Stroke and cognitive decline: associations of social support and family connections in CHARLS and ELSA cohorts
- 1Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province 430030 China
- 2Department of Neurosurgery, Western Theater Command Air Force Hospital, Chengdu, Sichuan Province 6000211 China
Abstract
Background: Stroke is associated with accelerated cognitive decline in older adults, but whether social support and family connections statistically moderate this association has rarely been tested formally in longitudinal, cross-national data.
Methods: We analyzed the China Health and Retirement Longitudinal Study (CHARLS; N = 11,569; Wave 1 [2011] baseline to Wave 4 [2018], up to 7.2 years) and the English Longitudinal Study of Ageing (ELSA; N = 5,713; Wave 3 [2006–2007] baseline to Wave 9 [2019], up to 13.0 years). Cognitive function was assessed with a harmonized composite (orientation, immediate and delayed word recall, plus pentagon drawing in CHARLS). Linear mixed-effects models with random intercepts and slopes estimated the incident-stroke × time interaction (annual cognitive decline, points/year), adjusting for age, sex, BMI, education, marital status, smoking, drinking, comorbidity count, and residence (CHARLS only). A three-way interaction (stroke × social support/family connection × time) formally tested moderation. Propensity-score matching (1:2 nearest-neighbor) and subgroup analyses (age, sex, education) served as sensitivity analyses.
Results: Incident stroke occurred in 770 CHARLS (6.6%) and 347 ELSA (6.1%) participants. In fully adjusted models, stroke was associated with significantly faster cognitive decline in both cohorts (CHARLS: β = −0.068 points/year, 95% CI − 0.123 to − 0.013, p = 0.016; ELSA: β = −0.190, 95% CI − 0.229 to − 0.152, p < 0.001); after propensity-score matching, the ELSA association remained robust (β = −0.150, p < 0.001) while the CHARLS estimate was attenuated and no longer significant (β = −0.029, p = 0.386). The formal three-way interaction showed that higher family connection significantly attenuated stroke-related decline in ELSA ; the corresponding interaction for social support in CHARLS was directionally consistent but not significant (β = +0.082, 95% CI − 0.037 to 0.202, p = 0.177). Subgroup analyses showed a significant stroke-decline association across all age, sex, and education strata in ELSA, and only among male and less-educated participants in CHARLS.
Conclusion: Incident stroke was associated with faster cognitive decline in both a Chinese and an English cohort of middle-aged and older adults.
A formal statistical test indicated that family connections significantly moderated this association in ELSA, whereas a similar but non-significant pattern was observed for social support in CHARLS.
These associations warrant further investigation of social relationships as a potentially modifiable factor in post-stroke cognitive health; the observational design precludes causal conclusions.
Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s12889-026-28890-0.
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BibTeX
@article{li2026stroke,
title = {{Stroke and cognitive decline: associations of social support and family connections in CHARLS and ELSA cohorts}},
author = {Mingdong Li and Kewei Xiao and Chaoli Song and Shengrong Long},
journal = {BMC Public Health},
year = {2026},
month = aug,
doi = {10.1186/s12889-026-28890-0},
url = {https://doi.org/10.1186/s12889-026-28890-0},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Stroke and cognitive decline: associations of social support and family connections in CHARLS and ELSA cohorts
AU - Mingdong Li
AU - Kewei Xiao
AU - Chaoli Song
AU - Shengrong Long
PY - 2026
DA - 2026/08/06
JO - BMC Public Health
DO - 10.1186/s12889-026-28890-0
UR - https://doi.org/10.1186/s12889-026-28890-0
AB - Background: Stroke is associated with accelerated cognitive decline in older adults, but whether social support and family connections statistically moderate this association has rarely been tested formally in longitudinal, cross-national data. Methods: We analyzed the China Health and Retirement Longitudinal Study (CHARLS; N = 11,569; Wave 1 [2011] baseline to Wave 4 [2018], up to 7.2 years) and the English Longitudinal Study of Ageing (ELSA; N = 5,713; Wave 3 [2006–2007] baseline to Wave 9 [2019], up to 13.0 years). Cognitive function was assessed with a harmonized composite (orientation, immediate and delayed word recall, plus pentagon drawing in CHARLS). Linear mixed-effects models with random intercepts and slopes estimated the incident-stroke × time interaction (annual cognitive decline, points/year), adjusting for age, sex, BMI, education, marital status, smoking, drinking, comorbidity count, and residence (CHARLS only). A three-way interaction (stroke × social support/family connection × time) formally tested moderation. Propensity-score matching (1:2 nearest-neighbor) and subgroup analyses (age, sex, education) served as sensitivity analyses. Results: Incident stroke occurred in 770 CHARLS (6.6%) and 347 ELSA (6.1%) participants. In fully adjusted models, stroke was associated with significantly faster cognitive decline in both cohorts (CHARLS: β = −0.068 points/year, 95% CI − 0.123 to − 0.013, p = 0.016; ELSA: β = −0.190, 95% CI − 0.229 to − 0.152, p < 0.001); after propensity-score matching, the ELSA association remained robust (β = −0.150, p < 0.001) while the CHARLS estimate was attenuated and no longer significant (β = −0.029, p = 0.386). The formal three-way interaction showed that higher family connection significantly attenuated stroke-related decline in ELSA ; the corresponding interaction for social support in CHARLS was directionally consistent but not significant (β = +0.082, 95% CI − 0.037 to 0.202, p = 0.177). Subgroup analyses showed a significant stroke-decline association across all age, sex, and education strata in ELSA, and only among male and less-educated participants in CHARLS. Conclusion: Incident stroke was associated with faster cognitive decline in both a Chinese and an English cohort of middle-aged and older adults. A formal statistical test indicated that family connections significantly moderated this association in ELSA, whereas a similar but non-significant pattern was observed for social support in CHARLS. These associations warrant further investigation of social relationships as a potentially modifiable factor in post-stroke cognitive health; the observational design precludes causal conclusions. Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s12889-026-28890-0.
SN - 1471-2458
ER -