社会经济特征在性别与中老年群体衰弱关联中的中介效应分析

崔珑严; 张东献

doi:10.16462/j.cnki.zhjbkz.2025.08.016

社会经济特征在性别与中老年群体衰弱关联中的中介效应分析

doi: 10.16462/j.cnki.zhjbkz.2025.08.016

崔珑严¹,
张东献^2, ,

1.
华中科技大学同济医学院医药卫生管理学院卫生管理系，武汉 430030
2.
海南医科大学公共卫生学院，海口 116044

基金项目:

海南省自然科学基金 823RC501

详细信息

通讯作者:
张东献，E-mail: zdx990326@163.com

中图分类号: R592.9;R181.3
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出版历程
- 收稿日期: 2025-03-28
- 修回日期: 2025-05-22
- 刊出日期: 2025-08-10

Analysis of the mediating relationship between socioeconomic in gender and frailty in middle-aged and older adults

CUI Longyan¹,
ZHANG Dongxian^{2
, ,}

1.
Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
2.
School of Public Health, Hainan Medical University, Haikou 116044, China

Funds:

Hainan Provincial Natural Science Foundation of China 823RC501

More Information

Corresponding author: ZHANG Dongxian, E-mail: zdx990326@163.com

摘要

摘要: 目的探究社会经济地位(socioeconomic status, SES)在性别与衰弱间的中介效应，为预防衰弱提供依据。方法基于2018年中国健康与养老追踪调查(China Health and Retirement Longitudinal Study, CHARLS)≥45岁受访者数据，采用χ²检验分析不同特征个体的衰弱检出情况，采用Bootstrap法的中介效应模型验证SES在性别与衰弱关系中的作用。结果 ≥45岁中老年群体衰弱检出率为34.70%，且女性(37.59%)高于男性(30.57%)(χ²=34.672, P < 0.001)。控制年龄、婚姻状况、居住地后，女性衰弱风险高于男性(OR=1.318, 95% CI: 1.181~1.470, P < 0.001)；女性SES水平低于男性(β=-1.282, P < 0.001)；SES与衰弱呈负相关(OR=0.928, 95% CI: 0.916~0.948, P < 0.001)。Bootstrap法检验结果表明，SES对衰弱的间接效应(natural indirect effect, NIE)为0.056(95% CI: 0.040~0.073, P < 0.001)，占总效应的25.5%。结论我国中老年群体衰弱问题严峻，SES在性别与衰弱间起部分中介作用，衰弱防治策略应重视不同SES梯度下的性别差异。
- 衰弱 /
- 性别 /
- 社会经济特征 /
- 中介效应
Abstract: Objective To explore the mediating effect of socioeconomic status (SES) between gender and frailty, and to provide further prevention of frailty. Methods Older adults aged 45 years and above in the 2018 China Health and Retirement Longitudinal Study(CHARLS) were selected, the χ² test was used to analyze the detection of frailty in older adults with different characteristics, and the mediating effect model using the Bootstrap method was used to validate the role of SES in the relationship between gender and frailty. Results The detection rate of frailty in middle-aged and older adults aged 45 years and above was 34.70%, and it was higher in women (37.59%) than in men (30.57%) (χ² =34.672, P < 0.001). After controlling for age, marital status, and residence, women had a higher risk of frailty than men (OR=1.318, 95% CI: 1.181-1.470, P < 0.001); women had lower SES levels than men (β=-1.282, P < 0.001); and SES was negatively associated with frailty (OR=0.928, 95% CI: 0.916-0.948, P < 0.001). Bootstrap test showed that the natural indirect effect (NIE) of SES on frailty was 0.056 (95 % CI: 0.040-0.073, P < 0.001), accounting for 25.5% of the total effect. Conclusions SES has a mediating effect between gender and frailty, and the prevention and treatment of frailty should be tailored to the characteristics of SES in individuals of different genders.
- Frailty /
- Gender /
- Socioecomic Status /
- Mediation effect

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图 1 M(SES)在X(性别)与Y(衰弱)关系中的中介效应

SES：社会经济地位；a：P < 0.001。

Figure 1. Mediating effect of M (SES) in the relationship between X (gender) and Y (frailty)

SES: socioeconomic status; a: P < 0.001.

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表 1 不同特征研究对象衰弱检出率比较

Table 1. Comparison of frailty detection rates among respondents with different characteristics

变量 Variable	总体 Total^① (n=6 561)	衰弱 Frailty^①		χ²值 value	P值 value
变量 Variable	总体 Total^① (n=6 561)	无 No (n=4 286)	有 Yes (n=2 275)	χ²值 value	P值 value
年龄组/岁 Age group/years				125.479	< 0.001
45~ < 55	1 397(21.3)	1 054(75.4)	343(24.6)
55~ < 65	2 218(33.8)	1 502(67.7)	716(32.3)
≥65	2 946(44.9)	1 730(58.7)	1 216(41.3)
性别 Gender				34.672	< 0.001
男性 Male	2 722(41.5)	1 890(69.4)	832(30.6)
女性 Female	3 839(58.5)	2 396(62.4)	1 443(37.6)
婚姻状况 Marital status				63.661	< 0.001
在婚 Married	5 526(84.2)	3 722(67.4)	1 804(32.6)
非在婚 Unmarried	1 035(15.8)	564(54.5)	471(45.5)
居住地 Residence				12.918	< 0.001
农村 Rural	4 756(72.5)	3 045(64.0)	1 711(36.0)
城镇 Urban	1 805(27.5)	1 241(68.8)	564(31.2)
教育程度 Education level				93.873	< 0.001
文盲 Illiterate	1 423(21.7)	805(56.6)	618(43.4)
小学 Primary school	3 092(47.1)	2 014(65.1)	1 078(34.9)
初中 Middle school	1 332(20.3)	929(69.7)	403(30.3)
高中 High school	615(9.4)	459(74.6)	156(25.4)
专科 Specialized training school	55(0.8)	41(74.5)	14(25.5)
本科及以上 College and above	44(0.7)	38(86.4)	6(13.6)
职业 Occupation				132.399	< 0.001
政府部门 Government	140(2.1)	112(80.0)	28(20.0)
事业单位 Public institution	919(14.0)	627(68.2)	292(31.8)
企业 Firm	216(3.3)	177(81.9)	39(18.1)
个体户 Individual firm	456(7.0)	359(78.7)	97(21.3)
农业 Farmer	3 880(59.1)	2 399(61.8)	1 481(38.2)
无职业 Occupation-free	950(14.5)	612(64.4)	338(35.6)
个人年收入/元 Annual personal income/yuan				141.697	< 0.001
< 5 000	2 551(38.9)	1 465(57.4)	1 086(42.6)
5 000~ < 10 000	352(5.4)	247(70.2)	105(29.8)
10 000~ < 15 000	1 674(25.5)	1 122(67.0)	552(33.0)
15 000~ < 20 000	713(10.9)	508(71.2)	205(28.8)
20 000~ < 25 000	217(3.3)	157(72.4)	60(27.6)
≥25 000	1 054(16.0)	787(74.7)	267(25.3)
注：①以人数(占比/%)表示。 Note: ① Number of people (proportion/%).

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表 2 性别对衰弱影响的回归结果

Table 2. Regression results for the effect of gender on frailty

回归方程 Regression equation	β值 value	s_x	OR值 value(95% CI)	P值 value
方程1 Equation 1
因变量：衰弱 Independent variable: frailty
自变量：性别 Dependent variable: gender	0.164	0.034	1.318(1.181~1.470)	< 0.001
方程2 Equation 2
因变量：社会经济地位 Independent variable：socioeconomic status
自变量：性别 Dependent variable: gender	-1.282	0.071	(-1.417~-1.139)	< 0.001
方程3 Equation 3
因变量：衰弱 Independent variable: frailty
自变量：社会经济地位 Dependent variable：socioeconomic status	-0.044	0.006	0.928(0.916~0.948)	< 0.001
注：方程1和方程3采用logistic回归模型；方程2采用线性回归分析；方程1和方程2，控制年龄、婚姻状况、居住地；方程3调整方程1+SES；OR值通过Probit系数近似转换(公式：OR≈e^β×1.7)，与Logit模型结果可比。 Note: Equations 1 and 3 were analyzed using logistic regression models; Equation 2 was analyzed using linear regression; Equations 1 and 2, controlling for age, marriage, and residence; Equation 3 adjusted for equation 1+SES; OR values were converted by Probit coefficient approximation (equation: OR≈e^β×1.7), comparable to Logit model results.

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表 3 社会经济地位在性别与衰弱间的中介效应分析

Table 3. Analysis of the mediating effect of socioeconomic status between gender and frailty

效应 Effect	β值 value	s_x	95% Bootstrap CI	P值 value	效应占比 Effect share/%
NDE(性别→衰弱) NDE (gender→frailty)	0.164	0.034	0.095~0.231	< 0.001	74.5
NIE(性别→SES→衰弱) NIE (gender→SES→frailty)	0.056	0.008	0.040~0.073	< 0.001	25.5
注：NDE，直接效应；NIE，间接效应；总效应=NDE+NIE；间接效应占比=间接效应/总效应。 Note: NDE, natural direct effect; NIE, natural indirect effect; Total effect=NDE+NIE; Indirect effect share=indirect effect/total effect.

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