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A panel analysis of the Mahjong card game and social activity with sleep-related measurements among Chinese older adults


Scientific research on the benefits of the Mahjong card game and social activity for sleep remains limited among older adults in China, although these two leisure behaviors are common among Chinese older adults. This study aims to examine this topic of interest in a single research effort. Applying panel data from the Chinese Longitudinal Healthy Longevity Survey from 4718 participants, a nationally representative sample, multivariable logistic regressions were performed to investigate the effects of the Mahjong card game and social activity on quality of sleep and recommended hours of sleep duration daily (between 7 and 8 h of sleep) among Chinese older adults. Of the study sample, approximately 62% of older adults reported good quality of sleep, but only 38% of them slept within the recommended range. Non-gamers had lower odds of reporting good quality of sleep (adjusted odds ratio [AOR] = 0.75, 95% CI 0.62, 0.90, p < 0.01), compared with daily Mahjong card gamers. Participation of social activity was not associated with sleep quality. Less frequent participation in social activity was positively associated with recommended hours of sleep duration daily, but there was no significant difference between older adults who did not participate in social activity at all and those who participated daily. The study results suggest that playing the Mahjong card game is associated with better sleep quality among older adults. However, the effect of social activity on sleep-related measurements should be investigated further. The effect of social activity and sleep quality remains inconclusive.

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  1. 1.

    Zheng X, Pang L, Chen G, Huang C, Liu L, Zhang L. Challenge of population aging on health. In: Islam MdN, editor. Public health challenges in contemporary China. Berlin: Springer; 2016.

    Google Scholar 

  2. 2.

    Gu D, Sautter J, Pipkin R, Zeng Y. Sociodemographic and health correlates of sleep quality and duration among very old Chinese. Sleep. 2010;33(5):601–10.

    Article  Google Scholar 

  3. 3.

    Wu F, Guo Y, Kowal P, Jiang Y, Yu M, Li X, et al. Prevalence of major chronic conditions among older Chinese adults: the Study on Global AGEing and adult health (SAGE) wave 1. PLoS ONE. 2013;8(9):e74176.

    CAS  Article  Google Scholar 

  4. 4.

    Lu L, Wang SB, Rao WW, Ungvari GS, Ng CH, Chiu H, et al. Sleep duration and patterns in Chinese older adults: a comprehensive meta-analysis. Int J Biol Sci. 2017;13(6):682–9.

    Article  Google Scholar 

  5. 5.

    Zhao C, Wong L, Zhu Q, Yang H. Prevalence and correlates of chronic diseases in an elderly population: a community-based survey in Haikou. PLoS ONE. 2018;13(6):e0199006.

    Article  Google Scholar 

  6. 6.

    Knutson KL, Ryden AM, Mander BA, Van Cauter E. Role of sleep duration and quality in the risk and severity of type 2 diabetes mellitus. JAMA Intern Med. 2006;16:1768–74.

    Article  Google Scholar 

  7. 7.

    Kohatsu ND, Tsai R, Young T, Vangilder R, Burmeister LF, Stromquist AM, et al. Sleep duration and body mass index in a rural population. JAMA Intern Med. 2006;166(16):1701–5.

    Article  Google Scholar 

  8. 8.

    Jean-Louis G, Williams NJ, Sarpong D, Pandey A, Youngstedt S, Zizi F, et al. Associations between inadequate sleep and obesity in the US adult population: analysis of the national health interview survey (1977–2009). BMC Public Health. 2014;14:290.

    Article  Google Scholar 

  9. 9.

    Luo J, Zhu G, Zhao Q, Guo Q, Meng H, Hong Z, et al. Prevalence and risk factors of poor sleep quality among Chinese elderly in an urban community: results from the Shanghai aging study. PLoS ONE. 2013;8(11):e81261.

    Article  Google Scholar 

  10. 10.

    Wu W, Wang W, Dong Z, Xie Y, Gu Y, Zhang Y, et al. Sleep Quality and Its Associated Factors among Low-Income Adults in a Rural Area of China: a Population-Based Study. Int J Environ Res Public Health. 2018;15(9):2055.

    Article  Google Scholar 

  11. 11.

    Lee Y-H, Chang Y-C, Lee Y-T, Shelley M, Liu CT. Dietary patterns with fresh fruits and vegetables consumption and quality of sleep among older adults in mainland China. Sleep Biol Rhythm. 2018;16(3):293–305.

    Article  Google Scholar 

  12. 12.

    Lee Y-H, Chang Y-C, Liu C-T, Shelley M. Evaluating the associations of consumption of non-red meat protein sources and flavor preferences on sleeping patterns among older adults in China. Sleep Biol Rhythm. 2019;17(1):79–92.

    Article  Google Scholar 

  13. 13.

    Lee Y-H, Chang Y-C, Chiang T, Liu C-T, Shelley M. Living arrangements and sleep-related outcomes among older adults in China: a panel analytic approach. Int J Aging Hum Dev. 2019 (Online first).

  14. 14.

    Crombie IK, Irvine L, Williams B, McGinnis AR, Slane PW, Alder EM, et al. Age Ageing. 2004;33(3):287–92.

    Article  Google Scholar 

  15. 15.

    Kline CE. The bidirectional relationship between exercise and sleep: implications for exercise adherence and sleep improvement. Am J Lifestyle Med. 2014;8(6):375–9.

    Article  Google Scholar 

  16. 16.

    Cheng ST, Chan AC, Yu EC. An exploratory study of the effect of mahjong on the cognitive functioning of persons with dementia. Int J Geriatric Psychiatry. 2006;21(7):617–61.

    Article  Google Scholar 

  17. 17.

    Tsang WW, Wong GC, Gao KL. Mahjong playing and eye-hand coordination in older adults-a cross-sectional study. J Phys Therapy Sci. 2016;28(10):2955–60.

    Article  Google Scholar 

  18. 18.

    Endeshaw YW, Yoo W. Association between social and physical activities and insomnia symptoms among community-dwelling older adults. J Aging Health. 2016;28(6):1073–89.

    Article  Google Scholar 

  19. 19.

    Hirshkowitz M, Whiton K, Albert SM, Alessi C, Bruni O, Doncarlos L, et al. National sleep foundation’s sleep time duration recommendations: methodology and results summary. Sleep Health. 2015;1(1):40–3.

    Article  Google Scholar 

  20. 20.

    Zeng Y. Towards Deeper Research and Better Policy for Healthy Aging –Using the Unique Data of Chinese Longitudinal Healthy Longevity Survey. China Econ J. 2012;5(2–3):131–49.

    Article  Google Scholar 

  21. 21.

    Hsiao C. Panel data analysis—advantages and challenges. TEST. 2007;16(1):1–22.

    Article  Google Scholar 

  22. 22.

    Croissant Y. Package ‘pglm’. 2017 (2019).

  23. 23.

    Kripke DF, Garfinkel L, Wingard DL, Klauber MR, Marler MR. Mortality Associated With Sleep Duration and Insomnia. JAMA Psychiatry. 2002;59(2):131–6.

    Google Scholar 

  24. 24.

    The University of Sydney. The secret of a good night’s sleep- aim for quality over quantity, new study shows. 2017.

  25. 25.

    Ohayon MM, Carskadon MA, Guilleminault C, Vitiello MV. Meta-Analysis of Quantitative Sleep Parameters From Childhood to Old Age in Healthy Individuals: developing Normative Sleep Values Across the Human Lifespan. Sleep. 2004;27(7):1255–73.

    Article  Google Scholar 

  26. 26.

    Schmidt C, Peigneux P, Cajochen C. Age-related changes in sleep and circadian rhythms: impact on cognitive performance and underlying neuroanatomical networks. Front Neurol. 2012;3:118.

    Article  Google Scholar 

  27. 27.

    Cornwell B, Laumann EO, Schumm LP. The Social Connectedness of Older Adults: a National Profile. Am Sociol Rev. 2008;73(2):185–203.

    Article  Google Scholar 

  28. 28.

    Kemperman A, van den Berg P, Weijs-Perrée M, Uijtdewillegen K. Loneliness of Older Adults: social Network and the Living Environment. Int J Environ Res Public Health. 2019;16(3):406.

    Article  Google Scholar 

  29. 29.

    Allaire JC, Mclaughlin AC, Trujillo A, Whitlock LA, Laporte L, Gandy M. Successful aging through digital games: socioemotional differences between older adult gamers and Non-gamers. Comput Hum Behav. 2013;29(4):1302–6.

    Article  Google Scholar 

  30. 30.

    Machishima K, Sakamoto M, Oshima C, Kitajima K, Koba T, Gohara R, et al. The effect of mahjong on healthy elderly persons cognitive function. Arch Clin Neuropsychol. 2014;29(6):505.

    Article  Google Scholar 

  31. 31.

    Wu S, Wang R, Zhao Y, Ma X, Wu M, Yan X, et al. The relationship between self-rated health and objective health status: a population-based study. BMC Public Health. 2013;13:320.

    Article  Google Scholar 

  32. 32.

    Liu X, Liu L. Sleep habits and insomnia in a sample of elderly persons in China. Sleep. 2005;28(12):1578–87.

    Google Scholar 

  33. 33.

    Thomas PA, Liu H, Umberson D. Family relationships and well-being. Innov Aging. 2017; 1(3): igx025.

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Data used for this research were provided by the “Chinese Longitudinal Healthy Longevity Survey” (CLHLS) managed by the Center for Healthy Aging and Development Studies, Peking University. CLHLS is supported by funds from the U.S. National Institutes on Aging (NIA), China Natural Science Foundation, China Social Science Foundation, and United Nations Population Fund. We thank research participants and researchers for their efforts in collecting the CLHLS data.


The authors of the present study did not receive any funding resources for this publication and research.

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YCC and YHL contributed equally to this research. YCC and YHL conducted statistical analysis and conceived study design; YCC, YHL, and MS prepared the manuscript; MS and CTL critically revised the manuscript; and CTL provided technical support.

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Correspondence to Yen-Han Lee.

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The authors used only secondary data sets in the public domain for this present study and data analyses. Hence, Institutional Review Board (IRB) approval was not required.

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Lee, YH., Chang, YC., Shelley, M. et al. A panel analysis of the Mahjong card game and social activity with sleep-related measurements among Chinese older adults. Sleep Biol. Rhythms 18, 109–119 (2020).

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  • Oldest old
  • Sleep
  • Mahjong
  • Social activity
  • China