Intergenerational Support and Risk of Incident Visual Impairment among Middle-aged and Older Chinese Adults: A National Longitudinal Cohort Study

Background Visual impairment is a major contributor to functional decline and reduced quality of life among older adults. While biological and demographic factors are well established, the role of family-based social support remains unclear. In China, intergenerational support from adult children—including financial assistance and regular contact—may influence access to care and health-related behaviors. This study examined whether such support is associated with the progression of visual impairment among middle-aged and older Chinese adults. Methods A prospective cohort design was applied using four waves (2011–2018) of nationally representative survey data from Chinese adults aged 45 years and older. A total of 56,929 person-wave observations were included in the analysis. Self-reported visual status was categorized into no impairment, mild impairment, and moderate-to-severe impairment. Intergenerational support was assessed by children’s financial transfers and frequency of contact. After controlling for demographic characteristics, socioeconomic status, and health-related factors, ordinal logistic regression models with repeated measures were used to estimate adjusted odds ratios. Interaction terms were included to evaluate joint effects. Results Lower levels of financial support were significantly associated with a greater risk of more severe visual impairment (odds ratio 1.195, 95% confidence interval 1.088–1.313). Infrequent contact with children was also associated with increased risk (odds ratio 1.249, 95% confidence interval 1.141–1.366). A significant cumulative effect was observed: participants reporting both low financial support and low contact frequency had the highest risk of visual impairment (odds ratio 1.526, 95% confidence interval 1.304–1.786). Conclusions Intergenerational support is an important protective factor against visual function decline among middle-aged and older Chinese adults. Insufficient financial assistance and limited daily contact with children accelerate the progression of visual impairment, with the dual absence of support exerting a synergistic detrimental effect. These findings highlight the potential role of family-based support in strategies to maintain visual health in aging populations. Trial registration Clinical trial number: not applicable.