Article 2026-04-23 under-review v1

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

C
Ce Shi Anhui University of Traditional Chinese Medicine
L
Lihua Wu Henan University of Traditional Chinese Medicine
Q
Qiqi Yang Anhui University of Traditional Chinese Medicine
F
Fei Wang Anhui University of Traditional Chinese Medicine
X
Xiang Shang Anhui University of Traditional Chinese Medicine
T
Tianxin Jiang Anhui University of Traditional Chinese Medicine
B
Baoguo Wang Anhui University of Traditional Chinese Medicine
J
Jianhong Gao Anhui University of Traditional Chinese Medicine
W
Weiran Li Anhui University of Traditional Chinese Medicine
Z
Ziyu Ye Anhui University of Traditional Chinese Medicine
F
Fei Li Anhui University of Traditional Chinese Medicine

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.

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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