A Health Ecological Model Study of Subjective Cognitive Decline Among Hypertensive Patients in Rural Shanxi, China

Hypertension and subjective cognitive decline (SCD) frequently co-occur, challenging healthy aging. This study aimed to identify multi-level determinants of SCD among hypertensive patients in rural China using the Health Ecological Model (HEM). We conducted a cross-sectional study with 860 hypertensive patients selected from three rural counties in Shanxi Province via multi-stage cluster random sampling. Participants were categorized into non-SCD (SCD-Q9 score < 5) and SCD (≥ 5) groups. Variables were classified into five HEM layers, and logistic regression was employed to identify associated factors. The prevalence of SCD was 80.58%. Multi-level factors were significantly associated with SCD. In the Individual Characteristics Layer, advanced age, family history of hypertension, and hypertensive complications increased risk. Within the Behavior and Lifestyle Layer, lack of physical exercise and poor sleep quality were risk factors, while alcohol abstinence was protective. In the Working and Living Conditions Layer, lower household income, utilization of county-level hospitals, and mild depression emerged as risk factors. Notably, out-of-pocket payment in the Policy Environment Layer was protective. These findings translate into actionable targets for rural primary care, advocating for integrated strategies addressing hypertension management, mental health, sleep hygiene, physical activity, and socioeconomic barriers to preserve cognitive health in this vulnerable population.