中国老年人不同严重程度跌倒风险与慢性病和睡眠的关联研究

林进龙; 魏玥; 陈功; 裴丽君

doi:10.16462/j.cnki.zhjbkz.2021.01.006

中国老年人不同严重程度跌倒风险与慢性病和睡眠的关联研究

doi: 10.16462/j.cnki.zhjbkz.2021.01.006

100871 北京，北京大学人口研究所，北京大学人口与健康发展研究中心

基金项目:

国家自然科学基金 41871360

国家重点研发计划 2018YFC2000603

详细信息

通讯作者:
裴丽君，E-mail: peilj@pku.edu.cn

中图分类号: R181
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出版历程
- 收稿日期: 2020-06-16
- 修回日期: 2020-10-19
- 刊出日期: 2021-01-10

Chronic diseases and sleep duration in association with falls of different severity among the Chinese elderly

Institute of Population Research, China Center on Population Health and Development, Peking University, Beijing 100871, China

Funds:

National Natural Science Fund 41871360

National Key Research and Development Project 2018YFC2000603

More Information

Corresponding author: PEI Li-jun, E-mail: peilj@pku.Edu.cn

摘要

摘要: 目的探索老年人慢性疾病和睡眠状况与不同严重程度跌倒风险之间的关联，为老年人跌倒所致伤害的预防和干预提供线索。方法采用病例对照研究发生风险，以“中国健康与养老追踪调查项目”数据为基础，利用2011-2015年抽样调查数据，运用多因素Logistic回归分析模型分析慢性疾病和睡眠的暴露与中国老年人普通跌倒和跌倒就医发生风险的关联。结果 11 912例老年人两年内普通跌倒报告率和跌倒就医报告率分别为7.82%和17.09%;多因素Logistic回归分析模型结果显示，听力退化、身体疼痛、有抑郁症状、肾脏病、关节炎和日常生活自理能力(activities of daily living, ADL)受损与老年人普通跌倒和跌倒就医发生风险存在关联(均有P < 0.05);患高血糖与普通跌倒发生风险存在关联(OR=1.43, 95% CI: 1.13~1.81, P=0.002)，患脑卒中与跌倒就医发生风险存在关联(OR=1.34, 95% CI: 1.03~1.75, P=0.031);睡眠时长5~ h和≥7 h与老年人两类跌倒发生风险存在负关联(均有P < 0.05)。结论老年人退行性疾病及慢性疾病可能是跌倒发生的共同危险因素，充足的睡眠可能是两类跌倒的共同保护因素，应当针对高危老年人群体和暴露因素开展跌倒的预防和干预。
- 老年人 /
- 跌倒 /
- 严重程度 /
- 危险因素
Abstract: Objective To explore the relationship between chronic diseases, sleeping time and the risk of falls of different severity in the elderly, so as to provide effective prevention of falls scientifically. Methods Based on the data of China Health and Retirement Longitudinal Study (CHARLS) from 2011 to 2015, a case-control study was conducted to analyze the relationship between multiple exposure factors and the risk of falls in different severity in the elderly. Results The report rate of common falls and serious falls medical in 11 912 elderly Chinese within two years were 7.82% and 17.09%, respectively; logistic regression results show that, hearing impairment, body pain, depression, kidney disease, arthritis and disability were the same risk factors of common falls and serious falls in the elderly(all P < 0.05). Hyperglycemia was associated with the risk of common falls (OR=1.43, 95% CI: 1.13-1.81, P=0.002) and stroke (OR=1.34, 95% CI: 1.03-1.75, P=0.031) was associated with the risk of serious falls; sleep duration of 5- hours and ≥ 7 hours were negatively associated with the risk of two types of falls (all P < 0.05). Conclusions The common falls and serious falls have multiple same risk factors in the elderly, and adequate sleep is the common protective factor for both. It is suggested that fall prevention education should be carried out for the elderly and risk factors should be effectively intervened.
- Elderly /
- Fall /
- Severity /
- Risk factors

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表 1 老年人两年内跌倒伤害报告率[n(%)]

Table 1. The report rate of fall among elderly people in two years [n(%)]

特征	调查(例)	普通跌倒(例)	跌倒就医(例)	普通跌倒报告率 (95% CI)值	跌倒就医报告率 (95% CI)值	跌倒报告率 (95% CI)值
总人群	11 912	932	2 036	7.82(7.34~8.31)	17.09(16.42~17.77)	24.92(24.14~25.69)
性别^a
男	5 922(49.73)	411(44.10)	772(37.92)	6.94(6.29~7.59)	13.04(12.18~13.89)	19.98(18.96~20.99)
女	5 987(50.27)	521(55.90)	1 264(62.08)	8.70(7.99~9.42)	20.08(18.15~22.17)	29.81(28.66~30.97)
年龄(岁)
60~	8 312(69.78)	624(66.95)	1 202(59.04)	7.51(6.94~8.08)	14.46(13.71~15.22)	21.97(21.08~22.87)
70~	2 778(23.32)	243(26.07)	606(29.76)	8.75(7.70~9.80)	21.82(13.71~15.22)	30.56(28.85~32.27)
≥80	822(6.90)	65(26.14)	228(11.20)	7.91(6.06~9.75)	27.74(24.68~30.80)	35.64(32.37~38.92)
注：^a性别：性别变量剔除3例缺失值信息; 表格显示的跌倒伤害报告率为2011、2013和2015年三次调查数据的计算结果; 性别、年龄在普通跌倒和跌倒就医病例与对照之间差异均有统计意义(均有P < 0.05)。

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表 2 老年人不同严重程度跌倒的病例对照暴露因素[n(%)]

Table 2. Exposure factors for falls of different severity in the elderly between case and control [n(%)]

特征	对照组(n=8 018)	普通跌倒(n=803)			跌倒就医(n=1 782)
特征	对照组(n=8 018)	例数	χ²值	P值	例数	χ²值	P值
年龄(岁)			8.289	0.016		104.355	< 0.001
60~	5 894(73.51)	554(68.99)			1 101(61.78)
70~	1 704(21.25)	205(25.53)			519(29.12)
≥80	420(5.24)	44(5.48)			162(9.09)
性别			23.359	< 0.001		133.132	< 0.001
男	4 271(53.27)	356(44.33)			680(38.16)
女	3 747(46.73)	447(55.67)			1 102(61.84)
教育程度				0.004		66.660	< 0.001
文盲	2 618(32.65)	309(38.48)	11.250		715(40.12)
小学	3 444(42.95)	318(39.60)			778(43.66)
初中及以上	1 956(24.40)	176(21.92)			289(16.22)
吸烟			5.174	0.075		68.952	< 0.001
从未吸烟	4 455(55.56)	475(59.15)			1 154(64.76)
过去吸烟	1 270(15.84)	106(13.20)			285(15.99)
现在吸烟	2 293(28.60)	222(27.65)			343(19.25)
饮酒			0.568	0.451		9.574	0.002
不饮酒	5 407(67.44)	531(66.13)			1 269(71.21)
饮酒	2 611(32.56)	272(33.87)			513(28.79)
睡眠时长(h)			52.717	< 0.001		128.598	< 0.001
< 5	1 479(18.45)	230(28.64)			536(30.08)
5~	2 812(35.07)	273(34.00)			592(33.22)
≥7	3 727(46.48)	300(37.36)			654(36.70)
午休时长(min)			1.820	0.402		25.894	< 0.001
无午休	3 537(44.11)	350(43.59)			894(50.17)
< 30	1 227(15.30)	111(13.82)			212(11.90)
≥30	3 254(40.58)	342(42.59)			676(37.93)
听力			58.561	< 0.001		84.352	< 0.001
好	3 203(39.95)	210(26.15)			504(28.28)
不好	4 815(60.05)	593(73.85)			1 278(71.72)
近视力			19.673	< 0.001		33.575	< 0.001
好	2 621(32.69)	201(25.03)			457(25.65)
不好	5 397(67.31)	602(74.97)			1 325(74.35)
远视力			36.483	< 0.001		82.255	< 0.001
好	2 709(33.79)	187(23.29)			405(22.73)
不好	5 309(66.21)	616(76.71)			1 377(77.27)
身体疼痛			69.664	< 0.001		148.691	< 0.001
无	6 257(78.04)	522(65.01)			1 146(64.31)
有	1 761(21.96)	281(34.99)			636(35.69)
抑郁症状			65.493	< 0.001		214.770	< 0.001
无	5 509(68.71)	439(54.67)			899(50.45)
有	2 509(31.29)	364(45.33)			883(49.55)
高血糖			17.200	< 0.001		11.159	< 0.001
无	7 396(92.24)	707(88.04)			1 601(89.84)
有	662(7.76)	96(11.96)			181(10.16)
脑卒中			4.674	0.031		25.772	< 0.001
无	7 796(97.23)	770(95.89)			1 691(94.89)
有	222(2.77)	33(4.11)			91(5.11)
肾脏病			18.633	< 0.001		45.937	< 0.001
无	7 556(94.24)	726(90.41)			1 601(89.84)
有	462(5.76)	77(9.59)			181(10.16)
关节炎			62.288	< 0.001		154.156	< 0.001
无	5 384(67.15)	428(53.30)			919(51.57)
有	2 634(32.85)	375(46.70)			863(48.43)
ADL			99.927	< 0.001		324.843	< 0.001
自理	7 082(88.33)	610(75.97)			1 276(71.60)
失能	936(11.67)	193(24.03)			506(28.40)

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表 3 老年人不同严重程度跌倒的暴露因素多因素分析

Table 3. Multivariate analysis of exposure factors for falls of different severity in the elderly

特征	普通跌倒^a			跌倒就医^b
特征	OR(95% CI)值	Wald χ²值	P值	OR(95% CI)值	Wald χ²值	P值
睡眠时长(h)
＜5	1.00			1.00
5~	0.79(0.65~0.97)	5.378	0.020	0.83(0.72~0.96)	6.194	0.012
≥7	0.71(0.58~0.86)	12.184	< 0.001	0.74(0.64~0.85)	16.898	< 0.001
午休时长(min)
无午休	-	-	-	1.00
< 30	-	-	-	0.67(0.57~0.80)	19.621	< 0.001
≥30	-	-	-	0.92(0.82~1.03)	1.963	0.161
听力
好	1.00			1.00
不好	1.52(1.27~1.82)	21.047	< 0.001	1.28(1.13~1.45)	14.700	< 0.001
近视力
好	1.00			1.00
不好	1.03(0.85~1.24)	0.074	0.785	0.97(0.85~1.11)	0.160	0.688
远视力
好	1.00			1.00
不好	1.14(0.94~1.39)	1.674	0.196	1.17(1.01~1.35)	4.696	0.030
身体疼痛
无	1.00			1.00
有	1.26(1.06~1.50)	6.822	0.009	1.21(1.07~1.37)	8.808	0.003
抑郁症状
无	1.00			1.00
有	1.23(1.05~1.45)	6.330	0.011	1.41(1.26~1.60)	33.052	< 0.001
高血糖
无	1.00			1.00
有	1.43(1.13~1.81)	8.855	0.002	1.18(0.99~1.43)	3.281	0.070
脑卒中
无	1.00			1.00
有	1.09(0.74~1.61)	0.203	0.652	1.34(1.03~1.75)	4.624	0.031
肾脏病
无	1.00			1.00
有	1.33(1.02~1.74)	4.558	0.032	1.50(1.24~1.82)	16.920	< 0.001
关节炎
无	1.00			1.00
有	1.39(1.19~1.63)	17.309	< 0.001	1.42(1.27~1.59)	36.956	< 0.001
ADL
自理	1.00			1.00
失能	1.63(1.34~1.99)	23.653	< 0.001	1.88(1.63~2.16)	77.094	< 0.001
注：^a普通跌倒：普通跌倒的多因素Logistic回归分析模型：调整了年龄、性别、教育程度。其中，午休时长变量在单因素检验中差异无统计学意义且尚无明确证据表明午休对普通跌倒存在重要影响，故不纳入模型; ^b跌倒就医跌倒就医的多因素Logistic回归分析模型：调整了年龄、性别、教育程度、吸烟、饮酒。

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