A health ecological model study of subjective cognitive decline among hypertensive patients in rural Shanxi, China.

Authors

Ruifeng Liang, Jiawei Liu, Wenhua Sun, Siyi Li, Jue Wang, Qiao Niu, Hongmei Yu, Xiaojiang Qin, Hongmei Zhang, Jisheng Nie, Zhihong Zhang, Jianying Bai, Simin Li, Shuhong Zhao

Published in

Scientific reports. Jul 14, 2026. Epub Jul 14, 2026.

Abstract

Hypertension and subjective cognitive decline (SCD) frequently co-occur, consistent with broader multimorbidity patterns observed in aging populations and highlighting the need for targeted assessment of associated factors. This study aimed to test the hypothesis that multi-level factors across the five Health Ecological Model (HEM) layers are independently associated with SCD among hypertensive patients in rural China, and to identify specific associated factors within each layer. We conducted a cross-sectional study from May to August 2024 with 860 hypertensive patients selected from three rural counties in Shanxi Province, China (Daning and Yonghe counties in Linfen City, and Yangqu County in Taiyuan City) via multi-stage cluster random sampling. Participants were categorized into non-SCD (SCD-Q9 score < 5) and SCD (≥ 5) groups based on self-reported cognitive symptoms.Variables were classified into five HEM layers, and logistic regression was employed to identify associated factors. Based on self-reported screening, 80.58% of participants met the criteria for SCD. Multi-level factors were significantly associated with SCD. In the Individual Characteristics Layer, advanced age (OR = 1.042, 95% CI 1.010 ~ 1.074), family history of hypertension (OR = 2.352, 95% CI 1.550 ~ 3.570), hypertensive complications (OR = 3.049, 95% CI 1.680 ~ 5.534) and moderate hypertension risk level (OR = 1.847, 95% CI 1.149 ~ 2.968) were associated with higher odds of SCD. Within the Behavior and Lifestyle Layer, lack of physical exercise (OR = 1.611, 95% CI 1.075 ~ 2.412) and fairly good and fairly poor sleep quality (fairly good: OR = 1.644, 95% CI 1.063 ~ 2.543; fairly poor: OR = 1.939, 95% CI 1.017 ~ 3.698) were associated with SCD, while former drinker was associated with lower odds of SCD (OR = 0.294, 95% CI 0.107 ~ 0.809), although this association may reflect residual confounding and should not be interpreted causally. In the Working and Living Conditions Layer, lower household income (< 1000 CNY: OR = 3.282, 95% CI 1.647 ~ 6.540), utilization of county-level hospitals (OR = 1.697, 95% CI 1.077 ~ 2.676), and mild depression (OR = 2.068, 95% CI 1.215 ~ 3.519) were associated with SCD. In the Policy Environment Layer, no significant associations were observed. These findings identify multi-level factors associated with SCD in this population, highlighting potential areas for integrated prevention strategies, though longitudinal studies are needed to establish their predictive value.

PMID:
42448799
Bibliographic data and abstract were imported from PubMed on 15 Jul 2026.

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