Abstract: Background The accelerated aging process，combined with the increase in widowhood and social isolation，has led to a rise in chronic diseases，further increasing the social burden. Objective To explore the association between the marital status of older adults and the prevalence of cognitive impairment，as well as the impact of social support and lifestyle on this association. Methods A total of 9 466 older adults aged 65 years and above from Wuhan and Xiaogan，Hubei Province，were included in this study from 2018 to 2023. Participants were categorized into a married group（n=7 055） and an unmarried group（n=2 411） based on their marital status. Baseline information was collected through structured questionnaires，and cognitive function was assessed using the Montreal Cognitive Assessment（MoCA） and multidomain cognitive function tests. A multivariable Logistic regression model was employed to analyze the association between marital status and cognitive impairment in the overall population as well as in subgroups stratified by age and sex. Further analyses explored the independent and combined effects of marital status，social support，and lifestyle habits on cognitive impairment risk. Results Compared with the elderly with spouses，no spouse was an independent risk factor for cognitive impairment（OR=1.299，95%CI=1.227-1.376，P<0.001）. Further subgroup analysis showed that never married（OR=1.679，95%CI=1.448-1.947，P<0.001） and widowed（OR=1.282，95%CI=1.206-1.362，P<0.001） were independent risk factors for cognitive impairment in the elderly.Gender and age stratified analysis showed that never married（OR=2.316，95%CI=1.680-3.193，P<0.001） and widowed（OR=1.731，95%CI=1.405-2.131，P<0.001） were independent risk factors for cognitive impairment in elderly men. Widowed was an independent risk factor for cognitive impairment in elderly women（OR=1.163，95%CI=1.002-1.351，P=0.047）. In the 65-74 years old group，never married（OR=1.953，95%CI=1.390-2.746，P<0.001） and widowed（OR=1.315，95%CI=1.120-1.545，P=0.001） were independent risk factors for cognitive impairment. In the ≥ 75 years old group，widowed was an independent risk factor for cognitive impairment（OR=1.470，95%CI=1.238-1.747，P<0.001）. Multivariate Logistic regression analysis showed that marital status，social support and living habits were associated with cognitive impairment. Compared with the elderly with spouse and social support and healthy living habits，the elderly with spouse and social support but unhealthy living habits（OR=1.262，95%CI=1.169-1.363，P=0.002），spouse and no social support but healthy lifestyle（OR=1.650，95%CI=1.479-1.841，P<0.001），spouse and no social support but unhealthy lifestyle（OR=1.777，95%CI=1.575-2.005，P<0.001），no spouse and social support with healthy lifestyle（OR=1.284，95%CI=1.189-1.397，P<0.001），no spouse and social support with unhealthy lifestyle（OR=1.999，95%CI=1.768-2.260，P<0.001），no spouse and social support with unhealthy lifestyle（OR=1.999，95%CI=1.768-2.260，P<0.001），no spouse and no social support but healthy lifestyle（OR=1.680，95%CI=1.50-1.882，P<0.001），no spouse and no social support but unhealthy lifestyle（OR=2.422，95%CI=2.141-2.740，P<0.001），no spouse and no social support but healthy lifestyle（OR=2.422，95%CI=2.141-2.740，P<0.001）were at increased risk for cognitive impairment. Conclusion The prevalence of cognitive impairment，especially among older adults without spouses，notably increases，particularly for those who have never married or are widowed. Regardless of marital status，the lack of social support and unhealthy lifestyle are risk factors for cognitive impairment. This study highlights the importance of paying attention to marital status，social support，and lifestyle in the health management of older adults.

Key words: Cognitive impairment, Older adults, Marital status, Widowhood, Social support, Healthy lifestyle

摘要： 背景 老龄化进程的加快与鳏寡孤独现象的加剧导致慢性疾病增多，进一步加重了社会负担。目的 探讨老年人婚姻状况与认知障碍患病的关联性及社会支持和生活习惯对此关联性的影响。方法 选取2018~2023年湖北省武汉市和孝感市9466例65岁以上老年人群为研究队列，依据婚姻状况分为有配偶组（7055例）和无配偶组（2411例）。通过问卷调查收集基本信息，采用蒙特利尔认知评估等量表进行全套神经心理评估；采用多维度认知域评估来评定老人认知功能状态。采用多因素Logistic回归模型分析全人群及年龄和性别分层后的婚姻状况与认知障碍的关联性，并进一步分析婚姻状况、社会支持和生活习惯两者或三者联合与认知功能障碍患病的关联性。结果 相较于有配偶老年人，无配偶是患认知障碍的独立危险因素（OR=1.299，95%CI=1.227~1.376，P<0.001）；进一步亚组分析发现，从未结婚（OR=1.679，95%CI=1.448~1.947，P<0.001）和丧偶（OR=1.282，95%CI=1.206~1.362，P<0.001）是老年人患认知障碍的独立危险因素；性别和年龄分层分析显示，从未结婚（OR=2.316，95%CI=1.680~3.193，P<0.001）与丧偶（OR=1.731，95%CI=1.405~2.131，P<0.001）是老年男性患认知障碍的独立危险因素，丧偶是老年女性患认知障碍的独立危险因素（OR=1.163，95%CI=1.002~1.351，P=0.047）；65~74岁组老年人中，从未结婚（OR=1.953，95%CI=1.390~2.746，P<0.001）和丧偶（OR=1.315，95%CI=1.120~1.545，P=0.001）是患认知障碍的独立危险因素；≥75岁年龄组中，丧偶是患认知障碍的独立危险因素（OR=1.470，95%CI=1.238~1.747，P<0.001）。婚姻状况、社会支持和生活习惯三者联合与认知障碍关联的多因素Logistic回归分析结果显示，相较于有配偶和社会支持且健康生活习惯的老年人，有配偶和社会支持但不健康生活习惯（OR=1.262，95%CI=1.169~1.363，P=0.002）、有配偶和无社会支持但健康生活习惯（OR=1.650，95%CI=1.479~1.841，P<0.001）、有配偶和无社会支持且不健康生活习惯（OR=1.777，95%CI=1.575~2.005，P<0.001）、无配偶和有社会支持且健康生活习惯（OR=1.284，95%CI=1.189~1.397，P<0.001）、无配偶和有社会支持但不健康生活习惯（OR=1.999，95%CI=1.768~2.260，P<0.001）、无配偶和无社会支持但健康生活习惯（OR=1.680，95%CI=1.500~1.882，P<0.001）、无配偶和无社会支持且不健康生活习惯（OR=2.422，95%CI=2.141~2.740，P<0.001）的老年人患认知障碍的风险增加。结论 无配偶特别是从未结婚和丧偶老年人群的认知障碍患病率显著增高，无论何种婚姻状况，无社会支持且不健康生活习惯均与认知障碍显著关联。建议制定老年健康管理策略时，重点关注婚姻状况、社会支持和生活习惯。

关键词: 认知功能障碍, 老年人, 婚姻状况, 丧偶, 社会支持, 健康生活习惯