Sex-Specific Longitudinal Pathways to Activities of Daily Living Disability in Older Adults with Cardiovascular Disease and/or Hypertension: Findings from the Health, Aging and Retirement in Thailand (HART) Study

Objective Cardiovascular diseases (CVDs) and/or hypertensions (HTN) are a major contributor to activities of daily living (ADL) disability in ageing populations. Although sex differences in CVDs/HTN incidence and outcomes are well documented, less is known about sex-specific mechanisms underlying functional disability among older adults with CVDs/HTN. Methods We analysed longitudinal data from four waves (2015–2022) of the HART study using two lagged panels (2015–2017–2020; 2017–2020–2022) to assess whether associations vary across time contexts. Psychosocial exposures (depressive symptoms, physical activity, multimorbidity, and pain) and mobility impairment were examined using ordinal structural equation modelling (SEM) weighted least squares mean- and variance- adjusted (WLSMV), adjusting for baseline covariates. Sex- stratified and panel moderation analyses were performed, with inverse probability weighting in sensitivity analyses. Results A total of 999 and 1,066 participants were included in Panels A and B, respectively. Baseline ADL distributions were similar across panels, with predominantly mild ADL disability. In Panel A, multimorbidity was positively associated with ADL disability, while pain showed an inverse association. In Panel B, mobility impairment was strongly associated with ADL disability. No mediation was observed at the panel level. However, an exploratory indirect association between depressive symptoms and ADL disability through mobility impairment was observed among men in Panel B (β = 0.07, 95% CI: 0.05–0.10), whereas no corresponding association was observed among women. Conclusion Longitudinal pathways to ADL disability among older adults with CVDs/HTN varied by sex and longitudinal observation window. An exploratory, panel-specific indirect association between depressive symptoms, mobility impairment, and ADL disability was observed only among men in Panel B. This finding should be interpreted cautiously and requires confirmation in future longitudinal studies with consistent mobility measurements.