Mahjong playing and cognitive health in older Chinese adults: exploring the moderating roles of smoking and alcohol use

Background This research examined the moderating effects of smoking and alcohol consumption on the association between Mahjong playing and cognitive impairment among Chinese older adults.Methods We selected older adults, aged 65 or above, from the Chinese Longitudinal Healthy Longevity Survey between 2008 and 2018 (n = 22,883). Ordered logistic regressions examined the associations between Mahjong and cognitive impairment. We also analyzed older adults’ smoking and alcohol consumption as moderating variables.Results Approximately 16.6% of participants reported experiences with Mahjong playing. About 17.7% and 22.1% of participants had moderate and severe cognitive impairment, respectively. Older adults who played Mahjong had significantly lower odds of cognitive impairment (p < 0.01). Smoking alone was not associated with cognitive impairment, but individuals who both smoked and played Mahjong had increased odds of cognitive impairment (p < 0.05), especially among those without formal education. By comparison, playing Mahjong and consuming alcohol were negatively associated with cognitive impairment, though such moderating effects were not observed among participants with formal education.Conclusion When public health practitioners promote Mahjong as a cognitive health intervention, they should also be aware of the moderating effects of smoking and alcohol consumption.