Baseline hypertension, adiposity, depressive symptoms, and incident stroke in middle-aged and older Chinese adults: a longitudinal analysis of CHARLS, 2011-2020.

BACKGROUND

Stroke is a major cause of disability and death among middle-aged and older adults in China. Hypertension, adiposity, and depressive symptoms often coexist, but their associations with incident stroke are often examined separately. We assessed baseline cardiometabolic, adiposity-related, and psychosocial factors associated with first reported incident stroke in a longitudinal China Health and Retirement Longitudinal Study (CHARLS) cohort.

METHODS

We used CHARLS data. Participants aged 45 years or older who were free of stroke at baseline and had at least one follow-up assessment were eligible. A person-period dataset was constructed to incorporate repeated follow-up intervals and the timing of first reported incident stroke. Person-period modified Poisson regression models with participant-level cluster-robust standard errors were used to estimate risk ratios (RRs) and 95% confidence intervals (CIs).

RESULTS

Among 15,992 eligible participants, 1,246 first reported incident stroke events were identified during follow-up. The body mass index (BMI) and waist circumference complete-case models included 11,674 and 11,604 participants, with 949 and 941 incident stroke events, respectively. In the BMI model, hypertension (RR, 1.80; 95% CI, 1.56-2.07), diabetes (RR, 1.51; 95% CI, 1.21-1.88), heart problems (RR, 1.39; 95% CI, 1.17-1.64), BMI (RR per 1 kg/m², 1.05; 95% CI, 1.03-1.06), and 10-item Center for Epidemiologic Studies Depression Scale (CESD-10) score (RR per 1 point, 1.03; 95% CI, 1.02-1.04) were associated with increased stroke risk. In the waist circumference model, waist circumference was also positively associated with incident stroke (RR per 1 cm, 1.02; 95% CI, 1.01-1.03). Sensitivity analyses yielded broadly consistent results.

CONCLUSIONS

Hypertension, diabetes, heart problems, higher BMI, larger waist circumference, and higher CESD-10 score were associated with increased risk of first reported incident stroke among middle-aged and older Chinese adults. These observational findings suggest that vascular, adiposity-related, and psychosocial factors may help characterize stroke risk in this population, but they should be interpreted cautiously given anthropometric missingness, self-reported stroke ascertainment, and potential residual confounding.