Influence of lifestyles on physical, psychological, and cognitive co-morbidity among older adults with diabetes in rural area

Yudong Miao^1*Mingyue Zhen¹Jingming Wei²Zhanlei Shen¹Jingbao Zhang¹Dongfang Zhu¹Junwen Bai¹Ruizhe Ren¹Dan Guo^3,4Clifford Silver Tarimo^3,5Jiajia Zhang³Jinxin Cui³Xinran Li³Wenyong Dong⁶Qiuping Zhao⁷

• ¹Department of Health Management, College of Public Health, Zhengzhou University, Zhengzhou, China
• ²Institute of Mental Health, Peking University Sixth Hospital, Beijing, Beijing Municipality, China
• ³Department of Health management, College of Public Health, Zhengzhou University, Zhengzhou, Henan Province, China
• ⁴Department of Neurology, Henan Provincial People’s Hospital, Zhengzhou, Henan Province, China
• ⁵Dar es Salaam Institute of Technology, Dar es Salaam, Tanzania
• ⁶Henan Provincial People's Hospital, Zhengzhou, Henan Province, China
• ⁷Fuwai Central China Cardiovascular Hospital, Zhengzhou, Henan Province, China

The association between lifestyles and the co-occurrence of physical, psychological, and cognitive conditions in older adults living with diabetes, especially in rural settings, remains unclear. This study investigated the prevalence of comorbidity and their association with lifestyle in a rural population of older adults with diabetes.Methods: From 1st July to 31 August 2023, a cross-sectional study based on the whole cluster sampling method was conducted in Jia County, Henan Province, China.Participants included adults aged ≥65 years. Lifestyle factors assessed included physical activity, diet, smoking, sleep, and social participation. Physical disease was defined as the presence of one or more chronic conditions, while psychological and cognitive disorders were measured using validated scales. Co-morbidity refers to the occurrence of physical, psychological, cognitive diseases. Depending on the number of diseases, we define different comorbidity status. The subgroups of subdivision included eight categories: no co-morbidity, physical co-morbidity, psychological co-morbidity, cognitive co-morbidity, and their four combinations. Logistic regression models were employed to estimate the association between lifestyles and co-morbidity. The net difference in lifestyle between co-morbidity categories was determined using the propensity score matching (PSM).Results: Among 6075 participants, the overall prevalence of physical, psychological, and cognitive co-morbidity was 86.08%. Regular physical activity, adequate sleep, healthy diet, and active social participation were associated with lower prevalence of co-morbidity. A one-unit increase in the lifestyle score was associated with a 34% (OR: 0.66, 95%CI: 0.61-0.72) reduction in the odds of physical-psychological-cognitive comorbidity. PSM analyses showed significant differences in lifestyle factors and scores across different co-morbidity status.Given the higher prevalence of co-morbidity in rural area and the positive association of lifestyle with co-morbidity status, multifactorial lifestyle interventions should be prioritized within diabetic populations to reduce the risk and burden of cooccurring conditions.