总体活动受限指数在中国老年人群中的适用性研究

张纹菱; 蔡玥; 江宇

doi:10.16462/j.cnki.zhjbkz.2024.09.001

总体活动受限指数在中国老年人群中的适用性研究

doi: 10.16462/j.cnki.zhjbkz.2024.09.001

张纹菱¹,
蔡玥²,
江宇^1, ,

1.
中国医学科学院北京协和医学院群医学及公共卫生学院流行病与生物统计学系，北京 100005
2.
国家卫生健康委统计信息中心统计处，北京 100044

详细信息

通讯作者:
江宇，E-mail：jiangyu@pumc.edu.cn

中图分类号: R161.7
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出版历程
- 收稿日期: 2024-04-21
- 修回日期: 2024-08-05
- 网络出版日期: 2024-10-24
- 刊出日期: 2024-09-10

The applicability of the global activity limitation indicator in the elderly population of China

1.
Department of Epidemiology and Biostatistics, School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100005, China
2.
Statistical Department, Center for Health Statistics and Information, National Health Commission of the People′s Republic of China, Beijing 100044, China

More Information

Corresponding author: JIANG Yu, E-mail: jiangyu@pumc.edu.cn

摘要

摘要: 目的通过对比其他健康测量指标，验证总体活动受限指数(global activity limitation indicator, GALI)衡量中国老年人群活动受限的能力，为推广GALI指标在我国的应用提供依据。方法利用中国老年健康影响因素跟踪调查(Chinese longitudinal healthy longevity survey, CLHLS)2018年数据，通过logistic回归分析模型和预测模型分析GALI与日常生活自理能力(activities of daily living, ADL)、工具性日常活动能力(instrumental activities of daily living, IADL)、躯体功能测量量表(physical performance test, PPT)之间的关联，探索GALI与抑郁症状间的关联。结果 Logistic回归分析模型分析结果显示，GALI活动受限与报告ADL受限(OR=13.355, 95% CI: 12.471~14.311)、IADL受限(OR=5.321, 95% CI: 5.085~5.567)和PPT躯体功能障碍(OR=4.073, 95% CI: 3.905~4.249)均相关(均P < 0.001)。有抑郁症状的人群更可能报告GALI活动受限(OR=2.311, 95% CI: 2.211~2.416, P < 0.001)。结论 GALI是测量中国老年人群一般身体活动受限状况的有效工具，在一定程度上可能反映抑郁症状的影响，在我国健康测量和监测指标体系中有一定的应用前景。
- 总体活动受限指数 /
- 健康预期寿命 /
- 健康测量 /
- 指标适用性
Abstract: Objective To compare other health measurement indicators and verify the effectiveness of the global activity limitation indicator (GALI) to measure activity limitations in the elderly population in China, providing a basis for promoting the application of GALI in China. Methods Using data from the 2018 Chinese longitudinal healthy longevity survey (CLHLS), logistic regression and predictive models were used to analyze the correlation between GALI and activities of daily living (ADL), instrumental activities of daily living (IADL), and physical performance test (PPT). Additionally, the study explored the association between GALI and depressive symptoms. Results The logistic regression results showed that the GALI activity was significantly associated with those who reported one or more ADL limitations (OR=13.355, 95% CI: 12.471-14.311), IADL limitations (OR=5.321, 95% CI: 5.085-5.567), and physical dysfunction as measured by PPT (OR=4.073, 95% CI: 3.905-4.249), respectively (all P < 0.001). Individuals with depressive symptoms were more likely to report GALI limitation (OR=2.311, 95% CI: 2.211-2.416, P < 0.001). Conclusions GALI proves to be an effective instrument for assessing the general status of physical activity limitations among the elderly in China. And it may also reflect the impact of psychological factors, such as depressive symptoms. Thus, it has certain application prospects in China′s health measurement and monitoring index system.
- Global activity limitation indicator /
- Healthy life expectancy /
- Health measurement /
- Indicator applicability

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图 1 GALI对ADL、IADL、PPT受限项目数量反应的预测概率分布

GALI，总体活动受限指数；ADL，日常生活活动能力；IADL，工具性日常活动能力；PPT，躯体功能测试。

Figure 1. The predicted probability distribution of the GALI response outcome by the number of ADL, IADL, PPT with limitations

GALI, global activity limitation indicator; ADL, activities of daily living; IADL, instrumental activities of daily living; PPT, physical performance test.

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表 1 研究对象基本特征

Table 1. Basic characteristics of the research subjects

变量 Variable	人数 Number of people (n=14 547)	构成比 Proportion /%
性别Gender
男性Male	6 373	47.6
女性Female	8 174	52.4
居住地Residence
城镇Urban	8 088	50.5
农村Rural	6 459	49.5
受教育水平Educational level
小学及以下Primary school and below	10 209	71.3
小学以上Over primary school	2 279	28.7
GALI
无活动受限Without activity limitation	9 037	78.9
活动受限Activity limitation	5 510	21.1
ADL
无失能Without disabilities	10 579	92.7
失能Disability	3 968	7.3
IADL
无失能Without disabilities	6 309	77.7
失能Disability	8 238	22.3
PPT
无障碍Without physical dysfunction	7 584	79.3
躯体功能障碍Physical dysfunction	6 963	20.7
注：1. GALI，总体活动受限指数；ADL，日常生活活动能力；IADL，工具性日常活动能力；PPT，躯体功能测试。 2. 构成比经过本研究的抽样权重加权计算。 Note: 1. GALI, global activity limitation indicator; ADL, activities of daily living; IADL, instrumental activities of daily living; PPT, physical performance test. 2. The proportion is calculated by weighting the sampling weight of this survey.

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表 2 GALI和ADL、IADL、PPT间的关联

Table 2. Associations between the GALI and ADL, IADL, PPT

变量 Variable	模型1 Model 1(ADL)		模型2 Model 2(IADL)		模型3 Model 3(PPT)
变量 Variable	OR值value (95% CI)	P值 value	OR值value (95% CI)	P值 value	OR值value (95% CI)	P值 value
年龄/岁Age/years	1.036(1.034~1.039)	＜0.001	1.012(1.009~1.015)	＜0.001	1.033(1.030~1.036)	＜0.001
性别Gender
男性Male	1.000		1.000		1.000
女性Female	1.277(1.227~1.330)	＜0.001	1.112(1.069~1.157)	＜0.001	1.161(1.116~1.207)	＜0.001
居住地Residence
城镇Urban	1.000		1.000		1.000
农村Rural	0.991(0.952~1.032)	0.679	0.932(0.896~0.970)	＜0.001	0.944(0.907~0.981)	0.004
受教育水平Educational level
小学及以下Primary school and below	1.000		1.000		1.000
小学以上Over primary school	0.878(0.836~0.922)	＜0.001	0.999(0.953~1.049)	0.990	0.898(0.856~0.941)	＜0.001
ADL
无失能Without disabilities	1.000
失能Disability	13.355(12.471~14.311)	＜0.001
IADL
无失能Without disabilities			1.000
失能Disability			5.321(5.085~5.567)	＜0.001
PPT
无障碍Without physical dysfunction					1.000
躯体功能障碍Physical dysfunction					4.073(3.905~4.249)	＜0.001
注：GALI，总体活动受限指数；ADL，日常生活活动能力；IADL，工具性日常活动能力；PPT，躯体功能测试。 Note: GALI, global activity limitation indicator; ADL, activities of daily living; IADL, instrumental activities of daily living; PPT, physical performance test.

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表 3 GALI和抑郁症状间的关联

Table 3. Association between GALI and depressive symptoms

变量 Variable	模型1 Model 1(ADL)		模型2 Model 2(IADL)		模型3 Model 3(PPT)
变量 Variable	OR值value (95% CI)	P值 value	OR值value (95% CI)	P值 value	OR值value (95% CI)	P值 value
年龄/岁Age/years	1.036(1.033~1.039)	＜0.001	1.012(1.009~1.016)	＜0.001	1.031(1.028~1.034)	＜0.001
性别Gender
男性Male	1.000	1.000	1.000
女性Female	1.208(1.158~1.261)	＜0.001	1.061(1.017~1.108)	0.006	1.118(1.072~1.166)	＜0.001
居住地Residence
城镇Urban	1.000	1.000	1.000
农村Rural	1.062(1.017~1.108)	0.006	1.004(0.963~1.048)	0.843	1.013(0.971~1.056)	0.546
受教育水平Educational level
小学及以下Primary school and below	1.000	1.000	1.000
小学以上Over primary school	0.957(0.910~1.006)	0.085	1.081(1.029~1.137)	0.002	0.967(0.920~1.016)	0.179
ADL
无失能Without disabilities	1.000
失能Disability	9.805(9.093~10.580)	＜0.001
IADL
无失能Without disabilities			1.000
失能Disability			4.374(4.166~4.594)	＜0.001
PPT
无障碍Without physical dysfunction					1.000
躯体功能障碍Physical dysfunction					3.372(3.220~3.531)	＜0.001
CES-D
无抑郁症状Without depressive symptoms	1.000		1.000		1.000
有抑郁症状With depressive symptoms	2.311(2.211~2.416)	＜0.001	2.170(2.076~2.267)	＜0.001	2.175(2.082~2.272)	＜0.001
注：1. 模型1，社会人口学特征和ADL为协变量；模型2，社会人口学特征和IADL为协变量；模型3，社会人口学特征和PPT为协变量。 2. GALI，总体活动受限指数；ADL，日常生活活动能力；IADL，工具性日常活动能力；PPT，躯体功能测试；CES-D，流行病学研究中心抑郁量表。 Note: 1. Model 1, social demographic characteristics and ADL as covariates; Model 2, social demographic characteristics and IADL as covariates; Model 3, social demographic characteristics and PPT as covariates. 2. GALI, global activity limitation indicator; ADL, activities of daily living; IADL, instrumental activities of daily living; PPT, physical performance test; CES-D, center for epidemiologic studies depression scale.

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