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Background <p>With global population ageing, maintaining independence through activities of daily living (ADL) and instrumental activities of daily living (IADL) is increasingly important for older adults. Existing evidence suggests that ADL/IADL disability is associated with higher mortality, but global evidence in middle-aged and older populations remains limited.</p> Methods <p>We conducted a multi-cohort pooled study using harmonized data from five major longitudinal studies in the Harmonized Gateway to Global Aging Data: the Health and Retirement Study (HRS), China Health and Retirement Longitudinal Study (CHARLS), Survey of Health, Ageing and Retirement in Europe (SHARE), English Longitudinal Study of Ageing (ELSA), and Mexican Health and Aging Study (MHAS). We used Cox proportional hazards models to examine the associations of ADL and IADL disabilities with all-cause mortality. We further assessed additive interaction between ADL and IADL disabilities on mortality and conducted exploratory mediation analyses to explore the roles of chronic conditions and depression in these associations.</p> Findings <p>The final analytic sample included 13,466 participants from CHARLS, 9,171 from ELSA, 21,042 from HRS, 13,463 from MHAS, and 35,934 from SHARE. Across all cohorts, ADL/IADL disability was associated with higher all-cause mortality. In pooled analyses, compared with no disability, the hazard ratio (HR) for mortality was 1.44 (95% CI 1.36–1.54) for one ADL disability item and 2.14 (2.01–2.27) for two or more ADL disability items. For IADL, the HR was 1.59 (1.42–1.79) for one IADL disability item and 2.41 (2.26–2.56) for two or more items. Exploratory mediation analyses suggested that the potential contribution of chronic conditions varied across cohorts and was not evident in CHARLS, whereas depression showed potential contributions across cohorts. Statistically significant additive interaction between ADL and IADL was detected in CHARLS and MHAS. Time-dependent Cox models suggested that, in some cohorts, the HR for the association between higher disability burden (≥2 items) and mortality decreased over follow-up time.</p> Interpretation <p>ADL/IADL disability is associated with increased long-term all-cause mortality among middle-aged and older adults across five major cohorts. Chronic conditions and depression may represent potential contributors to these associations. These findings underscore health inequities faced by people with disabilities and highlight the need for health systems to better include and serve people with disabilities in policies and services.</p>

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Associations of activities of daily living disability and instrumental activities of daily living disability with all-cause mortality: evidence from five major longitudinal studies

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年5月14日

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  • Heng Wang,
  • Cong Li,
  • Kaibo Yang,
  • Chingyu Cheng,
  • Jinghua Jiao,
  • Han Zhang,
  • Lei Liu

摘要

Background

With global population ageing, maintaining independence through activities of daily living (ADL) and instrumental activities of daily living (IADL) is increasingly important for older adults. Existing evidence suggests that ADL/IADL disability is associated with higher mortality, but global evidence in middle-aged and older populations remains limited.

Methods

We conducted a multi-cohort pooled study using harmonized data from five major longitudinal studies in the Harmonized Gateway to Global Aging Data: the Health and Retirement Study (HRS), China Health and Retirement Longitudinal Study (CHARLS), Survey of Health, Ageing and Retirement in Europe (SHARE), English Longitudinal Study of Ageing (ELSA), and Mexican Health and Aging Study (MHAS). We used Cox proportional hazards models to examine the associations of ADL and IADL disabilities with all-cause mortality. We further assessed additive interaction between ADL and IADL disabilities on mortality and conducted exploratory mediation analyses to explore the roles of chronic conditions and depression in these associations.

Findings

The final analytic sample included 13,466 participants from CHARLS, 9,171 from ELSA, 21,042 from HRS, 13,463 from MHAS, and 35,934 from SHARE. Across all cohorts, ADL/IADL disability was associated with higher all-cause mortality. In pooled analyses, compared with no disability, the hazard ratio (HR) for mortality was 1.44 (95% CI 1.36–1.54) for one ADL disability item and 2.14 (2.01–2.27) for two or more ADL disability items. For IADL, the HR was 1.59 (1.42–1.79) for one IADL disability item and 2.41 (2.26–2.56) for two or more items. Exploratory mediation analyses suggested that the potential contribution of chronic conditions varied across cohorts and was not evident in CHARLS, whereas depression showed potential contributions across cohorts. Statistically significant additive interaction between ADL and IADL was detected in CHARLS and MHAS. Time-dependent Cox models suggested that, in some cohorts, the HR for the association between higher disability burden (≥2 items) and mortality decreased over follow-up time.

Interpretation

ADL/IADL disability is associated with increased long-term all-cause mortality among middle-aged and older adults across five major cohorts. Chronic conditions and depression may represent potential contributors to these associations. These findings underscore health inequities faced by people with disabilities and highlight the need for health systems to better include and serve people with disabilities in policies and services.