中国≥45岁中老年人多重慢性病模式与日常和工具性日常生活活动能力残疾的关联性

李艳萍; 王媛; 纪之琳; 白婧琰; 张岩波; 陆姣

doi:10.16462/j.cnki.zhjbkz.2024.01.005

中国≥45岁中老年人多重慢性病模式与日常和工具性日常生活活动能力残疾的关联性

doi: 10.16462/j.cnki.zhjbkz.2024.01.005

李艳萍¹,
王媛²,
纪之琳³,
白婧琰¹,
张岩波^4, ,,
陆姣^5, ,

1.
山西医科大学公共卫生学院卫生统计学教研室，太原 030001
2.
山西医科大学管理学院，太原 030001
3.
山西医科大学公共卫生学院社会医学教研室，太原 030001
4.
山西医科大学公共卫生学院统计教研室，重大疾病风险评估山西省重点实验室，太原 030001
5.
西安交通大学公共政策与管理学院，卫生管理与政策研究所，西安 710049

基金项目:

教育部人文社会科学研究规划基金项目 22YJA630059

中国博士后科学基金第15批特别资助项目 2022T150514

国家自然科学基金青年项目 71804101

详细信息

通讯作者:
陆姣，E-mail：lujiao801@163.com

张岩波，E-mail：sxmuzyb@126.com

中图分类号: R195.4
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出版历程
- 收稿日期: 2023-05-17
- 修回日期: 2023-09-03
- 网络出版日期: 2024-02-05
- 刊出日期: 2024-01-10

Association of multimorbidity patterns with activity of daily living and instrumental activity of daily living disability among ≥45 years middle-aged and elderly population in China

LI Yanping¹,
WANG Yuan²,
JI Zhilin³,
BAI Jingyan¹,
ZHANG Yanbo^{4
, ,},
LU Jiao^{5
, ,}

1.
Department of Biostatistics, School of Public Health, Shanxi Medical University, Taiyuan 030001, China
2.
School of Administration, Shanxi Medical University, Taiyuan 030001, China
3.
Department of Social Medicine, School of Public Health, Shanxi Medical University, Taiyuan 030001, China
4.
Department of Biostatistics, School of Public Health, Shanxi Medical University, Shanxi Provincial Key Laboratory of Major Assessment Diseases Risk, Taiyuan 030001, China
5.
School of Public Policy and Administration, Xi′an Jiaotong University, Xi′an 710049, China

Funds:

The Humanities and Social Science Research Planning Foundation of the Ministry of Education 22YJA630059

The 15th Batch of China Postdoctoral Science Foundation 2022T150514

National Natural Science Foundation of China 71804101

More Information

Corresponding author: ZHANG Yanbo, E-mail: sxmuzyb@126.com; LU Jiao, E-mail: lujiao801@163.com

摘要

摘要: 目的聚类中国≥45岁中老年人多重慢性病模式的流行情况，并探讨多重慢性病模式与日常生活能力(activity of daily living, ADL)和工具性日常生活能力(instrumental activity of daily living，IADL)残疾的关联性。方法基于2018年中国健康与养老追踪调查(China Health and Retirement Longitudinal Study，CHARLS)数据库，以19 745名≥45岁中老年人为研究对象，采用双向聚类法(two-way clustering framework，TCF)识别非随机多重慢性疾病模式后进行人群聚类，并采用logistic回归分析模型分析多重慢性病模式与ADL和IADL残疾的相互关系。结果中国中老年人多重慢性病患者例数为10 941，占55.4%，可聚类为心脑血管-代谢模式、呼吸系统-内脏模式和消化-关节-精神模式，根据多重慢性病模式的关联强度将人群划分为5个多重慢性病关联组。其中，高度关联心脑血管-代谢模式和消化-关节-精神模式人群的ADL和IADL残疾负担最重(OR=4.696, 95% CI: 4.196~5.255, P < 0.001; OR=3.155, 95% CI: 2.840~3.504, P < 0.001)，高度关联心脑血管-代谢模式合并中度关联呼吸系统-内脏模式的人群罹患ADL和IADL残疾的风险次之(OR=2.821, 95% CI: 2.210~3.602, P < 0.001; OR=2.662, 95% CI: 2.120~3.342, P < 0.001)。结论中国中老年人群中高度关联心脑血管-代谢模式发生ADL和IADL残疾的风险最高。
- 多重慢性病 /
- 中老年人 /
- 日常生活能力 /
- 工具性日常生活能力 /
- 双向聚类法
Abstract: Objective To cluster the epidemic situation of multimorbidity patterns in middle-aged and elderly people aged 45 years and above in China, and explore the relationship between multimorbidity patterns and activity of daily living (ADL)/instrumental activity of daily living (IADL) disability. Methods Based on the 2018 China Health and Retirement Longitudinal Study (CHARLS), the study included a total of 19 745 individuals aged 45 years and older from the middle-aged and elderly population. To identify non-random multimorbidity patterns, a two-way clustering framework (TCF) was utilized for clustering people, while logistic regression was employed to analyze the association between multimorbidity patterns and ADL/IADL disability. Results The number of middle-aged and elderly patients with multimorbidity in China was 10 941, accounting for 55.4% of the sample, which could be clustered into three patterns: cardio-cerebrovascular-metabolic pattern, respiratory system-visceral pattern and digestion-articular-mental pattern. According to the association strength of multimorbidity patterns, the population was divided into five multimorbidity association groups. ADL/IADL disability burden was the highest in people with highly related cardio-cerebrovascular-metabolic pattern and digestion-articular-mental pattern (OR=4.696, 95% CI: 4.196-5.255, P < 0.001; OR=3.155, 95% CI: 2.840-3.504, P < 0.001). The risk of ADL /IADL disability in people with highly related cardio-cerebrovascular metabolic pattern and moderate related respiratory system-visceral pattern was the second (OR=2.821, 95% CI: 2.210-3.602, P < 0.001; OR=2.662, 95% CI: 2.120-3.342, P < 0.001). Conclusions The risk of ADL /IADL disability is the highest in middle-aged and elderly people with highly related cardio-cerebrovascular metabolic patterns.
- Multimorbidity /
- Middle-aged and elderly adults /
- Activity of daily living /
- Instrumental activity of daily living /
- Two-way clustering framework

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图 1 5类多重慢性病模式特征

G1心脑血管-代谢模式(高血压、血脂异常、糖尿病和血糖升高、心脏病、脑卒中、与记忆相关的疾病)；G2呼吸系统-内脏模式(慢性肺部疾病、肝脏疾病、肾脏疾病、哮喘)；G3消化-关节-精神模式(胃部疾病或消化系统疾病、情感及精神方面问题、关节炎和风湿病)。

Figure 1. Characteristics of five types of multimorbid

G1 cardio-cerebrovascular-metabolic pattern (hypertension, dyslipidemia, diabetes and high blood sugar, heart disease, stroke, memory-related diseases); G2 respiratory system-visceral pattern (chronic lung disease, liver disease, kidney disease, asthma) and G3 digestion-articular-mental pattern (diseases of the stomach or digestive system, emotional and psychiatric problems, arthritis and rheumatism).

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表 1 调查对象基本情况

Table 1. Baseline characteristics of subjects in cross-lagged analysis

变量Variable	总人数^① Total ^① (n=19 745)	ADL残疾^① ADL disability ^① (n＝3 636)	无ADL残疾^① No ADL disability ^① (n＝16 109)	IADL残疾^① IADL disability ^① (n＝14 439)	无IADL残疾^① No IADL disability ^① (n＝5 306)
年龄组/岁Age group/years
45~ < 60	8 652(43.8)	794(9.2)	7 858(90.8)	1 262(14.6)	7 390(85.4)
60~ < 75	8 695(44.0)	1 907(21.9)	6 788(78.0)	2 726(31.4)	5 969(68.6)
75~ < 90	2 301(11.7)	875(38.0)	1 426(62.0)	1 237(53.8)	1 064(46.2)
≥90	97(0.5)	60(62.0)	37(38.0)	81(83.5)	16(16.5)
性别Gender
男Male	9 303(47.1)	1 366(37.6)	7 937(49.3)	1 957(21.0)	7 346(79.0)
女Female	10 442(52.9)	2 270(62.4)	8 172(50.7)	3 349(24.3)	7 093(75.7)
教育水平Education level
小学以下Below primary school	8 584(43.5)	2 259(26.0)	6 325(74.0)	3 462(40.3)	5 122(59.7)
小学Primary school	4 348(22.0)	688(15.8)	3 660(84.2)	979(22.5)	3 369(77.5)
中学及以上Secondary school and above	6 813(34.5)	689(10.0)	6 124(90.0)	865(12.7)	5 948(87.3)
居住地区Region
城镇Urban	4 924(24.9)	652(13.2)	4 272(86.8)	898(18.3)	4 026(81.7)
农村Rural	14 735(74.6)	2 977(20.2)	11 758(79.8)	4 399(29.9)	10 336(70.1)
特殊地区Special area	86(0.4)	7(8.1)	79(91.9)	9(10.5)	77(89.5)
婚姻状况Marital status
已婚Married	16 809(85.1)	2 693(16.0)	14 116(84.0)	3 970(23.6)	12 839(76.4)
离异Divorced	312(1.6)	64(20.5)	248(79.5)	76(24.4)	236(75.6)
丧偶或其他Widowed or other	2 624(33.5)	879(24.2)	1 745(66.5)	1 260(48.0)	1 364(52.0)
慢性病数量Number of chronic diseases
0	4 137(21.0)	197(4.8)	3 940(95.2)	490(11.8)	3 647(88.2)
1	4 667(23.6)	516(11.0)	4 151(89.0)	884(18.9)	3 783(81.1)
≥2	10 941(55.4)	2 923(26.7)	8 018(73.3)	3 932(35.9)	7 009(64.1)
注: ADL, 日常生活能力; IADL, 工具性日常生活能力。 ①以人数(占比/%)表示。 Note: ADL, activity of daily living; IADL, instrumental activity of daily living. ① Number of people(proportion/%).

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表 2 分析ADL和IADL残疾与样本特征之间关系的logistic回归分析模型

Table 2. Logistic regression models to analyze the relationship between ADL/ IADL disability and sample characteristics

变量Variable	ADL		IADL
变量Variable	校正前Before adjustment OR值value (95% CI)	校正后^① After adjusting ^① OR值value (95% CI)	校正前Before adjustment OR值value (95% CI)	校正后^① After adjusting ^① OR值value (95% CI)
年龄组/岁Age group/years
60~ < 75	2.780(2.544~3.039)	1.837(1.667~2.023)	2.674(2.481~2.882)	1.749(1.610~1.900)
75~ < 90	6.073(5.432~6.788)	3.612(3.180~4.104)	6.808(6.151~7.534)	4.030(3.588~4.527)
≥90	16.049(10.586~24.332)	10.245(6.518~16.104)	29.645(17.284~50.846)	16.819(9.527~29.691)
性别Gender
女Female	1.614(1.499~1.738)	1.366(1.255~1.488)	1.772(1.661~1.891)	1.437(1.332~1.549)
教育水平Education level
小学Primary school	1.671(1.492~1.871)	1.291(1.142~1.459)	1.998(1.807~2.210)	1.572(1.410~1.753)
小学以下Below primary school	3.174(2.895~3.481)	1.843(1.653~2.056)	4.648(4.276~5.052)	2.816(2.556~3.103)
居住地区Region
农村Rural	1.659(1.514~1.818)	1.580(1.422~1.755)	1.908(1.761~2.068)	1.624(1.478~1.784)
特殊经济地区Special area	0.581(0.267~1.263)	0.574(0.251~1.311)	0.524(0.262~1.049)	0.463(0.218~0.983)
婚姻状况Marital status
离异Divorced	1.353(1.025~1.786)	1.509(1.106~2.058)	1.041(0.802~1.352)	1.184(0.881~1.592)
丧偶或其他Widowed or other	2.640(2.411~2.892)	1.304(1.172~1.452)	2.987(2.745~3.251)	1.394(1.262~1.540)
慢性病数量Number of chronic diseases
1	2.486(2.098~2.946)	2.095(1.741~2.520)	1.739(1.543~1.960)	1.447(1.264~1.656)
≥2	7.291(6.280~8.464)	5.489(4.663~6.462)	4.175(3.770~4.624)	3.182(2.833~3.575)
注: ADL, 日常生活能力; IADL, 工具性日常生活能力。 ①代表根据年龄、性别、居住地区、教育程度、婚姻状况和慢性病数量调整的多变量logistic回归模型，P < 0.001。 Note: ADL, activity of daily living; IADL, instrumental activity of daily living. ① Multivariate logistic regression model adjusted for age, gender, region, education level, marital status, and number of chronic diseases, P < 0.001.

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表 3 多重慢性病关联组分与ADL和IADL残疾的logistic回归分析模型

Table 3. Logistic regression analysis of multimorbidity-related components and ADL /IADL disability

多重慢性病组分Multimorbidity component	人数(占比%) Number of people (proportion%)	ADL	IADL
多重慢性病组分Multimorbidity component	人数(占比%) Number of people (proportion%)	校正后After adjusting OR值value (95% CI)	校正后After adjusting OR值value (95% CI)
组分1 Component 1	11 079(56.1)	1.000	1.000
组分2 Component 2	1 025(5.2)	2.271(1.901~2.715)	1.708(1.453~2.007)
组分3 Component 3	4 193(21.2)	2.821(2.210~3.602)	2.662(2.120~3.342)
组分4 Component 4	566(2.9)	2.311(2.073~2.577)	1.850(1.681~2.037)
组分5 Component 5	2 882(14.6)	4.696(4.196~5.255)	3.155(2.840~3.504)
注: ADL, 日常生活能力; IADL, 工具性日常生活能力。 Note: ADL, activity of daily living; IADL, instrumental activity of daily living.

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中国≥45岁中老年人多重慢性病模式与日常和工具性日常生活活动能力残疾的关联性

doi: 10.16462/j.cnki.zhjbkz.2024.01.005

通讯作者:
陆姣，E-mail：lujiao801@163.com

张岩波，E-mail：sxmuzyb@126.com

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Association of multimorbidity patterns with activity of daily living and instrumental activity of daily living disability among ≥45 years middle-aged and elderly population in China

Corresponding author: ZHANG Yanbo, E-mail: sxmuzyb@126.com; LU Jiao, E-mail: lujiao801@163.com

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中国≥45岁中老年人多重慢性病模式与日常和工具性日常生活活动能力残疾的关联性

doi: 10.16462/j.cnki.zhjbkz.2024.01.005

通讯作者: 陆姣，E-mail：lujiao801@163.com 张岩波，E-mail：sxmuzyb@126.com

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出版历程

Association of multimorbidity patterns with activity of daily living and instrumental activity of daily living disability among ≥45 years middle-aged and elderly population in China

Corresponding author: ZHANG Yanbo, E-mail: sxmuzyb@126.com; LU Jiao, E-mail: lujiao801@163.com

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通讯作者:
陆姣，E-mail：lujiao801@163.com

张岩波，E-mail：sxmuzyb@126.com