中国65岁及以上老年人日常生活活动能力与死亡的关系

寇硕; 卢肇骏; 郑卫军; 王俊苹; 荣超

doi:10.16462/j.cnki.zhjbkz.2022.03.004

中国65岁及以上老年人日常生活活动能力与死亡的关系

doi: 10.16462/j.cnki.zhjbkz.2022.03.004

1.
310053 杭州，浙江中医药大学公共卫生学院医学统计教研室
2.
310053 杭州，浙江中医药大学人文与管理学院健康管理教研室

基金项目:

2016年度国家社会科学基金项目 16CSH071

详细信息

通讯作者:
荣超，E-mail: rcnj2008@126.com

中图分类号: R181.3
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- 被引次数: 0
出版历程
- 收稿日期: 2021-07-20
- 修回日期: 2021-10-08
- 网络出版日期: 2022-03-17
- 刊出日期: 2022-03-10

The relationship between the activities of daily living and death in the elderly aged 65 and over in China

1.
Department of Medical Statistics, School of Public Health, Zhejiang Chinese Medicial University, Hangzhou 310053, China
2.
Hangzhou, Department of Health Management, School of Humanities and Management, Zhejiang Chinese Medicial University, Hangzhou 310053, China

Funds:

2016 National Social Science Foundation Project 16CSH071

More Information

Corresponding author: Rong Chao, E-mail: rcnj2008@126.com

摘要

摘要: 目的探讨老年人日常生活活动能力(activities of daily living, ADL)与中短期死亡之间的关系。方法本研究使用了来自中国老年健康影响因素跟踪调查(Chinese Longitudinal Healthy Longevity Survey, CLHLS)的数据。分析样本包括37 173名CLHLS项目历次调查中的新人群，生存结局来自研究对象2~4年后首次跟踪随访调查结果。失能情况是通过ADL能力量表进行测量。计算ADL总分并进行分组之后，本研究通过多种统计建模策略，探讨不同失能水平对老年人死亡的影响。结果调整人口学、健康行为、膳食摄入特征等混杂因素后，ADL总分人群死亡风险存在着统计学关联(RR=1.09, 95% CI：1.08~1.09, P < 0.001)。以6分组作对照，得分高于6分组的人群发生死亡的风险增加69%(RR=1.69, 95% CI：1.65~1.74, P < 0.001)。以正常组作为对照组，低级失能组和高级失能组的人群发生死亡的风险分别增加52%和92%(RR=1.52, 95% CI：1.47~1.56, P < 0.001; RR=1.92, 95% CI: 1.86~1.97, P < 0.001)。结论基于CLHLS样本发现，失能会增加老年人发生死亡的风险，短期随访、低年龄段的失能老年人发生死亡的风险更大。
- 日常生活活动能力 /
- 老年人 /
- 死亡
Abstract: Objective To explore the relationship between disability in activities of daily living and death in the elderly. Methods Data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS), which is a nationally representative study. The analysis included 37 173 subjects, all of whom were new entrants in the year of the interview. The survival outcome was derived from the first follow-up after 2-4 year. And disability was measured using the scale of Activities of Daily Living (ADL). By calculating and grouping the ADL scores, several statistical models were used to analyze the relationship between disability and death in the elderly. Results After adjusted for confounding factors such as demographics, health behaviors, and dietary intake characteristics, a statistical association was observed between ADL total score and the risk of death in the population (RR=1.09, 95% CI: 1.08-1.09, P < 0.001). Compared scored of 6, death for people with scores >6 increased by 69% (RR=1.69, 95% CI: 1.65-1.74, P < 0.001). Compared normal group, the risk of death in the low-grade disability group and the high-grade disability group increase by 52% and 92%, respectively (RR=1.52, 95% CI: 1.47-1.56, P < 0.001; RR=1.92, 95% CI: 1.86-1.97, P < 0.001). Conclusion In the CLHLS sample, disability increases the risk of death in the elderly, and short-term follow-up and low-age disabled elderly are at greater risk of death.
- Activities of daily living /
- The elderly /
- Death

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图 1 样本筛选流程图

Figure 1. Sample Screening Flow Chart

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表 1 不同血压水平人群相关影响因素的无序多分类Logistic回归分析[n (%)]

Table 1. Disordered multiple Logistic regression analysis of related factors in different blood pressure levels [n (%)]

变量	ADL总分[M(P₂₅, P₇₅)](N=37 173人)	Z值/H值^a	P值	ADL正常组(n=26 441人)	ADL低失能组(n=6 941人)	ADL高失能组(n=3 791人)	χ²值	P值
性别		-32.23	< 0.001				1 012.99	< 0.001
男性	6.00(6.00, 6.00)			12 209(46.2)	2 147(30.9)	926(24.4)
女性	6.00(6.00, 6.00)			14 232(53.8)	4 794(69.1)	2 865(75.6)
年龄(岁)		-48.78	< 0.001				2 426.39	< 0.001
65~ < 80	6.00(6.00, 6.00)			6 902(26.1)	335(4.8)	69(1.8)
≥80	6.00(6.00, 8.00)			19 539(73.9)	6 606(95.2)	3 722(98.2)
户籍地		-9.40	< 0.001				128.06	< 0.001
农村	6.00(6.00, 7.00)			16 012(60.6)	3 684(53.1)	2 206(58.2)
城镇	6.00(6.00, 7.00)			10 429(39.4)	3 257(46.9)	1 585(41.8)
居住情况		647.45	< 0.001				644.48	< 0.001
和家人	6.00(6.00, 7.00)			21 503(81.3)	6 201(89.3)	3 419(90.2)
独居	6.00(6.00, 6.00)			4 148(15.7)	473(6.8)	189(5.0)
养老院	6.00(6.00, 8.00)			790(3.0)	267(3.8)	183(4.8)
吸烟		694.79	< 0.001				696.37	< 0.001
从不	6.00(6.00, 7.00)			17 301(65.4)	5 029(72.5)	3 011(79.4)
曾经	6.00(6.00, 7.00)			3 513(13.3)	1 060(15.3)	535(14.1)
一直	6.00(6.00, 6.00)			5 627(21.3)	852(12.3)	245(6.5)
饮酒		372.39	< 0.001				374.18	< 0.001
从不	6.00(6.00, 7.00)			17 911(67.7)	4 979(71.7)	2 922(77.1)
曾经	6.00(6.00, 8.00)			2 487(9.4)	791(11.4)	457(12.1)
一直	6.00(6.00, 6.00)			6 043(22.9)	1 171(16.9)	412(10.9)
锻炼		1 932.14	< 0.001				2 052.2	< 0.001
从不	6.00(6.00, 7.00)			17 050(64.5)	4 600(66.3)	3 044(80.3)
曾经	7.00(6.00, 10.00)			1 173(4.4)	860(12.4)	592(15.6)
一直	6.00(6.00, 6.00)			8 218(31.1)	1 481(21.3)	155(4.1)
体力劳动		-14.84	< 0.001				215.98	< 0.001
从不	6.00(6.00, 8.00)			5 031(19.0)	1 754(25.3)	1 017(26.8)
一直	6.00(6.00, 7.00)			21 410(81.0)	5 187(74.7)	2 774(73.2)
教育程度		766.45	< 0.001				766.04	< 0.001
0年	6.00(6.00, 8.00)			16 417(62.1)	5 192(74.8)	3 042(80.2)
1~≤7年	6.00(6.00, 6.00)			7 534(28.5)	1 342(19.3)	568(15.0)
＞7年	6.00(6.00, 6.00)			2 490(9.4)	407(5.9)	181(4.8)
职业		-1.66	0.098				1.19	0.557
脑力工作	6.00(6.00, 7.00)			8 750(33.1)	2 260(32.6)	1 229(32.4)
体力工作	6.00(6.00, 7.00)			17 691(66.9)	4 681(67.4)	2 562(67.6)
婚姻状况		-41.20	< 0.001				1710.12	< 0.001
有配偶	6.00(6.00, 6.00)			8 344(31.6)	851(12.3)	329(8.7)
无配偶	6.00(6.00, 8.00)			18 097(68.4)	6 090(87.7)	3 462(91.3)
患慢病情况		452.47	< 0.001				446.34	< 0.001
0种	6.00(6.00, 7.00)			15 884(60.1)	3 552(51.2)	1 845(48.7)
1~2种	6.00(6.00, 7.00)			7 381(27.9)	2 090(30.1)	1 164(30.7)
＞2种	6.00(6.00, 8.00)			3 176(12.0)	1 299(18.7)	782(20.6)
主食种类		-11.00	< 0.001				164.35	< 0.001
精粮	6.00(6.00, 7.00)			23 649(89.4)	5 825(83.9)	3 309(87.3)
杂粮	6.00(6.00, 8.00)			2 791(10.6)	1 116(16.1)	482(12.7)
主食摄入量		-29.00	< 0.001				830.73	< 0.001
300 g/天	6.00(6.00, 8.00)			16 489(62.4)	5 137(74.0)	3 138(82.8)
>300 g/天	6.00(6.00, 6.00)			9 951(37.6)	1 804(26.0)	653(17.2)
新鲜水果		134.19	< 0.001				170.97	< 0.001
每天	6.00(6.00, 8.00)			2 950(11.2)	1 117(16.1)	513(13.5)
冬天除外	6.00(6.00, 7.00)			4 662(17.6)	1 054(15.2)	504(13.3)
偶尔	6.00(6.00, 7.00)			18 828(71.2)	4 770(68.7)	2 774(73.2)
新鲜蔬菜		234.67	< 0.001				287.85	< 0.001
每天	6.00(6.00, 7.00)			17 436(65.9)	4 449(64.1)	2 196(57.9)
冬天除外	6.00(6.00, 7.00)			6 008(22.7)	1 460(21.0)	813(21.4)
偶尔	6.00(6.00, 8.00)			2 996(11.3)	1 032(14.9)	782(20.6)
注：^a ADL总分呈偏态分布，采用独立样本秩和检验分析，故统计量为Z值/H值。

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表 2 不同ADL形式人群发生死亡风险的修正Poisson回归模型[RR (95% CI)]

Table 2. Modified Poisson regression model of the risk of death among people with different forms of ADL [RR (95% CI)]

分组	人数	模型1 ^a		模型2 ^b		模型3 ^c
分组	人数	RR(95% CI)	P值	RR(95% CI)	P值	RR(95% CI)	P值
ADL总分	37 173	1.12(1.11~1.12)	< 0.001	1.10(1.09~1.10)	< 0.001	1.09(1.08~1.09)	< 0.001
ADL得分
6分	26 441	1.00		1.00		1.00
>6分	10 732	2.14(2.10~2.19)	< 0.001	1.74(1.70~1.79)	< 0.001	1.69(1.65~1.74)	< 0.001
ADL失能程度
正常	26 441	1.00		1.00		1.00
低失能	6 941	1.90(1.85~1.96)	< 0.001	1.56(1.52~1.61)	< 0.001	1.52(1.47~1.56)	< 0.001
失能	3 791	2.58(2.52~2.65)	< 0.001	2.07(2.02~2.13)	< 0.001	1.92(1.86~1.97)	< 0.001
注：^a未纳入混杂因素；^b纳入年龄、性别因素；^c纳入人口学特征、健康行为特征、膳食摄入特征等因素。

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表 3 不同随访时间下人群发生死亡风险的修正Poisson回归模型[RR (95% CI)]

Table 3. Modified Poisson Regression Model for the Risk of Death in the Population at Different Follow-up Time [RR (95% CI)]

分组	人数	2年随访			人数	3~4年随访
分组	人数	模型1	模型2	模型3	人数	模型1	模型2	模型3
ADL总分	14 663	1.12(1.12~1.13) ^a	1.12(1.11~1.12) ^a	1.10(1.10~1.11) ^a	22 510	1.12(1.12~1.13) ^a	1.08(1.07~1.08) ^a	1.07(1.06~1.07) ^a
ADL得分
6分	9 593	1.00	1.00	1.00	16 848	1.00	1.00	1.00
>6分	5 070	2.12(2.03~2.21) ^a	2.02(1.94~2.11) ^a	1.89(1.81~1.97) ^a	5 662	2.23(2.117~2.30) ^a	1.62(1.57~1.66) ^a	1.54(1.50~1.59) ^a
ADL失能程度
正常	9 593	1.00	1.00	1.00	16 848	1.00	1.00	1.00
低失能	3 220	1.80(1.72~1.89) ^a	1.73(1.64~1.81) ^a	1.67(1.58~1.75) ^a	3 721	2.03(1.97~2.10) ^a	1.50(1.45~1.55) ^a	1.45(1.40~1.50) ^a
高失能	1 850	2.67(2.55~2.79) ^a	2.54(2.43~2.66) ^a	2.30(2.19~2.41) ^a	1 941	2.62(2.54~2.70) ^a	1.85(1.80~1.91) ^a	1.72(1.66~1.78) ^a
注：模型1：未纳入混杂因素；模型2：纳入年龄、性别因素；模型3：纳入人口学特征、健康行为特征、膳食摄入特征等因素; ^a表示结果具有统计学意义(P < 0.001)。

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表 4 不同年龄人群发生死亡风险的修正Poisson回归模型[RR (95% CI)]

Table 4. Modified Poisson Regression Model for the risk of death among people of different ages [RR (95% CI)]

分组	人数	65~＜80岁			人数	≥80岁
分组	人数	模型1	模型2	模型3	人数	模型1	模型2	模型3
ADL总分	7 306	1.24(1.22~1.26) ^a	1.24(1.22~1.27) ^a	1.19(1.15~1.22) ^a	29 867	1.09(1.09~1.09) ^a	1.09(1.09~1.09) ^a	1.08(1.08~1.08) ^a
ADL得分
6分	6 902	1.00	1.00	1.00	19 539	1.00	1.00	1.00
>6分	404	2.89(2.51~3.33) ^a	2.92(2.53~3.36) ^a	2.38(1.98~2.85) ^a	10 328	1.71(1.67~1.75) ^a	1.71(1.67~1.75) ^a	1.64(1.60~1.68) ^a
ADL失能程度
正常	6 902	1.00	1.00	1.00	19 539	1.00	1.00	1.00
低失能	335	2.24(1.87~2.68) ^a	2.26(1.89, 2.71) ^a	2.05(1.66~2.55) ^a	6 606	1.53(1.49~1.58) ^a	1.54(1.50~1.58) ^a	1.50(1.46~1.54) ^a
高失能	69	5.62(4.73~6.68) ^a	5.60(4.71, 6.66) ^a	3.83(2.95~4.97) ^a	3 722	2.02(1.97~2.08) ^a	2.02(1.97~2.07) ^a	1.90(1.85~1.95) ^a
注：模型1：未纳入混杂因素；模型2：纳入年龄、性别因素；模型3：纳入人口学特征、健康行为特征、膳食摄入特征等因素; ^a表示结果具有统计学意义(P < 0.001)。

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参考文献(15)

[1]	国家统计局. 中华人民共和国2018年国民经济和社会发展统计公报~([1])[N]. 人民日报. National Bureau of Statistics. The People's Republic of China 2018 National Economic and Social Development Statistical Bulletin~([1])[N]. People's Daily.
[2]	Smith AK, Walter LC, Miao Y, et al. Disability during the last two years of life[J]. JAMA Intern Med, 2013, 173(16): 1506-1513. DOI: 10.1001/jamainternmed.2013.8738.
[3]	Gill TM, Gahbauer EA, Han L, et al. Trajectories of disability in the last year of life[J]. N Engl J Med, 2010, 362(13): 1173-1180. DOI: 10.1056/NEJMoa0909087.
[4]	Katz S, Ford AB, Moskowitz RW, et al. Studies of Illness in the Aged. The Index of Adl: A Standardized Measure of Biological and Psychosocial Function[J]. JAMA, 1963, 185: 914-919. DOI: 10.1001/jama.1963.03060120024016.
[5]	Hou C, Ping Z, Yang K, et al. Trends of activities of daily living disability situation and association with chronic conditions among elderly aged 80 years and over in China[J]. J Nutr Health Aging, 2018, 22(3): 439-445. DOI: 10.1007/s12603-017-0947-7.
[6]	童峰, 陈坤. 常见结局事件的前瞻性研究中修正Poisson回归模型的应用[J]. 中国卫生统计, 2006(5): 410-412. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGWT200605008.htm Tong F, Chen K. Application of Modified Poisson Regression Model in Prospective Study of Common Outcomes[J]. China Health Statistics, 2006(5): 410-412. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGWT200605008.htm
[7]	Yang F, Gu D. Predictability of frailty index and its components on mortality in older adults in China[J]. BMC Geriatr, 2016, 16: 145. DOI: 10.1186/s12877-016-0317-z.
[8]	Lunney JR, Lynn J, Foley DJ, et al. Patterns of functional decline at the end of life[J]. JAMA, 2003, 289(18): 2387-2392. DOI:10.1001/jama.28 9.18.2387.
[9]	Waidmann T, Bound J, Schoenbaum M. The illusion of failure: trends in the self-reported health of the U.S. elderly[J]. Milbank Q, 1995, 73(2): 253-287. DOI: 10.2307/3350259.
[10]	Zhao J, Barclay S, Farquhar M, et al. The "oldest old" in the last year of life: population-based findings from CC75C study participants aged at least 85 at death[J]. J Am Geriatr Soc, 2010;58(1): 1-11. DOI: 10.1111/j.1532-541 5.2009.02622.x.
[11]	Zhang WJ, Marcus W. Peng D. Process of Decline in Activities of Daily Living of Older Chinese People Prior to Death: Evidence From Three Cohorts[J]. Research on Aging, 2019, 41(8): 727-750. DOI: 10.1177/0164027519841016.
[12]	Stolz E, Gill TM, Mayerl H, et al. Short-Term Disability Fluctuations in Late Life[J]. J Gerontol B Psychol Sci Soc Sci, 2019, 74(8): e135-e140. DOI: 10.1093/geronb/gbz089.
[13]	Xu WH, Li YX, Hu YX, et al. Association of frailty with recovery from disability among community-dwelling Chinese older adults: China health and retirement longitudinal study[J]. BMC Geriatr, 2020, 20(1): 119. DOI: 10.1186/s12877-020-01519-6.
[14]	Zhang YC, Xiong Y, Yu QH, et al. The activity of daily living (ADL) subgroups and health impairment among Chinese elderly: A latent profile analysis[J]. BMC Geriatr. 2021, 21(1): 30. DOI: 10.1186/s12877-020-01986-x.
[15]	Formiga F, Ferrer A, Pérez-Castejon JM, et al. Risk factors for functional decline in nonagenarians: a one-year follow-up. The NonaSantfeliu study[J]. Gerontology, 2007, 53(4): 211-217. DOI: 10.1159/000100780.