中国老年人慢性病患病、失能与失智状况对死亡风险的影响：基于人群的前瞻性队列研究

胡曦元; 郭超

doi:10.16462/j.cnki.zhjbkz.2022.12.011

中国老年人慢性病患病、失能与失智状况对死亡风险的影响：基于人群的前瞻性队列研究

doi: 10.16462/j.cnki.zhjbkz.2022.12.011

胡曦元¹,
郭超^{1, 2, ,}

1.
100871 北京，北京大学人口研究所
2.
100871 北京，北京大学亚太经合组织健康科学研究院

基金项目:

国家自然科学基金 82103955

北京大学人才启动项目 7100603693

详细信息

通讯作者:
郭超，E-mail: chaoguo@pku.edu.cn

中图分类号: R19
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- 被引次数: 0
出版历程
- 收稿日期: 2021-09-29
- 修回日期: 2022-06-03
- 网络出版日期: 2022-12-30
- 刊出日期: 2022-12-10

The effect of chronic disease, disability, and dementia on all-cause mortality among older adults in China: a population-based prospective cohort study

HU Xi-yuan¹,
GUO Chao^{1, 2
, ,}

1.
Institute of Population Research, Peking University, Beijing 100871, China
2.
APEC Health Science Academy, Peking University, Beijing 100871, China

Funds:

National Natural Science Foundation of China 82103955

The Scientific Research Foundation of Peking University 7100603693

More Information

Corresponding author: GUO Chao, E-mail: chaoguo@pku.edu.cn

摘要

摘要: 目的利用基于人群的前瞻性队列研究，分析协同控制后中国老年人慢性病患病、失能和失智对死亡风险的影响。方法基于中国老年健康影响因素，跟踪调查2002―2018年共6期数据中13 540位65岁及以上老年人，采用Cox比例风险模型分析慢性病患病、失能和失智与死亡风险的关系。结果 65岁及以上老年人的生存平均时间为5.75(2.33. 13.00)年。在充分调整混杂因素并协同控制三个维度健康因素后，本研究发现在慢性病患病维度，癌症患者比未患癌症者死亡风险高50%(HR=1.50, 95% CI: 1.16~1.94)，而非癌慢性病患病与否与死亡风险的关系差异无统计学意义。在失能维度，日常活动能力受限者比不受限者死亡风险高40%(HR=1.40, 95% CI: 1.32~1.47)。在失智维度，认知受损者相较于未受损者死亡风险高30%(HR=1.30, 95% CI: 1.23~1.37)，痴呆患者相较于未患痴呆者死亡风险高26%(HR=1.26, 95% CI: 1.09~1.46)。结论在过去20年里，中国老年人健康相关的死亡风险因素主要来自患癌、日常活动能力受限、认知受损和罹患痴呆，提示对于老年人的死亡风险，相较于疾病特别是非癌慢性病患病本身，罹患疾病后的失能与失智尤为值得关注。
- 老年人 /
- 死亡 /
- 慢性病 /
- 失能 /
- 失智
Abstract: Objective To analyze the effects of chronic diseases, disability, and dementia on all-cause mortality among older adults in China using a prospective population-based cohort study. Methods Based on 13 540 older adults aged 65 years and above from the Chinese Longitudinal Healthy Longevity Survey, the Cox proportional hazard model was used to analyze the relationship between chronic diseases, disability as well as dementia, and all-cause mortality. Results The median survival time of older adults aged 65 years old and above was 5.75(2.33. 13.00) years. After adjusting for confounders, cancer respondents had a 50% risk of mortality than those without cancer (HR=1.50, 95% CI: 1.16-1.94), while the relationship between noncancerous chronic disease and mortality risk was not statistically significant. With a view to a disability, the mortality risk increased by 40% in subjects with activities of daily living (ADL) restriction than in those without ADL restriction (HR=1.40, 95% CI: 1.32-1.47). In terms of cognitive ability, subjects with cognitive impairment had a 30% higher risk of mortality than those without cognitive impairment (HR=1.30, 95% CI: 1.23-1.37), and those with dementia had a 26% risk of mortality than those without dementia (HR=1.26, 95% CI: 1.09-1.46). Conclusions During the past 20 years, the health factors associated with all-cause mortality risk among older adults in China are mainly cancer, ADL restriction, cognitive impairment, and dementia, suggesting that for the all-cause mortality risk of the older adults, compared with diseases, especially noncancerous chronic diseases themselves, the disability and dementia after suffering from diseases are particularly worthy of attention.
- Older adults /
- Death /
- Chronic diseases /
- Disability /
- Dementia

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图 1 样本筛选流程图

Figure 1. Flow chart of sample screening

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图 2 不同健康状况人群死亡风险的Kaplan-Meier生存估计(N=13 540)

Figure 2. Kaplan-Meier survival estimates of all-cause mortality of people with different health statuses (N=13 540)

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表 1 队列基线受访者的基本特征(N=13 540)

Table 1. Basic characteristics of cohort baseline respondents (N=13 540)

变量	n(%)	变量	n(%)	变量	n(%)	变量	n(%)
人口学特征		婚姻状况		健康及健康行为特征		是否锻炼
年龄(岁)		离异/丧偶/不婚	8 918(65.86)	自评健康与否		否	8 950(66.10)
65~ < 75	3 096(22.87)	已婚	4 622(34.14)	健康	11 312(83.55)	是	4 590(33.90)
75~ < 85	3 383(24.98)	生育孩子数量(个)		不健康	2 228(16.45)	是否经常做家务
85~ < 95	3 746(27.67)	0	558(4.12)	有无抑郁症状		否	6 574(48.55)
≥95	3 315(24.48)	1~2	2 242(16.56)	无	13 492(99.65)	是	6 966(51.45)
性别		3~5	6 247(46.14)	有	48(0.35)	慢性病-失能-失智
女	7 609(56.20)	≥6	4 493(33.18)	是否经常摄入水果		非癌慢性病患病与否
男	5 931(43.80)	受教育年限		否	8 826(65.18)	否	6 466(47.75)
居住地		小学以下	8 109(59.89)	是	4 714(34.82)	是	7 074(52.25)
城镇	6 342(46.84)	小学	3 971(29.33)	是否经常摄入蔬菜		癌症患病与否
农村	7 198(53.16)	中学及以上	1 460(10.78)	否	1 797(13.27)	否	13 484(99.59)
民族		(退休前)职业		是	11 743(86.73)	是	56(0.41)
非汉族	760(5.61)	农民及其他类别	9 789(72.30)	吸烟行为		ADL受限与否
汉族	12 780(94.39)	一般职员类别	2 486(18.36)	从不吸烟	8 721(64.41)	不受限	9 951(73.49)
地区		专业技术人员类别	1 265(9.34)	目前吸烟	2 603(19.22)	受限	3 589(26.51)
东部	8 254(60.96)	是否有退休金		过去吸烟	2 216(16.37)	认知受损与否
中部	3 246(23.97)	否	10 594(78.24)	饮酒行为		未受损	10 636(78.55)
西部	2 040(15.07)	是	2 946(21.76)	从不饮酒	9 004(66.50)	受损	2 904(21.45)
家庭及社会经济特征		收入是否足够生活		目前饮酒	2 866(21.17)	痴呆患病与否
居住安排		否	2 518(18.60)	过去饮酒	1 670(12.33)	否	13 359(98.66)
与他人同住	11 695(86.37)	是	11 022(81.40)			是	181(1.34)
独居	1 845(13.63)

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表 2 中国老年人的慢性病患病、失能、失智状况与死亡风险的Cox回归结果(基线n=13 540)

Table 2. Cox regression analysis of chronic diseases, disability, dementia, and all-cause mortality among Chinese older adults (baseline n=13 540)

健康维度	自变量	模型1		模型2		模型3		模型4
健康维度	自变量	HR(95% CI)值	P值	HR(95% CI)值	P值	HR(95% CI)值	P值	HR(95% CI)值	P值
慢性病	非癌慢性病患病与否		< 0.001		0.320		0.717		0.705
	否	1.00		1.00		1.00		1.00
	是	0.86(0.82~0.90)		0.98(0.93~1.02)		0.99(0.95~1.04)		0.99(0.95~1.04)
	癌症患病与否		0.043		0.001		< 0.001		0.002
	否	1.00		1.00		1.00		1.00
	是	1.30(1.01~1.68)		1.54(1.19~1.99)		1.60(1.24~2.07)		1.50(1.16~1.94)
失能	ADL受限与否		< 0.001		< 0.001		< 0.001		< 0.001
	不受限	1.00		1.00		1.00		1.00
	受限	2.22(2.11~2.33)		1.58(1.50~1.66)		1.57(1.49~1.65)		1.40(1.32~1.47)
失智	认知受损与否		< 0.001		< 0.001		< 0.001		< 0.001
	未受损	1.00		1.00		1.00		1.00
	受损	2.01(1.91~2.11)		1.39(1.32~1.47)		1.39(1.31~1.46)		1.30(1.23~1.37)
	痴呆患病与否		0.003		< 0.001		< 0.001		0.002
	否	1.00		1.00		1.00		1.00
	是	1.24(1.08~1.44)		1.30(1.12~1.50)		1.30(1.13~1.50)		1.26(1.09~1.46)
注：模型1仅纳入所有维度健康指标，未调整其他控制变量；模型2=模型1+年龄、性别、居住地、民族和地区；模型3=模型2+居住安排、婚姻状况、生育孩子数量、受教育年限、(退休前)职业、是否有退休金和收入是否足够生活；模型4=模型3+自评健康与否、有无抑郁症状、是否经常摄入水果、是否经常摄入蔬菜、吸烟行为、饮酒行为、是否锻炼和是否经常做家务。

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