Associations of Leisure Activities with Visual and Hearing Difficulties among older Chinese adults: a cross-sectional study

Abstract Background This cross-sectional study explored the associations and dose-response relationships between leisure activities and self-reported visual difficulty/hearing difficulty among older Chinese adults, using 2018 data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Methods A total of 13681 participants aged ≥60 years were included after excluding those with missing data on leisure activities, sensory difficulties, or covariates. SPSS 27.0 and R Studio 4.4.3 were used for analyses: chi-square tests and independent t-tests compared baseline characteristics. Binary logistic regression models examined associations between leisure activities and sensory difficulties, adjusting for sociodemographic (sex, age, co-residence, current marital status) and health-related (smoking, drinking, exercise, activity limitations, toothache, fall history, nutrient supplement use, fresh fruit/vegetable intake) covariates. Restricted cubic spline (RCS) analysis explored dose-response patterns (p < 0.05 = statistically significant). Results Results showed that leisure activities exhibited divergent associations with visual and hearing difficulties. After covariate adjustment, higher leisure activity scores were significantly associated with a reduced risk of visual difficulty (OR= 0.857, 95% CI: 0.843~0.872, P< 0.001) but an increased risk of hearing difficulty (OR = 1.136, 95% CI: 1.117~1.155, P< 0.001). RCS analysis confirmed significant nonlinear dose-response relationships for both outcomes (all P≤ 0.001): for visual difficulty, the OR declined continuously with increasing leisure activity scores, eventually stabilizing below 1.0, for hearing difficulty, the OR initially rose above 1.0 and remained elevated even at higher leisure activity levels. Additionally, correlation analysis revealed positive intercorrelations among different leisure activities, indicating a clustered participation pattern. Conclusions Leisure activities exert opposing effects on visual and hearing health in older Chinese adults, with distinct dose-response patterns. These findings highlight the need for tailored leisure interventions to optimize sensory health in this population.