Association between Life Satisfaction and Incident Stroke in Middle-Aged and Older Chinese Adults: A Prospective Cohort Study from the CHARLS.

INTRODUCTION

While conventional risk factors fail to fully explain stroke incidence, psychological well-being has emerged as a potential determinant of cerebrovascular health. The aim of this study was to investigate the prospective association between baseline life satisfaction and incident stroke among middle-aged and older Chinese adults.

METHODS

About 15,225 participants aged ≥45 years were included from the China Health and Retirement Longitudinal Study (CHARLS, 2011-2020). Life satisfaction was assessed at baseline using a single-item 5-point scale. Incident stroke was self-reported in follow-up waves. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs), adjusting for sociodemographic factors, lifestyle behaviors, comorbidities, and depression symptoms. Subgroup analyses were performed by age, gender, comorbidities, BMI, and depression symptoms.

RESULTS

Over the follow-up of 9 years, 1,296 participants (8.5%) developed stroke. Higher life satisfaction was associated with a significantly reduced risk of stroke (HR: 0.83; 95% CI: 0.72-0.95). Subgroup analyses indicated that the protective association was more pronounced among older adults, females, participants with chronic conditions (hypertension, diabetes, heart disease), overweight individuals, and those with depression symptoms.

CONCLUSIONS

Higher life satisfaction was prospectively associated with a lower risk of incident stroke in middle-aged and older Chinese adults. Given the observational design and reliance on self-reported measures, these findings should be interpreted as evidence of association rather than causation. Future studies incorporating repeated assessments of well-being and clinically verified stroke outcomes are warranted.