农村中老年人认知功能障碍影响因素的多水平模型分析

毕圣贤; 王倩文; 杨琪娇; 彭馨怡; 陈迎春

doi:10.16462/j.cnki.zhjbkz.2025.08.007

农村中老年人认知功能障碍影响因素的多水平模型分析

doi: 10.16462/j.cnki.zhjbkz.2025.08.007

毕圣贤¹,
王倩文²,
杨琪娇¹,
彭馨怡¹,
陈迎春^{1, 3, ,}

1.
华中科技大学同济医学院医药卫生管理学院卫生管理系，武汉 430030
2.
龙岩市长汀县汀州镇社区卫生服务中心，龙岩 366300
3.
湖北省人文社科重点研究基地农村健康服务研究中心，武汉 430030

基金项目:

中央高校基本科研业务费专项资金 2022WKYXZD003

详细信息

通讯作者:
陈迎春，E-mail: chenyingchunhust@163.com

中图分类号: R741
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- 被引次数: 0
出版历程
- 收稿日期: 2025-03-12
- 修回日期: 2025-06-09
- 刊出日期: 2025-08-10

Multilevel model analysis of factors influencing cognitive impairment in middle-aged and elderly adults in rural areas

1.
Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
2.
Tingzhou Town Community Health Service Center, Changting County, Longyan City, Longyan 366300, China
3.
Research Center for Rural Health Services Hubei Province Key Research Institute of Humanities and Social Sciences, Wuhan 430030, China

Funds:

The Fundamental Research Funds for the Central Universities 2022WKYXZD003

More Information

Corresponding author: CHEN Yingchun, E-mail: chenyingchunhust@163.com

摘要

摘要: 目的探讨农村中老年人认知功能障碍的影响因素，为制定针对性干预策略提供科学依据。方法筛选2011―2020年中国健康与养老追踪调查(China Health and Retirement Longitudinal Study, CHARLS)5轮调查中5 927名农村中老年人为研究对象。采用三水平logistic回归分析模型，分析时间、个体与地区因素对认知功能障碍的影响。结果个体层面的影响因素差异为主导，标准差(s)为1.481，同时地区层面也呈现聚集性(s=0.444, P < 0.001)。2018年(OR=3.755, 95% CI: 3.131~4.502)、2020年(OR=1.279, 95% CI: 1.040~1.572)的认知功能障碍高于2011年。男性(OR=0.432, 95% CI: 0.375~0.496)、低龄老年(OR=0.481, 95% CI: 0.431~0.536)、高龄老年(OR=0.252, 95% CI: 0.203~0.312)、参加社交活动(OR=0.597, 95% CI: 0.548~0.650)、全年日照时数(OR=0.809, 95% CI: 0.702~0.933)与认知功能障碍低风险相关；小学教育水平(OR=10.842, 95% CI: 2.119~55.490)、离婚/丧偶/未婚(OR=1.551, 95% CI: 1.333~1.803)、无养老保险(OR=2.126, 95% CI: 1.495~3.025)、无医疗保险(OR=1.528, 95% CI: 1.011~2.310)、不经常与子女交流(OR=1.440, 95% CI: 1.130~1.836)、失眠(OR=1.124, 95% CI: 1.010~1.250)、工具性日常活动能力受损(OR=1.691, 95% CI: 1.531~1.868)、疼痛感(OR=1.179, 95% CI: 1.073~1.296)、抑郁(OR=1.201, 95% CI: 1.099~1.313)与认知功能障碍高风险相关。结论农村中老年人认知功能障碍受时间、个体和地区层面因素的多重影响，应从个体层面的健康行为、教育水平和社会保障等因素入手，并结合社区层面的社交活动和心理健康服务，以及政策层面的资源配置进行综合干预。
- 农村中老年人 /
- 认知功能障碍 /
- 三水平模型
Abstract: Objective To investigate factors that influence cognitive impairment among middle-aged and elderly adults in rural areas and provide a scientific basis for targeted interventions. Methods A total of 5 927 middle-aged and elderly adults from rural areas were selected from five waves (2011-2020) of the China Health and Retirement Longitudinal Study. A three-level logistic regression model was used to analyze the effects of time, individual characteristics, and regional factors on cognitive impairment. Results Variation at the individual level was the primary contributor, standard deviation (s)=1.481, and regional-level clustering was also observed (s=0.444, P < 0.001). The risk of cognitive impairment in 2018 (OR=3.755, 95% CI: 3.131-4.502) and 2020 (OR=1.279, 95% CI: 1.040-1.572) was higher than in 2011. A lower risk was associated with being male (OR=0.432, 95% CI: 0.375-0.496), younger elderly (OR=0.481, 95% CI: 0.431-0.536), older elderly (OR=0.252, 95% CI: 0.203-0.312), participating in social activities (OR=0.597, 95% CI: 0.548-0.650), and higher annual sunshine duration (OR=0.809, 95% CI: 0.702-0.933). A higher risk was associated with primary education (OR=10.842, 95% CI: 2.119-55.490), being divorced/widowed/unmarried (OR=1.551, 95% CI: 1.333-1.803), lacking pension insurance (OR=2.126, 95% CI: 1.495-3.025), lacking health insurance (OR=1.528, 95% CI: 1.011-2.310), infrequent communication with children (OR=1.440, 95% CI: 1.130-1.836), insomnia (OR=1.124, 95% CI: 1.010-1.250), impaired instrumental activities of daily living (OR=1.691, 95% CI: 1.531-1.868), pain (OR=1.179, 95% CI: 1.073-1.296), and depression (OR=1.201, 95% CI: 1.099-1.313). Conclusions Cognitive impairment among rural middle-aged and elderly adults is influenced by factors at the temporal, individual, and regional levels. Comprehensive interventions should target individual-level determinants such as health behaviors, education, and social security, while also addressing community-level social engagement and mental health services, and policy-level resource allocation.
- Rural middle-aged and elderly adults /
- Cognitive impairment /
- Three-level model

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表 1 农村中老年人认知功能的单因素分析

Table 1. Univariate analysis of cognitive function in middle-aged and elderly adults in rural areas

变量Variable	总量 Total (n=29 635)	认知功能障碍Cognitive impairment		Kruskal- Wallis/ VIF	P值 value
变量Variable	总量 Total (n=29 635)	否No^① (n=24 345)	是Yes^① (n=5 290)	Kruskal- Wallis/ VIF	P值 value
时间Time				22.48	＜0.001
2011	5 927	4 906(82.8)	1 021(17.2)
2013	5 927	5 081(85.7)	846(14.3)
2015	5 927	4 975(83.9)	952(16.1)
2018	5 927	4 315(72.8)	1 612(27.2)
2020	5 927	5 068(85.5)	859(14.5)	274.06	＜0.001
地区Region	106
性别Gender				844.66	＜0.001
女Female	15 564	11 829(76.0)	3 735(24.0)
男Male	14 071	12 516(88.9)	1 555(11.1)
年龄组/岁Age group/years				3.25	0.072
45~ < 60 (中年Middle-aged)	12 405	10 142(81.8)	2 263(18.2)
60~ < 75 (低龄老年Younger elderly)	15 024	12 363(82.3)	2 661(17.7)
≥75 (高龄老年Older elderly)	2 206	1 840(83.4)	366(16.6)
教育水平Education level				1 317.19	＜0.001
高等教育Higher education	104	102(98.1)	2(1.9)
高中教育High school education	7 779	7 431(95.5)	348(4.5)
小学教育Primary school education	21 752	16 812(77.3)	4 940(22.7)
婚姻状况Marital status				101.68	＜0.001
已婚Married	26029	21 600(83.0)	4 429(17.0)
离婚/丧偶/未婚Divorced/widowed/unmarried	3 606	2 745(76.1)	861(23.9)
养老保险Pension insurance				32.24	＜0.001
职工Employee	1 211	1 139(94.1)	72(5.9)
居民Resident	18 129	14 843(81.9)	3 286(18.1)
无None	10 295	8 363(81.2)	1 932(18.8)
医疗保险Health insurance				145.18	＜0.001
职工Employee	1 082	1 020(94.3)	62(5.7)
居民Resident	26 726	21 942(82.1)	4 784(17.9)
无None	1 827	1 383(75.7)	444(24.3)
亲子交流Parent-child communication				24.44	＜0.001
经常Frequent	28 923	23 810(82.3)	5 113(17.7)
不经常Infrequent	712	535(75.1)	177(24.9)
吸烟Smoking				172.89	＜0.001
否No	22 925	18 470(80.6)	4 455(19.4)
是Yes	6 710	5 875(87.6)	835(12.4)
饮酒Drinking				159.78	＜0.001
否No	23 232	18 742(80.7)	4 490(19.3)
是Yes	6 403	5 603(87.5)	800(12.5)
慢性疾病Chronic disease				17.82	＜0.001
否No	9 077	7 585(83.6)	1 492(16.4)
是Yes	20 558	16 760(81.5)	3 798(18.5)
社交活动Social activity				289.77	＜0.001
否No	14 789	11 588(78.4)	3 201(21.6)
是Yes	14 846	12 757(85.9)	2 089(14.1)
失眠Insomnia				177.28	＜0.001
否No	24 219	20 235(83.6)	3 984(16.4)
是Yes	5 416	4 110(75.9)	1 306(24.1)
日常活动能力Activities of daily living				152.18	＜0.001
未受损Not impaired	23 920	19 971(83.5)	3 949(16.5)
受损Impaired	5 715	4 374(76.5)	1 341(23.5)
工具性日常活动能力Instrumental activities of daily living				711.90	＜0.001
未受损Not impaired	21 601	18 527(85.8)	3 074(14.2)
受损Impaired	8 034	5 818(72.4)	2 216(27.6)
疼痛感Pain				116.09	＜0.001
否No	13 652	10 861(79.6)	2 791(20.4)
是Yes	15 983	13 484(84.4)	2 499(15.6)
抑郁Depression				231.53	＜0.001
否No	16 423	13 990(85.2)	2 433(14.8)
是Yes	13 212	10 355(78.4)	2 857(21.6)
年平均臭氧浓度Annual average ozone concentration/(μg·m^-3)	89.94±0.14	89.97±0.15	89.79±0.31	1.15^②
年平均气温Annual average temperature/℃	16.12±0.05	16.05±0.06	16.46±0.12	2.15^②
年平均相对湿度Annual average relative humidity/%	69.14±0.10	68.89±0.11	70.26±0.23	5.48^②
全年降水量Annual precipitation/mm	992.61±5.20	982.83±5.77	1 037.63±11.91	3.64^②
全年日照时数Annual sunshine duration/h	1 974.35±5.44	1 987.78±6.01	1 912.58±12.61	4.10^②
年平均风速Annual average wind speed/(m·s^-1)	2.09±0.01	2.10±0.01	2.02±0.01	1.63^②
注：VIF，方差膨胀因子。 ①以人数(占比/%)和x±s表示; ② VIF。 Note：VIF, variance inflation factor. ① Number of people(proportion/%)and x±s; ② VIF.

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表 2 农村中老年人认知功能障碍影响因素的三水平logistic分析结果

Table 2. Three-level logistic regression analysis of factors influencing cognitive impairment in middle-aged and elderly adults in rural areas

自变量 Independent variable	β值 value	s_x值 value	Z值 value	P值 value	OR值value (95% CI)
固定效应Fixed effect
截距Intercept	-4.646	0.846	-5.489	< 0.001	0.010 (0.002~0.050)
时间Time
2011					1.000
2013	-0.084	0.078	-1.081	0.280	0.919 (0.789~1.071)
2015	-0.013	0.102	-0.131	0.896	0.987 (0.808~1.205)
2018	1.323	0.093	14.278	< 0.001	3.755 (3.131~4.502)
2020	0.246	0.106	2.330	0.020	1.279 (1.040~1.572)
性别Gender
女Female					1.000
男Male	-0.840	0.071	-11.767	< 0.001	0.432 (0.375~0.496)
年龄组/岁Age group/years
45~ <60 (中年Middle-aged)					1.000
60~<75 (低龄老年Younger elderly)	-0.732	0.056	-13.106	< 0.001	0.481 (0.431~0.536)
≥75 (高龄老年Older elderly)	-1.379	0.110	-12.555	< 0.001	0.252 (0.203~0.312)
教育水平Education level
高等教育Higher education					1.000
高中教育High school education	0.525	0.833	0.630	0.529	1.690 (0.330~8.655)
小学教育Primary school education	2.384	0.833	2.861	0.004	10.842 (2.119~55.490)
婚姻状况Marital status
已婚Married					1.000
离婚/丧偶/未婚Divorced/widowed/unmarried	0.439	0.077	5.698	< 0.001	1.551 (1.333~1.803)
养老保险Pension insurance
职工Employee					1.000
居民Resident	0.595	0.179	3.321	< 0.001	1.813 (1.276~2.575)
无None	0.755	0.180	4.197	< 0.001	2.126 (1.495~3.025)
医疗保险Health insurance
职工Employee					1.000
居民Resident	0.065	0.200	0.324	0.746	1.067 (0.721~1.577)
无None	0.424	0.211	2.010	0.044	1.528 (1.011~2.310)
亲子交流Parent-child communication
经常Frequent					1.000
不经常Infrequent	0.365	0.124	2.945	0.003	1.440 (1.130~1.836)
吸烟Smoking
否No					1.000
是Yes	0.007	0.072	0.091	0.928	1.007 (0.875~1.158)
饮酒Drinking
否No					1.000
是Yes	-0.012	0.069	-0.177	0.859	0.988 (0.863~1.130)
慢性疾病Chronic disease
否No					1.000
是Yes	-0.048	0.055	-0.876	0.381	0.953 (0.855~1.062)
社交活动Social activity
否No					1.000
是Yes	-0.516	0.044	-11.795	< 0.001	0.597 (0.548~0.650)
失眠Insomnia
否No					1.000
是Yes	0.117	0.054	2.148	0.032	1.124 (1.010~1.250)
日常活动能力Activities of daily living
未受损Not impaired					1.000
受损Impaired	0.018	0.059	0.306	0.759	1.018 (0.908~1.142)
工具性日常活动能力Instrumental activities of daily living
未受损Not impaired					1.000
受损Impaired	0.526	0.051	10.359	< 0.001	1.691 (1.531~1.868)
疼痛感Pain
否No					1.000
是Yes	0.165	0.048	3.428	< 0.001	1.179 (1.073~1.296)
抑郁Depression
否No					1.000
是Yes	0.183	0.045	4.035	< 0.001	1.201 (1.099~1.313)
年平均臭氧浓度Annual average ozone concentration/(μg·m^-3)	-0.071	0.043	-1.649	0.099	0.932 (0.856~1.013)
年平均气温Annual average temperature/℃	-0.048	0.056	-0.859	0.390	0.953 (0.854~1.064)
年平均相对湿度Annual average relative humidity/%	0.108	0.073	1.468	0.142	1.113 (0.965~1.285)
全年降水量Annual precipitation/mm	-0.066	0.055	-1.198	0.231	0.936 (0.840~1.043)
全年日照时数Annual sunshine duration/h	-0.212	0.073	-2.922	0.003	0.809 (0.702~0.933)
年平均风速Annual average wind speed/(m·s^-1)	-0.010	0.052	-0.197	0.844	0.990 (0.894~1.096)

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变量Variable	总量 Total (n=29 635)	认知功能障碍Cognitive impairment		Kruskal- Wallis/ VIF	P值 value
变量Variable	总量 Total (n=29 635)	否No^① (n=24 345)	是Yes^① (n=5 290)	Kruskal- Wallis/ VIF	P值 value
时间Time				22.48	＜0.001
2011	5 927	4 906(82.8)	1 021(17.2)
2013	5 927	5 081(85.7)	846(14.3)
2015	5 927	4 975(83.9)	952(16.1)
2018	5 927	4 315(72.8)	1 612(27.2)
2020	5 927	5 068(85.5)	859(14.5)	274.06	＜0.001
地区Region	106
性别Gender				844.66	＜0.001
女Female	15 564	11 829(76.0)	3 735(24.0)
男Male	14 071	12 516(88.9)	1 555(11.1)
年龄组/岁Age group/years				3.25	0.072
45~ < 60 (中年Middle-aged)	12 405	10 142(81.8)	2 263(18.2)
60~ < 75 (低龄老年Younger elderly)	15 024	12 363(82.3)	2 661(17.7)
≥75 (高龄老年Older elderly)	2 206	1 840(83.4)	366(16.6)
教育水平Education level				1 317.19	＜0.001
高等教育Higher education	104	102(98.1)	2(1.9)
高中教育High school education	7 779	7 431(95.5)	348(4.5)
小学教育Primary school education	21 752	16 812(77.3)	4 940(22.7)
婚姻状况Marital status				101.68	＜0.001
已婚Married	26029	21 600(83.0)	4 429(17.0)
离婚/丧偶/未婚Divorced/widowed/unmarried	3 606	2 745(76.1)	861(23.9)
养老保险Pension insurance				32.24	＜0.001
职工Employee	1 211	1 139(94.1)	72(5.9)
居民Resident	18 129	14 843(81.9)	3 286(18.1)
无None	10 295	8 363(81.2)	1 932(18.8)
医疗保险Health insurance				145.18	＜0.001
职工Employee	1 082	1 020(94.3)	62(5.7)
居民Resident	26 726	21 942(82.1)	4 784(17.9)
无None	1 827	1 383(75.7)	444(24.3)
亲子交流Parent-child communication				24.44	＜0.001
经常Frequent	28 923	23 810(82.3)	5 113(17.7)
不经常Infrequent	712	535(75.1)	177(24.9)
吸烟Smoking				172.89	＜0.001
否No	22 925	18 470(80.6)	4 455(19.4)
是Yes	6 710	5 875(87.6)	835(12.4)
饮酒Drinking				159.78	＜0.001
否No	23 232	18 742(80.7)	4 490(19.3)
是Yes	6 403	5 603(87.5)	800(12.5)
慢性疾病Chronic disease				17.82	＜0.001
否No	9 077	7 585(83.6)	1 492(16.4)
是Yes	20 558	16 760(81.5)	3 798(18.5)
社交活动Social activity				289.77	＜0.001
否No	14 789	11 588(78.4)	3 201(21.6)
是Yes	14 846	12 757(85.9)	2 089(14.1)
失眠Insomnia				177.28	＜0.001
否No	24 219	20 235(83.6)	3 984(16.4)
是Yes	5 416	4 110(75.9)	1 306(24.1)
日常活动能力Activities of daily living				152.18	＜0.001
未受损Not impaired	23 920	19 971(83.5)	3 949(16.5)
受损Impaired	5 715	4 374(76.5)	1 341(23.5)
工具性日常活动能力Instrumental activities of daily living				711.90	＜0.001
未受损Not impaired	21 601	18 527(85.8)	3 074(14.2)
受损Impaired	8 034	5 818(72.4)	2 216(27.6)
疼痛感Pain				116.09	＜0.001
否No	13 652	10 861(79.6)	2 791(20.4)
是Yes	15 983	13 484(84.4)	2 499(15.6)
抑郁Depression				231.53	＜0.001
否No	16 423	13 990(85.2)	2 433(14.8)
是Yes	13 212	10 355(78.4)	2 857(21.6)
年平均臭氧浓度Annual average ozone concentration/(μg·m^-3)	89.94±0.14	89.97±0.15	89.79±0.31	1.15^②
年平均气温Annual average temperature/℃	16.12±0.05	16.05±0.06	16.46±0.12	2.15^②
年平均相对湿度Annual average relative humidity/%	69.14±0.10	68.89±0.11	70.26±0.23	5.48^②
全年降水量Annual precipitation/mm	992.61±5.20	982.83±5.77	1 037.63±11.91	3.64^②
全年日照时数Annual sunshine duration/h	1 974.35±5.44	1 987.78±6.01	1 912.58±12.61	4.10^②
年平均风速Annual average wind speed/(m·s^-1)	2.09±0.01	2.10±0.01	2.02±0.01	1.63^②
注：VIF，方差膨胀因子。 ①以人数(占比/%)和x±s表示; ② VIF。 Note：VIF, variance inflation factor. ① Number of people(proportion/%)and x±s; ② VIF.

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农村中老年人认知功能障碍影响因素的多水平模型分析

doi: 10.16462/j.cnki.zhjbkz.2025.08.007

通讯作者:
陈迎春，E-mail: chenyingchunhust@163.com

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Multilevel model analysis of factors influencing cognitive impairment in middle-aged and elderly adults in rural areas

Corresponding author: CHEN Yingchun, E-mail: chenyingchunhust@163.com

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农村中老年人认知功能障碍影响因素的多水平模型分析

doi: 10.16462/j.cnki.zhjbkz.2025.08.007

通讯作者: 陈迎春，E-mail: chenyingchunhust@163.com

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Multilevel model analysis of factors influencing cognitive impairment in middle-aged and elderly adults in rural areas

Corresponding author: CHEN Yingchun, E-mail: chenyingchunhust@163.com

计量

出版历程

目录

通讯作者:
陈迎春，E-mail: chenyingchunhust@163.com