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Article(id=1322924515893850680, tenantId=1146029695717560320, journalId=1220038315760373764, issueId=1322924415817757501, articleNumber=null, orderNo=null, doi=10.12102/j.issn.1009-6493.2026.17.003, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1778947200000, receivedDateStr=2026-05-17, revisedDate=1784044800000, revisedDateStr=2026-07-15, acceptedDate=null, acceptedDateStr=null, onlineDate=1793339383337, onlineDateStr=2026-10-30, pubDate=1788969600000, pubDateStr=2026-09-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793339383337, onlineIssueDateStr=2026-10-30, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793339383337, creator=13701087609, updateTime=1793339383337, updator=13701087609, issue=Issue{id=1322924415817757501, tenantId=1146029695717560320, journalId=1220038315760373764, year='2026', volume='40', issue='17', pageStart='2961', pageEnd='3152', issueExtLink='null', onlineDate='null', pubDate='1788969600000', pubDateStr='2026-09-10', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1793339359478, creator='13701087609', updateTime=1793343089343, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1322940060072542250, tenantId=1146029695717560320, journalId=1220038315760373764, issueId=1322924415817757501, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1322940060072542251, tenantId=1146029695717560320, journalId=1220038315760373764, issueId=1322924415817757501, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=2975, endPage=2981, ext={EN=ArticleExt(id=1322924516099371577, articleId=1322924515893850680, tenantId=1146029695717560320, journalId=1220038315760373764, language=EN, title=Association between on frailty development trajectories and adverse childhood experiences in Chinese middle-aged and older adults:a 10-year longitudinal study, columnId=1322924477746655521, journalTitle=Chinese Nursing Research, columnName=Special Planning-Chronic Disease Frailty, runingTitle=null, highlight=null, articleAbstract=
Objective

To examine the association between adverse childhood experiences(ACEs) and the 10‑year frailty development trajectories in Chinese middle‑aged and older adults,so as to provide evidence for life‑course‑oriented healthy ageing promotion strategies.

Methods

Using data from the China Health and Retirement Longitudinal Study(CHARLS) spanning 2011-2020,we identified frailty development trajectories through group‑based trajectory modelling,and applied multinomial Logistic regression to analyse the relationship between ACEs and these trajectories.

Results

A total of 10 032 middle‑aged and older adults were included.The baseline frailty index was 0.14±0.09,and 78.86% of the respondents reported at least one ACE.Three frailty trajectories were identified in the Chinese sample:stable non‑frailty(65.9%),critical turning point(23.9%),and progressive frailty(10.1%).Multinomial Logistic regression showed that ACEs were significantly associated with frailty trajectories(P<0.05),and a higher number of ACEs was associated with a higher relative risk of belonging to more severe frailty trajectory groups(P<0.05).

Conclusions

ACEs are associated with the 10‑year frailty development trajectories in Chinese middle‑aged and older adults,suggesting that childhood adversity may be an important distal risk factor for the long‑term evolution of frailty in later life.This highlights the need for early prevention from a life‑course perspective and precise intervention in old age.

, authors=Xiuxiu ZHOU, Xiaoxu YIN, Yanhong GONG, authorsList=Xiuxiu ZHOU, Xiaoxu YIN, Yanhong GONG, authorCompany=null, correspAuthors=Yanhong GONG, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1322924518297186876, articleId=1322924515893850680, tenantId=1146029695717560320, journalId=1220038315760373764, language=CN, title=中国中老年人衰弱发展轨迹与童年不良经历的关联：基于10年随访数据的纵向研究, columnId=1322924477901844771, journalTitle=护理研究, columnName=衰弱专题, runingTitle=null, highlight=null, articleAbstract=
目的

分析我国中老年人10年衰弱发展轨迹与童年不良经历（ACEs）的关系，为生命历程导向的老龄健康促进策略制定提供依据。

方法

利用中国健康与养老追踪调查（CHARLS）2011—2020年数据，通过组基轨迹建模识别中老年人衰弱发展轨迹，采用多项Logistic回归分析童年不良经历与衰弱发展轨迹之间的关系。

结果

共纳入10 032名中老年人，基线衰弱指数为（0.14±0.09），78.86%的受访者报告至少经历过1种童年不良经历；我国中老年人衰弱发展存在3种轨迹类别，即稳定非衰弱型（65.9%）、临界转折型（23.9%）和衰弱加重型（10.1%）。多项Logistic回归分析显示，童年不良经历与中老年人衰弱发展轨迹相关（P<0.05）；童年不良经历暴露数量越多，我国中老年人归属于更严重衰弱发展轨迹组的相对风险越高（P<0.05）。

结论

童年不良经历与我国中老年人10年衰弱发展轨迹相关。提示童年不良经历可能是中老年期衰弱长期演变的重要远端风险因素，应从生命历程视角加强早期预防与老年期精准干预。

, authors=周秀秀, 殷晓旭, 龚言红*, *, authorsList=周秀秀, 殷晓旭, 龚言红, authorCompany=null, correspAuthors=龚言红, authorNote=

周秀秀，博士研究生

, correspAuthorsNote=
龚言红，E-mail:
GONG Yanhong, E-mail:
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周秀秀，博士研究生

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周秀秀，博士研究生

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later life:a prospective population-based cohort study[J].Age and Ageing,2023,52(2):afad010., articleTitle=Adverse childhood experiences and frailty in later life:a prospective population-based cohort study, refAbstract=null), Reference(id=1322924524467008120, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322924515893850680, doi=null, pmid=null, pmcid=null, year=2020, volume=371, issue=null, pageStart=null, pageEnd=null, url=null, language=null, rfNumber=22, rfOrder=21, authorNames=Nelson C A, Scott R D, Bhutta Z A, journalName=BMJ, refType=null, unstructuredReference=Nelson C A,Scott R D,Bhutta Z A,et al.Adversity in childhood is linked to mental and physical health throughout life[J].BMJ,2020,371:m3048., articleTitle=Adversity in childhood is linked to mental and physical health throughout life, refAbstract=null), Reference(id=1322924524555088505, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322924515893850680, doi=null, pmid=null, 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al.Frailty and socioeconomic position:a systematic review of observational studies[J].Ageing Research Reviews,2024,100:102420., articleTitle=Frailty and socioeconomic position:a systematic review of observational studies, refAbstract=null)], funds=null, companyList=[AuthorCompany(id=1322924518548845117, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322924515893850680, xref=1, ext=[AuthorCompanyExt(id=1322924518557233726, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322924515893850680, companyId=1322924518548845117, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1Department of Social Medicine and Health Management, School of Public Health, Huazhong University of Science and Technology, Hubei 430012 China), AuthorCompanyExt(id=1322924518565622335, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322924515893850680, companyId=1322924518548845117, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1华中科技大学公共卫生学院社会医学与卫生事业管理系，湖北 430012)])], figs=[ArticleFig(id=1322924520276898393, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322924515893850680, language=EN, label=Figure 1, caption=Frailty development trajectories in middle-aged and older adults, figureFileSmall=Z/PiUG+NjQqktHDKEsoxcw==, figureFileBig=FkcIcRm7tJWmDRy/JDXO1A==, tableContent=null), ArticleFig(id=1322924520339812954, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322924515893850680, language=CN, label=图1, caption=中老年人的衰弱发展轨迹, figureFileSmall=Z/PiUG+NjQqktHDKEsoxcw==, figureFileBig=FkcIcRm7tJWmDRy/JDXO1A==, tableContent=null), ArticleFig(id=1322924520520168027, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322924515893850680, language=EN, label=Table 1, caption=

Fit indices for frailty trajectory classes in middle-aged and older adults

, figureFileSmall=null, figureFileBig=null, tableContent=
类别AICBICEntropyAvePP类别概率（%）
243 757.2843 728.420.6610.908/0.88662.2/37.8
351 808.6951 769.010.8400.955/0.851/0.91465.9/23.9/10.1
444 809.0244 754.910.4090.524/0.451/0.614/0.86240.4/17.5/29.2/12.8
), ArticleFig(id=1322924520625025628, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322924515893850680, language=CN, label=表1, caption=

中老年人衰弱轨迹类别拟合指标

, figureFileSmall=null, figureFileBig=null, tableContent=
类别AICBICEntropyAvePP类别概率（%）
243 757.2843 728.420.6610.908/0.88662.2/37.8
351 808.6951 769.010.8400.955/0.851/0.91465.9/23.9/10.1
444 809.0244 754.910.4090.524/0.451/0.614/0.86240.4/17.5/29.2/12.8
), ArticleFig(id=1322924520696328797, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322924515893850680, language=EN, label=Table 2, caption=

Univariate analysis of factors associated with frailty trajectory classes in middle-aged and older adults

, figureFileSmall=null, figureFileBig=null, tableContent=
项目分类稳定非衰弱型（n=6 616）临界转折型(n=2 398)衰弱加重型(n=1 018)P
FI0.10±0.050.19±0.070.29±0.11<0.001
童年不良经历[人（%）]无1 581(23.90)366(15.26)174(17.09)<0.001
1种2 061(31.15)652(27.19)241(23.67)
2种1 585(23.96)620(25.85)229(22.50)
≥3种1 389(20.99)760(31.69)374(36.74)
社会参与[人（%）]无3 206(51.12)1 358(58.74)607(61.94)<0.001
有3 066(48.88)954(41.26)373(38.06)
年龄（岁）56.87±8.1760.11± 8.6462.18±8.88<0.001
性别[人（%）]女3 155(47.69)1 521(63.43)704(69.16)<0.001
男3 461(52.31)877(36.57)314(30.84)
文化程度[人（%）]小学以下2 800(42.32)1 464(61.05)693(68.07)<0.001
小学1 463(22.11)477(19.89)166(16.31)
初中1 523(23.02)323(13.47)107(10.51)
高中及以上830(12.55)134(5.59)52(5.11)
居住地[人（%）]城市2 387(36.08)683(28.48)268(26.33)<0.001
农村4 229(63.92)1 715(71.52)750(73.67)
婚姻状况[人（%）]已婚/同居6 101(92.22)2 073(86.45)854(83.89)
离婚/分居/单身94(1.42)51(2.13)22(2.16)<0.001
丧偶421(6.36)274(11.43)142(13.95)
参加医疗保险[人（%）]否341(5.17)108(4.53)56(5.51)0.370
是6 253(94.83)2 276(95.47)961(94.49)
饮酒[人（%）]否4 113(62.21)1 782(74.34)809(79.47)<0.001
是2 499(37.79)615(25.66)209(20.53)
吸烟[人（%）]否4 329(67.38)1 791(75.76)789(78.35)<0.001
是2 096(32.62)573(24.24)218(21.65)
年度人均家庭支出（元）4 594.70(2 682.45,7 992.42)4 250.95(2 466.86,7 160.99)4 293.56(2 591.99,7 571.97)<0.001
), ArticleFig(id=1322924520784409182, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322924515893850680, language=CN, label=表2, caption=

中老年人衰弱发展轨迹类别影响因素的单因素分析

, figureFileSmall=null, figureFileBig=null, tableContent=
项目分类稳定非衰弱型（n=6 616）临界转折型(n=2 398)衰弱加重型(n=1 018)P
FI0.10±0.050.19±0.070.29±0.11<0.001
童年不良经历[人（%）]无1 581(23.90)366(15.26)174(17.09)<0.001
1种2 061(31.15)652(27.19)241(23.67)
2种1 585(23.96)620(25.85)229(22.50)
≥3种1 389(20.99)760(31.69)374(36.74)
社会参与[人（%）]无3 206(51.12)1 358(58.74)607(61.94)<0.001
有3 066(48.88)954(41.26)373(38.06)
年龄（岁）56.87±8.1760.11± 8.6462.18±8.88<0.001
性别[人（%）]女3 155(47.69)1 521(63.43)704(69.16)<0.001
男3 461(52.31)877(36.57)314(30.84)
文化程度[人（%）]小学以下2 800(42.32)1 464(61.05)693(68.07)<0.001
小学1 463(22.11)477(19.89)166(16.31)
初中1 523(23.02)323(13.47)107(10.51)
高中及以上830(12.55)134(5.59)52(5.11)
居住地[人（%）]城市2 387(36.08)683(28.48)268(26.33)<0.001
农村4 229(63.92)1 715(71.52)750(73.67)
婚姻状况[人（%）]已婚/同居6 101(92.22)2 073(86.45)854(83.89)
离婚/分居/单身94(1.42)51(2.13)22(2.16)<0.001
丧偶421(6.36)274(11.43)142(13.95)
参加医疗保险[人（%）]否341(5.17)108(4.53)56(5.51)0.370
是6 253(94.83)2 276(95.47)961(94.49)
饮酒[人（%）]否4 113(62.21)1 782(74.34)809(79.47)<0.001
是2 499(37.79)615(25.66)209(20.53)
吸烟[人（%）]否4 329(67.38)1 791(75.76)789(78.35)<0.001
是2 096(32.62)573(24.24)218(21.65)
年度人均家庭支出（元）4 594.70(2 682.45,7 992.42)4 250.95(2 466.86,7 160.99)4 293.56(2 591.99,7 571.97)<0.001
), ArticleFig(id=1322924520855712351, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322924515893850680, language=EN, label=Table 3, caption=

Association between frailty trajectory classes and adverse childhood experiences in middle-aged and older adults（n=10 032）

, figureFileSmall=null, figureFileBig=null, tableContent=
童年不良经历临界转折型衰弱加重型
RRR[95% CI]Z值PRRR[95% CI]Z值P
无1.001.00
1种1.46[1.24,1.72]4.47<0.0011.10[0.87,1.40]0.790.430
2种1.86[1.57,2.21]7.21<0.0011.43[1.13,1.82]2.920.003
≥3种2.66[2.25,3.14]11.47<0.0012.99[2.39,3.74]9.61<0.001
), ArticleFig(id=1322924522537628256, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322924515893850680, language=CN, label=表3, caption=

中老年人衰弱发展轨迹类别与童年不良经历的关联（n=10 032）

, figureFileSmall=null, figureFileBig=null, tableContent=
童年不良经历临界转折型衰弱加重型
RRR[95% CI]Z值PRRR[95% CI]Z值P
无1.001.00
1种1.46[1.24,1.72]4.47<0.0011.10[0.87,1.40]0.790.430
2种1.86[1.57,2.21]7.21<0.0011.43[1.13,1.82]2.920.003
≥3种2.66[2.25,3.14]11.47<0.0012.99[2.39,3.74]9.61<0.001
), ArticleFig(id=1322924522634097249, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322924515893850680, language=EN, label=Table 4, caption=

Effect of adverse childhood experiences on frailty trajectory classes in middle-aged and older adults

, figureFileSmall=null, figureFileBig=null, tableContent=
童年不良经历临界转折型衰弱加重型
RRR[95%CI]Z值PRRR[95%CI]Z值P
无1.001.00
1种1.25[1.07,1.45]2.870.0041.53[1.28,1.83]4.72<0.001
2种1.32[1.12,1.55]3.350.0011.94[1.61,2.33]7.02<0.001
≥3种1.84[1.55,2.18]7.07<0.0013.60[2.98,4.33]13.42<0.001
), ArticleFig(id=1322924522713789026, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322924515893850680, language=CN, label=表4, caption=

童年不良经历对中老年人10年衰弱发展轨迹类别的影响

, figureFileSmall=null, figureFileBig=null, tableContent=
童年不良经历临界转折型衰弱加重型
RRR[95%CI]Z值PRRR[95%CI]Z值P
无1.001.00
1种1.25[1.07,1.45]2.870.0041.53[1.28,1.83]4.72<0.001
2种1.32[1.12,1.55]3.350.0011.94[1.61,2.33]7.02<0.001
≥3种1.84[1.55,2.18]7.07<0.0013.60[2.98,4.33]13.42<0.001
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中国中老年人衰弱发展轨迹与童年不良经历的关联：基于10年随访数据的纵向研究
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周秀秀 , 殷晓旭 , 龚言红 *, *
护理研究 | 衰弱专题 2026,40(17): 2975-2981
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护理研究 |衰弱专题 2026 , 40 (17) : 2975 -2981
中国中老年人衰弱发展轨迹与童年不良经历的关联：基于10年随访数据的纵向研究
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周秀秀, 殷晓旭, 龚言红*, *
作者信息
  • 1华中科技大学公共卫生学院社会医学与卫生事业管理系，湖北 430012
通讯作者:
龚言红，E-mail:
GONG Yanhong, E-mail:
作者简介:

周秀秀，博士研究生

Association between on frailty development trajectories and adverse childhood experiences in Chinese middle-aged and older adults:a 10-year longitudinal study
Xiuxiu ZHOU, Xiaoxu YIN, Yanhong GONG
Affiliations
  • 1Department of Social Medicine and Health Management, School of Public Health, Huazhong University of Science and Technology, Hubei 430012 China
出版时间: 2026-09-10 doi: 10.12102/j.issn.1009-6493.2026.17.003
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摘要
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目的

分析我国中老年人10年衰弱发展轨迹与童年不良经历（ACEs）的关系，为生命历程导向的老龄健康促进策略制定提供依据。

方法

利用中国健康与养老追踪调查（CHARLS）2011—2020年数据，通过组基轨迹建模识别中老年人衰弱发展轨迹，采用多项Logistic回归分析童年不良经历与衰弱发展轨迹之间的关系。

结果

共纳入10 032名中老年人，基线衰弱指数为（0.14±0.09），78.86%的受访者报告至少经历过1种童年不良经历；我国中老年人衰弱发展存在3种轨迹类别，即稳定非衰弱型（65.9%）、临界转折型（23.9%）和衰弱加重型（10.1%）。多项Logistic回归分析显示，童年不良经历与中老年人衰弱发展轨迹相关（P<0.05）；童年不良经历暴露数量越多，我国中老年人归属于更严重衰弱发展轨迹组的相对风险越高（P<0.05）。

结论

童年不良经历与我国中老年人10年衰弱发展轨迹相关。提示童年不良经历可能是中老年期衰弱长期演变的重要远端风险因素，应从生命历程视角加强早期预防与老年期精准干预。

中老年人  /  童年不良经历  /  衰弱  /  发展轨迹  /  生命历程
Objective

To examine the association between adverse childhood experiences(ACEs) and the 10‑year frailty development trajectories in Chinese middle‑aged and older adults,so as to provide evidence for life‑course‑oriented healthy ageing promotion strategies.

Methods

Using data from the China Health and Retirement Longitudinal Study(CHARLS) spanning 2011-2020,we identified frailty development trajectories through group‑based trajectory modelling,and applied multinomial Logistic regression to analyse the relationship between ACEs and these trajectories.

Results

A total of 10 032 middle‑aged and older adults were included.The baseline frailty index was 0.14±0.09,and 78.86% of the respondents reported at least one ACE.Three frailty trajectories were identified in the Chinese sample:stable non‑frailty(65.9%),critical turning point(23.9%),and progressive frailty(10.1%).Multinomial Logistic regression showed that ACEs were significantly associated with frailty trajectories(P<0.05),and a higher number of ACEs was associated with a higher relative risk of belonging to more severe frailty trajectory groups(P<0.05).

Conclusions

ACEs are associated with the 10‑year frailty development trajectories in Chinese middle‑aged and older adults,suggesting that childhood adversity may be an important distal risk factor for the long‑term evolution of frailty in later life.This highlights the need for early prevention from a life‑course perspective and precise intervention in old age.

middle‑aged and older adults  /  adverse childhood experiences  /  frailty  /  development trajectory  /  life course
周秀秀, 殷晓旭, 龚言红. 中国中老年人衰弱发展轨迹与童年不良经历的关联：基于10年随访数据的纵向研究. 护理研究, 2026 , 40 (17) : 2975 -2981 . DOI: 10.12102/j.issn.1009-6493.2026.17.003
Xiuxiu ZHOU, Xiaoxu YIN, Yanhong GONG. Association between on frailty development trajectories and adverse childhood experiences in Chinese middle-aged and older adults:a 10-year longitudinal study[J]. Chinese Nursing Research, 2026 , 40 (17) : 2975 -2981 . DOI: 10.12102/j.issn.1009-6493.2026.17.003
正文
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随着全球老龄化程度不断加深，衰弱已成为影响中老年人健康水平和生活质量的重要公共卫生问题。衰弱是一种与衰老密切相关的动态综合征，主要表现为机体多系统生理储备下降、内稳态调节能力减弱以及对应激源易损性增加[1]。除身体功能衰退外，衰弱还常伴随心理功能、认知功能和社会功能受损，其发生发展受到生理、心理和社会等多重因素的共同作用[2-3]。研究表明，衰弱与跌倒、失能、慢性病共病、反复住院及死亡等多种不良健康结局密切相关[4]，并进一步增加医疗费用和家庭照护负担[5]。因此，识别衰弱的发生发展规律，尤其是从纵向视角揭示其动态变化，对于早期发现高风险人群、识别可干预危险因素以及制定精准预防策略具有重要意义。有研究显示，生命早期不良经历可能通过长期影响个体的生理调节系统、心理适应能力及社会功能储备，进而塑造中老年时期的健康脆弱性[6-7]。童年不良经历（adverse childhood experiences，ACEs）是指个体在18岁以前遭遇的各类负性成长经历，包括虐待、忽视、家庭功能障碍以及社区或集体暴力等[8]。作为生命早期的重要逆境暴露，童年不良经历可通过生命历程中的累积劣势过程，对个体的身心健康产生长期不利影响，并进一步增加成年后慢性病、功能受损以及衰弱等发生风险[9-10]。
然而，现有研究多聚焦于童年不良经历与某一时点衰弱状态之间的横断面关联[10]，或仅考察童年不良经历对衰弱发生风险的影响[11]，较少从纵向轨迹角度探讨童年不良经历与衰弱发展模式之间的关系，尤其在中国中老年人群中，相关证据仍较为有限。基于此，本研究从生命历程视角出发，识别我国中老年人10年衰弱发展轨迹，并进一步探讨童年不良经历与衰弱轨迹之间的关联，以期加深对衰弱早期起源及其长期演变机制的理解，并为制定贯穿全生命周期的衰弱预防与干预策略提供科学依据。
1　对象与方法
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1.1　研究对象
本研究数据来源于中国健康与养老追踪调查（CHARLS），该数据由北京大学国家发展研究院发布。CHARLS是一项针对我国45岁及以上中老年人的全国代表性综合队列研究，全国基线调查于2011年开展，覆盖150个县级单位、450个村级单位，约1万户家庭中的1.7万人[12]。本研究使用2011年基线调查，2014年生命历程调查，以及2013年、2015年、2018年、2020年的随访调查数据进行分析。本研究选取的研究对象为基线年龄≥45岁的中老年人，经剔除缺失的关键变量，最终纳入10 032名中老年人。CHARLS项目经北京大学伦理委员会审查，研究对象均签署知情同意书（伦理批号：IRB 00001052-11015）。
1.2　变量选取与界定
1.2.1　衰弱指数（Frailty Index）
参照以往研究[13]，本研究采用FI评估衰弱状态，选取44项与年龄相关的健康缺陷构建衰弱指数，涵盖以下维度：日常生活活动能力（洗澡、穿衣、进食、上下床、如厕、控制大小便），工具性日常生活活动能力（做饭、购物、做家务、打电话、服药、管理财务），身体功能限制（提5 kg重物、慢跑1 km、步行1 km、步行100 m、久坐后站起、弯腰或下蹲、从桌面拾起硬币、手臂向上伸展过肩、爬楼梯），慢性病[慢性肺部疾病、高血压、高脂血症、糖尿病、哮喘、癌症、肝脏疾病、心脏病、脑卒中、情感及精神问题、关节炎、肾脏疾病、胃部疾病、记忆相关疾病（如阿尔茨海默病、脑萎缩、帕金森病）]，心理健康状况（情绪低落、感到害怕、无法继续生活、感到快乐、对未来充满希望、睡眠不佳、做事费力）以及主观评价（自评健康、生活满意度）。
各项健康缺陷依据预设的临界值转换为0~1分值，其中0代表没有缺陷，1代表最大程度缺陷。FI计算公式=个体所呈现的健康缺陷分值之和/该个体实际参与评估的条目数[14]，取值为0~1之间。以FI≥0.25作为判定衰弱的界值，得分越高表示衰弱程度越严重[15]。
1.2.2　童年不良经历
本研究中的童年不良经历是指在18岁之前发生的各类潜在压力性事件，涵盖身体虐待、情感虐待、忽视、家庭功能障碍、躯体疾病以及家庭成员去世等多种类型。参照既往研究[16]，本研究采用12类不良经历构建童年不良经历指标，具体包括17岁前经历的身体虐待、情感忽视、父母药物滥用、父母患有精神疾病、家庭暴力、家庭成员被监禁、父母分居或离异、不安全的邻里环境、遭受霸凌、父母早亡、兄弟姐妹死亡以及父母残疾。针对每类不良经历，将受访者的回答转换为0与1的二分类变量，其中0表示在童年时期没有经历过任何童年不良经历，1表示经历过任意1种童年不良经历。随后，将12个条目的得分相加，计算每位受访者的累积童年不良经历得分，取值为0~12分。依据受访者经历的童年不良经历数量，将其分为无、1种、2种、≥3种4组。
1.2.3　衰弱影响因素
参照既往研究[17]，本研究将可能影响衰弱状态的变量作为本研究的潜在混杂变量纳入分析，包括性别、年龄、居住地、文化程度、婚姻状况、年度家庭人均支出、是否吸烟、是否饮酒、社会参与以及医疗保险参保情况等。
1.3　统计学方法
为比较不同衰弱轨迹组间的基线特征，服从正态分布的定量资料采用均数±标准差（x±s）描述，非正态分布的定量资料采用中位数、四分位数[M(P25,P75)]描述，定性资料采用频数、百分比（%）描述。定性资料比较采用χ2检验，服从正态分布的定量资料比较采用方差分析，非正态分布的定量资料采用Kruskal-Wallis H检验。
采用组基轨迹建模（group-based trajectory modeling,GBTM）识别中老年人的衰弱发展轨迹，GBTM是一种用于分析纵向数据、探索群体异质性的统计方法，其核心假设为总体中存在多个异质性亚群，旨在揭示不同亚群随时间的动态发展轨迹。模型拟合优度的评估指标包括贝叶斯信息准则（Bayesian information criterion,BIC）与赤池信息准则（Akaike's information criterion,AIC），其绝对值越小表示模型拟合效果越好；平均后验概率（average posterior probability,AvePP）需>0.7，Entropy越接近1表示模型分类的准确性越高[11]。
采用多项Logistic回归分析童年不良经历与10年衰弱发展轨迹之间的关系。统计分析均采用Stata 18.0和R4.5.0软件完成。以P<0.05表示差异有统计学意义。
2　结果
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2.1　中老年人基线特征
本研究共纳入10 032名中老年人,基线FI为(0.14±0.09)；78.86%的受访者至少经历过1种童年不良经历；女性占53.63%，文化程度为小学及以下者占49.41%，居住在农村者占66.73%，不参加任何社会参与者占54.07%。总体样本年龄（58.18±8.57）岁。
2.2　中老年人衰弱发展轨迹
基于2011—2020年的数据，我国中老年人衰弱发展轨迹模型的拟合指标信息见表1。综合AIC、BIC、AvePP、Entropy以及组别比例，最终确定3分类轨迹模型为最优拟合模型。通过GBTM，并结合衰弱的临界值，本研究识别出我国中老年人衰弱发展的3个轨迹类别，即稳定非衰弱型（65.9%）、临界转折型（23.9%）、衰弱加重型（10.1%）。我国中老年人衰弱发展轨迹类别的变化趋势见图1。
2.3　中老年人衰弱发展轨迹类别影响因素的单因素分析（见表2）
2.4　中老年人衰弱发展轨迹与童年不良经历的关联
中老年人衰弱发展轨迹与童年不良经历的关联见表3。结果显示，童年不良经历与中老年人的衰弱发展轨迹存在关联，即随着童年不良经历数量的增加，中老年人归属于更严重轨迹组的相对风险随之升高。与没有经历童年不良经历的中老年人相比，经历1种童年不良经历的中老年人归属于临界转折型轨迹组的相对风险比为1.46（RRR=1.46,P<0.001）；经历≥3种童年不良经历的中老年人归属于临界转折型轨迹组的相对风险比为2.66（RRR=2.66,P<0.001），其归属于衰弱加重型轨迹组的相对风险比为2.99（RRR=2.99,P<0.001）。
各类型的童年不良经历与不同衰弱发展轨迹的多分类Logistic回归结果显示，不同类型童年不良经历与中老年期衰弱发展轨迹存在差异性关联。在“临界转折型”轨迹中，关联强度较大的3种不良经历分别为父母离婚/分居/单身[RRR=2.09，95%CI（1.19，3.66），P=0.01]、家人患有精神疾病[RRR=1.85，95%CI（1.59，2.16），P<0.001]以及不安全的社区环境[RRR=1.77，95%CI（1.48，2.13），P<0.001]。在“衰弱加重型”轨迹中，关联强度较大的3种不良经历分别为家人患有精神疾病[RRR=2.72，95%CI（2.24，3.29），P<0.001]、父母残疾[RRR=2.45，95%CI（2.06，2.91），P<0.001]、家庭暴力[RRR=2.31，95%CI（1.79，2.96），P<0.001]。与未经历相应童年不良经历者相比，童年时期经历家人患有精神疾病者、父母残疾者、家庭暴力者分别进入“衰弱加重型”轨迹的相对风险增加约172%、145%和131%。
2.5　亚组分析
童年不良经历累积数量与不良衰弱发展轨迹的亚组分析结果显示，在不同性别、居住地和社会参与状态人群中，童年不良经历数量增加均与不良衰弱轨迹风险升高相关。
按性别分层后，男性和女性中均观察到童年不良经历累积数量与临界转折型轨迹风险升高相关。对于衰弱加重型，男性仅在经历3种及以上童年不良经历时风险显著升高[RRR=2.97，95%CI（1.98，4.44），P<0.001]；女性在经历2种、3种及以上童年不良经历时风险显著升高，相对风险比分别为[RRR=1.50，95%CI（1.12，2.00），P=0.006]和[RRR=3.06，95%CI（2.32，4.02），P<0.001]。性别与童年不良经历累积数量的交互作用无统计学意义（P交互=0.54）。
按居住地分层后，无论城市还是农村居民，童年不良经历累积数量越多，进入临界转折型和衰弱加重型的风险总体越高。农村居民经历3种及以上童年不良经历者进入临界转折型和衰弱加重型轨迹组的相对风险比分别为2.80[95%CI（2.30，3.41），P<0.001]和3.16[95%CI（2.43，4.11），P<0.001]，高于城市居民。居住地与童年不良经历累积数量之间未见显著交互作用（P交互=0.82）。
按社会参与状态分层后，无社会参与者经历3种及以上童年不良经历时，进入“临界转折型”和“衰弱加重型”的相对风险比分别为2.71[95%CI（2.18，3.37），P<0.001]和2.70[95%CI（2.04，3.58），P<0.001]；有社会参与者经历3种及以上童年不良经历时，进入临界转折型和衰弱加重型的相对风险比分别为2.62[95%CI（2.01，3.40），P<0.001]和3.62[95%CI（2.49，5.27），P<0.001]。社会参与和童年不良经历累积数量之间的交互作用无统计学意义（P交互=0.44）。
总体来看，童年不良经历累积数量与中老年期不良衰弱发展轨迹的关联在不同性别、城乡居住地及社会参与状态人群中基本一致，未发现明显调节作用。
2.6　敏感性分析
为检验研究结果的稳健性，本研究进一步剔除基线时已处于衰弱状态的受访者，以更准确评估童年不良经历与衰弱发展轨迹之间的关系。敏感性分析结果显示，童年不良经历与中老年人衰弱发展轨迹之间仍呈现剂量反应关系，即随着童年不良经历数量的增加，中老年人归属于更严重的衰弱轨迹组的相对风险随之升高。敏感性分析结果见表4。
3　讨论
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3.1　中老年人童年不良经历是不良衰弱发展轨迹的重要早期风险因素
本研究基于2011—2020年CHARLS调查数据，从生命历程视角探讨童年不良经历与中老年人10年衰弱发展轨迹之间的关系。研究结果显示，童年不良经历与中老年人衰弱发展轨迹之间存在关联，且呈现剂量-反应关系：随着童年不良经历暴露数量增加，中老年个体归属到更不利的衰弱发展轨迹组的相对风险持续升高。相较于未经历童年不良经历的中老年人，经历3种及以上童年不良经历的中老年人更可能归属于“临界转折型”与“衰弱加重型”。提示童年不良经历暴露可能是中老年期不良衰弱发展轨迹类别的重要早期风险因素，并且其不良作用具有累积性和长期性。
3.2　童年不良经历与不同衰弱发展轨迹的关联
本研究发现，中老年人童年不良经历与衰弱发展轨迹之间存在关联。随着童年不良经历暴露从无、1种逐渐增加至3种及以上，中老年个体归属到临界转折型和衰弱加重型轨迹组的相对风险依次上升，提示童年不良经历并非仅与老年期某一时点的衰弱状态有关，更可能深刻影响衰弱在后续生命历程中的演变方向。既往研究多聚焦于童年不良经历与中老年人某一时点衰弱状态之间的关联[14]，主要采用横断面设计评估童年不良经历与衰弱患病风险或衰弱水平的关系，而对衰弱长期动态发展轨迹的关注相对不足。也有研究虽关注衰弱随时间的变化趋势，但多将中老年人整体归纳为单一衰弱发展轨迹，未能充分揭示老年个体衰弱演变过程中的异质性[18]。本研究在此基础上进一步表明，衰弱并不是静态、均质的健康结局，而是一个具有显著异质性的动态发展过程。童年不良经历所造成的健康损害，可能在中老年阶段表现为进入更不利的衰弱发展轨迹，并在长期随访中逐渐累积和显现。这一发现与生命历程理论和累积劣势理论相一致。生命早期是个体生理、心理和社会功能发育的关键阶段，若在童年时期遭遇虐待、忽视、家庭功能失调或严重物资匮乏等不良经历，可能对机体的长期健康储备产生深远影响[19]。累积劣势理论认为，早期逆境会使个体在后续生命历程中持续暴露于更多不利社会环境和健康风险之中，进而形成健康损耗的连续累积[20]。本研究观察到的关联支持了这一理论框架，即童年不良经历越多，后期进入不良衰弱发展轨迹的风险越高。这说明童年不良经历不仅是早年生活事件的简单记录，更可能是中老年健康脆弱化过程的重要远端暴露指标。
3.3　童年不良经历与衰弱轨迹关联的潜在机制
从潜在机制来看，中老年人童年经历与不良衰弱发展轨迹之间的关联可能通过生物、心理和社会多重路径共同实现。首先，在生物学层面，童年长期处于应激环境中可能导致下丘脑-垂体-肾上腺轴功能异常、慢性炎症水平升高、免疫调节受损以及细胞衰老加速，从而降低个体在老年期维持生理稳态的能力，增加衰弱发生和进展的可能[21]。其次，在心理与行为层面，经历童年不良经历的个体更容易在成年后出现抑郁、焦虑、睡眠问题及较差的应对方式，这些因素均可促进衰弱累积[22]。再者，在社会层面，童年不良经历可能通过影响教育获得、就业机会和收入水平，造成个体在生命历程中持续处于社会经济不利地位[23]；同时，这类早期逆境还可能削弱个体后续社会关系和支持资源的积累，而社会经济资源匮乏及社会支持不足均被认为是老年衰弱发生与进展的重要社会决定因素[24]。因此，童年不良经历对衰弱发展轨迹的作用很可能并非单一路径，而是多维机制长期叠加的结果。
本研究发现，童年不良经历与“临界转折型”与“衰弱加重型”均有关联，但在“衰弱加重型”轨迹组中，经历3种及以上童年不良经历者的相对风险更高。这提示童年不良经历可能不仅与个体较早进入衰弱状态有关，还可能与其后续健康恶化速度更快、衰退程度更重有关。此外，父母离婚、不安全的社区环境与临界转折型轨迹关联较强，提示家庭结构变化和社区安全感不足可能更多影响个体由相对健康状态向衰弱临界状态转变的过程。相比之下，家人患有精神疾病、父母残疾和家庭暴力与衰弱加重型轨迹关系更为密切，说明严重家庭功能受损和持续性家庭压力可能与衰弱程度加重相关。此类经历不仅可能削弱儿童时期的情感支持和照护资源，还可能增加长期心理应激、降低健康行为水平，并进一步影响成年后慢性病发生和功能维持能力[6,23]。尤其是家人患有精神疾病在两类不良衰弱轨迹中均表现出较强关联，提示家庭精神健康问题可能是识别中老年期衰弱进展高风险人群的重要早期线索。
4　小结
收起
本研究结果对于制定生命历程导向的老龄健康促进策略具有重要启示。衰弱预防的关口应适当前移，不应仅局限于老年期，而应从儿童早期不良经历的预防与干预做起。本研究发现，父母离婚、家人患有精神疾病和不安全的社区环境与临界转折型轨迹的关联较强，提示家庭结构不稳定、家庭精神健康问题和社区安全环境不足，可能是个体由相对健康状态转向衰弱风险状态的重要早期影响因素。因此，减少儿童虐待、忽视、家庭暴力、家庭功能失调和不安全环境暴露，不仅有助于改善儿童当下健康，也可能在长期生命历程中降低中老年期衰弱进展风险。其次，本研究发现，家人患有精神疾病、父母残疾和家庭暴力与衰弱加重型轨迹的关联最为突出，提示严重家庭逆境和持续性家庭压力可能与衰弱程度加重密切相关。因此，在中老年健康评估中，尤其应关注童年期曾经历家庭成员精神疾病、父母残疾、家庭暴力等严重家庭功能受损经历的个体。
本研究仍存在以下局限。首先，童年不良经历主要依赖受访者回顾性自我报告，可能存在记忆偏倚和报告偏倚，尤其在高龄人群中，早年经历可能被低估。其次，尽管本研究已在统计模型中控制了多项混杂因素，但由于观察性研究设计的局限，仍不能完全排除残余混杂，因此不能推断出因果关系。最后，衰弱发展轨迹的识别受模型设定和分类方法影响，尽管结果具有较好的解释性，但仍需在其他中国队列和不同文化背景人群中进一步验证。

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doi: 10.12102/j.issn.1009-6493.2026.17.003
  • 接收时间：2026-05-17
  • 首发时间：2026-10-30
  • 出版时间：2026-09-10
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  • 收稿日期：2026-05-17
  • 修回日期：2026-07-15
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    1华中科技大学公共卫生学院社会医学与卫生事业管理系，湖北 430012

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龚言红，E-mail:
GONG Yanhong, E-mail:
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