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中国≥45岁中老年人多重慢性病模式与日常和工具性日常生活活动能力残疾的关联性

李艳萍 王媛 纪之琳 白婧琰 张岩波 陆姣

李艳萍, 王媛, 纪之琳, 白婧琰, 张岩波, 陆姣. 中国≥45岁中老年人多重慢性病模式与日常和工具性日常生活活动能力残疾的关联性[J]. 中华疾病控制杂志, 2024, 28(1): 26-31. doi: 10.16462/j.cnki.zhjbkz.2024.01.005
引用本文: 李艳萍, 王媛, 纪之琳, 白婧琰, 张岩波, 陆姣. 中国≥45岁中老年人多重慢性病模式与日常和工具性日常生活活动能力残疾的关联性[J]. 中华疾病控制杂志, 2024, 28(1): 26-31. doi: 10.16462/j.cnki.zhjbkz.2024.01.005
LI Yanping, WANG Yuan, JI Zhilin, BAI Jingyan, ZHANG Yanbo, LU Jiao. Association of multimorbidity patterns with activity of daily living and instrumental activity of daily living disability among ≥45 years middle-aged and elderly population in China[J]. CHINESE JOURNAL OF DISEASE CONTROL & PREVENTION, 2024, 28(1): 26-31. doi: 10.16462/j.cnki.zhjbkz.2024.01.005
Citation: LI Yanping, WANG Yuan, JI Zhilin, BAI Jingyan, ZHANG Yanbo, LU Jiao. Association of multimorbidity patterns with activity of daily living and instrumental activity of daily living disability among ≥45 years middle-aged and elderly population in China[J]. CHINESE JOURNAL OF DISEASE CONTROL & PREVENTION, 2024, 28(1): 26-31. doi: 10.16462/j.cnki.zhjbkz.2024.01.005

中国≥45岁中老年人多重慢性病模式与日常和工具性日常生活活动能力残疾的关联性

doi: 10.16462/j.cnki.zhjbkz.2024.01.005
基金项目: 

教育部人文社会科学研究规划基金项目 22YJA630059

中国博士后科学基金第15批特别资助项目 2022T150514

国家自然科学基金青年项目 71804101

详细信息
    通讯作者:

    陆姣,E-mail:lujiao801@163.com

    张岩波,E-mail:sxmuzyb@126.com

  • 中图分类号: R195.4

Association of multimorbidity patterns with activity of daily living and instrumental activity of daily living disability among ≥45 years middle-aged and elderly population in China

Funds: 

The Humanities and Social Science Research Planning Foundation of the Ministry of Education 22YJA630059

The 15th Batch of China Postdoctoral Science Foundation 2022T150514

National Natural Science Foundation of China 71804101

More Information
  • 摘要:   目的  聚类中国≥45岁中老年人多重慢性病模式的流行情况,并探讨多重慢性病模式与日常生活能力(activity of daily living, ADL)和工具性日常生活能力(instrumental activity of daily living,IADL)残疾的关联性。  方法  基于2018年中国健康与养老追踪调查(China Health and Retirement Longitudinal Study,CHARLS)数据库,以19 745名≥45岁中老年人为研究对象,采用双向聚类法(two-way clustering framework,TCF)识别非随机多重慢性疾病模式后进行人群聚类,并采用logistic回归分析模型分析多重慢性病模式与ADL和IADL残疾的相互关系。  结果  中国中老年人多重慢性病患者例数为10 941,占55.4%,可聚类为心脑血管-代谢模式、呼吸系统-内脏模式和消化-关节-精神模式,根据多重慢性病模式的关联强度将人群划分为5个多重慢性病关联组。其中,高度关联心脑血管-代谢模式和消化-关节-精神模式人群的ADL和IADL残疾负担最重(OR=4.696, 95% CI: 4.196~5.255, P < 0.001; OR=3.155, 95% CI: 2.840~3.504, P < 0.001),高度关联心脑血管-代谢模式合并中度关联呼吸系统-内脏模式的人群罹患ADL和IADL残疾的风险次之(OR=2.821, 95% CI: 2.210~3.602, P < 0.001; OR=2.662, 95% CI: 2.120~3.342, P < 0.001)。  结论  中国中老年人群中高度关联心脑血管-代谢模式发生ADL和IADL残疾的风险最高。
  • 图  1  5类多重慢性病模式特征

    G1心脑血管-代谢模式(高血压、血脂异常、糖尿病和血糖升高、心脏病、脑卒中、与记忆相关的疾病);G2呼吸系统-内脏模式(慢性肺部疾病、肝脏疾病、肾脏疾病、哮喘);G3消化-关节-精神模式(胃部疾病或消化系统疾病、情感及精神方面问题、关节炎和风湿病)。

    Figure  1.  Characteristics of five types of multimorbid

    G1 cardio-cerebrovascular-metabolic pattern (hypertension, dyslipidemia, diabetes and high blood sugar, heart disease, stroke, memory-related diseases); G2 respiratory system-visceral pattern (chronic lung disease, liver disease, kidney disease, asthma) and G3 digestion-articular-mental pattern (diseases of the stomach or digestive system, emotional and psychiatric problems, arthritis and rheumatism).

    表  1  调查对象基本情况

    Table  1.   Baseline characteristics of subjects in cross-lagged analysis

    变量Variable 总人数 Total (n=19 745) ADL残疾 ADL disability (n=3 636) 无ADL残疾 No ADL disability (n=16 109) IADL残疾 IADL disability (n=14 439) 无IADL残疾 No IADL disability (n=5 306)
    年龄组/岁Age group/years
      45~ < 60 8 652(43.8) 794(9.2) 7 858(90.8) 1 262(14.6) 7 390(85.4)
      60~ < 75 8 695(44.0) 1 907(21.9) 6 788(78.0) 2 726(31.4) 5 969(68.6)
      75~ < 90 2 301(11.7) 875(38.0) 1 426(62.0) 1 237(53.8) 1 064(46.2)
      ≥90 97(0.5) 60(62.0) 37(38.0) 81(83.5) 16(16.5)
    性别Gender
      男Male 9 303(47.1) 1 366(37.6) 7 937(49.3) 1 957(21.0) 7 346(79.0)
      女Female 10 442(52.9) 2 270(62.4) 8 172(50.7) 3 349(24.3) 7 093(75.7)
    教育水平Education level
      小学以下Below primary school 8 584(43.5) 2 259(26.0) 6 325(74.0) 3 462(40.3) 5 122(59.7)
      小学Primary school 4 348(22.0) 688(15.8) 3 660(84.2) 979(22.5) 3 369(77.5)
      中学及以上Secondary school and above 6 813(34.5) 689(10.0) 6 124(90.0) 865(12.7) 5 948(87.3)
    居住地区Region
      城镇Urban 4 924(24.9) 652(13.2) 4 272(86.8) 898(18.3) 4 026(81.7)
      农村Rural 14 735(74.6) 2 977(20.2) 11 758(79.8) 4 399(29.9) 10 336(70.1)
      特殊地区Special area 86(0.4) 7(8.1) 79(91.9) 9(10.5) 77(89.5)
    婚姻状况Marital status
      已婚Married 16 809(85.1) 2 693(16.0) 14 116(84.0) 3 970(23.6) 12 839(76.4)
      离异Divorced 312(1.6) 64(20.5) 248(79.5) 76(24.4) 236(75.6)
      丧偶或其他Widowed or other 2 624(33.5) 879(24.2) 1 745(66.5) 1 260(48.0) 1 364(52.0)
    慢性病数量Number of chronic diseases
      0 4 137(21.0) 197(4.8) 3 940(95.2) 490(11.8) 3 647(88.2)
      1 4 667(23.6) 516(11.0) 4 151(89.0) 884(18.9) 3 783(81.1)
      ≥2 10 941(55.4) 2 923(26.7) 8 018(73.3) 3 932(35.9) 7 009(64.1)
    注: ADL, 日常生活能力; IADL, 工具性日常生活能力。
    ①以人数(占比/%)表示。
    Note: ADL, activity of daily living; IADL, instrumental activity of daily living.
    ① Number of people(proportion/%).
    下载: 导出CSV

    表  2  分析ADL和IADL残疾与样本特征之间关系的logistic回归分析模型

    Table  2.   Logistic regression models to analyze the relationship between ADL/ IADL disability and sample characteristics

    变量Variable ADL IADL
    校正前Before adjustment OR值value (95% CI) 校正后 After adjusting OR值value (95% CI) 校正前Before adjustment OR值value (95% CI) 校正后 After adjusting OR值value (95% CI)
    年龄组/岁Age group/years
      60~ < 75 2.780(2.544~3.039) 1.837(1.667~2.023) 2.674(2.481~2.882) 1.749(1.610~1.900)
      75~ < 90 6.073(5.432~6.788) 3.612(3.180~4.104) 6.808(6.151~7.534) 4.030(3.588~4.527)
      ≥90 16.049(10.586~24.332) 10.245(6.518~16.104) 29.645(17.284~50.846) 16.819(9.527~29.691)
    性别Gender
      女Female 1.614(1.499~1.738) 1.366(1.255~1.488) 1.772(1.661~1.891) 1.437(1.332~1.549)
    教育水平Education level
      小学Primary school 1.671(1.492~1.871) 1.291(1.142~1.459) 1.998(1.807~2.210) 1.572(1.410~1.753)
      小学以下Below primary school 3.174(2.895~3.481) 1.843(1.653~2.056) 4.648(4.276~5.052) 2.816(2.556~3.103)
    居住地区Region
      农村Rural 1.659(1.514~1.818) 1.580(1.422~1.755) 1.908(1.761~2.068) 1.624(1.478~1.784)
      特殊经济地区Special area 0.581(0.267~1.263) 0.574(0.251~1.311) 0.524(0.262~1.049) 0.463(0.218~0.983)
    婚姻状况Marital status
      离异Divorced 1.353(1.025~1.786) 1.509(1.106~2.058) 1.041(0.802~1.352) 1.184(0.881~1.592)
      丧偶或其他Widowed or other 2.640(2.411~2.892) 1.304(1.172~1.452) 2.987(2.745~3.251) 1.394(1.262~1.540)
    慢性病数量Number of chronic diseases
      1 2.486(2.098~2.946) 2.095(1.741~2.520) 1.739(1.543~1.960) 1.447(1.264~1.656)
      ≥2 7.291(6.280~8.464) 5.489(4.663~6.462) 4.175(3.770~4.624) 3.182(2.833~3.575)
    注: ADL, 日常生活能力; IADL, 工具性日常生活能力。
    ①代表根据年龄、性别、居住地区、教育程度、婚姻状况和慢性病数量调整的多变量logistic回归模型,P < 0.001。
    Note: ADL, activity of daily living; IADL, instrumental activity of daily living.
    ① Multivariate logistic regression model adjusted for age, gender, region, education level, marital status, and number of chronic diseases, P < 0.001.
    下载: 导出CSV

    表  3  多重慢性病关联组分与ADL和IADL残疾的logistic回归分析模型

    Table  3.   Logistic regression analysis of multimorbidity-related components and ADL /IADL disability

    多重慢性病组分Multimorbidity component 人数(占比%) Number of people (proportion%) ADL IADL
    校正后After adjusting OR值value (95% CI) 校正后After adjusting OR值value (95% CI)
    组分1 Component 1 11 079(56.1) 1.000 1.000
    组分2 Component 2 1 025(5.2) 2.271(1.901~2.715) 1.708(1.453~2.007)
    组分3 Component 3 4 193(21.2) 2.821(2.210~3.602) 2.662(2.120~3.342)
    组分4 Component 4 566(2.9) 2.311(2.073~2.577) 1.850(1.681~2.037)
    组分5 Component 5 2 882(14.6) 4.696(4.196~5.255) 3.155(2.840~3.504)
    注: ADL, 日常生活能力; IADL, 工具性日常生活能力。
    Note: ADL, activity of daily living; IADL, instrumental activity of daily living.
    下载: 导出CSV
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  • 收稿日期:  2023-05-17
  • 修回日期:  2023-09-03
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  • 刊出日期:  2024-01-10

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