经历生命早期丧亲对中国老年人寿命影响研究

沈文达; 张旭熙; 孙昕霙; 冯星淋; 曾毅

doi:10.16462/j.cnki.zhjbkz.2024.09.002

经历生命早期丧亲对中国老年人寿命影响研究

doi: 10.16462/j.cnki.zhjbkz.2024.09.002

沈文达^{1, 6},
张旭熙^{1, 4},
孙昕霙^{1, 4, ,},
冯星淋²,
曾毅^{3, 5}

1.
北京大学公共卫生学院社会医学与健康教育系，北京 100191
2.
北京大学公共卫生学院卫生政策与管理学系，北京 100191
3.
北京大学国家发展研究院健康老龄与发展研究中心，北京 100871
4.
北京大学医学部老年健康研究中心，北京 100191
5.
杜克大学医学院老龄与人类发展研究中心和老年医学部，达勒姆 NC27710
6.
天津市疾病预防控制中心非传染性疾病预防控制所，天津 300011

基金项目:

科技部国家重点研发计划 2022YFC3600904

国家自然科学基金 72061137004

天津市医学重点学科(专科)建设项目流行病学-非传染病预防与控制 TJYXZDXK-051A

天津市卫生健康委重点学科专项 TJWJ2023XK028

详细信息

通讯作者:
孙昕霙，E-mail：xysun@bjmu.edu.cn

中图分类号: R195.3
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- 被引次数: 0
出版历程
- 收稿日期: 2023-12-06
- 修回日期: 2024-05-13
- 刊出日期: 2024-09-10

Study of the impact of experiencing early parental death on the lifespan of the elderly in China

SHEN Wenda^{1, 6},
ZHANG Xuxi^{1, 4},
SUN Xinying^{1, 4
, ,},
FENG Xinglin²,
ZENG Yi^{3, 5}

1.
Department of Social Medicine and Health Education, School of Public Health, Peking University, Beijing 100191, China
2.
Department of Health Policy and Management, School of Public Health, Peking University, Beijing 100191, China
3.
Center for Healthy Aging and Development Studies, National School of Development, Peking University, Beijing 100871, China
4.
Center for Healthy Aging, Health Science Center, Peking University, Beijing 100191, China
5.
Center for the Study of Aging and Human Development, Medical School of Duke University, Durham NC27710, USA
6.
Institute of Non-communicable Disease Control and Prevention, Tianjin Centers for Diseases Control and Prevention, Tianjin 300011, China

Funds:

National Key Research and Development Program of China 2022YFC3600904

National Natural Science Foundation of China 72061137004

Tianjin Key Medical Discipline (Specialty) Construction Project TJYXZDXK-051A

Special Project for Key Discipline of Tianjin Health Commission TJWJ2023XK028

More Information

Corresponding author: SUN Xinying, E-mail: xysun@bjmu.edu.cn

摘要

摘要: 目的探索经历生命早期丧亲(即父亲或母亲死亡)事件对中国老年人寿命的影响。方法使用中国老年健康影响因素跟踪调查(Chinese longitudinal healthy longevity survey, CLHLS)2002―2021年数据，获取个体死亡或失访结局信息和早期丧亲状况等变量信息。组间比较使用χ²检验，单因素生存分析采用Kaplan-Meier法，多因素生存分析使用加速失效时间模型(accelerated failure time model, AFT)，以时间比(time ratio, TR)表示发生风险。敏感性分析采用多重线性回归。结果追踪收集10 278名研究对象的生存数据，最终死亡7 738人，平均死亡年龄为(92.49±9.35)岁，存活358人，失访2 182人。通过Log-rank检验得出P=0.002，非早期丧亲中位生存时间为95岁(95% CI: 94.654~95.346)，早期丧亲中位生存时间为94岁(95% CI: 93.494~94.506)，差异有统计学意义(χ² =9.404, P=0.002)。纳入控制变量，通过加速失效时间模型分析，经历早期丧亲者平均寿命是非早期丧亲者的0.994 2(95% CI: 0.990 3~0.998 2, P=0.004)，即经历早期丧亲平均会缩短0.58%的个体寿命。结论经历早期丧亲事件会导致寿命缩短，应将早期丧亲作为危险因素加以研究和干预，缩小健康差异，提升国民健康水平。
- 丧亲 /
- 老年人 /
- 寿命 /
- 加速失效时间模型 /
- 时间比
Abstract: Objective To explore the impact of early parental death (i.e., death of father or mother) on the life span of the elderly in China. Methods The tracking data from the Chinese longitudinal healthy longevity survey (CLHLS) from 2002 to 2021 were utilized to acquire information on individual mortality/loss to follow-up outcomes and variables such as early parental death. Differences between groups were assessed using the χ² test. Univariate survival analysis employed the Kaplan-Meier method, while multivariate survival analysis employed the accelerated failure time model(AFT), with the risk of occurrence expressed as the time ratio (TR). Sensitivity analysis was conducted by multiple linear regression. Results A total of 10 278 individuals were recruited as study participants, of whom 7 738 passed away, with an average age of 92.49±9.35 years. 358 survived and 2 182 were lost to follow-up. The Kaplan-Meier analysis revealed a P-value of 0.002 and the median survival time for non-early parental death was 95 years old (95% CI: 94.654-95.346) whereas the median survival time for early parental death was 94 years old (95% CI: 93.494-94.506). with the difference was statistically significant. After adjusting for control variables, the AFT model analysis indicated that the average lifespan of those who had experienced early parental death was 0.994 2 that of those who had not (95% CI: 0.990 3-0.998 2, P=0.004), indicating that experiencing early parental death reduces an individual′s average lifespan by 0.58%. Conclusions Experiencing early parental death will lead to a shortened life span. It is necessary to study and intervene the early parental death as a risk factor, thereby narrowing the health gap and improving the national health level.
- Parental death /
- Elderly /
- Lifespan /
- Accelerated failure time model /
- Time ratio

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表 1 早期丧亲和非早期丧亲老年人基线情况

Table 1. Baseline characteristics of the elderly with early parental and non-early parental death

变量 Variable	样本人数Sample size(n=10 278)^①		χ²值 value	P值 value
变量 Variable	非早期丧亲 No-early parental death	早期丧亲 Early parental death	χ²值 value	P值 value
性别Gender			0.551	0.458
男性Male	3 317(69.9)	1 425(30.1)
女性Female	3 835(69.3)	1 701(30.7)
民族Ethnicity			1.489	0.222
汉族Han	6 754(69.7)	2 933(30.3)
少数民族Minority	398(67.3)	193(32.7)
出生地Birthplace			2.235	0.135
城市Urban	1 055(68.0)	497(32.0)
农村Rural	6 097(69.9)	2 629(30.1)
婚姻状况Marital status			0.550	0.459
在婚In marriage	2 342(69.1)	1 047(30.9)
非在婚Non-married	4 810(69.8)	2 079(30.2)
是否有子女Status of children			1.223	0.269
是Yes	6 885(69.7)	2 995(30.3)
否No	267(67.1)	131(32.9)
注：①以人数(占比/%)表示。 Note: ① Number of people (proportion/%).

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表 2 2002―2005年早期丧亲和非早期丧亲老年人直接死因分布情况

Table 2. Distribution of direct causes of death among the elderly with early parental and non-early parental death, 2002-2005

遗传相关性 Genetic correlation	直接死因 Direct causes of death	死亡人数Number of death(n=5 031)^①		χ²值 value	P值 value
遗传相关性 Genetic correlation	直接死因 Direct causes of death	非早期丧亲 No-early parental death	早期丧亲 Early parental death	χ²值 value	P值 value
遗传相关死因Genetically related causes of death	恶性肿瘤Malignant tumor	51(4.4)	186(4.8)	6.113	0.910
	心血管病Cardiovascular disease	94(8.2)	342(8.8)
	心脏病Heart disease	93(8.1)	265(6.8)
	呼吸系统疾病Respiratory diseases	84(7.3)	264(6.8)
	内分泌、营养、代谢或免疫性疾病Endocrine, nutritional, metabolic or immune diseases	31(2.7)	115(3.0)
	泌尿或生殖系统疾病Diseases of urinary or reproductive system	8(0.7)	25(0.6)
	痴呆或精神病Dementia or psychosis	1(0.1)	12(0.3)
	消化系统疾病Digestive system diseases	31(2.7)	113(2.9)
非遗传相关死因Non-genetically related causes of death	意外Accident	57(5.0)	213(5.5)
	伤害或中毒Injury or poisoning	9(0.8)	35(0.9)
	结核病Tuberculosis	7(0.6)	28(0.7)
其他Others	其他Other	672(58.5)	2 245(57.8)
	不知道Don′t know	10(0.9)	40(1.1)
合计Total		1 148	3 883
注：①以人数(占比/%)表示。 Note: ① Number of people (proportion/%).

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表 3 早期丧亲事件对我国老年人寿命影响的AFT分析结果

Table 3. Results of AFT analysis of the impact of early parental death on the life span of the elderly in China

变量 Variable	人数 Number of people (n=10 278)	模型1 Model 1		模型2 Model 2		模型3 Model 3
变量 Variable	人数 Number of people (n=10 278)	TR值value (95% CI)	P值 value	TR值value (95% CI)	P值 value	TR值value (95% CI)	P值 value
丧亲情况Status of early parental death
非早期丧亲Non-early parental death	7 152	1.000 0		1.000 0		1.000 0
早期丧亲Early parental death	3 126	0.993 6(0.989 9~0.997 4)	0.001	0.993 7(0.989 9~0.997 4)	0.001	0.994 2(0.990 3~0.998 2)	0.004
性别Gender
女性Female	5 536	1.000 0		1.000 0		1.000 0
男性Male	4 742	0.993 9(0.989 6~0.998 2)	0.006	0.994 0(0.989 7~0.998 2)	0.006	1.000 5(0.995 6~1.005 4)	0.851
现住城乡Current residence
农村Rural	5 786	1.000 0		1.000 0		1.000 0
城市Urban	4 492	1.011 9(1.008 0~1.015 6)	< 0.001	1.011 9(1.008 0~1.016 0)	< 0.001	1.014 5(1.010 2~1.018 8)	< 0.001
居住方式Residential mode
独居Living alone	1 342	1.000 0		1.000 0		1.000 0
与家人居住Living with family	8 508	1.017 8(1.012 4~1.023 2)	< 0.001	1.017 6(1.012 2~1.023 1)	< 0.001	1.013 9(1.008 0~1.019 8)	< 0.001
养老院Nursing home	428	0.990 9(0.981 3~1.000 5)	0.060	0.990 8(0.981 2~1000 5)	0.062	0.991 6(0.981 5~1.001 9)	0.108
婚姻状况Marital status
非在婚Non-married	410	1.000 0		1.000 0		1.000 0
在婚In marriage	3 389	0.976 1(0.966 6~0.985 8)	< 0.001	0.976 0(0.966 5~0.985 7)	< 0.001	0.985 7(0.975 8~0.996 2)	0.008
丧偶Widowed	6 479	1.032 0(1.022 4~1.041 7)	< 0.001	1.032 0(1.022 2~1.041 6)	< 0.001	1.038 8(1.028 4~1.049 2)	< 0.001
子女状况Status of children
未育子女Childless	398	1.000 0		1.000 0		1.000 0
子女均存活All children survive	5 589	0.980 2(0.971 0~0.989 5)	< 0.001	0.980 2(0.970 9~0.989 5)	< 0.001	0.978 2(0.968 6~0.987 9)	< 0.001
有子女死亡Death of children	4 291	1.004 6(0.995 0~1.014 2)	0.352	1.004 4(0.995 0~1.014 1)	0.362	1.003 8(0.993 9~1.013 9)	0.450
文化程度Education
文盲Illiterate	6 010	1.000 0		1.000 0		1.000 0
非文盲Literate	4 268	0.985 6(0.981 2~0.990 0)	< 0.001	0.985 5(0.981 2~0.989 8)	< 0.001	0.989 3(0.984 8~0.993 9)	< 0.001
儿童期挨饿情况Childhood hunger situation
不挨饿Not going hungry	3 796			1.000 0		1.000 0
挨饿Go hungry	6 482			0.996 7(0.992 9~1.000 5)	0.088	0.997 0(0.993 1~1.001 0)	0.141
吸烟情况Smoking status
从不吸烟Never	6 488					1.000 0
仅过去吸烟Only past	1 724					0.990 0(0.984 6~0.995 5)	< 0.001
仅现在吸烟Only now	97					0.965 4(0.947 9~0.983 8)
一直吸烟Always	1 969					0.973 1(0.967 9~0.978 4)	< 0.001
患高血压Hypertension
否No	8 689					1.000 0
是Yes	1 589					0.986 8(0.981 5~0.992 1)	< 0.001
代答情况Answered by help
否No	6 553					1.000 0
是Yes	3 725					1.047 3(1.043 1~1.051 6)	< 0.001
注：1. 模型1，控制变量纳入了性别、民族、区域、现住城乡、居住方式、婚姻状况、子女状况、文化程度、职业、主观收入水平和老年及时就医情况；模型2，在模型1的基础上增加出生地、儿童期及时就医情况和儿童期挨饿情况；模型3，在模型2基础上增加吸烟情况、经常饮酒情况、经常锻炼情况、患高血压、患糖尿病、患心脏病、患脑卒中、患恶性肿瘤、患肺部疾病和代答情况。表中展示部分控制变量。 2. AFT, 加速失效时间模型; TR, 时间比。 Note: 1. Model 1, controls for variables such as gender, ethnicity, region, residence, residential mode, marital status, children′s status, educational, occupation, subjective income level, and timely medical care for the elderly; Model 2, adds variables such as birthplace, timely medical care during childhood, and childhood hunger situation on the basis of model 1; Model 3, adds variables such as smoking, regular alcohol consumption, regular exercise, hypertension, diabetes, heart disease, stroke, maligenant tumor, lung disease, and answered by help based on model 2. The table displays only part of the control variables. 2. AFT, accelerated failure time model; TR, time ratio.

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