Journal of Shandong University (Health Sciences) ›› 2026, Vol. 64 ›› Issue (6): 115-126.doi: 10.6040/j.issn.1671-7554.0.2025.1162

• Public Health and Preventive Medicine • Previous Articles    

Association between multimorbidity of chronic diseases and subjective and objective cognitive function in rural middle-aged and older adults

MENG Kexin1, WANG Qi1, YU Ruihong2, XU Ruiqi1, FU Chunying1, XIE Bo1, ZHU Dongshan1,3   

  1. 1. Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan 250012, Shandong, China;
    2. Pingyin Center for Disease Control and Prevention, Jinan 250400, Shandong, China;
    3. Center for Clinical Epidemiology and Evidence-Based Medicine, Shandong University, Jinan 250012, Shandong, China
  • Published:2026-06-29

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Abstract: Objective To investigate the association between chronic diseases/multimorbidity and subjective/objective cognitive function among middle-aged and older adults in rural China, providing evidence for developing targeted intervention strategies. Methods Utilizing data from the Pingyin Chronic Disease and Cognitive Aging Cohort, 3,132 rural residents aged 45-70 years were enrolled through multi-stage sampling. Subjective cognitive decline was assessed using the subjective cognitive decline questionnaire-9(SCD-Q9), while objective cognitive function was evaluated with the Montreal cognitive assessment-basic(MoCA-B). Based on 19 chronic diseases, participants were categorized by multimorbidity level: no multimorbidity(0-1 disease), low-level multimorbidity(2-3 diseases), and high-level multimorbidity(≥4 diseases). Logistic regression and multiple linear regression models were applied to examine the associations. Results The prevalence rates of abnormal subjective and objective cognitive scores were 57.5% and 60.5%, respectively. Univariate analysis showed that both subjective and objective cognitive impairment rates increased with higher multimorbidity levels(P<0.001). Multivariable logistic regression analysis revealed that, after adjusting for demographic characteristics, lifestyle factors, and depression status, multimorbidity level was independently and positively associated with abnormal SCD-Q9 scores(low-level multimorbidity: OR=1.52, 95%CI: 1.27-1.82; high-level multimorbidity: OR=3.00, 95%CI: 1.80-5.03), but showed no independent association with abnormal MoCA-B scores(P>0.05). Multiple linear regression analysis further confirmed a linear dose-response relationship between the number of chronic diseases and SCD-Q9 scores(β=0.34, 95%CI: 0.27-0.42), whereas no significant association was found with MoCA-B scores. Advanced age, low education level, and depression were common risk factors for both subjective and objective cognitive impairment, while females exhibited higher susceptibility specifically to subjective cognitive decline. Conclusion Multimorbidity is significantly associated with subjective cognitive decline in a dose-response manner among rural middle-aged and older adults, but shows no independent association with objective cognitive impairment.

Key words: Cognitive function, Chronic disease, Multimorbidity, Rural middle-aged and older adults, Healthy aging

CLC Number: 

  • R195.4
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