Educational attainment modifies the association between stroke history and orientation impairment among middle-aged and older Chinese adults: a cross-sectional study of CHARLS 2018
Abstract
Background Stroke contributes to cognitive impairment, but vulnerability varies. Education, a proxy for cognitive reserve and social advantage, may modify stroke-related orientation problems; evidence in China is limited. We examined whether education modifies the association between stroke history and orientation impairment in the 2018 China Health and Retirement Longitudinal Study (CHARLS).Methods We analyzed 2018 CHARLS participants aged ≥ 45 years. Orientation was assessed by five items (score 0–5); impairment was defined as score ≤ 3. Education was grouped as low, middle, or high. We fitted multivariable logistic regression with a stroke-by-education interaction and compared models using likelihood ratio tests; we also reported education-stratified adjusted odds ratios and marginally standardized predicted probabilities. Sensitivity analyses varied impairment thresholds and missing-data approaches.Results Among 16,972 participants, 869 (5.1%) reported physician-diagnosed stroke and 6,736 (39.7%) had orientation impairment. Evidence of effect modification was observed (interaction likelihood ratio test p = 0.049). In education-stratified models, stroke was associated with higher odds of impairment in the high-education group (adjusted odds ratio 1.51, 95% confidence interval 1.04–2.20), whereas estimates in the low and middle groups were closer to null. Predicted probabilities showed the largest stroke–no stroke contrast in the high-education group. Findings were directionally consistent across sensitivity analyses.Conclusions Educational attainment may modify the association between stroke history and orientation impairment in a large community sample of Chinese adults. The results highlight heterogeneity in post-stroke cognitive vulnerability and support risk-stratified cognitive surveillance, while longitudinal studies are needed to clarify temporality and mechanisms.
Keywords
Citation Information
@article{ceshi2026,
title={Educational attainment modifies the association between stroke history and orientation impairment among middle-aged and older Chinese adults: a cross-sectional study of CHARLS 2018},
author={Ce Shi and Lihua Wu and Qiqi Yang and Fei Wang and Xiang Shang and Tianxin Jiang and Baoguo Wang and Jianhong Gao and Weiran Li and Ziyu Ye and Fei Li},
journal={Scientific Reports},
year={2026},
doi={https://doi.org/10.21203/rs.3.rs-8765346/v1}
}
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