Evidence map›Paper›PMID 40355654›Full record

ArticleAging clinical and experimental research2025

Language, literacy, and sensory impairments and missing cognitive test scores in the Harmonized Cognitive Assessment Protocol of the China Health and Retirement Longitudinal Study.

Alden L Gross, Ying Liu, Yuan S Zhang, Yaohui Zhao, Chihua Li, Erik Meijer, Jinkook Lee, Lindsay C Kobayashi

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Aging clinical and experimental research, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed.

  1. The association between lifetime marital histories and later-life cognitive function: evidence from the United States and China.The journals of gerontology. Series B, Psychological sciences and social sciences · 2026
    Article
  2. Article
  3. Missing data and imputation in the international studies following the Harmonized Cognitive Assessment Protocol.The journals of gerontology. Series B, Psychological sciences and social sciences · 2026
    Article
  4. Article
  5. Observational
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Alden L GrossDepartment of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 616 N. Wolfe St., Baltimore, MD, 21205, USA. agross14@jhu.edu.ORCID http://orcid.org/0000-0002-4678-0562
Ying LiuCenter for Economic and Social Research, University of Southern California, 635 Downey Way, Los Angeles, CA, USA.
Yuan S ZhangDepartment of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA.
Yaohui ZhaoDepartment of Economics, Peking University, Beijing, China.
Chihua LiCenter for Social Epidemiology and Population Health, Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA.
Erik MeijerCenter for Economic and Social Research, University of Southern California, 635 Downey Way, Los Angeles, CA, USA.
Jinkook LeeCenter for Economic and Social Research, University of Southern California, 635 Downey Way, Los Angeles, CA, USA.
Lindsay C KobayashiCenter for Social Epidemiology and Population Health, Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA.

Funding

Integrting Information About Aging SurveysR01AG030153 · NIA · UNIVERSITY OF SOUTHERN CALIFORNIA · PI Sara Adar, Alden L. Gross · 2007 to 2026
$41.7M
Health and Retirement Study: Harmonized Cognitive Assessment Protocol (HCAP)U01AG058499 · NIA · UNIVERSITY OF MICHIGAN AT ANN ARBOR · PI LANGA, KENNETH M · 2018 to 2023
$8.3M
Socioeconomic, Cardiovascular, and Psychosocial Sources of Cross-National Variation in Cognitive Health Among Older AdultsR01AG070953 · NIA · UNIVERSITY OF MICHIGAN AT ANN ARBOR · PI Alden L. Gross, Lindsay C Kobayashi · 2021 to 2026
$4.6M
Harmonized Cognitive and Dementia Assessment in ChinaR01AG053228 · NIA · PEKING UNIVERSITY · PI HUANG, YUEQIN, STRAUSS, JOHN A · 2016 to 2019
$1.7M
A cross-national comparative study on cardiometabolic risk, education, and cognitive agingR00AG070274 · NIA · COLUMBIA UNIVERSITY HEALTH SCIENCES · PI ZHANG, YUAN S · 2023 to 2025
$721k
NIA NIH HHS R00 AG070274NIA NIH HHS R01 AG030153NIA NIH HHS R01 AG053228NIA NIH HHS R01 AG070953NIA NIH HHS U01 AG058499
6 · The paper itself

Abstract

backgroundThe potentially biasing impacts of low language fluency, illiteracy, and sensory impairments on cognitive test performance are unknown, which may have implications for understanding their roles in cognitive decline and dementia.

aimsWe investigated effects of these features on cognitive test item completion and performance among older adults in China, a multilingual country with high prevalence of illiteracy and sensory impairment.

methodsWe used cognitive test data from the Harmonized Cognitive Assessment Protocol of the China Health and Retirement Longitudinal Study conducted in 2018 (N = 9755, age 60 + years). We first tested associations of fluency in spoken Mandarin, literacy, and sensory impairment (hearing and vision) with missingness of cognitive items. We then tested for differential item functioning (DIF) in observed cognitive items by these features.

resultsWe observed high levels of missing data in most cognitive test items - on average 13% and as high as 65%. Low fluency in spoken Mandarin, illiteracy, and impairments in hearing and vision were each associated with greater odds of missingness on nearly all tests. Partly because of differential missingness, there was minimal evidence of DIF by these features in items in which we expected a priori to find DIF (e.g., repetition of a spoken phrase among those with hearing impairment). Several cognitive test items exhibited statistically significant DIF, however there was minimal evidence of meaningful DIF.

conclusionsDifferential missingness in cognitive items by spoken language, literacy, and sensory impairments is potentially more of an inferential threat than measurement differences in test items.

Indexed as

CognitionCognitive DysfunctionLanguageLiteracyAgedAged, 80 and overChinaFemaleHumansLongitudinal StudiesMaleMiddle AgedNeuropsychological TestsChinaCognitive performanceDifferential item functioningGerontologyMissing dataPopulation survey

Identifiers

PMID40355654
PMCPMC12069510

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.