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摘要:
目的 采用衰弱指数(frailty index，FI)对上海市50岁及以上人群的衰弱状况进行分析。 方法 数据来源于世界卫生组织"全球老龄化与成人健康研究(study on global AGEing and adult health，SAGE)"上海现场第一轮横断面调查(2009-2010年)，以40个健康相关变量为基础构建FI以评估50岁及以上人群衰弱状况，FI值的范围为0~1，将FI ≥ 0.2判定为衰弱。 结果 共纳入8 632名调查对象，平均年龄(63.3±9.9)岁。衰弱率为7.8%(95% CI：5.8%~10.4%)，FI值为0.08(95% CI：0.07~0.09)，两者均在女性、高龄、离异(分居/丧偶)者、文化程度低、家庭经济情况较差者中较高。多因素分析结果显示增龄、水果蔬菜摄入不足、低水平体力活动与衰弱及FI值较高相关。 结论 本研究提供了上海市50岁及以上人群衰弱率和衰弱指数的分布情况。面对上海人口深度老龄化的现状，开展对老年人，尤其是衰弱高危人群的评估及针对性干预尤为必要。 Abstract:Objective To evaluate frailty in people aged 50 years and above in Shanghai. Methods Cross-sectional data was collected from 2009 to 2010 among people aged 50 and above in Shanghai in the World Health Organization (WHO) study on global AGEing and adult health (SAGE) wave 1. A frailty index (FI) was constructed as the proportion of deficits in 40 variables. A FI of 0.2 or greater was recognized as approaching a frail state. Results A total of 8 632 participants were included, with average age of 63.3 years. The overall weighted prevalence of frailty was 7.8% (95% CI: 5.8-10.4%), the score of FI was 0.08 (95% CI: 0.07-0.09), which were both higher among women, elderly people, the divorced (separated/widowed) and individuals with lower levels of education and wealth. In addition, Ageing, insufficient intake of vegetable and fruit and low level of physical activity were significantly associated with frailty and higher FI. Conclusions Our study provides the epidemiological characteristics of frailty in people aged 50 years and older in Shanghai. It highlights the need for targeted preventive approaches and support programs to promote physical, psychological and social health in elderly people. -
Key words:
- Frailty /
- Frailty index /
- Elderly
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表 1 上海市50岁及以上人群基本情况
Table 1. Sociodemographic characteristics of the study population aged 50 years and above in Shanghai
影响因素 男性 女性 合计 人数 比例(%) 人数(加权) 比例(%，加权) 人数 比例(%) 人数(加权) 比例(%，加权) 人数 比例(%) 人数(加权) 比例(%，加权) 年龄组(岁) 50~ 1 709 42.63 2 415 56.78 2 111 45.66 2 349 53.65 3 820 44.25 4 764 55.19 60~ 1 251 31.20 1 104 25.97 1 249 27.02 1 076 24.58 2 500 28.96 2 181 25.27 70~ 775 19.33 549 12.91 882 19.08 671 15.33 1 657 19.20 1 220 14.14 ≥80 274 6.83 185 4.34 381 8.24 282 6.44 655 7.59 467 5.41 居住地a 城市 2 123 53.73 2 520 59.72 2 574 56.56 2 612 60.13 4 697 55.25 5 132 59.93 农村 1 828 46.27 1 700 40.28 1 977 43.44 1 732 39.87 3 805 44.75 3 432 40.07 婚姻状况a 未婚 67 1.69 78 1.85 38 0.83 33 0.76 105 1.23 111 1.29 已婚/同居 3 588 90.26 3 890 91.72 3 728 81.45 3 671 84.20 7 316 85.55 7 561 87.90 离异/分居/丧偶 320 8.05 273 6.44 811 17.72 656 15.05 1 131 13.22 929 10.80 文化程度a 未受正规教育 296 7.38 193 4.54 994 21.51 718 16.41 1 290 14.95 911 10.56 小学未毕业 625 15.59 548 12.88 810 17.52 749 17.12 1 435 16.63 1 297 15.03 小学毕业 805 20.08 816 19.19 688 14.89 726 16.58 1493 17.30 1 542 17.87 初中毕业 1 151 28.71 1 444 33.95 1 199 25.94 1 260 28.78 2 350 27.23 2 704 31.33 高中毕业 742 18.51 858 20.18 754 16.31 761 17.40 1 496 17.33 1 620 18.77 大学及以上 390 9.73 394 9.26 177 3.83 163 3.72 567 6.57 557 6.45 家庭经济情况a 第一分位(最低) 777 19.52 628 14.82 980 21.36 761 17.44 1 757 20.51 1 390 16.15 第二分位 826 20.75 816 19.24 933 20.34 847 19.41 1 759 20.53 1 663 19.32 第三分位 804 20.20 914 21.54 906 19.75 890 20.37 1 710 19.96 1 803 20.95 第四分位 798 20.05 943 22.23 887 19.33 901 20.63 1 685 19.67 1 843 21.42 第五分位(最高) 775 19.47 940 22.17 882 19.22 967 22.15 1 657 19.34 1 907 22.16 蔬菜水果摄入 不足 642 16.01 649 15.26 681 14.73 575 13.13 1323 15.33 1224 14.18 充足 3 367 83.99 3 604 84.74 3 942 85.27 3 803 86.87 7 309 84.67 7 407 85.82 饮酒a 从不饮酒 2 451 68.31 2 583 67.04 4 432 98.45 4 219 98.62 6 883 85.08 6 802 83.66 轻度饮酒 879 24.50 989 25.67 62 1.38 52 1.21 941 11.63 1 041 12.80 偶尔重度饮酒 26 0.72 29 0.75 1 0.02 0 0.01 27 0.33 29 0.36 经常重度饮酒 232 6.47 252 6.54 7 0.16 7 0.16 239 2.95 259 3.18 吸烟a 从不吸烟 1740 44.01 1798 42.71 4523 98.91 4297 98.87 6263 73.45 6095 71.23 目前不吸烟 384 9.71 330 7.85 6 0.13 5 0.11 390 4.57 335 3.92 偶尔吸烟 160 4.05 160 3.80 4 0.09 3 0.06 164 1.92 163 1.90 目前每日吸烟 1670 42.24 1921 45.64 40 0.87 42 0.96 1710 20.05 1963 22.95 体力活动a 低水平体力活动 2353 59.28 2468 58.41 2774 60.66 2606 59.98 5127 60.02 5074 59.20 中等水平体力活动 1135 28.60 1218 28.82 1249 27.31 1166 26.82 2384 27.91 2383 27.81 高水平体力活动 481 12.12 539 12.77 550 12.03 574 13.20 1031 12.07 1113 12.99 合计 4 009 46.44 4 253 49.28 4 623 53.56 4 378 50.72 8 632 100.00 8 631 100.00 注：a存在数据缺失。 
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表 2 上海市50岁及以上人群衰弱分布情况
Table 2. Prevalence of frailty among adults aged 50 years and above in Shanghai
影响因素 男性 女性 合计 率(%) 95% CI值 率(%) 95% CI值 率(%) 95% CI值 年龄组(岁) 50~ 3.7 (2.3~6.0) 5.1 (3.4~7.5) 4.4 (2.9~6.6) 60~ 5.3 (2.7~9.9) 7.6 (4.6~12.1) 6.4 (3.8~10.7) 70~ 12.1 (8.5~16.9) 16.9 (11.5~24.1) 14.7 (10.4~20.3) ≥80 28.7 (22.6~35.6) 33.8 (25.5~43.3) 31.8 (25.0~39.4) F值 36.99 56.77 59.99 P值 < 0.001 < 0.001 < 0.001 居住地 城市 5.7 (3.6~9.0) 8.1 (5.6~11.5) 6.9 (4.7~9.9) 农村 7.2 (4.4~11.4) 11.2 (7.0~17.2) 9.2 (5.9~14.0) F值 0.56 1.65 1.30 P值 0.466 0.218 0.273 婚姻状况 未婚 4.7 (1.3~15.2) 14.3 (6.6~28.2) 7.5 (3.1~16.8) 已婚/同居 6.0 (4.3~8.4) 7.6 (5.3~10.9) 6.8 (4.8~9.5) 离异/分居/丧偶 10.6 (6.8~16.1) 18.4 (13.4~24.9) 16.1 (12.2~21.0) F值 4.70 25.84 28.85 P值 0.017 < 0.001 < 0.001 文化程度 未受正规教育 17.7 (11.2~26.8) 18.5 (12.3~26.9) 18.3 (12.3~26.4) 小学未毕业 8.5 (5.0~14.0) 10.2 (6.6~15.6) 9.5 (6.1~14.6) 小学毕业 8.8 (5.6~13.3) 10.1 (6.7~15.1) 9.4 (6.6~13.3) 初中毕业 4.1 (2.9~5.9) 6.1 (3.9~9.5) 5.1 (3.5~7.2) 高中毕业 3.6 (1.9~6.8) 4.8 (2.1~10.3) 4.1 (2.1~8.0) 大学及以上 6.2 (2.3~15.6) 7.0 (2.1~20.8) 6.4 (2.3~16.8) F值 7.85 8.03 10.97 P值 < 0.001 < 0.001 < 0.001 家庭经济情况 第一分位(最低) 8.5 (5.5~12.9) 16.1 (10.5~24.0) 12.7 (8.3~18.9) 第二分位 8.1 (5.8~11.3) 9.2 (6.4~13.0) 8.7 (6.4~11.7) 第三分位 6.2 (3.5~10.8) 8.1 (5.4~11.9) 7.1 (4.6~10.9) 第四分位 5.4 (4.0~7.4) 7.3 (5.0~10.7) 6.4 (4.8~8.3) 第五分位(最高) 4.1 (2.1~7.8) 6.9 (3.6~13.1) 5.6 (3.0~10.0) F值 3.14 5.48 5.61 P值 0.031 0.007 0.007 合计 6.3 (4.5~8.7) 9.3 (6.9~12.4) 7.8 (5.8~10.4)
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表 3 上海市50岁及以上人群衰弱指数分布情况
Table 3. Frailty index score for adults aged 50 years and above in Shanghai
影响因素 男性 女性 合计 均数 95% CI值 均数 95% CI值 均数 95% CI值 年龄组(岁) 50~ 0.05 (0.04~0.06) 0.06 (0.05~0.07) 0.06 (0.05~0.06) 60~ 0.07 (0.06~0.09) 0.08 (0.07~0.10) 0.08 (0.07~0.09) 70~ 0.11 (0.10~0.13) 0.13 (0.11~0.14) 0.12 (0.10~0.14) ≥80 0.19 (0.15~0.23) 0.24 (0.16~0.31) 0.22 (0.17~0.27) F值 62.24 216.51 238.82 P值 < 0.001 < 0.001 < 0.001 居住地 城市 0.07 (0.06~0.09) 0.08 (0.07~0.10) 0.08 (0.06~0.09) 农村 0.07 (0.06~0.09) 0.09 (0.07~0.11) 0.08 (0.07~0.10) F值 0.53 41.83 21.22 P值 0.466 < 0.001 < 0.001 婚姻状况 未婚 0.06 (0.04~0.08) 0.14 (0.05~0.22) 0.08 (0.05~0.11) 已婚/同居 0.07 (0.06~0.08) 0.08 (0.07~0.09) 0.07 (0.06~0.08) 离异/分居/丧偶 0.10 (0.08~0.13) 0.13 (0.11~0.16) 0.12 (0.10~0.15) F值 12.11 61.11 64.15 P值 < 0.001 < 0.001 < 0.001 文化程度 未受正规教育 0.14 (0.09~0.18) 0.14 (0.11~0.18) 0.14 (0.11~0.17) 小学未毕业 0.09 (0.07~0.11) 0.10 (0.09~0.11) 0.09 (0.08~0.11) 小学毕业 0.08 (0.06~0.09) 0.08 (0.07~0.10) 0.08 (0.07~0.09) 初中毕业 0.06 (0.05~0.07) 0.07 (0.05~0.09) 0.06 (0.05~0.08) 高中毕业 0.07 (0.05~0.09) 0.06 (0.05~0.07) 0.06 (0.05~0.08) 大学及以上 0.07 (0.05~0.08) 0.07 (0.05~0.10) 0.07 (0.05~0.09) F值 11.51 53.93 57.49 P值 < 0.001 < 0.001 < 0.001 家庭经济情况 第一分位(最低) 0.09 (0.07~0.12) 0.13 (0.10~0.16) 0.11 (0.09~0.14) 第二分位 0.09 (0.07~0.11) 0.10 (0.07~0.12) 0.09 (0.07~0.11) 第三分位 0.07 (0.05~0.09) 0.08 (0.07~0.09) 0.08 (0.06~0.09) 第四分位 0.07 (0.06~0.07) 0.07 (0.06~0.08) 0.07 (0.06~0.08) 第五分位(最高) 0.06 (0.04~0.07) 0.07 (0.05~0.08) 0.06 (0.05~0.07) F值 6.87 36.50 34.63 P值 < 0.001 < 0.001 < 0.001 合计 0.07 (0.06~0.08) 0.09 (0.08~0.10) 0.08 (0.07~0.09)
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表 4 衰弱、衰弱指数影响因素的多因素分析
Table 4. Regression analysis of risk factors associated with frailty and frailty index
影响因素 衰弱 衰弱指数 OR值 95% CI值 P值 β 95% CI值 P值 常数项 0.08 (0.03~0.27) < 0.001 0.08 (0.03~0.28) < 0.001 年龄组(岁) 50~a 60~ 1.58 (1.18~2.11) 0.002 1.02 (1.01~1.03) < 0.001 70~ 3.80 (2.72~5.30) < 0.001 1.05 (1.04~1.06) < 0.001 ≥80 11.78 (7.50~18.49) < 0.001 1.16 (1.12~1.20) < 0.001 性别 男性a 女性 1.54 (1.21~1.96) 0.001 1.00 (1.00~1.01) 0.185 城乡 城市a 农村 0.96 (0.51~1.80) 0.902 0.99 (0.97~1.01) 0.396 婚姻状况 未婚a 已婚/同居 0.58 (0.26~1.28) 0.179 0.98 (0.95~1.02) 0.294 离异/分居/丧偶 0.65 (0.29~1.49) 0.310 0.98 (0.95~1.02) 0.372 文化程度 未受过正规教育a 小学未毕业 0.72 (0.52~0.99) 0.045 0.98 (0.97~0.99) 0.038 小学毕业 0.99 (0.69~1.41) 0.958 0.98 (0.97~0.99) 0.004 初中毕业 0.73 (0.53~1.01) 0.060 0.98 (0.96~0.99) < 0.001 高中毕业 0.53 (0.32~0.87) 0.011 0.97 (0.96~0.98) < 0.001 大学及以上 0.65 (0.36~1.16) 0.144 0.96 (0.94~0.98) < 0.001 财富五分位 第一分位(最低)a 第二分位 1.10 (0.78~1.55) 0.587 1.00 (0.98~1.01) 0.615 第三分位 1.23 (0.81~1.87) 0.331 1.00 (0.98~1.01) 0.487 第四分位 1.17 (0.76~1.81) 0.472 0.99 (0.98~1.00) 0.126 第五分位(最高) 1.07 (0.61~1.89) 0.803 0.99 (0.98~1.01) 0.224 水果蔬菜摄入 摄入不足a 摄入充足 0.68 (0.49~0.95) 0.023 0.99 (0.97~0.99) 0.019 饮酒 从不饮酒a 轻度饮酒 1.14 (0.71~1.83) 0.590 0.99 (0.98~1.00) 0.051 偶尔重度饮酒 3.24 (1.11~9.46) 0.031 1.02 (1.01~1.04) 0.011 经常重度饮酒 1.94 (0.95~3.97) 0.070 1.00 (0.98~1.01) 0.527 吸烟 从不吸烟a 目前不吸烟 1.08 (0.54~2.14) 0.834 1.01 (0.99~1.04) 0.210 偶尔吸烟 0.81 (0.31~2.10) 0.658 0.99 (0.98~1.01) 0.447 目前每日吸烟 0.89 (0.53~1.49) 0.653 1.00 (0.98~1.01) 0.380 体力活动 低水平体力活动a 中等水平体力活动 0.68 (0.48~0.94) 0.021 0.98 (0.97~0.99) 0.018 高水平体力活动 0.65 (0.39~1.07) 0.087 0.98 (0.97~0.99) 0.008 注：a为参照组。
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