社会经济地位和体力活动对中国中老年人认知功能衰退的联合影响

白林; 李成福; 武昱; 苏彬彬; 郑晓瑛; 郭帅

doi:10.16462/j.cnki.zhjbkz.2025.06.002

社会经济地位和体力活动对中国中老年人认知功能衰退的联合影响

doi: 10.16462/j.cnki.zhjbkz.2025.06.002

白林¹,
李成福²,
武昱¹,
苏彬彬¹,
郑晓瑛^1, ,,
郭帅^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人口健康与老龄科学系，北京 100730
2.
中国人口与发展研究中心，北京 100081

白林和李成福为共同第一作者

基金项目:

国家重点研发计划 2022YFC3600800

中国医学科学院中央级公益性科研院所基本科研业务费专项资金 2023-RC330-01

中国博士后科学基金 2024M760259

“国家资助博士后研究人员计划”资助 GZC20240155

详细信息

通讯作者:
郑晓瑛，E-mail: zhengxiaoying@sph.pumc.edu.cn

郭帅，E-mail: guoshuai@pumc.edu.cn

中图分类号: R181; R749.1; D669.6
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- 文章访问数: 3
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- 被引次数: 0
出版历程
- 收稿日期: 2024-06-28
- 修回日期: 2024-12-10
- 网络出版日期: 2025-07-07
- 刊出日期: 2025-06-10

Joint effects of socioeconomic status and physical activity on cognitive decline among Chinese middle-aged and older adults

BAI Lin¹,
LI Chengfu²,
WU Yu¹,
SU Binbin¹,
ZHENG Xiaoying^{1
, ,},
GUO Shuai^{1
, ,}

1.
Department of Population Health and Aging Science, School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
2.
China Population and Development Research Center, Beijing 100081, China

BAI Lin and LI Chengfu contribute equally to this article

Funds:

National Key Research and Development Program 2022YFC3600800

The Non-profit Central Research Institute Fund of Chinses Academy of Medicine Sciences 2023-RC330-01

Funded by the China Postdoctoral Science Foundation 2024M760259

The Postdoctoral Fellowship Program of China Postdoctoral Science Foundation GZC20240155

More Information

Corresponding author: ZHENG Xiaoying, E-mail: zhengxiaoying@sph.pumc.edu.cn; GUO Shuai, E-mail: guoshuai@pumc.edu.cn

摘要

摘要: 目的探究中国中老年人社会经济地位(socioeconomic status, SES)和体力活动(physical activity, PA)对认知功能衰退的联合影响。方法选取中国健康与养老追踪调查中2011―2018年的4轮数据，在基线纳入4 352名≥45岁的中老年人作为研究样本。根据SES和PA，将其分为4组：低SES低PA、低SES高PA、高SES低PA和高SES高PA。采用线性混合效应模型进行分析。结果研究样本总体的基线认知功能得分平均为(15.02±4.67)分，不同SES-PA分组间的认知功能得分差异有统计学意义。回归模型结果显示，在控制混杂因素后，与低SES组相比，高SES组的认知功能水平更高(β_高SES低PA=0.96, P=0.008; β_高SES高PA=0.73, P=0.022)；此外，SES及PA的提升均能减缓认知功能的衰退速度(β_{年龄×低SES高PA}=0.03, P=0.047; β_{年龄×高SES低PA}=0.05, P=0.010; β_{年龄×高SES高PA}=0.07, P＜0.001)。综合来看，高SES高PA组认知功能水平最高且认知功能衰退速度最慢。结论随着年龄的增长，认知功能在人群中主要表现为SES的差异，但PA水平在其中起到一定的调节作用。鉴于PA干预措施的成本效益更高，未来需进一步关注体质锻炼在提升中老年人认知健康方面的作用。
- 认知功能衰退 /
- 社会经济地位 /
- 体力活动 /
- 联合效应
Abstract: Objective To examine the joint effects of socioeconomic status (SES) and physical activity (PA) on cognitive decline among middle-aged and older adults in China. Methods Four waves of data from the China Health and Retirement Longitudinal Study (2011-2018) were used to identify 4 352 eligible adults aged 45 years and above. The sample was divided into four groups: low SES-low PA, low SES-high PA, high SES-low PA, and high SES-high PA. The linear mixed effects model was used for analysis. Results The baseline average cognitive function score of the study sample was (15.02±4.67) points. There were significant differences in cognitive function score between different combinations of SES and PA. Results showed that after controlling for confounders, those in high SES group had higher levels of cognitive function compared to the low SES group (β_{high SES-low PA}=0.96, P=0.008; β_{high SES-high PA}=0.73, P=0.022); in addition, the increase of SES and PA slowed the rate of cognitive function decline (β_{age×low SES-high PA}=0.03, P=0.047; β_{age×high SES-low PA}=0.05, P=0.010; β_{age×high SES-high PA}=0.07, P < 0.001). Moreover, the high SES-high PA group had the highest cognitive function level and the slowest cognitive decline rate. Conclusions Cognitive decline is mainly characterized by differences in socioeconomic status, but physical activity levels play a moderating role. Considering that physical activity interventions are more cost-effective, more attention needs to be paid to physical exercise to improve cognitive health among middle-aged and older adults in the future.
- Cognitive decline /
- Socioeconomic status /
- Physical activity /
- Joint effects

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图 1 样本筛选流程图

CHARLS：中国健康与养老追踪调查。

Figure 1. Sample selection flowchart

CHARLS: China Health and Retirement Longitudinal Study.

下载: 全尺寸图片幻灯片

图 2 不同SES-PA组的认知功能年龄轨迹

SES：社会经济地位；PA：体力活动。

Figure 2. Age trajectories of cognitive function in different combinations of SES and PA

SES: socioeconomic status; PA: physical activity.

下载: 全尺寸图片幻灯片

表 1 研究样本总体及SES-PA分组的基线特征

Table 1. Baseline characteristics of the total sample and in different combinations of SES and PA

变量 Variable	总体 Total^①(n=4 352)	分组Group^①				P值value
变量 Variable	总体 Total^①(n=4 352)	低SES低PA Low SES-low PA(n=778)	低SES高PA Low SES-high PA(n=1 441)	高SES低PA High SES-low PA(n=709)	高SES高PA High SES-high PA(n=1 424)	P值value
认知功能得分/分Cognitive function score/score	15.02±4.67	13.16±4.79	13.67±4.54	16.76±4.24	16.52±4.10	＜0.001
年龄/岁Age/years	58.06±8.85	62.41±9.39	58.82±8.40	57.43±8.85	55.24±7.86	＜0.001
性别Gender						＜0.001
男Male	2 171(49.89)	298(38.30)	658(45.66)	373(52.61)	842(59.13)
女Female	2 181(50.11)	480(61.70)	783(54.34)	336(47.39)	582(40.87)
婚姻状况Marital status						＜0.001
有配偶Married	3 726(85.62)	613(78.79)	1 212(84.11)	623(87.87)	1 278(89.75)
无配偶Not married	626(14.38)	165(21.21)	229(15.89)	86(12.13)	146(10.25)
居住地Residence						＜0.001
农村Rural	3 265(75.02)	612(78.66)	1 311(90.98)	317(44.71)	1 025(71.98)
城镇Urban	1 087(24.98)	166(21.34)	130(9.02)	392(55.29)	399(28.02)
吸烟Smoking						＜0.001
是Yes	1 744(40.07)	273(35.09)	537(37.27)	280(39.49)	654(45.93)
否No	2 608(59.93)	505(64.91)	904(62.73)	429(60.51)	770(54.07)
饮酒Drinking						＜0.001
是Yes	1 772(40.72)	228(29.31)	555(38.51)	289(40.76)	700(49.16)
否No	2 580(59.28)	550(70.69)	886(61.49)	420(59.24)	724(50.84)
参与社交活动Social activities						＜0.001
是Yes	2 223(51.08)	364(46.79)	689(47.81)	355(50.07)	815(57.23)
否No	2 129(48.92)	414(53.21)	752(52.19)	354(49.93)	609(42.77)
自评健康Self-rated health						＜0.001
较差Poor	1 077(24.75)	260(33.42)	384(26.65)	164(23.13)	269(18.89)
一般General	2 197(50.48)	365(46.91)	742(51.49)	348(49.08)	742(52.11)
较好Better	1 078(24.77)	153(19.67)	315(21.86)	197(27.79)	413(29.00)
抑郁症状Depressive symptoms						＜0.001
是Yes	1 474(33.87)	332(42.67)	579(40.18)	180(25.39)	383(26.90)
否No	2 878(66.13)	446(57.33)	862(59.82)	529(74.61)	1 041(73.10)
ADL失能ADL disability						＜0.001
是Yes	637(14.64)	191(24.55)	216(14.99)	86(12.13)	144(10.11)
否No	3 715(85.36)	587(75.45)	1 225(85.01)	623(87.87)	1 280(89.89)
IADL失能IADL disability						＜0.001
是Yes	750(17.23)	218(28.02)	285(19.78)	94(13.26)	153(10.74)
否No	3 602(82.77)	560(71.98)	1 156(80.22)	615(86.74)	1 271(89.26)
注：SES，社会经济地位；PA，体力活动；ADL，日常生活能力；IADL，工具性日常生活能力。 ①以人数(占比/%)或x ±s表示。 Note：SES，socioeconomic status；PA，physical activity; ADL, activities of daily living; IADL, instrumental activities of daily living. ①Number of people (proportion/%) or x ±s.

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表 2 时变变量在历轮调查中的特征

Table 2. The characteristics of time-varying variables in each round of the survey

变量 Variable	2011年year(n=4 352)	2013年year(n=3 053)	2015年year(n=2 724)	2018年year(n=2 074)	P_趋势值 P_trendvalue
认知功能得分/分Cognitive function score/score	15.02±4.67	15.65±4.47	14.90±4.62	15.62±5.14	＜0.001
年龄/岁Age/years	58.06±8.85	59.33±8.35	61.24±8.18	63.23±7.79	＜0.001
婚姻状况Marital status					0.013
有配偶Married	3 726(85.62)	2 606(85.36)	2 322(85.24)	1 714(82.64)
无配偶Not married	626(14.38)	447(14.64)	402(14.76)	360(17.36)
居住地Residence					0.252
农村Rural	3 265(75.02)	2 252(73.76)	2 052(75.33)	1 520(73.29)
城镇Urban	1 087(24.98)	801(26.24)	672(24.67)	554(26.71)
吸烟Smoking					＜0.001
是Yes	1 744(40.07)	1 371(44.91)	1 283(47.10)	933(44.99)
否No	2 608(59.93)	1 682(55.09)	1 441(52.90)	1 141(55.01)
饮酒Drinking					＜0.001
是Yes	1 772(40.72)	1 450(47.49)	1 330(48.83)	1 015(48.94)
否No	2 580(59.28)	1 603(52.51)	1 394(51.17)	1 059(51.06)
参与社交活动Social activities					＜0.001
是Yes	2 223(51.08)	1760(57.65)	1 361(49.96)	1 020(49.18)
否No	2 129(48.92)	1 293(42.35)	1 363(50.04)	1 054(50.82)
自评健康Self-rated health					0.002
较差Poor	1 077(24.75)	678(22.21)	641(23.53)	529(25.51)
一般General	2 197(50.48)	1 693(55.45)	1 448(53.16)	1 064(51.30)
较好Better	1 078(24.77)	682(22.34)	635(23.31)	481(23.19)
抑郁症状Depressive symptoms					＜0.001
是Yes	1 474(33.87)	894(29.28)	863(31.68)	733(35.34)
否No	2 878(66.13)	2 159(70.72)	1 861(68.32)	1 341(64.66)
ADL失能ADL disability					＜0.001
是Yes	637(14.64)	476(15.59)	497(18.25)	371(17.89)
否No	3 715(85.36)	2 577(84.41)	2 227(81.75)	1 703(82.11)
IADL失能IADL disability					＜0.001
是Yes	750(17.23)	611(20.01)	636(23.35)	461(22.23)
否No	3 602(82.77)	2 442(79.99)	2 088(76.65)	1 613(77.77)
注：ADL，日常生活能力；IADL，工具性日常生活能力。 ①以人数(占比/%)或x ±s表示。 Note：ADL, activities of daily living; IADL, instrumental activities of daily living. ①Number of people (proportion/%) or x ±s.

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表 3 线性混合效应模型分析结果

Table 3. Estimated results of linear mixed effects model

变量Variable	模型1 Model 1		模型2 Model 2		模型3 Model 3
变量Variable	β值value(95% CI)	P值value	β值value(95% CI)	P值value	β值value(95% CI)	P值value
年龄/岁Age/years^①	-0.17(-0.19~-0.14)	＜0.001	-0.17(-0.19~-0.14)	＜0.001	-0.15(-0.18~-0.13)	＜0.001
SES-PA分组(低SES低PA) SES-PA grouping(low SES-low PA)
低SES高PA low SES-high PA	-0.55(-1.22~0.12)	0.105	-0.60(-1.26~0.06)	0.074	-0.66(-1.31~-0.01)	0.046
高SES低PA high SES-low PA	1.20(0.47~1.93)	0.001	1.15(0.43~1.88)	0.002	0.96(0.25~1.67)	0.008
高SES高PA high SES-high PA	0.98(0.34~1.62)	0.003	0.91(0.27~1.54)	0.005	0.73(0.11~1.35)	0.022
年龄×SES-PA分组(年龄×低SES低PA) Age×SES-PA grouping(age×low SES-low PA)
年龄×低SES高PA Age×low SES-high PA	0.03(-0.00~0.06)	0.082	0.03(-0.00~0.07)	0.053	0.03(0.00~0.06)	0.047
年龄×高SES低PA Age×high SES-low PA	0.04(0.00~0.08)	0.023	0.04(0.01~0.08)	0.018	0.05(0.01~0.08)	0.010
年龄×高SES高PA Age×high SES-high PA	0.07(0.04~0.10)	＜0.001	0.07(0.04~0.10)	＜0.001	0.07(0.04~0.10)	＜0.001
性别Gender
女性Female	-0.70(-0.92~-0.49)	＜0.001	-0.93(-1.22~-0.64)	＜0.001	-0.69(-0.97~-0.40)	＜0.001
婚姻状况Marital status
有配偶Married	0.49(0.25~0.72)	＜0.001	0.51(0.28~0.74)	＜0.001	0.44(0.21~0.67)	＜0.001
居住地Residence
农村Rural	-1.99(-2.23~-1.75)	＜0.001	-1.93(-2.17~-1.68)	＜0.001	-1.77(-2.01~-1.54)	＜0.001
吸烟Smoking
是Yes			-0.34(-0.60~-0.08)	0.011	-0.28(-0.54~-0.02)	0.035
饮酒Drinking
是Yes			0.04(-0.15~0.22)	0.712	0.06(-0.12~0.25)	0.519
参与社交活动Social activities
是Yes			0.63(0.48~0.77)	＜0.001	0.57(0.43~0.71)	＜0.001
自评健康(较差) Self-rated health(poor)
一般General					0.13(-0.05~0.32)	0.156
较好Better					0.27(0.04~0.50)	0.020
有抑郁症状Depressive symptoms
是Yes					-0.86(-1.02~-0.69)	＜0.001
ADL失能ADL disability
是Yes					-0.22(-0.43~-0.01)	0.045
IADL失能IADL disability
是Yes					-0.73(-0.93~-0.54)	＜0.001
模型拟合优度Goodness of fit
赤池信息准则Akaike information criterion	69 110.76		68 996.87		67 648.39
贝叶斯信息准则Bayesian information criterion	69 207.29		69 115.67		67 803.98
注：1. SES, 社会经济地位; PA, 体力活动; ADL, 日常生活能力; IADL, 工具性日常生活能力。 2. 模型1, 调整了社会人口特征; 模型2, 调整了社会人口特征和生活方式变量; 模型3, 调整了社会人口特征、生活方式变量和健康状况。 ①年龄中心化到45岁。 Note：1. SES, socioeconomic status; PA, physical activity; ADL, activities of daily living; IADL, instrumental activities of daily living. 2. Model 1, controlling for socio-demographic characteristics; Model 2, further controlling for life-style variables; Model 3, further controlling for health status. ①Age was centered to 45.

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社会经济地位和体力活动对中国中老年人认知功能衰退的联合影响

doi: 10.16462/j.cnki.zhjbkz.2025.06.002

通讯作者:
郑晓瑛，E-mail: zhengxiaoying@sph.pumc.edu.cn

郭帅，E-mail: guoshuai@pumc.edu.cn

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Joint effects of socioeconomic status and physical activity on cognitive decline among Chinese middle-aged and older adults

Corresponding author: ZHENG Xiaoying, E-mail: zhengxiaoying@sph.pumc.edu.cn; GUO Shuai, E-mail: guoshuai@pumc.edu.cn

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社会经济地位和体力活动对中国中老年人认知功能衰退的联合影响

doi: 10.16462/j.cnki.zhjbkz.2025.06.002

通讯作者: 郑晓瑛，E-mail: zhengxiaoying@sph.pumc.edu.cn 郭帅，E-mail: guoshuai@pumc.edu.cn

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Joint effects of socioeconomic status and physical activity on cognitive decline among Chinese middle-aged and older adults

Corresponding author: ZHENG Xiaoying, E-mail: zhengxiaoying@sph.pumc.edu.cn; GUO Shuai, E-mail: guoshuai@pumc.edu.cn

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通讯作者:
郑晓瑛，E-mail: zhengxiaoying@sph.pumc.edu.cn

郭帅，E-mail: guoshuai@pumc.edu.cn