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Cognitive function, body mass index and mortality in a rural elderly Chinese cohort

Sujuan Gao1*, Yinlong Jin8, Frederick W Unverzagt2, Yibin Cheng8, Liqin Su8, Chenkun Wang1, Feng Ma8, Ann M Hake37, Carla Kettler1, Chen Chen8, Jingyi Liu8, Jianchao Bian9, Ping Li10, Jill R Murrell4, Daniel O Clark56 and Hugh C Hendrie256

Author Affiliations

1 Department of Biostatistics, Indiana University School of Medicine, 410 West 10th Street, #3000, Indianapolis IN 46202-2872, Indiana

2 Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana

3 Department of Neurology, Indiana University School of Medicine, Indianapolis, Indiana

4 Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, Indiana

5 Indiana University Center for Aging Research, Indianapolis, Indiana

6 Regenstrief Institute, Inc, Indianapolis, Indiana

7 Eli Lilly and Company, Indianapolis, Indiana

8 Institute for Environmental Health and Related Product Safety, Chinese Center for Disease Control and Prevention, Beijing, China

9 Shandong Institute for Prevention and Treatment of Endemic Disease in China, Jinan, China

10 Sichuan Provincial Center for Disease Control and Prevention in China, Chengdu, China

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Archives of Public Health 2014, 72:9  doi:10.1186/2049-3258-72-9

Published: 26 March 2014



Previous studies have shown that poor cognition and low body mass index were associated with increased mortality. But few studies have investigated the association between cognition and mortality across the entire cognitive spectrum while adjusting for BMI. The objective of this study is to examine the associations between cognitive function, BMI and 7-year mortality in a rural elderly Chinese cohort.


A prospective cohort of 2,000 Chinese age 65 and over from four rural counties in China were followed for 7-years. Cognitive function, BMI and other covariate information were obtained at baseline. Cox’s proportional hazard models were used to determine the effects of cognitive function and BMI on mortality risk.


Of participants enrolled, 473 (23.7%) died during follow-up. Both lower cognitive function (HR = 1.48, p = 0.0049) and lower BMI (HR = 1.6, p < 0.0001) were independently associated with increased mortality risk compared to individuals with average cognitive function and normal weight. Higher cognitive function was associated with lower mortality risk (HR = 0.69, p = 0.0312). We found no significant difference in mortality risk between overweight/obese participants and those with normal weight.


Cognitive function and BMI were independent predictors of mortality risk. Intervention strategies for increasing cognitive function and maintaining adequate BMI may be important in reducing morality risk in the elderly population.