Cross-sectional relationship between social trust and health in middle-aged and older Chinese adults: Can social trust explain the education-health link?

Aim: Evidence on the association of social trust with health in middle-aged and older Chinese adults is limited, and its mediating role in the education-health link remains unclear. This study investigated the association of social trust with chronic diseases and mental health, and its mediating effects.

Methods: Cross-sectional data came from the 2018-2019 baseline survey of the Chongqing Cohort of the China Multi-Ethnic Cohort study, including 15 251 participants aged ≥45 years, with data collected using questionnaires and physical examinations. Logistic regression and serial multiple mediation models were used.

Results: Low social trust was associated with higher risks of dyslipidemia (odds ratio [OR] 1.30, 95% confidence interval [CI] 1.07, 1.56), stroke (OR 2.60, 95% CI 1.26, 5.33) and kidney disease (OR 2.44, 95% CI 1.30, 4.57). A gradient in the risk of anxiety (high social trust: OR 1.38, 95% CI 1.05, 1.81; medium: OR 2.26, 95% CI 1.69, 3.02; low: OR 2.76, 95% CI 1.91, 3.99, compared with very high) and depression (medium: OR 1.67, 95% CI 1.26, 2.20; low: OR 1.74, 95% CI 1.19, 2.56) was identified. The serial mediation analysis found no mediation of social trust on the relationships between education and chronic diseases, but only an indirect effect of household income for impaired lung and liver function. Social trust mediated the relationships between education and anxiety and depression, with small effects.

Conclusions: Social trust is associated with certain chronic conditions and mental health. Alongside household income, it mediates the relationship between education and mental health, implying that enhancing social trust could be an effective strategy for improving mental health. Geriatr Gerontol Int 2025; ••: ••-••.