preventing cognitive deterioration among Chinese older adults. Timely interventions targeting these modifiable factors may help delay or mitigate the onset of objective cognitive decline and preserve cognitive health in aging populations.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eAD\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Alzheimer\u0026apos;s Disease\u003c/p\u003e\n\u003cp\u003eCI\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Confidence Interval\u003c/p\u003e\n\u003cp\u003eDI\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Dual Impairment\u003c/p\u003e\n\u003cp\u003eGAD-7\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Generalized Anxiety Disorder-7\u003c/p\u003e\n\u003cp\u003eHI\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Hearing Impairment\u003c/p\u003e\n\u003cp\u003eMNA\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Mini Nutritional Assessment\u003c/p\u003e\n\u003cp\u003eOR\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Odds Ratio\u003c/p\u003e\n\u003cp\u003ePHQ-9\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Patient Health Questionnaire-9\u003c/p\u003e\n\u003cp\u003ePASE\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Physical Activity Scale for the Elderly\u003c/p\u003e\n\u003cp\u003eSCD\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Subjective Cognitive Decline\u003c/p\u003e\n\u003cp\u003eSCD-Q9\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Subjective Cognitive Decline Questionnaire-9\u003c/p\u003e\n\u003cp\u003eSD\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Standard Deviation\u003c/p\u003e\n\u003cp\u003eVI \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Vision Impairment\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was conducted in strict accordance with the ethical principles outlined in the World Medical Association (WMA) Declaration of Helsinki\u0026nbsp;\u0026ndash;\u0026nbsp;Ethical Principles for Medical Research Involving Human Participants (2024 revision, https://www.wma.net/policies-post/wma-declaration-of-helsinki/).\u003c/p\u003e\n\u003cp\u003eEthics approval for this study was obtained from the Ethics Committee of The First Affiliated Hospital, Sun Yat-Sen University. The committee reviewed and approved the study protocol, including procedures for participant recruitment, structured face-to-face interviews, data collection, storage, and confidentiality protection, ensuring full compliance with national and international ethical standards for research involving human participants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors confirm that all participants (or their legal representatives) have provided written consent for the publication of this study and its associated data.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\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\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was supported by the Guangdong Provincial Science and Technology Planning Project (Grant No. 2023B110009).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eShengwei Wang, Jinjun Li, and Wen He conceived and designed the study.\u003c/p\u003e\n\u003cp\u003eJinjun Li, Miaohong Chen, and Ling Zhang collected the data.\u003c/p\u003e\n\u003cp\u003eShengwei Wang and Ling Zhang performed the statistical analyses.\u003c/p\u003e\n\u003cp\u003eQiaochao Chen and Wen He drafted the manuscript.\u003c/p\u003e\n\u003cp\u003eAll authors revised the manuscript critically, approved the final version, and agreed to be accountable for all aspects of the work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eRabin LA, Smart CM, Crane PK, et al. 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The association between sensory impairment and motoric cognitive risk syndrome in Chinese.\u003c/span\u003e \u003cspan\u003eolder. adults. 2024.\u003c/span\u003e\u003c/li\u003e\u003c/ol\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":"Subjective cognitive decline (SCD), Sensory impairment, Depression, Older adults, Cross-sectional study","lastPublishedDoi":"10.21203/rs.3.rs-8432557/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8432557/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003eSubjective cognitive decline (SCD), the self-experienced onset of cognitive deterioration before deficits are measurable, is an early Alzheimer\u0026rsquo;s marker. Little is known about whether vision (VI), hearing (HI) or dual sensory impairment (DI) predicts SCD in Chinese older adults, or whether depressive symptoms mediate such links.\u003c/p\u003e\u003ch2\u003eMaterials and Methods\u003c/h2\u003e \u003cp\u003eCross-sectional community survey in Guangdong, January\u0026ndash;October 2024. 1,162 participants aged 65\u0026ndash;98 (mean 73.7\u0026thinsp;\u0026plusmn;\u0026thinsp;6.8; 52.7% female). SCD was quantified with the 9-item Subjective Cognitive Decline Questionnaire; depression with PHQ-9; VI/HI by self-report. Multiple linear regression, subgroup and sensitivity analyses tested sensory\u0026ndash;SCD associations; bias-corrected bootstrapping assessed mediation by depression.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eOverall SCD prevalence 42.9%. Relative to no impairment, severity of SCD was higher in HI (β\u0026thinsp;=\u0026thinsp;0.589, 95% CI 0.229\u0026ndash;0.949), VI (β\u0026thinsp;=\u0026thinsp;1.597, 1.159\u0026ndash;2.036) and DI (β\u0026thinsp;=\u0026thinsp;2.072, 1.678\u0026ndash;2.466) after full adjustment (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Effects were consistent across sex, residence, physical activity, nutrition, hypertension and diabetes; excluding smokers or individuals with hypertension/diabetes did not alter results. Depression mediated 6.8% of the VI\u0026ndash;SCD effect and 4.7% of the DI\u0026ndash;SCD effect (1,000 bootstrap samples), but mediation was non-significant for HI alone.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eSensory impairments, particularly concurrent VI and HI, are strongly associated with SCD in southern Chinese elders. Depressive symptoms partially explain these links, indicating a modifiable psychosocial pathway. Early detection and management of sensory loss and depression may help forestall subsequent\u003c/p\u003e","manuscriptTitle":"Sensory Impairment and Subjective Cognitive Decline in Older Adults: A Cross-Sectional Study of Depression as Mediators in Southern China","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-16 09:38:05","doi":"10.21203/rs.3.rs-8432557/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":"daf08261-6b86-4d12-b6dc-873aa77ee9f2","owner":[],"postedDate":"February 16th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-03-25T07:26:40+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-16 09:38:05","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8432557","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8432557","identity":"rs-8432557","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}