# The Impact of Social Stress and Healthy Lifestyle on the Mortality of Chinese Older Adults: Prospective Cohort Study

## TL;DR

This study finds that social stress increases mortality risk in older Chinese adults, and this effect is partly reduced by maintaining a healthy lifestyle.

## Contribution

The study identifies social stress as an independent predictor of mortality and quantifies the mediating role of healthy lifestyle behaviors in Chinese older adults.

## Key findings

- High social stress is associated with a 28-38% increased mortality risk in older adults.
- Approximately 7% of the mortality risk from social stress is mediated through lifestyle behaviors.
- Unhealthy lifestyles increase mortality risk regardless of social stress levels.

## Abstract

With social progress, social stress (SS) has become a key factor affecting health. Unhealthy lifestyles may exacerbate these effects. However, the relationship between SS, lifestyle, and older adults’ mortality rate still needs to be studied.

This study aimed to explore the relationship between SS and all-cause mortality in Chinese older adults, as well as the influence of healthy lifestyle factors.

Three groups of SS were defined through latent class analysis: low, medium, and high. We created a healthy lifestyle index based on smoking, alcohol consumption, physical activity, and diet. Multivariable Cox proportional hazards models, interaction analyses, and mediation analyses were conducted.

The Chinese Longitudinal Healthy Longevity Survey (CLHLS) datasets included participants from 806 cities and counties across 23 provinces in China from 1998 to 2018. In this study, participants were recruited from 4 waves of the CLHLS (2005, 2008, 2011, and 2014). Finally, 19,236 participants were included in this study, of which 6891 (35.8%) had low SS, 11,662 (60.6%) had medium SS, and 683 (3.6%) had high SS. In the fully adjusted model, the hazard ratio (HR) for medium SS was 1.16 (95% CI 1.11‐1.20; P<.001), and for high SS, it was 1.28 (95% CI 1.18‐1.40; P<.001) compared to the low SS group. For individuals aged ≥80 years, the medium SS group had a 28% (HR 1.28, 95% CI 1.22‐1.34; P<.001) increased mortality risk, and the high SS group had a 38% (HR 1.38, 95%CI 1.26‐1.52; P<.001) increased risk compared to the low SS group. Approximately 7% of the association between SS and mortality was mediated through the healthy lifestyle. Under different SS, the lower the healthy lifestyle score, the higher the risk of mortality.

SS was an independent predictor of all-cause mortality in Chinese older adults. The healthy lifestyle mediated this effect to some extent. Unhealthy lifestyle behaviors were associated with a higher risk of mortality at all SS levels.