南京市60岁及以上人群衰弱状况

王巍巍; 戚圣香; 陈一佳; 孙倩男; 吴洁; 周海茸; 洪忻

doi:10.16462/j.cnki.zhjbkz.2025.09.003

南京市60岁及以上人群衰弱状况

doi: 10.16462/j.cnki.zhjbkz.2025.09.003

南京医科大学附属南京疾病预防控制中心慢性非传染病防制科，南京 210018

基金项目:

江苏省预防医学及血地寄防科研课题 Ym2023060

南京医科大学南京公共卫生研究院科研创新项目 NCX2407

南京市卫生科技发展专项资金项目 YKK23195

详细信息

通讯作者:
洪忻, E-mail: nj_hongxin@126.com

中图分类号: R161.7
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出版历程
- 收稿日期: 2025-02-18
- 修回日期: 2025-05-02
- 网络出版日期: 2025-10-10
- 刊出日期: 2025-09-10

Evaluation of frailty in people aged 60 years and above in Nanjing

Department of Non-communicable Chronic Disease Control and Prevention, Nanjing Center for Disease Control and Prevention Affiliated to Nanjing Medical University, Nanjing 210018, China

Funds:

Jiangsu Province Prevention Medicine and Blood-Borne Parasitic Diseases Control Research Projects Ym2023060

Research and Innovation Project of Nanjing Institute of Public Health, Nanjing Medical University NCX2407

Nanjing Municipal Medical Science and Technique Development Foundation YKK23195

More Information

Corresponding author: HONG Xin, E-mail: nj_hongxin@126.com

摘要

摘要: 目的了解2021–2023年南京市≥60岁人群的衰弱状况及相关影响因素的重要性。方法数据来源于南京市慢性病及其危险因素监测(2021–2023年)，采用多阶段分层整群随机抽样方法，调查内容包括问卷调查、身体测量和实验室检测。以30个健康相关变量为基础构建衰弱指数，评价人群衰弱状态。采用极端梯度提升算法模型结合沙普利加性解释方法对影响衰弱的社会人口学特征和生活行为方式进行重要性分析。结果共纳入22 475名≥60岁研究对象，平均年龄为(67.62±5.88)岁。其中，衰弱患者3 750名(18.5%)，衰弱指数为0.176。女性、≥80岁者、离异/丧偶/分居者、小学及以下文化程度者、低收入水平人群和不健康的生活行为方式(吸烟、饮酒、不健康饮食、体力活动不足和睡眠障碍)人群中衰弱比例和衰弱指数值均较高(均P＜0.001)。男性中影响因素贡献前5位的是睡眠质量、家庭年收入、年龄、体力活动和吸烟情况；女性中影响因素贡献前5位的是睡眠质量、年龄、体力活动、家庭年收入和膳食得分。结论 2021–2023年南京市≥60岁人群衰弱指数均较高，不良生活方式、高龄和低水平收入是衰弱的影响因素。对于南京市人口深度老龄化的现状，针对老年人尤其是衰弱高危人群开展针对性干预尤为必要。
- 衰弱 /
- 衰弱指数 /
- 老年人
Abstract: Objective To evaluate frailty and the importance of its influencing factors in people aged 60 years and above in Nanjing. Methods The data were from the Chronic Disease and Risk Factor Surveillance in Nanjing during 2021-2023. A population-based cross-sectional survey was conducted by multi-stage stratified cluster random sampling. A representative sample of residents aged ≥60 years was interviewed by face-to-face questionnaire survey, anthropometric measurements and laboratory examinations. The frailty index (FI) was constructed as the proportion of deficits in 30 variables to evaluate the frailty status of the population, and extreme gradient boosting model combined with ShaPley additive explanations method was used to analyze the importance of the sociodemographic and life behavior factors affecting the prevalence of frailty. Results A total of 22 475 subjects were included, with average age of (67.62±5.88) years. The overall weighted prevalence of frailty was 18.5%, and the median FI score was 0.176, which were both higher among women, ≥80 years old people, the divorced/separated/widowed and individuals with lower levels of education and income. In addition, smoking, drinking, unhealthy dietary behavior, low level of physical activity and sleep disorders were significantly associated with frailty and higher FI (all P < 0.001). The top five contributing factors were sleep quality, annual family income level, age, physical activity and smoking in elderly men, and sleep quality, age, physical activity, annual family income level and diet scores in elderly women. Conclusions The FI scores were observed higher in Nanjing's elderly (≥60 years), with unhealthy lifestyles, age, and low income being key risk factors. It highlights the need for targeted preventive approaches and support programs to promote physical, psychological and social health in elderly people.
- Frailty /
- Frailty index /
- Elderly

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图 1 衰弱10个影响因素SHAP汇总图

SHAP：沙普利加性解释; 纵轴影响因素是按照SHAP值进行降序排序，反映了影响因素重要性顺序；横轴是SHAP值，>0代表正向作用，表示增加衰弱风险； < 0代表负向作用，表示降低衰弱风险。

Figure 1. SHAP summary plot of the top 10 factors associated with frailty

SHAP: ShaPley additive explanations; The y-axis variables are ranked in descending order of SHAP values, reflecting their relative importance. The x-axis represents SHAP values, where values >0 indicate positive effects (increasing frailty risk) and values < 0 indicate negative effects (reducing frailty risk).

下载: 全尺寸图片幻灯片

图 2 衰弱10个影响因素SHAP依赖图(男性)

SHAP：沙普利加性解释。

Figure 2. SHAP dependence plots for the top 10 factors associated with frailty (Male)

SHAP: ShaPley additive explanations.

下载: 全尺寸图片幻灯片

图 3 衰弱10个影响因素SHAP依赖图(女性)

SHAP：沙普利加性解释。

Figure 3. SHAP dependence plots for the top 10 factors associated with frailty (Female)

SHAP: ShaPley additive explanations.

下载: 全尺寸图片幻灯片

图 4 衰弱10个影响因素SHAP依赖图(全人群)

SHAP：沙普利加性解释。

Figure 4. SHAP dependence plots for the top 10 factors associated with frailty (total population)

SHAP: ShaPley additive explanations.

下载: 全尺寸图片幻灯片

表 1 不同社会人口学特征研究对象的衰弱情况

Table 1. Frailty status of participants across different sociodemographic characteristics

社会人口学特征 Sociodemographic characteristics	男性Male^①			χ² value	P值 value
社会人口学特征 Sociodemographic characteristics	无衰弱None	衰弱前期Pre-frailty	衰弱Frailty	χ² value	P值 value
总人群Total population	2 375(20.8)	6 655(61.2)	1 846(18.0)
年龄组/岁Age group/years				167.259	< 0.001
60~＜70	1 802(24.8)	4 411(60.6)	1 065(14.6)
70~＜80	514(16.1)	1 968(62.6)	661(21.3)
≥80	59(13.5)	276(60.6)	120(25.9)
地区Area				25.773	< 0.001
城区Rural	1 334(22.0)	3 336(59.4)	965(18.6)
郊县Urban	1 041(19.5)	3 319(63.1)	881(17.4)
文化程度Education level				11.466	0.022
小学及以下Primary school and lower	747(19.7)	2 286(62.9)	610(17.4)
初中/高中Junior or senior high school	1 334(21.2)	3 677(60.7)	1 024(18.1)
大专及以上College and higher	294(22.4)	692(58.5)	212(19.1)
婚姻状况Marriage				44.075	< 0.001
离异/丧偶/分居Separated/divorced/widowed	78(12.9)	330(60.5)	138(26.6)
未婚Single	49(27.7)	90(52.3)	31(20.0)
已婚Married	2 248(21.2)	6 235(61.4)	1 677(17.4)
家庭年收入Annual household income				43.619	< 0.001
低收入水平Lower	682(17.0)	1 997(61.0)	671(22.0)
中收入水平Middle	938(18.3)	2 403(58.1)	650(23.6)
高收入水平Higher	755(20.9)	2 255(62.8)	525(16.3)
总人群Total population	2 707(20.7)	6 988(60.4)	1 904(18.9)
年龄组/岁Age group/years				343.633	< 0.001
60~＜70	2 130(27.1)	4 668(59.6)	1 039(13.3)
70~＜80	535(15.7)	2 041(62.1)	709(22.2)
≥80	42(8.0)	279(60.1)	156(31.9)
地区Area				99.030	< 0.001
城区Rural	1 683(23.1)	3 582(58.2)	978(18.7)
郊县Urban	1 024(17.6)	3 406(63.3)	926(19.1)
文化程度Education level				179.937	< 0.001
小学及以下Primary school and lower	1 151(16.3)	3 875(62.7)	1 129(21.0)
初中/高中Junior or senior high school	1 319(25.6)	2 743(57.7)	686(16.7)
大专及以上College and higher	237(28.0)	370(57.1)	89(14.9)
婚姻状况Marriage				105.028	< 0.001
离异/丧偶/分居Separated/divorced/widowed	212(11.3)	868(61.7)	339(27.0)
未婚Single	11(27.4)	22(62.2)	4(10.4)
已婚Married	2 484(22.6)	6 098(60.1)	1 561(17.3)
家庭年收入Annual household income				156.073	< 0.001
低收入水平Lower	836(17.6)	2 462(57.9)	882(24.5)
中收入水平Middle	981(21.1)	2 463(59.3)	656(19.6)
高收入水平Higher	890(24.6)	2 063(61.9)	366(13.5)

社会人口学特征 Sociodemographic characteristics	合计Total^①			χ²值 value	P值 value
社会人口学特征 Sociodemographic characteristics	无衰弱None	衰弱前期Pre-frailty	衰弱Frailty	χ²值 value	P值 value
总人群Total population	5 082(20.7)	13 643(60.8)	3 750(18.5)
年龄组/岁Age group/years				496.371	< 0.001
60~＜70	3 932(25.9)	9 079(60.1)	2 104(14.0)
70~＜80	1 049(15.9)	4 009(62.4)	1 370(21.7)
≥80	101(10.3)	555(60.3)	276(29.4)
地区Area				113.354	< 0.001
城区Rural	3 017(22.6)	6 918(58.7)	1 943(18.7)
郊县Urban	2 065(18.5)	6 725(63.2)	1 807(18.3)
文化程度Education level				117.588	< 0.001
小学及以下Primary school and lower	1 898(17.5)	6 161(62.8)	1 739(19.7)
初中/高中Junior or senior high school	2 653(23.1)	6 420(59.4)	1 710(17.5)
大专及以上College and higher	531(24.6)	1 062(57.9)	301(17.5)
婚姻状况Marriage				137.618	< 0.001
离异/丧偶/分居Separated/divorced/widowed	290(11.7)	1 198(61.4)	477(26.9)
未婚Single	60(27.7)	112(53.9)	35(18.4)
已婚Married	4 732(21.8)	12 333(60.8)	3 238(17.4)
家庭年收入Annual household income				166.621	< 0.001
低收入水平Lower	1 518(17.4)	4 459(59.3)	1 553(23.3)
中收入水平Middle	1 919(19.6)	4 866(58.7)	1 306(21.7)
高收入水平Higher	1 645(21.0)	4 318(62.7)	891(16.3)
注：①以人数(占比/%)表示。 Note: ①Number of people (proportion/%).

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表 2 不同生活行为方式研究对象的衰弱情况

Table 2. Frailty status of participants across different lifestyle patterns

生活行为方式 Life behavior patterns	男性Male^①			χ²值 value	P值 value
生活行为方式 Life behavior patterns	无衰弱None	衰弱前期Pre-frailty	衰弱Frailty	χ²值 value	P值 value
总人群Total population	2 375(20.8)	6 655(61.2)	1 846(18.0)
吸烟情况Smoking				137.286	< 0.001
从不吸烟No smoking	1 303(22.0)	3369(61.1)	860(16.9)
现在吸烟Smoking	888(21.3)	2 555(62.4)	637(16.3)
已戒烟Quit smoking	184(13.6)	731(57.8)	349(28.6)
饮酒情况Drinking				19.385	0.001
从不饮酒No drinking	1 469(21.7)	3 784(59.9)	1 081(18.4)
过去30 d内饮酒In the past 30 days	709(19.9)	2 217(63.2)	580(16.9)
过去30 d前饮酒Last 30 days ago	197(18.1)	654(63.3)	185(18.6)
膳食得分Diet scores				4.036	0.401
0~＜3	814(20.6)	2 305(60.8)	664(18.6)
3	911(20.7)	2 619(62.4)	688(16.9)
≥4	650(21.2)	1 731(59.9)	494(18.9)
体力活动/(min·周^-1) Physical activity/(min·week^-1)				62.373	< 0.001
< 600	598(18.0)	1 950(62.6)	571(19.4)
600~＜4 000	1 201(21.1)	3 289(60.2)	957(18.7)
4 000~＜8 000	295(21.1)	857(63.5)	208(15.4)
≥8 000	281(29.2)	559(58.5)	110(12.3)
睡眠质量Sleep quality				881.103	< 0.001
0~＜5	1 880(27.7)	4 000(61.1)	701(11.2)
5~＜8	366(12.9)	1 704(64.4)	560(22.7)
≥8	129(7.1)	951(56.3)	585(36.6)

生活行为方式 Life behavior patterns	女性Female^①			χ²值 value	P值 value
生活行为方式 Life behavior patterns	无衰弱None	衰弱前期Pre-frailty	衰弱Frailty	χ²值 value	P值 value
总人群Total population	2 707(20.7)	6 988(60.4)	1 904(18.9)
吸烟情况Smoking				38.000	< 0.001
从不吸烟No smoking	2 688(20.8)	6 923(60.5)	1 860(18.7)
现在吸烟Smoking	16(10.5)	57(56.8)	32(32.7)
已戒烟Quit smoking	3(10.9)	8(28.1)	12(61.0)
饮酒情况Drinking				7.184	0.126
从不饮酒No drinking	2 518(20.8)	6 459(60.3)	1 743(18.9)
过去30 d内饮酒In the past 30 days	108(18.2)	338(64.0)	93(17.8)
过去30 d前饮酒Last 30 days ago	81(21.0)	191(56.5)	68(22.5)
膳食得分Diet scores				45.054	< 0.001
0~＜3	752(18.8)	2 212(61.0)	646(20.2)
3	916(20.0)	2 486(60.6)	689(19.4)
≥4	1 039(23.1)	2 290(59.7)	569(17.2)
体力活动/(min·周^-1) Physical activity/(min·week^-1)				46.340	< 0.001
< 600	544(17.2)	1 515(59.2)	524(23.6)
600~＜4 000	1 391(21.1)	3 576(60.5)	927(18.4)
4 000~＜8 000	529(22.5)	1 373(62.8)	319(14.7)
≥8 000	243(26.0)	524(58.1)	134(15.9)
睡眠质量Sleep quality				1 204.295	< 0.001
0~＜5	1 878(30.6)	3 263(59.7)	447(9.7)
5~＜8	579(16.4)	1 966(63.9)	540(19.7)
≥8	250(7.1)	1 759(58.2)	917(34.7)

生活行为方式 Life behavior patterns	合计Total^①			χ²值 value	P值 value
生活行为方式 Life behavior patterns	无衰弱None	衰弱前期Pre-frailty	衰弱Frailty	χ²值 value	P值 value
总人群Total population	5 082(20.7)	13 643(60.8)	3 750(18.5)
吸烟情况Smoking				154.693	< 0.001
从不吸烟No smoking	3 991(21.2)	10 292(60.7)	2 720(18.1)
现在吸烟Smoking	904(21.0)	2 612(62.2)	669(16.8)
已戒烟Quit smoking	187(13.6)	739(57.1)	361(29.3)
饮酒情况Drinking				26.249	< 0.001
从不饮酒No drinking	3 987(21.1)	10 243(60.2)	2 824(18.7)
过去30 d内饮酒In the past 30 days	817(19.6)	2 555(63.3)	673(17.1)
过去30 d前饮酒Last 30 days ago	278(18.8)	845(61.6)	253(19.6)
膳食得分Diet scores				36.016	< 0.001
0~＜3	1 566(19.7)	4 517(60.9)	1 310(19.4)
3	1 827(20.3)	5 105(61.5)	1 377(18.2)
≥4	1 689(22.3)	4 021(59.8)	1 063(17.9)
体力活动/(min·周^-1) Physical activity/(min·week^-1)				90.579	< 0.001
< 600	1 142(17.6)	3 465(61.0)	1 095(21.4)
600~＜4 000	2 592(21.1)	6 865(60.4)	1 884(18.5)
4 000~＜8 000	824(21.9)	2 230(63.1)	527(15.0)
≥8 000	524(27.7)	1 083(58.3)	244(14.0)
睡眠质量Sleep quality				2 008.801	< 0.001
0~＜5	3 758(29.1)	7 263(60.4)	1 148(10.5)
5~＜8	945(14.8)	3 670(64.1)	1 100(21.1)
≥8	379(7.1)	2 710(57.5)	1 502(35.4)
注：①以人数(占比/%)表示。 Note: ①Number of people (proportion/%).

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