The impact of self-rated health on the Parkinson’s disease-disability association: evidence from CHARLS

Parkinson’s disease (PD) is a major cause of functional disability among older adults, yet the role of patients’ subjective health perceptions in this association remains poorly quantified. This study aimed to examine the independent association between PD and impairments in basic (BADL) and instrumental activities of daily living (IADL), and to decompose the relative contributions of multi-domain factors—with a primary focus on self-rated health—in a nationally representative Chinese population. This cross-sectional analysis used data from the 2020 wave of the China Health and Retirement Longitudinal Study (CHARLS), enrolling 17,311 community-dwelling adults aged ≥ 45 years, including 196 with physician-diagnosed PD.

Multivariate logistic regression with sequential adjustment was applied to estimate the independent association of PD with BADL/IADL disability. A stepwise effect-size decomposition approach was employed to quantify the percentage contribution of each covariate block (sociodemographic, lifestyle, and clinical factors) to the total PD–disability effect, with particular emphasis on self-rated health. PD was independently associated with significantly elevated risks of BADL impairment (OR = 2.73, 95%CI: 1.99–3.75) and IADL impairment (OR = 1.88, 95%CI: 1.37–2.60) after full adjustment.

Sequential effect decomposition revealed that self-rated health accounted for the largest attenuation of the association, explaining 26.5% of the PD–BADL effect and 29.8% of the PD–IADL effect—far exceeding the contributions of depression, multimorbidity, and cognitive dysfunction. Subgroup analyses confirmed the robustness of these findings across all strata (all P for interaction > 0.05). Self-rated health emerges as the dominant explanatory factor in the PD–functional disability pathway, outperforming conventional clinical indicators.

These findings advocate a paradigm shift from symptom-focused management toward integrated care that prioritizes patients’ subjective health perceptions. We recommend incorporating routine self-rated health assessment and targeted psycho-behavioral interventions into standard PD care as a promising strategy to slow progressive functional decline. We gratefully acknowledge support from the National Natural Science Foundation of China (82371258); the Xinjiang Uygur Autonomous Region Key Research and Development Program (2023B03003); the Autonomous Region Tianshan Talents - Science and Technology Innovation Leading Talent Program (2022TSYCLJ0066); and the Integration and Standardized Validation of Novel Technologies for Precision Screening of Cardiocerebrovascular and Metabolic Chronic Diseases Based on Multimodal Fusion (2026ZD0557602).

We also appreciate the China Health and Retirement Longitudinal Study (CHARLS) data provided by the National School of Development, Peking University and the Institute of Social Science Survey, Peking University, and we thank the staff and participants of CHARLS for their invaluable contributions. This work was supported by the National Natural Science Foundation of China (82371258); the Xinjiang Uygur Autonomous Region Key Research and Development Program Project (2023B03003); the Tianshan Elite-Science and Technology Innovation Leading Talent Project, Xinjiang Uygur Autonomous Region (2022TSYCLJ0066); and the Integration and Standardized Validation of Novel Technologies for Precision Screening of Cardiocerebrovascular and Metabolic Chronic Diseases Based on Multimodal Fusion (2026ZD0557602). Xinjiang Medical University, No.567, Shangde North Road, Shuimogou District, Ürümqi, 830000, Xinjiang Uygur Autonomous Region, People’s Republic of China Jinshuo Liu, Zihao Wang, Huan Xia & Xinling Yang The Second Affiliated Hospital of Xinjiang Medical University, No. 38, North Second Lane, Nanhu East Road, Ürümqi, 830000, Xinjiang Uygur Autonomous Region, People’s Republic of China The CHARLS survey received ethical approval from the Peking University Bioethics Committee (IRB No.

This study utilized publicly available, anonymized data from the CHARLS, which meet the exemption criteria outlined in Article 32 of the Measures for Ethical Review of Life Science and Medical Research Involving Human Subjects, issued on February 18, 2023, by the National Health Commission of China, Ministry of Education, Ministry of Science and Technology, and the National Administration of Traditional Chinese Medicine. Specifically, research using legally obtained public datasets or anonymized data that do not cause harm to individuals, involve sensitive personal information, or pertain to commercial interests is exempt from additional ethical review. The authors declare no competing interests.