Patterns and health relevance of neuroticism in Chinese men and women: evidence from the China Kadoorie Biobank

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Objectives To characterise the sociodemographic patterning of neuroticism and evaluate its associations with major mental and physical diseases in Chinese adults. Study design Prospective cohort study of 25,041 adults from 5 urban and 5 rural areas in China, participating in the second resurvey of the China Kadoorie Biobank in 2013–2014. Methods Neuroticism was assessed using the 23-item Eysenck Personality Questionnaire and expressed as a neuroticism score (N-score). Logistic regression examined cross-sectional associations of N-score with socioeconomic characteristics and prevalence of mental and general health conditions, while Cox regression assessed prospective associations of N-score with incidence of major diseases identified through linkage to electronic health registries. Results Mean N-score was 2.52 and was higher in women and urban residents, with a clear downward trend with age. A higher N-score was strongly associated with socioeconomic disadvantage, including not being in marriage and having a lower level of household income. Compared with participants with an N-score of 0, those with an N-score ≥ 4 had a higher prevalence of mental health problems and poor general health, with adjusted risk ratios ranging from 1.52 to 41.01. Prospectively, a higher N-score was significantly associated with higher risks of ischaemic heart disease, stroke, mental and behavioural disorders, and nervous and digestive system diseases (hazard ratios 1.17–1.81 for the highest versus lowest N-score group). Conclusions Neuroticism showed substantial sociodemographic patterning and was associated with a broad range of mental and physical health outcomes. These findings highlight its potential relevance to population health and risk stratification.