Chinese Longitudinal Healthy Longevity Survey (CLHLS) Chinese Longitudinal Healthy Longevity Study (CLHLS) collected longitudinal data coordinated by the Center for Healthy Aging and Development Studies of National School of Development at Peking University. The baseline survey was conducted in 1998 and the follow-up surveys were conducted in 2000, 2002, 2005, 2008-2009, 2011-2012, 2014 and 2017-2018 in randomly selected about half of the counties and city districts in 23 Chinese provinces. In the 8 waves of the CLHLS conducted in 1998-2018, we have conducted face-to-face home-based 113 thousands interviews, including 19.5 thousand centenarians, 26.8 thousands nonagenarians, 29.7 thousands octogenarians, 25.5 thousands younger elders aged 65-79, and 11.3 thousands middle-age adults aged 35-64. In the latest follow-up survey (2017-2018), 15,874 elder people aged 65 and above were visited, and information about 2,226 elder people deceased during 2014-2018 were collected. The questionnaire data collected provides information on family structure, living arrangements and proximity to children, activities of daily living (ADL), the capacity of physical performance, self-rated health, self-evaluation of life satisfaction, cognitive functioning, chronic disease prevalence, care needs and costs, social activities, diet, smoking and drinking behaviors, psychological characteristics, economic resources, and care giving and family support among elderly respondents and their relatives. Information about the health status of the CLHLS participants who were interviewed in the previous wave but died before the current survey was collected by interviewing a close family member. Information provided consists of cause of death, chronic diseases, ADL before dying, frequency of hospitalization or instances of being bedridden from the last interview until death, whether bedridden before death, length of disability and suffering before death, etc. As of March 10, 2020 according to incomplete statistics, there are 8019 registered CLHLS data users (excluding their students and other group members), and they produced following publications using the CLHLS datasets: 356 papers written in English, published in U.S. or European peer-reviewed journals, 455 papers written and published in peer-reviewed Chinese journals, 17 books (in English or in Chinese), 35 Ph.D. dissertations and 104 M.A. theses successfully defended at Universities inside and outside of China.

The project has been collecting detailed panel data about the health, disability, demographic, family, socioeconomic, and behavioral risk-factors for mortality and healthy longevity of the oldest old, with a comparative sub-sample of younger elders, to examine the factors in healthy longevity. The baseline survey was conducted in 1998 and the follow-up surveys with replacement to compensate for deceased elders were conducted in 2000, 2002, 2005, and 2008, For each centenarian, one near-by octogenarian (aged 80-89) and one near-by nonagenarian (aged 90-99) of pre-designated age and sex were interviewed. Near-by is loosely defined it could be in the same village or street if available, or in the same town or in the same county or city. The idea was to have comparable numbers of male and female octogenarians and nonagenarians at each age from 80 to 99. In 2002, the study added a refresher sub-sample of 4,845 interviewees aged 65-79, and a sub-sample of 4,478 adult children (aged 35-65) of the elderly interviewees aged 65-110 in eight provinces Comparative study of intergenerational relationships in the context of rapid aging and healthy longevity between Mainland China and Taiwan is possible. At each wave, the longitudinal survivors were re-interviewed, and the deceased interviewees were replaced by additional participants. Data on mortality and health status before dying for the 12,136 elders aged 65-112 who died between the waves were collected in interviews with a close family member of the deceased. The study also included interviews and follow-ups with 4,478 elderly interviewees'''' children aged 35-65. * Dates of Study: 1998-2005 * Study Features: Longitudinal, International * Sample Size: ** 1998: 8,993 ** 2000: 11,199 ** 2002: 16,064 ** 2005: 14,923 Links * Data Archive, http://www.geri.duke.edu/china_study/CLHLS6.htm * ICPSR, http://www.icpsr.umich.edu/icpsrweb/NACDA/studies/03891

Chinese Longitudinal Healthy Longevity Survey (CLHLS) WELCOME! The Chinese Longitudinal Healthy Longevity Survey (CLHLS) has been supported by NIA/NIH grants R01 AG023627-01 (PI: Zeng Yi) (Grant name: Demographic Analysis of Healthy Longevity in China) and P01 AG 008761 (PI: Zeng Yi; Program Project Director: James W. Vaupel), awarded to Duke University, with Chinese matching support for personnel costs and some local expenses. UNFPA and the China Social Sciences Foundation provided additional support for expanding the 2002 CLHLS survey. The Max Planck Institute for Demographic Research has provided support for international training since the CLHLS 1998 baseline survey. Finally, in December 2004 the China Natural Sciences Foundation and the Hong Kong Research Grants Council (RGC) partnered with NIA/NIH, providing grants to partially support the CLHLS project. Until present, the CLHLS conducted face-to-face interviews with 8,959, 11,161, 20,421, 18,524 and 19,863 individuals in 1998, 2000, 20002, 2005, and 2008-09, respectively, using internationally compatible questionnaires. Among the approximately 80,000 interviews conducted in the five waves, 14,290 were with centenarians, 18,910 with nonagenarians, 20,743 with octogenarians, 14,416 with younger elders aged 65-79, and 10,569 with middle-age adults aged 35-64. At each wave, survivors were re-interviewed, and deceased interviewees were replaced with new participants. Data on mortality and health status before dying for the 17,721 elders aged 65-110 who died between waves were collected in interviews with a close family member of the deceased. The CLHLS has the largest sample of centenarians in the world according to a report in Science (see the report). Our general goal is to shed new light on a better understanding of the determinants of healthy longevity of human beings. We are compiling extensive data on a much larger population of the oldest-old aged 80-112 than has previously been studied, with a comparison group of younger elders aged 65-79. We propose to use innovative demographic and statistical methods to analyze longitudinal survey data. Our goal is to determine which factors, out of a large set of social, behavioral, biological, and environmental risk factors, play an important role in healthy longevity. The large population size, the focus on healthy longevity (rather than on a specific disease or disorder), the simultaneous consideration of various risk factors, and the use of analytical strategies based on demographic concepts make this an innovative demographic data collection and research project. Our specific objectives are as follows: Collect intensive individual interview data including health, disability, demographic, family, socioeconomic, and behavioral risk factors for mortality and healthy longevity. Follow up the oldest-old and the comparison group of the younger elders, as well as some of the elders’ adult children to ascertain changes in their health status, care needs and costs, and associated factors. We will also ascertain mortality and causes of death, as well as care needs, costs, and health/disability status before death. Analyze the collected data to estimate the impacts of social, behavioral, environmental, and biological risk factors that are determinants of healthy longevity and mortality in the oldest-old. Compare the findings with results from other studies of large populations at advanced age.

The Chinese Longitudinal Healthy Longevity Survey (CLHLS) provides information on health status and quality of life of the elderly aged 65 and older in 22 provinces of China in the period 2002 to 2005. The study was conducted to shed light on the determinants of healthy human longevity and advanced age mortality. To this end, data were collected on a large percentage of the oldest population, including centenarian and nonagenarian; the CLHLS provides information on the health, socioeconomic characteristics, family, lifestyle, and demographic profile of this aged population. Data are provided on respondents' health conditions, daily functioning, self-perceptions of health status and quality of life, life satisfaction, mental attitude, and feelings about aging.

Respondents were asked about their diet and nutrition, use of medical services, and drinking and smoking habits, including how long ago they quit either or both. They were also asked about their physical activities, reading habits, television viewing, and religious activities, and were tested for motor skills, memory, and visual functioning. In order to ascertain their current state of health, respondents were asked if they suffered from such health conditions as hypertension, diabetes, heart disease, stroke, cancer, emphysema, asthma, tuberculosis, cataracts, glaucoma, gastric or duodenal ulcer, arthritis, Parkinson's disease, bedsores, or other chronic diseases. Respondents were further queried about assistance with bathing, dressing, toileting, or feeding, and who provided help in times of illness. Other questions focused on siblings, parents, and children, the frequency of family visits, and the distance lived from each other. Demographic and background variables include age, sex, ethnicity, place of birth, marital history and status, history of childbirth, living arrangements, education, main occupation before age 60, and sources of financial support.

Additional file 2: Table S1. Top ten frequent unique combination clusterswith multimorbidity, stratified by age. Table S2. Top ten frequentunique combination clusters with multimorbidity, stratified by sex. Table S3. Top ten frequent unique combination clusters with multimorbidity, stratified by residence. Table S4. Top ten frequent unique combination clusters with multimorbidity, stratified by region.

The CLHLS parent-child dyads datasets were collected by the Center for Healthy Aging and Development Studies (CHADS) of National School of Development at Peking University in the 2002 and 2005 waves. The datasets contain 4,478 parent-child dyads respondents among the eight provinces (Beijing, Shanghai, Jiangsu, Zhejiang, Fujian, Shandong, Guangdong, and Guangxi) out of the 23 provinces in CLHLS in 2002 and 2005. During the sampling process of CLHLS in 2002, either the single surviving child, or a randomly selected surviving child of the elderly participants will act as a valid sample. With the parents’ personal information on their families and health status, the survey collected the elderly participants’ adult-child’s information, including level of education, income and occupation, marriage and family, kinship network, intergenerational interaction and the change of social values. The survey aims to explore the impact of adult-child’s status on the elderly’s health and their support arrangement. The adult-child samples in 2005 came from the samples of adult-child dataset in 2002 with no newly added participants. This dataset consists of five components, including the information of 2002 elderly respondents, 2005 follow-up elderly respondents, 2002 adult-child respondents, 2005 follow-up adult-child respondents, and the deceased elderly persons during the period 2002-2005.

BackgroundPrevious studies have shown social activity is associated with reduced risk of health outcomes. However, among older people (≥65 years) who were socially inactive at baseline, limited study explored whether increased participation in social activity in later life was associated with reduced risk of health outcomes; therefore, using the data from the Chinese Longitudinal Healthy Longevity Survey, the study was performed.MethodsThe study outcomes were 10-year all-cause mortality (sample number = 9,984) and 10-year heart diseases (sample number = 7,496). The exposure was the change of social activity frequency. Cox regression analysis was used for data analysis.ResultsDuring the follow-up, there were 6,407 all-cause mortalities and 1,035 heart diseases, respectively. Kaplan–Meier analysis demonstrated that cumulative incidences of all-cause mortality were significantly lower in participants with changes into more frequent social activity (log-rank p 

Objective: Examining the relationship between the plant-based dietary index and vision impairment (VI), hearing impairment (HI), and dual sensory impairment (DSI) among Chinese aged 65 and older. Methods: Based on the 2018 data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS), a cross-sectional study was conducted on 14,859 samples. The assessment of dietary quality utilized the Plant-Based Diet Index (PDI), Healthy Plant-Based Diet Index (hPDI), and Unhealthy Plant-Based Diet Index (uPDI). Logistic regression analysis was used to examine the associations between PDIs and sensory impairments. Additionally, restricted cubic spline analysis was utilized to investigate the non-linear association between PDIs and sensory impairments. Results: Participants in the highest quintile of PDI exhibited reduced prevalence of VI (OR 0.78, 95% CI:0.67-0.90, Ptrend

This study analyzes data from the 2011-2018 wave of the China Longitudinal Healthy Longevity Survey (CLHLS), which provides complete mortality follow-up and all required covariates. The data comprise a nationally representative sample of individuals aged 65 and older across 23 provinces in China. Approval was granted by Peking University's Biomedical Ethics Committee (IRB00001052-13074), and written informed consent was obtained from all participants.

The Chinese Longitudinal Healthy Longevity Survey (CLHLS) is an open cohort dataset. The data consists of a survey of older people aged 65 and above from 22 provinces, municipalities and autonomous regions in China. approximately 16,000 people participated in the CLHLS in 2018, covering aspects such as respondents' health, economic and living conditions, and social welfare. Based on the needs of the study, 8,061 valid data were finally obtained after eliminating samples with answers of "I don't know", "I'm not sure", inconsistencies or missing key variables, thus forming the cleaned data.

BackgroundOlder people in low- and middle-income countries are more susceptible to the impact of childhood experiences. This study comprehensively examines how childhood socioeconomic status (SES) and adult SES collectively influence late-life healthy longevity from a life course perspective, providing insights for shaping health-related policies.MethodsThis study analyzed data from the Chinese Longitudinal Healthy Longevity Survey (1998–2018) with 37,264 individuals aged 65 and above. Using R software, we applied continuous-time multi-state models incorporating the Rockwood frailty index with 38 indicators to assess participants’ health. Childhood SES or life course SES trajectories were core explanatory variables, while age and gender were controlled. Multinomial regression estimated annual transition probabilities between different states, and the multi-state life table method calculated total and frailty-specific life expectancy (LE).Results(1) Social mobility among older people in China showed an upward trend from childhood to adulthood. (2) Transition probabilities for robust-frailty, robust-dead, and frailty-dead increased with age, while frailty-robust decreased. Transition probabilities and LE varied across different childhood SES (low, medium, high) or life-course SES trajectory categories (low-low, low-medium, low-high, medium-low, medium-medium, medium-high, high-low, high-medium, high-high), with probabilities of robust-frailty, robust-dead, and frailty-dead decreasing sequentially across different categories, and frailty-robust increasing sequentially across different categories. Total LE, robust LE, and robust LE proportion increased sequentially across different categories, while frailty LE decreased sequentially across different categories. (3) Women had higher total LE and frailty incidence, but lower recovery rate, mortality risk, robust LE, and robust LE proportion compared to men.ConclusionFavorable childhood SES and lifelong accumulation of SES advantages protect against frailty morbidity, improve recovery rate, reduce mortality risk, and increase total LE, robust LE, and robust LE proportion. High childhood SES has a stronger protective effect than high adult SES, indicating the lasting impact of childhood conditions on healthy longevity. Systematic interventions in education, food supply, and medical accessibility for children from impoverished families are crucial.

BackgroundThis study aimed to explore the prevalence of elder neglect (EN) and its associated factors among community-based Chinese older adults.MethodsWe used data from the 2018 phase of a nationwide cross-sectional study, the Chinese Longitudinal Healthy Longevity Survey (CLHLS), which recruited 15,854 older adults to complete the study interviews that incorporated six dimensions of EN, namely, life neglect, social isolation, medical neglect, poor living situation, family neglect, and social neglect. Multivariate logistic regression was used to explore factors associated with EN.ResultsWe included demographic factors, chronic diseases, cognitive function, and daily activity function in our comprehensive analysis and showed that they had different effects on the six EN dimensions. Different demographic factors such as gender, age, marriage, education, occupation, residence, and household income were included in the comprehensive analysis, and the results showed that these factors had different effects on the six dimensions of EN. Next, we found that older adults with chronic diseases are prone to life neglect, medical neglect, and residential environment neglect. Older adults with better cognitive abilities were less likely to be neglected, and a decline in daily activity capacity has been linked to EN in older adults.ConclusionFuture studies are needed to identify the health effects of these associated factors, develop prevention strategies for EN, and improve the quality of life of older adults living in communities.

ObjectiveBecause of rapid economic growth and followed urban expansion in China, many people drinking natural water had to change their water sources to tap water. We aimed to test the unknown association that whether continued use of natural water for drinking is different from switching to tap water in all-cause mortality risks in elderly people.MethodsIn total, based on Chinese Longitudinal Healthy Longevity Survey, 26,688 elderly participants drinking natural water from childhood to young-old were included in the final analyses. Associations between whether changing drinking water sources or not and all-cause mortality risk were then estimated by Cox regression models with the use of multiple propensity score methods, and the primary analysis used propensity score matching, with other propensity score methods confirming the robustness of the results.ResultsBaseline characteristics were fairly well balanced by the three post-randomization methods. During a median follow-up period of 3.00 (IQR: 1.52, 5.73) years, 21,379 deaths were recorded. The primary analysis showed people using natural water unchangeably was associated with a lower risk of all-cause mortality than those switching to tap water in later life (HR: 0.94, 95% CI: 0.91–0.97, p < 0.001). Other propensity score methods, as well as Cox regression analysis without using propensity score methods, showed similar results.ConclusionsAmong elderly people depending on natural water for drinking from their childhood to young-old in China, continued use of natural water was associated with a lower all-cause mortality risk than conversion to tap water later. Further studies in different countries and populations are needed to verify our conclusions.

Objective

To investigate the relationship between late-life duration of poverty exposure and cognitive function and decline among older adults in China.

Methods

Data were from 3,209 participants aged ≥64 in the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Duration of poverty, defined according to urban and rural regional standards from the China Statistical Yearbook, was assessed from 2005-2011 (never in poverty; 1/3 of the period in poverty; ≥2/3 of the period in poverty). Cognitive function was measured by the Chinese Mini Mental State Exam (CMMSE) from 2011 to 2018. We used attrition-weighted, multivariable mixed-effects Tobit regression to examine the association of duration of poverty with cognitive performance and rate of decline.

Results

A total of 1,162 individuals (36.21%) were never in poverty over the period from 2005 to 2011, 1,172 (36.52%) were in poverty 1/3 of the period, and 875 (27.27%) were in poverty ≥2/3 of the period. A longer poverty durat...

Objectives: This study aimed to prospectively investigate gender-specific relationship between hyperuricemia and all-cause mortality among Chinese older adults.Methods: The study was based on the Chinese Longitudinal Healthy Longevity Survey (CLHLS) 2008–2018, a prospective nationwide cohort of older adults in China. Multivariate Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% CIs for all-cause mortality. Restricted cubic splines (RCS) were conducted to explore the dose-response relationship between SUA levels and all-cause mortality.Results: For older women, compared to the participants in the third quartile of SUA level, those in the highest quartile of SUA was associated with significantly higher risk of all-cause mortality in the fully adjusted model (HR: 1.41, 95% CI: 1.03–1.92). No significant associations between SUA levels and all-cause mortality were observed in older men. The present study further found a U-shaped non-linear relationship between SUA levels and all-cause mortality in both sexes of older population (P for non-linear <0.05).Conclusions: This study provided prospective epidemiological evidence for the predictive role of SUA on all-cause mortality among the Chinese aging population over 10 years of follow-up, while revealing considerable gender-related differences.

Objectives: To assess the effect of health check-ups on health among the elderly Chinese.Methods: The first dataset was panel data extracted from the 2011, 2014, and 2018 waves of the Chinese Longitudinal Health Longevity Survey (CLHLS). The second dataset was cross-sectional data come from CLHLS 2018 linked with the lagged term of health check-ups in CLHLS 2011. Health check-ups were measured by a binary variable annual health check-up (AHC). Health was assessed by a binary variable self-rated health (SRH). A coarsened exact matching method and individual fixed-effects models, as well as logistic regressions were employed.Results: AHC attendance among the elderly increased from 2011 to 2018, with higher utilization of AHC also detected in the rural group. AHC had positive effects on SRH among rural respondents (short-term effect: OR = 1.567, p < 0.05; long-term effect: OR = 3.385, p < 0.001).Conclusion: This study highlights a higher utilization of AHC in rural area, and the effectiveness of AHC in SRH improvement among rural participants. It indicates enhanced access to public healthcare services in rural area and underlying implications of health check-ups for reducing urban–rural health inequalities.

AimsTo investigate the prevalence and correlates of risky drinking in Chinese elderly people aged 80 and over.MethodsData were obtained from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) conducted in 2018. A total of 10,141 respondents aged 80 years or older were included in this analysis. Risky drinking was defined as drinking > 2 drinks per day. The participants were divided into no risky drinking, past risky drinking, and current risky drinking groups. The prevalence of risky drinking, daily dosage, and type of alcohol beverages were assessed. The correlates of risky drinking were analyzed using logistic regression.ResultsThe prevalence of past and current risky drinking was 6.2 and 4.4%, respectively. A total of 12.2% of males and 2.1% of females reported past risky drinking, and 8.9% of males and 1.4% of females reported current risky drinking. The median of the daily dosage of the past risky drinking group was 4.5 and 4 drinks in males and females, respectively, and were 4 and 3.3, respectively, of the current risky drinking group. Strong liquor was the most popular alcohol beverage in all groups. Men who were older or had white-collar work were less likely to be past risky drinkers, while those with smoking in past or current or heart disease were more likely to be past risky drinkers. Women who smoked in the past were more likely to be past risky drinkers. Men with older age or living in the urban areas or with heart disease were less likely to be current risky drinkers. Women with higher education or with heart disease were less likely to be current risky drinkers. Women with current smoking were more likely to have current risky drinking.ConclusionsOur findings indicated that risky drinking among the oldest-old was not rare in China. The correlates of past and current risky drinking were different. Men and women had various correlates of risky drinking as well. Those with higher socioeconomic status seemed less likely to be risky drinking. More attention should be given to risky drinking among the oldest old, and sex-specific intervention may be needed.

Objectives: We examined the magnitude and determinants of socioeconomic disparities in disability-free life expectancy and life expectancy at age 65 (DFLE65 and LE65) in China.Methods: Data from Chinese Longitudinal Healthy Longevity Survey collected during 2011–2018 (8,184 participants aged ≥65) were used. Socioeconomic status (SES) was measured by economic status (ES), and education, respectively. Multistate Markov models and microsimulations were fitted to estimate DFLE65 and LE65.Results: LE65 between high- and low-ES groups differed by 2.20 years for males and 2.04 years for females. The DFLE65 disparity in ES was 1.51 and 1.29 years for males and females, respectively. Not undergoing physical examinations, inadequate fruit/vegetable intake, and stress contributed to 35.10% and 57.36% of DFLE65 disparity in ES, as well as 26.36% and 42.65% of LE65 disparity for males and females, respectively. These disparities in education and ES were of a similar magnitude, while the above factors contributed little to education disparity.Conclusion: Socioeconomic disparities in DFLE65 and LE65 existed in China. Physical examination, fruit/vegetable intake and stress partly explained these disparities.

BackgroundVast accumulative evidence suggests that the consumption of tea and its components have various potential health benefits. This study used a longitudinal study to examine the causality between tea consumption and frailty in older Chinese people.MethodsThis study employed the longitudinal data from 2008 to 2014 of the Chinese Longitudinal Healthy Longevity Survey (CLHLS), which were systematically collected through face-to-face interviews. Two thousand four hundred and seventy three participants completed six-follow-up surveys in 2014 and were analyzed in this study. The frailty index recommended by Searle and co-authors, including 44 health deficits, was used. A Generalized Estimating Equation (GEE) was applied to determine the risk ratio (RR) with a 95% confidence interval (CI) for frailty, and further subgroup analyses were conducted to investigate whether the risk differed stratified by age, sex, and socioeconomic status. Additionally, the interaction between tea consumption with sex and frailty was tested.ResultsOf the 2,473 participants, 14.1% were consistent daily tea drinkers, and 22.6% reported frailty at the 6-year follow-up. Compared to non-tea drinkers, consistent daily tea drinkers reported a significantly lower ratio of having frailty [risk ratio (RR) = 0.54, 95% confidence interval (CI): 0.38–0.78], adjusting for sociodemographic characteristics, health behavior, socioeconomic status, and chronic illnesses. In further subgroup analyses, consistent daily tea consumption significantly reduced the risk of frailty for males (RR = 0.53, 95% CI: 0.32–0.87) but not females (RR = 0.65, 95% CI: 0.37–1.12); in the young (RR = 0.40, 95% CI: 0.22–0.74) but not in the oldest (aged ≥ 80) (RR = 0.66, 95% CI: 0.40–1.06); informal education (RR = 0.48, 95% CI: 0.28–0.84) but not formal education (RR = 0.62, 95% CI: 0.37–1.03); financial dependence (RR = 0.42, 95% CI: 0.25–0.71) but not financial independence (RR = 0.71, 95% CI: 0.41–1.23). Additionally, females showed a lower tea-mediated risk of frailty in occasional tea consumers (RR = 0.51, 95% CI: 0.29–0.89) and inconsistent tea drinkers (RR = 0.58, 95% CI: 0.37–0.93).ConclusionsHabitual tea consumption can reduce the risk of frailty in older Chinese, and the benefit varied by age, sex, education, and financial support.

ObjectiveWe aimed to examine the association between social participation and depressive symptoms among Chinese older people aged 65 years or above to supplement limited studies in China on this topic.MethodsThis community-based longitudinal prospective cohort study used the data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS, baseline in 2014 and a follow-up in 2018). Depressive symptoms were assessed using the 10-item Center for Epidemiologic Studies Depression Scale. Social participation was assessed using a composite index by considering the frequency for the two types of social activity: organized social activities and informal activities. Pearson's χ2 test was used to correlate the characteristics of participants with social participation or depressive symptoms. Log-binomial regression models were used to assess the association between social participation and the risk of depressive symptoms.ResultsThe incidence of depressive symptoms was 28.8% among 2,200 participants in 2018 after a 4-year follow-up. Participants with no social participation (32.6%), organized social activities (30.6%), or informal social activities (31.2%) were more likely to have depressive symptoms. After the adjustment of demographic factors, socioeconomic status, lifestyle habits, and health status, in comparison with older people who often engaged in social participation, organized social activities, and informal social activities, the risk of depressive symptoms was 45% [adjusted risk ratio (aRR): 1.45, 95% CI: 1.16–1.82], 42% (aRR: 1.45, 95% CI: 1.02–2.00), and 29% (aRR: 1.29, 95% CI: 1.02–1.99) higher among older people with no social participation and who never engaged in organized social activities and informal social activities, respectively.ConclusionsThis study showed that the lack of social participation, including organized social activities and informal social activities, was associated with a higher risk of depressive symptoms after 4 years among older adults in China. Our findings shed lights into the feasibility of promoting social participation to reduce the risk of depressive symptoms and promote longevity and healthy aging among older adults.