Trajectories of activities of daily living/ instrumental activities of daily living and the risk of cardiovascular diseases

Abstract

Background and aim

Prior research has reported the association between activities of daily living (ADL)/instrumental activities of daily living (IADL) of cardiovascular disease (CVD). We aimed to identify distinctive ADL/IADL trajectories and evaluate their relationship of the risk of CVD.

Methods and results

Our analysis included 7717 participants with four ADL/IADL assessments from the China Health and Retirement Longitudinal Study. Trajectories of ADL/IADL were identified by latent mixture modeling. Cox proportional hazards regression models were used to examine the association of ADL/IADL trajectories with CVD risk (stroke or cardiac events).

Three distinct ADL/IADL trajectory groups were identified: maintaining a low ADL/IADL score throughout the follow-up (low-low trajectory); low starting ADL/IADL scores then increasing to mild scores (low-mild trajectory), and mild starting ADL/IADL scores then increasing (mild-increasing trajectory). During a median follow-up of 24 months (23 months-25months), a total of 519 respondents experienced CVD (including 143 stroke and 394 cardiac events). Individuals with low-mild and mild-increasing ADL trajectory were significantly associated with higher risk of CVD, with the corresponding hazard ratios were 1.50(1.24–1.81) and 2.02(1.44–2.84), respectively, compared to the individuals with low-low IADL trajectory. Similarly, individuals with low-mild and mild-increasing IADL trajectory were associated with 29 % (hazard ratios = 1.29, 95 % confidence intervals 1.06–1.58) and 59 % (hazard ratios = 1.59, 95 % confidence intervals 1.13–2.22) increased risk of CVD. Furthermore, Individuals with low-mild and mild-increasing ADL/IADL trajectory also had higher risks of stroke and cardiac events.

Conclusion

Individuals with low-mild and mild-increasing ADL/IADL trajectory over time were associated with increased risk of incident CVD.