Life-course trajectories and modifiable risk factors for incident walking limitation and mortality in 25 high-income, middle-income, and low-income countries (PURE): a prospective cohort study.

Abstract

This prospective cohort study examined the incidence, trajectories, and modifiable risk factors associated with walking limitations and mortality among adults from 25 countries participating in the PURE (Prospective Urban Rural Epidemiology) study. A total of 150,221 participants aged 35–70 years without walking limitations at baseline were followed for an average of 14.5 years. The incidence of walking limitations was highest in low-income countries and lowest in China, with women experiencing higher rates than men. Individuals in low-income countries developed walking limitations approximately 12 years earlier than those in high-income countries. Key risk factors included low educational attainment, obesity, hypertension, low recreational physical activity, poor diet, and incident stroke. These factors were also strongly associated with mortality. The findings indicate that walking limitations and mortality share common modifiable risk factors, highlighting opportunities for integrated prevention strategies aimed at promoting healthy ageing and reducing disability across different socioeconomic settings.