BMC Public Health · Jun 27, 2026

Baseline hypertension, adiposity, depressive symptoms, and incident stroke in middle-aged and older Chinese adults: a longitudinal analysis of CHARLS, 2011-2020

By Li W, Shao J, Zhu Y

BACKGROUND: Stroke is a major cause of disability and death among middle-aged and older adults in China. Hypertension, adiposity, and depressive symptoms often coexist, but their associations with incident stroke are often examined separately. We assessed baseline cardiometabolic, adiposity-related, and psychosocial factors associated with first reported incident stroke in a longitudinal China Health and Retirement Longitudinal Study (CHARLS) cohort. METHODS: We used CHARLS data. Participants aged 45 years or older who were free of stroke at baseline and had at least one follow-up assessment were eligible. A person-period dataset was constructed to incorporate repeated follow-up intervals and the timing of first reported incident stroke. Person-period modified Poisson regression models with participant-level cluster-robust standard errors were used to estimate risk ratios (RRs) and 95% confidence intervals (CIs). RESULTS: Among 15,992 eligible participants, 1,246 first reported incident stroke events were identified during follow-up. The body mass index (BMI) and waist circumference complete-case models included 11,674 and 11,604 participants, with 949 and 941 incident stroke events, respectively. In the BMI model, hypertension (RR, 1.80; 95% CI, 1.56-2.07), diabetes (RR, 1.51; 95% CI, 1.21-1.88), heart problems (RR, 1.39; 95% CI, 1.17-1.64), BMI (RR per 1 kg/m², 1.05; 95% CI, 1.03-1.06), and 10-item Center for Epidemiologic Studies Depression Scale (CESD-10) score (RR per 1 point, 1.03; 95% CI, 1.02-1.04) were associated with increased stroke risk. In the waist circumference model, waist circumference was also positively associated with incident stroke (RR per 1 cm, 1.02; 95% CI, 1.01-1.03). Sensitivity analyses yielded broadly consistent results. CONCLUSIONS: Hypertension, diabetes, heart problems, higher BMI, larger waist circumference, and higher CESD-10 score were associated with increased risk of first reported incident stroke among middle-aged and older Chinese adults. These observational findings suggest that vascular, adiposity-related, and psychosocial factors may help characterize stroke risk in this population, but they should be interpreted cautiously given anthropometric missingness, self-reported stroke ascertainment, and potential residual confounding.

doi.org/10.1186/s12889-026-28310-3Open accessPubMed 42374299Populations