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Four-year trajectories of episodic memory decline in mid-late life by living arrangements: a cross-national comparison between China and England
  1. Yaoyue Hu1,
  2. Milagros Ruiz2,
  3. Martin Bobak2,
  4. Pekka Martikainen3,4,5
  1. 1School of Public Health and Management, Chongqing Medical University, Chongqing, China
  2. 2Research Department of Epidemiology and Public Health, University College London, London, UK
  3. 3Population Research Unit, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
  4. 4Max Planck Institute for Demographic Research, Rostock, Germany
  5. 5Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
  1. Correspondence to Professor Yaoyue Hu, School of Public Health and Management, Chongqing Medical University, Chongqing 400016, China;{at}


Background There is mixed evidence on the association between living arrangements and mid-late life cognition, which may be due to distinct familial arrangements and preferences between populations. To address such heterogeneity, we assessed these associations in China and England.

Methods Four-year trajectories of episodic memory scores (0–20, word recall test) by living arrangements (living with partner only, living with partner and children/grandchildren, living with no partner but with children/grandchildren, and living alone) were estimated using latent growth curve modelling for men and women aged 50+ from China (n=12 801) and England (n=10 964).

Results After adjusting for baseline socioeconomic, health behaviours and health covariates, worse baseline memory was found in Chinese adults living with no partner but with children/grandchildren and in Chinese women living with partner and children/grandchildren, compared with those living with partner only. Better baseline memory was associated with living alone in English women. A faster memory decline was found in Chinese men living with no partner but with children/grandchildren (−0.122 word/year, 95% CI −0.213 to –0.031), as well as in English women living with children/grandchildren with (−0.114, 95% CI −0.180 to –0.049) or without (−0.118, 95% CI −0.209 to –0.026) a partner, and those living alone (−0.075, 95% CI −0.127 to –0.024). No differences at baseline nor over follow-up were found between English men in different living arrangements.

Conclusion Overall, our findings did not confirm the protective effects of co-residence with children/grandchildren, nor the detrimental effects of living alone on mid-late life cognition in China and England.

  • cognition
  • social and life-course epidemiology
  • social factors
  • cohort studies

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  • YH and MR are joint first authors.

  • Contributors YH and MR, as joint first authors, conceived the study, developed the harmonised variables, conducted the scientific literature search, prepared the data for analysis, analysed the data, interpreted the results, and prepared the first and final drafts of the manuscript. MB and PM made substantial contributions to the analysis and interpretation of data and results, and critically reviewed the first and final drafts of the manuscript for important intellectual content. All authors agreed on the submission of this manuscript.

  • Funding MR, MB and PM are supported by a European Commission Horizon 2020 grant (#667661) as part of the Promoting Mental Wellbeing in the Ageing Population: Determinants, Policies and Interventions in European Cities (MINDMAP) research project. PM is also funded by the Academy of Finland (#1294861, #1308247). The funders had no role in the design and conduct of the study; collection, management, analysis and interpretation of the data; and preparation, review or approval of this manuscript.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Ethical approval was provided by the Ethical Review Committee of Peking University (IRB00001052-11015) and the London Multi-Centre Research Ethics Committee (MREC/01/2/91), respectively, for CHARLS and ELSA.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data from the China Health and Retirement Longitudinal Study and the English Longitudinal Study of Ageing are available in a public, open access repository (CHARLS:; ELSA:

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.