中国中老年人中心性肥胖和疼痛与衰弱关联研究

侯丁淳; 梁博; 裴丽君; 陈功

文章摘要

侯丁淳,梁博,裴丽君,陈功.中国中老年人中心性肥胖和疼痛与衰弱关联研究[J].中华流行病学杂志,2025,46(9):1531-1539

中国中老年人中心性肥胖和疼痛与衰弱关联研究

Study of association of central obesity and pain with frailty in middle-aged and old people in China

收稿日期:2025-03-12 出版日期:2025-09-12

DOI：10.3760/cma.j.cn112338-20250312-00156

中文关键词: 中心性肥胖腰围身高比疼痛衰弱队列研究

英文关键词: Central obesity Waist-to-height ratio Pain Frailty Cohort study

基金项目:国家重点研发计划（2018YFC2000603）；国家社会科学基金（23ZDA101）；北京大学校级项目（2023003437）

作者	单位	E-mail
侯丁淳	北京大学人口研究所, 北京 100871
梁博	北京大学人口研究所, 北京 100871
裴丽君	北京大学人口研究所, 北京 100871	peilj@pku.edu.cn
陈功	北京大学中国老龄事业发展研究中心, 北京 100871	chengong@pku.edu.cn

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中文摘要:

目的探究中老年人中心性肥胖和疼痛及其联合效应和交互作用与衰弱发生风险的关联。方法应用中国健康与养老追踪调查数据，以2011、2013、2015年的14 359名≥45岁样本为基线人群，构建队列数据库。应用Cox比例风险回归模型估计腰围身高比（WHtR）和疼痛与衰弱风险的关联，并进行联合效应与交互作用分析。结果在随访77 783人年中，3 198名研究对象发生衰弱，发病密度为41.11/1 000人年。相比于WHtR的Q₁水平，其Q₂、Q₃和Q₄水平分别使衰弱风险增加17%（HR=1.17，95%CI：1.05~1.31）、24%（HR=1.24，95%CI：1.11~1.40）和43%（HR=1.43，95%CI：1.25~1.63）；相比于无疼痛，有疼痛使衰弱风险增加97%（HR=1.97，95%CI：1.83~2.11），且有1、2、≥3个疼痛部位分别使衰弱风险增加42%（HR=1.42，95%CI：1.25~1.61）、86%（HR=1.86，95%CI：1.64~2.11）、138%（HR=2.38，95%CI：2.18~2.60）；限制性立方样条结果显示，WHtR水平与衰弱风险呈J形剂量-反应关系（总P<0.001，非线性P<0.001），疼痛数量与衰弱风险呈正向非线性剂量-反应关系（总P<0.001，非线性P<0.001）；阈值效应分析结果显示，WHtR和疼痛数量的拐点分别为0.46和2.00（P<0.001）。联合效应分析显示，WHtR的Q₂、Q₃和Q₄水平合并疼痛分别使衰弱发生风险增加146%（HR=2.46，95%CI：2.11~2.87）、169%（HR=2.69，95%CI：2.30~3.16）和157%（HR=2.57，95%CI：2.18~3.03）。结论中老年人中较高的WHtR水平和较多部位的疼痛可增加衰弱风险，且WHtR和疼痛存在联合效应，综合的肥胖和疼痛管理与干预对衰弱的早期预防具有重要意义。

英文摘要:

Objective To explore the association of central obesity, pain, their joint effect, and interaction with frailty in middle-aged and old people in China. Methods A total of 14 359 participants aged ≥45 years in 2011, 2013 and 2015 were selected from the China Health and Retirement Longitudinal Study to construct a cohort database. Cox proportional hazards regression models were used to estimate the association of waist-to-height ratio (WHtR) and pain with the risk for frailty. Joint effect and interaction analyses were performed. Results In the follow-up of 77 783 person-years, frailty developed in 3 198 participants, with an incidence density of 41.11 per 1 000 person-years. Compared with the Q₁ level of WHtR, its Q₂, Q₃ and Q₄ level increased risk for frailty by 17% (HR=1.17, 95%CI: 1.05-1.31), 24% (HR=1.24, 95%CI: 1.11-1.40), and 43% (HR=1.43, 95%CI: 1.25-1.63), respectively. Compared with painlessness, suffering from pain increased the risk for frailty by 97% (HR=1.97, 95%CI: 1.83-2.11), and having 1, 2, and ≥3 pain sites increased the risk by 42% (HR=1.42, 95%CI: 1.25-1.61), 86% (HR=1.86, 95%CI: 1.64-2.11), and 138% (HR=2.38, 95%CI: 2.18-2.60), respectively. The results of restricted cubic spline showed that WHtR level was associated with the risk for frailty in a J-type dose-response relationship (total P<0.001, nonlinear P<0.001), and pain quantity was positively associated with the risk in a nonlinear dose-response relationship (total P<0.001, nonlinear P<0.001). Threshold effect analysis revealed that the inflection points of WHtR and pain site number were 0.46 and 2.00, respectively (P<0.001). Joint effect analysis showed that the Q₂, Q₃ and Q₄ levels of WHtR combined with pain increased the risk for frailty by 146% (HR=2.46, 95%CI: 2.11-2.87), 169% (HR=2.69, 95%CI: 2.30-3.16), and 157% (HR=2.57, 95%CI: 2.18-3.03). Conclusions The risk for frailty increased with the level of WHtR and the number of pain sites in middle-aged and old people, and there was joint effect between WHtR and pain. Comprehensive management and intervention of obesity and pain are significant for the early prevention of frailty.

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