中国中老年人群社会经济状况与躯体、心理和认知退行性共病动态发展的关联研究

赵镒沛; 倪于捷; 周亚冠; 安传波; 俞文韬; 徐小林

文章摘要

赵镒沛,倪于捷,周亚冠,安传波,俞文韬,徐小林.中国中老年人群社会经济状况与躯体、心理和认知退行性共病动态发展的关联研究[J].中华流行病学杂志,2024,45(10):1410-1418

中国中老年人群社会经济状况与躯体、心理和认知退行性共病动态发展的关联研究

Associations between socioeconomic status and dynamic development of physical, psychological and cognitive degenerative multimorbidity among middle aged and older adults in China

收稿日期:2024-05-28 出版日期:2024-10-22

DOI：10.3760/cma.j.cn112338-20240528-00311

中文关键词: 躯体性心理性认知退行性共病社会经济状况

英文关键词: Physical Psychological Cognitive degenerative Multimorbidity Socioeconomic status

基金项目:中央高校基本科研业务费专项资金；浙江省智能预防医学重点实验室2023年种子基金；国家自然科学基金（72474197）

作者	单位	E-mail
赵镒沛	浙江大学公共卫生学院, 杭州 310058 浙江省智能预防医学重点实验室, 杭州 310058
倪于捷	帝国理工学院, 伦敦W12
周亚冠	浙江大学公共卫生学院, 杭州 310058 浙江省智能预防医学重点实验室, 杭州 310058
安传波	浙江大学公共卫生学院, 杭州 310058 浙江省智能预防医学重点实验室, 杭州 310058
俞文韬	浙江大学公共卫生学院, 杭州 310058 浙江省智能预防医学重点实验室, 杭州 310058
徐小林	浙江大学公共卫生学院, 杭州 310058 浙江省智能预防医学重点实验室, 杭州 310058 昆士兰大学医学院公共卫生学院, 昆士兰布里斯班 4072	xiaolin.xu@zju.edu.cn

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中文摘要:

目的分析我国≥45岁中老年人躯体、心理和认知退行性共病的动态发展，并探究社会经济状况（SES）与躯体、心理和认知退行性共病进展的纵向关联。方法基于中国健康与养老追踪调查（CHARLS）2011-2020年5次随访数据，采用桑基图描述我国中老年人群2011-2020年躯体、心理和认知退行性共病的动态发展。以文化程度和家庭总财富水平衡量SES，采用logistic回归模型估计OR值及其95%CI，分析SES与不同疾病状态发展的关联。结果共纳入5 393名研究对象，其中4 484名（83.14%）在随访过程中发展新的疾病，躯体、心理和认知退行性共病患病率由38.04%上升至74.23%。与基线无报告疾病人群相比，基线患有心理障碍（与新发展躯体-认知二元共病：OR=4.59，95%CI：2.89~7.29）、认知障碍（与新发展躯体-心理二元共病：OR=2.24，95%CI：1.40~3.60）或共病者更有可能进展为躯体、心理和认知退行性共病。控制混杂因素后，与高SES人群相比，低SES人群更有可能新发展躯体性疾病（OR=1.45，95%CI：1.11~1.89）、认知障碍（OR=1.84，95%CI：1.16~2.91）、躯体-心理二元共病（OR=1.87，95%CI：1.37~2.56）、躯体-认知二元共病（OR=3.58，95%CI：2.54~5.06）、心理-认知二元共病（OR=5.66，95%CI：3.04~10.55）、躯体-心理-认知三元共病（OR=3.21，95%CI：2.06~5.01），且SES与发展二元共病的关联强度随着SES的降低而增强（均趋势检验P<0.001）。结论中国中老年人群躯体、心理和认知退行性共病患病率显著升高，SES与躯体、心理和认知退行性共病进展之间存在显著关联。

英文摘要:

Objective To analyze the dynamic development of physical, psychological, and cognitive degenerative multimorbidity among middle-aged and older Chinese adults (≥45 years old) while estimating the longitudinal association between socioeconomic status (SES) and the progression of multimorbidity. Methods Based on data from the China Health and Retirement Longitudinal Study (2011-2020), the Sankey diagram was used to show the dynamic development of physical, psychological, and cognitive degenerative multimorbidity from 2011 to 2020. SES was constructed based on the level of education and total household wealth. Logistic regression was used to estimate OR and 95%CI to evaluate the association between SES and the progression of multimorbidity. Results Of the 5 393 participants included, 4 484 (83.14%) of them developed new diseases, and the prevalence of physical, psychological, and cognitive degenerative multimorbidity increased from 38.04% to 74.23%. Compared to those with no reported disorders at baseline, participants with psychological disorder (for newly developed physical-cognitive multimorbidity: OR=4.59,95%CI: 2.89-7.29), cognitive disorder (for newly developed physical-psychological multimorbidity: OR=2.24,95%CI: 1.40-3.60), or their multimorbidity at baseline were more likely to progress to physical, psychological, and cognitive degenerative multimorbidity. After adjusting covariates, individuals with low SES were more likely to develop physical diseases (OR=1.45, 95%CI: 1.11-1.89), cognitive disorder (OR=1.84, 95%CI: 1.16-2.91), physical-psychological multimorbidity (OR=1.87, 95%CI: 1.37-2.56), physical-cognitive multimorbidity (OR=3.58, 95%CI: 2.54-5.06), psychological-cognitive multimorbidity (OR=5.66, 95%CI: 3.04-10.55), and physical-psychological-cognitive multimorbidity (OR=3.21, 95%CI: 2.06-5.01) in comparison to those with high SES. There is a dose-response relationship between SES and the multimorbidity progression (all trend P<0.001). Conclusions The prevalence of physical, psychological, and cognitive degenerative multimorbidity increased significantly among middle-aged and older Chinese adults. Lower SES was associated with multiple patterns of physical, psychological, and cognitive disorders progression.

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