Article(id=1322609049200349506, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1322609030938346427, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202503130, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1741190400000, receivedDateStr=2025-03-06, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1793264170217, onlineDateStr=2026-10-29, pubDate=1764000000000, pubDateStr=2025-11-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793264170217, onlineIssueDateStr=2026-10-29, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793264170217, creator=13701087609, updateTime=1793264170217, updator=13701087609, issue=Issue{id=1322609030938346427, tenantId=1146029695717560320, journalId=1227665162245664772, year='2025', volume='52', issue='22', pageStart='4033', pageEnd='4224', issueExtLink='null', onlineDate='null', pubDate='1764000000000', pubDateStr='2025-11-25', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1793264165863, creator='13701087609', updateTime=1793264299902, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1322609593264489401, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1322609030938346427, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1322609593264489402, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1322609030938346427, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=4097, endPage=4104, ext={EN=ArticleExt(id=1322609049401676099, articleId=1322609049200349506, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Research on the transition of the quality of life status of the elderly in communities and its influencing factors based on the multi-stage Markov Models, columnId=1228016572892119056, journalTitle=Modern Preventive Medicine, columnName=Primary Health Services, runingTitle=null, highlight=null, articleAbstract=
Objective

Toanalyze the dynamic evolution laws of the quality of life status of the elderly in communities and its influencing factors, so as to provide a reference basis for improving the quality of life of the elderly.

Methods

Using the data of the Ma’anshan Healthy Aging Cohort, 2 495 community residents aged ≥ 60 years old in Ma’anshan City were selected. Taking the clustering status of the scores of the World Health Organization Quality of Life-BREF(WHOQOL-BREF)as the main outcome indicator, a multi-state Markov(MSM)model was used to analyze the conversion patterns of the three quality of life statuses, namely low, medium, and high.

Results

For individuals with moderate quality of life, the estimated probabilities of deteriorating to low quality of life, remaining at moderate quality of life, and improving to high quality of life were 0.220, 0.648, and 0.132 respectively in the 1-year observation, and evolved to 0.405, 0.448, and 0.148 respectively within the 5-year observation. The results of the multivariable MSM model analysis revealed the key factors influencing the dynamic transition of the quality of life of the elderly. Age is a negative predictor of the improvement of quality of life. Compared with the 60-69-year-old group, the probability of transition from low quality of life to moderate quality of life in the 70-79-year-old group(HR=0.638, 95% CI:0.484-0.841)and the group aged 80 and above(HR=0.404, 95% CI:0.255-0.641)decreased successively. Conversely, a higher level of education was a significant promoting factor. Compared with the illiterate group, those with primary school/junior high school education(HR=1.467, 95% CI: 1.089-1.975)and those with senior high school/junior college or above education(HR=1.909, 95% CI:1.282-2.844)were more likely to achieve an improvement in quality of life. In addition, having multiple chronic diseases(≥3 types)had a dual negative impact on the quality of life. It reduced the possibility of improving the quality of life(for example, from moderate to high quality of life, HR=0.638, 95% CI:0.417-0.877)and also increased the risk of deteriorating the quality of life(for example, from high to moderate quality of life, HR=1.512, 95% CI:1.156-2.625). Factors such as marital status, smoking, living alone, and physical exercise also had a significant impact on the transition of the quality of life status.

Conclusion

This study uses a multi-state model to reveal the dynamic evolution law of the quality of life of the elderly. The high-quality-of-life state is unstable, but the low-quality-of-life state is reversible. Prospective intervention strategies should be formulated for high-risk groups to delay the decline process of their quality of life.

, authors=Yuan XU1, Yu-ting LIANG2, Qin WANG2, Fen HUANG1, Jie LI2, Qi-rong QIN1, 3, 4, authorsList=Yuan XU, Yu-ting LIANG, Qin WANG, Fen HUANG, Jie LI, Qi-rong QIN, authorCompany=null, correspAuthors=Qi-rong QIN, 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=1322609050412503371, articleId=1322609049200349506, tenantId=1146029695717560320, journalId=1227665162245664772, language=CN, title=基于多态Markov模型的社区老年人生活质量状态转变及其影响因素研究, columnId=1228016573533847611, journalTitle=现代预防医学, columnName=基层卫生服务, runingTitle=null, highlight=null, articleAbstract=
目的

分析社区老年人生活质量状态的动态演变规律及其影响因素,为改善老年人生活质量提供参考依据。

方法

利用马鞍山健康老龄化队列数据,选取马鞍山市≥60岁2 495名社区居民。以世界卫生组织生活质量测定简表(WHOQOL-BREF)评分聚类状态为主要结局指标,采用多状态马尔可夫(MSM)模型分析低、中、高3种生活质量状态的转换规律。

结果

对于中等生活质量的个体,观察到恶化为低生活质量、保持为中等生活质量和改善到高生活质量的估计概率在1年观察中分别为0.220、0.648和 0.132,并在5年观察内分别演变为 0.405、0.448和0.148。多变量MSM模型分析结果揭示了影响老年人生活质量动态转变的关键因素。其中年龄是生活质量改善的负向预测因子,与60~69岁组相比,70~79岁(HR=0.638, 95% CI “0.484~0.841”)和80岁及以上组(HR=0.404, 95% CI “0.255~0.641”)从低生活质量向中等生活质量转变的可能性依次降低。相反,较高的文化程度是显著的促进因素,与文盲组相比,小学/初中(HR=1.467, 95% CI “1.089~1.975”)及高中/大专以上学历者(HR=1.909, 95% CI “1.282~2.844”)更有可能实现生活质量的改善。此外,患有多种慢性病(≥3种)对生活质量具有双重负面影响,它既降低了生活质量改善的可能性(如从中等到高生活质量,HR=0.638,95% CI “0.417~0.877”),也增加了生活质量恶化的风险(如从高到中生活质量,HR=1.512,95% CI “1.156~2.625”)。婚姻状况、吸烟、独居和体育锻炼等因素亦对生活质量状态转变有显著影响。

结论

本研究采用多状态模型揭示了老年生活质量的动态演变规律。高生活质量状态不稳定,但低生活质量可逆转。应针对高危人群制定前瞻性干预策略,以延缓其生活质量的衰退进程。

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许愿(2001—),男,硕士在读,研究方向:老年人健康管理

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秦其荣,E-mail:
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3.马鞍山市疾病预防控制中心,慢性非传染病疾病防控科
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A correlation study between physical activity and disability in Chinese elderly [J]. Chinese Journal of Prevention and Control of Chronic Diseases, 2024, 32 (5): 332-336, 342.(In Chinese), articleTitle=A correlation study between physical activity and disability in Chinese elderly, refAbstract=null)], funds=[Fund(id=1322609057924501904, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322609049200349506, awardId=KJ2021A0231, language=CN, fundingSource=中国安徽省自然科学基金重点项目(KJ2021A0231), fundOrder=null, country=null), Fund(id=1322609057983222161, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322609049200349506, awardId=2024GWXTYRZ001, language=CN, fundingSource=安徽医科大学公共卫生学院高峰学科项目(2024GWXTYRZ001), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1322609050630607180, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322609049200349506, xref=1., ext=[AuthorCompanyExt(id=1322609050638995789, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322609049200349506, companyId=1322609050630607180, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei,Anhui 230032, China), AuthorCompanyExt(id=1322609050651578702, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322609049200349506, companyId=1322609050630607180, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1.安徽医科大学公共卫生学院流行病学与卫生统计学系,安徽 合肥 230032)]), AuthorCompany(id=1322609050706104655, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322609049200349506, xref=2., ext=[AuthorCompanyExt(id=1322609050714493264, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322609049200349506, companyId=1322609050706104655, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2.安徽医科大学公共卫生学院健康促进与行为科学系)]), AuthorCompany(id=1322609050815156561, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322609049200349506, xref=3., ext=[AuthorCompanyExt(id=1322609050819350866, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322609049200349506, companyId=1322609050815156561, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=3.马鞍山市疾病预防控制中心,慢性非传染病疾病防控科)]), AuthorCompany(id=1322609050899042644, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322609049200349506, xref=4., ext=[AuthorCompanyExt(id=1322609050903236949, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322609049200349506, companyId=1322609050899042644, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=4.安徽医科大学附属马鞍山疾病预防控制中心,慢性非传染病疾病防控科)])], figs=[ArticleFig(id=1322609055110123905, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322609049200349506, language=EN, label=Fig.1, caption=The distribution status of the baseline quality of life of the elderly in communities, figureFileSmall=BnQ5yrSJxO4aiW1KpgDzaA==, figureFileBig=JJSRq38oSBdLbFVjBpa3zQ==, tableContent=null), ArticleFig(id=1322609055206592898, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322609049200349506, language=CN, label=图1, caption=社区老年人基线生活质量状态分布状况, figureFileSmall=BnQ5yrSJxO4aiW1KpgDzaA==, figureFileBig=JJSRq38oSBdLbFVjBpa3zQ==, tableContent=null), ArticleFig(id=1322609055391142275, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322609049200349506, language=EN, label=Fig.2, caption=Probability graphs of predicted conversion of the quality of life status of the elderly in communities with in the intervals of 1 year, 3 years, 5 years and 10 years, figureFileSmall=+D0S45OsFEkSfhE4yiX/Iw==, figureFileBig=XZpBlY/q8ZzsQoNdfUOV+A==, tableContent=null), ArticleFig(id=1322609055470834052, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322609049200349506, language=CN, label=图2, caption=社区老年人1 年、 3 年、 5 年和 10 年区间的生活质量状态预测转换概率图, figureFileSmall=+D0S45OsFEkSfhE4yiX/Iw==, figureFileBig=XZpBlY/q8ZzsQoNdfUOV+A==, tableContent=null), ArticleFig(id=1322609055567303045, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322609049200349506, language=EN, label=Table 1, caption=

Comparison of baseline characteristics of the elderly with different quality of life statuses

, figureFileSmall=null, figureFileBig=null, tableContent=
变量[(n, %)]总人群生活质量状态(n=2 495)P
低生活质量
(n=695)
中等生活质量
(n=1 122)
高生活质量
(n=678)
年龄0.033
60~691 306(52.3)330(47.5)598(53.3)378(55.8)
70~791 027(41.2)313(45.0)456(40.6)258(38.1)
≥80162(6.5)52(7.5)68(6.1)42(6.2)
性别0.016
男性1 094(43.8)294(42.3)471(42.0)329(48.5)
女性1 401(56.2)401(57.7)651(58.0)349(51.5)
BMI0.307
正常体重1 192(47.8)317(45.6)551(49.1)324(47.8)
体重过轻84(3.4)20(2.9)44(3.9)20(2.9)
肥胖/超重1 219(48.9)358(51.5)527(47.0)334(49.3)
婚姻状况0.003
已婚2 090(83.8)563(81.0)933(83.2)594(87.6)
其它405(16.2)132(19.0)189(16.8)84(12.4)
受教育程度<0.001
文盲713(28.6)231(33.2)321(28.6)161(23.7)
小学/初中1 261(50.5)348(50.1)560(49.9)353(52.1)
高中、大专及以上521(20.9)116(16.7)241(21.5)521(20.9)
是否吸烟0.423
是516(20.7)140(20.1)224(20.0)152(22.4)
否1 979(79.3)555(79.9)898(80.0)526(77.6)
是否饮酒<0.001
是586(23.5)130(18.7)266(23.7)190(28.0)
否1 909(76.5)565(81.3)856(76.3)488(72.0)
是否独居<0.001
是239(9.6)90(12.9)103(9.2)46(6.8)
否2 256(90.4)605(87.1)1 019(90.8)632(93.2)
是否认知障碍<0.001
是172(6.9)82(11.8)62(5.5)28(4.1)
否2 323(93.1)613(88.2)1 060(94.5)650(95.9)
参加体育锻炼<0.001
不参加508(20.4)201(28.9)223(19.9)84(12.4)
偶尔参加451(18.1)167(24.0)209(18.6)75(11.1)
经常参加1 536(61.6)327(47.1)690(61.5)519(76.5)
日常生活能力<0.001
无损伤2 117(84.8)515(74.1)996(88.8)606(89.4)
轻度损伤206(8.3)74(10.6)76(6.8)56(8.3)
重度损伤172(6.9)106(15.3)50(4.5)16(2.4)
慢性病数量<0.001
0653(26.2)149(21.4)299(26.6)205(30.2)
1~21 336(53.5)343(49.4)609(54.3)384(56.6)
≥3506(20.3)203(29.2)214(19.1)89(13.1)
), ArticleFig(id=1322609055646994822, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322609049200349506, language=CN, label=表1, caption=

不同生活质量状态老年人基线特征比较

, figureFileSmall=null, figureFileBig=null, tableContent=
变量[(n, %)]总人群生活质量状态(n=2 495)P
低生活质量
(n=695)
中等生活质量
(n=1 122)
高生活质量
(n=678)
年龄0.033
60~691 306(52.3)330(47.5)598(53.3)378(55.8)
70~791 027(41.2)313(45.0)456(40.6)258(38.1)
≥80162(6.5)52(7.5)68(6.1)42(6.2)
性别0.016
男性1 094(43.8)294(42.3)471(42.0)329(48.5)
女性1 401(56.2)401(57.7)651(58.0)349(51.5)
BMI0.307
正常体重1 192(47.8)317(45.6)551(49.1)324(47.8)
体重过轻84(3.4)20(2.9)44(3.9)20(2.9)
肥胖/超重1 219(48.9)358(51.5)527(47.0)334(49.3)
婚姻状况0.003
已婚2 090(83.8)563(81.0)933(83.2)594(87.6)
其它405(16.2)132(19.0)189(16.8)84(12.4)
受教育程度<0.001
文盲713(28.6)231(33.2)321(28.6)161(23.7)
小学/初中1 261(50.5)348(50.1)560(49.9)353(52.1)
高中、大专及以上521(20.9)116(16.7)241(21.5)521(20.9)
是否吸烟0.423
是516(20.7)140(20.1)224(20.0)152(22.4)
否1 979(79.3)555(79.9)898(80.0)526(77.6)
是否饮酒<0.001
是586(23.5)130(18.7)266(23.7)190(28.0)
否1 909(76.5)565(81.3)856(76.3)488(72.0)
是否独居<0.001
是239(9.6)90(12.9)103(9.2)46(6.8)
否2 256(90.4)605(87.1)1 019(90.8)632(93.2)
是否认知障碍<0.001
是172(6.9)82(11.8)62(5.5)28(4.1)
否2 323(93.1)613(88.2)1 060(94.5)650(95.9)
参加体育锻炼<0.001
不参加508(20.4)201(28.9)223(19.9)84(12.4)
偶尔参加451(18.1)167(24.0)209(18.6)75(11.1)
经常参加1 536(61.6)327(47.1)690(61.5)519(76.5)
日常生活能力<0.001
无损伤2 117(84.8)515(74.1)996(88.8)606(89.4)
轻度损伤206(8.3)74(10.6)76(6.8)56(8.3)
重度损伤172(6.9)106(15.3)50(4.5)16(2.4)
慢性病数量<0.001
0653(26.2)149(21.4)299(26.6)205(30.2)
1~21 336(53.5)343(49.4)609(54.3)384(56.6)
≥3506(20.3)203(29.2)214(19.1)89(13.1)
), ArticleFig(id=1322609055718297991, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322609049200349506, language=EN, label=Table 2, caption=

The distribution of the elderly with different quality of life statuses from 2016 to 2021

, figureFileSmall=null, figureFileBig=null, tableContent=
低生活质量
[(n,%)]
中等生活质量
[(n,%)]
高生活质量
[(n,%)]
2016年695(27.8)1 083(43.4)717(28.7)
2018年757(30.3)1 052(42.1)686(27.4)
2021年1 102(44.2)1 229(49.3)164(6.6)
), ArticleFig(id=1322609055789601160, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322609049200349506, language=CN, label=表2, caption=

2016—2021年老年人不同生活质量状态的分布

, figureFileSmall=null, figureFileBig=null, tableContent=
低生活质量
[(n,%)]
中等生活质量
[(n,%)]
高生活质量
[(n,%)]
2016年695(27.8)1 083(43.4)717(28.7)
2018年757(30.3)1 052(42.1)686(27.4)
2021年1 102(44.2)1 229(49.3)164(6.6)
), ArticleFig(id=1322609055860904329, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322609049200349506, language=EN, label=Table 3, caption=

The observed changes in the quality of life status of the elderly from 2016 to 2021

, figureFileSmall=null, figureFileBig=null, tableContent=
状态转变后[(n,%)]
低生活质量中等生活质量高生活质量
状态转变前[(n,%)]
低生活质量837(57.6)486(33.5)129(8.9)
中等生活质量756(35.4)1 047(49.0)332(15.6)
高生活质量266(19.0)748(53.3)389(27.7)
), ArticleFig(id=1322609055944790410, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322609049200349506, language=CN, label=表3, caption=

2016—2021年观察到老年人生活质量状态转变情况

, figureFileSmall=null, figureFileBig=null, tableContent=
状态转变后[(n,%)]
低生活质量中等生活质量高生活质量
状态转变前[(n,%)]
低生活质量837(57.6)486(33.5)129(8.9)
中等生活质量756(35.4)1 047(49.0)332(15.6)
高生活质量266(19.0)748(53.3)389(27.7)
), ArticleFig(id=1322609056028676491, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322609049200349506, language=EN, label=Table 4, caption=

The conversion intensity of different quality of life statuses of the elderly in communities of Ma’anshan City from 2016 to 2021

, figureFileSmall=null, figureFileBig=null, tableContent=
过渡模式转变强度(95% CI)
改善过渡
低生活质量至中等生活质量0.805(0.726~0.894)
中等生活质量至高生活质量0.599(0.518~0.694)
恶化过渡
高生活质量至中等生活质量1.830(1.638~2.044)
中等生活质量至低生活质量0.776(0.710~0.848)
), ArticleFig(id=1322609056083202444, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322609049200349506, language=CN, label=表4, caption=

马鞍山市2016—2021年社区老年人不同生活质量状态的转换强度

, figureFileSmall=null, figureFileBig=null, tableContent=
过渡模式转变强度(95% CI)
改善过渡
低生活质量至中等生活质量0.805(0.726~0.894)
中等生活质量至高生活质量0.599(0.518~0.694)
恶化过渡
高生活质量至中等生活质量1.830(1.638~2.044)
中等生活质量至低生活质量0.776(0.710~0.848)
), ArticleFig(id=1322609056146117005, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322609049200349506, language=EN, label=Table 5, caption=

Analysis of multivariate MSM model on the transition of elderly people’s quality of life in communities

, figureFileSmall=null, figureFileBig=null, tableContent=
变量风险比HR(95% CI)
改善过渡恶化过渡
低生活质量→中等生活质量中等生活质量→高生活质量高生活质量→中等生活质量中等生活质量→低生活质量
年龄(岁)
60~69参照参照
70~790.638(0.484~0.841)0.917(0.657~1.280)1.113(0.845~1.466)0.791(0.618~1.014)
≥800.404(0.255~0.641)1.028(0.444~2.378)1.645(0.859~3.150)0.762(0.543~1.070)
性别
女性参照参照
男性0.988(0.731~1.336)0.894(0.591~1.352)1.070(0.758~1.510)0.933(0.717~1.215)
BMI
正常体重参照参照
体重过轻1.183(0.592~2.366)0.862(0.383~1.941)0.721(0.376~1.382)1.482(0.839~2.619)
肥胖/超重0.942(0.729~1.216)1.132(0.821~1.563)0.941(0.725~1.223)1.083(0.871~1.348)
婚姻状况
已婚参照参照
其它0.461(0.233~0.910)0.485(0.199~1.182)0.493(0.267~0.911)0.646(0.355~1.174)
受教育程度
文盲参照参照
小学/初中1.467(1.089~1.975)1.017(0.678~1.525)1.243(0.894~1.728)0.812(0.630~1.046)
高中/大专及以上1.909(1.282~2.844)0.864(0.552~1.350)0.981(0.688~1.398)0.777(0.548~1.100)
是否吸烟
否参照参照
是1.210(0.741~1.976)0.837(0.513~0.965)1.020(0.687~1.514)1.083(0.871~1.348)
是否饮酒
否参照参照
是1.207(0.758~1.923)1.159(0.741~1.813)0.732(0.507~1.056)1.181(0.802~1.738)
是否独居
否参照参照
是0.803(0.568~1.134)0.546(0.324~0.921)0.868(0.586~1.284)0.818(0.604~1.107)
是否认知障碍
否参照参照
是0.699(0.468~1.046)1.158(0.561~2.391)1.000(0.535~1.870)1.192(0.827~1.718)
参加体育锻炼
不参加参照参照
偶尔参加1.005(0.753~1.342)1.007(0.638~1.587)1.365(0.965~1.931)0.922(0.717~1.185)
经常参加2.446(1.701~3.517)2.096(1.383~3.175)0.845(0.607~1.178)1.468(1.051~2.050)
日常生活能力
无损伤参照参照
轻度损伤1.112(0.733~1.686)0.731(0.399~1.338)0.866(0.553~1.356)1.374(0.936~2.018)
重度损伤0.783(0.508~1.207)7.334(0.108~10.426)9.988(0.020~14.431)1.467(0.935~2.303)
慢性病数量
0参照参照
1~21.062(0.793~1.422)0.816(0.561~1.186)0.966(0.716~1.304)0.975(0.764~1.243)
≥30.879(0.625~0.985)0.638(0.417~0.877)1.512(1.156~2.625)1.282(1.005~1.661)
), ArticleFig(id=1322609057811255695, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322609049200349506, language=CN, label=表5, caption=

社区老年人生活质量状态转变的多变量 MSM 模型分析

, figureFileSmall=null, figureFileBig=null, tableContent=
变量风险比HR(95% CI)
改善过渡恶化过渡
低生活质量→中等生活质量中等生活质量→高生活质量高生活质量→中等生活质量中等生活质量→低生活质量
年龄(岁)
60~69参照参照
70~790.638(0.484~0.841)0.917(0.657~1.280)1.113(0.845~1.466)0.791(0.618~1.014)
≥800.404(0.255~0.641)1.028(0.444~2.378)1.645(0.859~3.150)0.762(0.543~1.070)
性别
女性参照参照
男性0.988(0.731~1.336)0.894(0.591~1.352)1.070(0.758~1.510)0.933(0.717~1.215)
BMI
正常体重参照参照
体重过轻1.183(0.592~2.366)0.862(0.383~1.941)0.721(0.376~1.382)1.482(0.839~2.619)
肥胖/超重0.942(0.729~1.216)1.132(0.821~1.563)0.941(0.725~1.223)1.083(0.871~1.348)
婚姻状况
已婚参照参照
其它0.461(0.233~0.910)0.485(0.199~1.182)0.493(0.267~0.911)0.646(0.355~1.174)
受教育程度
文盲参照参照
小学/初中1.467(1.089~1.975)1.017(0.678~1.525)1.243(0.894~1.728)0.812(0.630~1.046)
高中/大专及以上1.909(1.282~2.844)0.864(0.552~1.350)0.981(0.688~1.398)0.777(0.548~1.100)
是否吸烟
否参照参照
是1.210(0.741~1.976)0.837(0.513~0.965)1.020(0.687~1.514)1.083(0.871~1.348)
是否饮酒
否参照参照
是1.207(0.758~1.923)1.159(0.741~1.813)0.732(0.507~1.056)1.181(0.802~1.738)
是否独居
否参照参照
是0.803(0.568~1.134)0.546(0.324~0.921)0.868(0.586~1.284)0.818(0.604~1.107)
是否认知障碍
否参照参照
是0.699(0.468~1.046)1.158(0.561~2.391)1.000(0.535~1.870)1.192(0.827~1.718)
参加体育锻炼
不参加参照参照
偶尔参加1.005(0.753~1.342)1.007(0.638~1.587)1.365(0.965~1.931)0.922(0.717~1.185)
经常参加2.446(1.701~3.517)2.096(1.383~3.175)0.845(0.607~1.178)1.468(1.051~2.050)
日常生活能力
无损伤参照参照
轻度损伤1.112(0.733~1.686)0.731(0.399~1.338)0.866(0.553~1.356)1.374(0.936~2.018)
重度损伤0.783(0.508~1.207)7.334(0.108~10.426)9.988(0.020~14.431)1.467(0.935~2.303)
慢性病数量
0参照参照
1~21.062(0.793~1.422)0.816(0.561~1.186)0.966(0.716~1.304)0.975(0.764~1.243)
≥30.879(0.625~0.985)0.638(0.417~0.877)1.512(1.156~2.625)1.282(1.005~1.661)
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基于多态Markov模型的社区老年人生活质量状态转变及其影响因素研究
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许愿 1 , 梁雨婷 2 , 王勤 2 , 黄芬 1 , 李杰 2 , 秦其荣 1, 3, 4
现代预防医学 | 基层卫生服务 2025,52(22): 4097-4104
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现代预防医学 |基层卫生服务 2025 , 52 (22) : 4097 -4104
基于多态Markov模型的社区老年人生活质量状态转变及其影响因素研究
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3.马鞍山市疾病预防控制中心,慢性非传染病疾病防控科
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许愿1, 梁雨婷2, 王勤2, 黄芬1, 李杰2, 秦其荣1, 3, 4
作者信息
  • 1.安徽医科大学公共卫生学院流行病学与卫生统计学系,安徽 合肥 230032
  • 2.安徽医科大学公共卫生学院健康促进与行为科学系
  • 3.马鞍山市疾病预防控制中心,慢性非传染病疾病防控科
  • 4.安徽医科大学附属马鞍山疾病预防控制中心,慢性非传染病疾病防控科
通讯作者:
秦其荣,E-mail:
作者简介:

许愿(2001—),男,硕士在读,研究方向:老年人健康管理

Research on the transition of the quality of life status of the elderly in communities and its influencing factors based on the multi-stage Markov Models
Yuan XU1, Yu-ting LIANG2, Qin WANG2, Fen HUANG1, Jie LI2, Qi-rong QIN1, 3, 4
Affiliations
  • Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei,Anhui 230032, China
出版时间: 2025-11-25 doi: 10.20043/j.cnki.MPM.202503130
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目的

分析社区老年人生活质量状态的动态演变规律及其影响因素,为改善老年人生活质量提供参考依据。

方法

利用马鞍山健康老龄化队列数据,选取马鞍山市≥60岁2 495名社区居民。以世界卫生组织生活质量测定简表(WHOQOL-BREF)评分聚类状态为主要结局指标,采用多状态马尔可夫(MSM)模型分析低、中、高3种生活质量状态的转换规律。

结果

对于中等生活质量的个体,观察到恶化为低生活质量、保持为中等生活质量和改善到高生活质量的估计概率在1年观察中分别为0.220、0.648和 0.132,并在5年观察内分别演变为 0.405、0.448和0.148。多变量MSM模型分析结果揭示了影响老年人生活质量动态转变的关键因素。其中年龄是生活质量改善的负向预测因子,与60~69岁组相比,70~79岁(HR=0.638, 95% CI “0.484~0.841”)和80岁及以上组(HR=0.404, 95% CI “0.255~0.641”)从低生活质量向中等生活质量转变的可能性依次降低。相反,较高的文化程度是显著的促进因素,与文盲组相比,小学/初中(HR=1.467, 95% CI “1.089~1.975”)及高中/大专以上学历者(HR=1.909, 95% CI “1.282~2.844”)更有可能实现生活质量的改善。此外,患有多种慢性病(≥3种)对生活质量具有双重负面影响,它既降低了生活质量改善的可能性(如从中等到高生活质量,HR=0.638,95% CI “0.417~0.877”),也增加了生活质量恶化的风险(如从高到中生活质量,HR=1.512,95% CI “1.156~2.625”)。婚姻状况、吸烟、独居和体育锻炼等因素亦对生活质量状态转变有显著影响。

结论

本研究采用多状态模型揭示了老年生活质量的动态演变规律。高生活质量状态不稳定,但低生活质量可逆转。应针对高危人群制定前瞻性干预策略,以延缓其生活质量的衰退进程。

生活质量  /  马尔可夫模型  /  状态转移  /  老龄化  /  纵向研究
Objective

Toanalyze the dynamic evolution laws of the quality of life status of the elderly in communities and its influencing factors, so as to provide a reference basis for improving the quality of life of the elderly.

Methods

Using the data of the Ma’anshan Healthy Aging Cohort, 2 495 community residents aged ≥ 60 years old in Ma’anshan City were selected. Taking the clustering status of the scores of the World Health Organization Quality of Life-BREF(WHOQOL-BREF)as the main outcome indicator, a multi-state Markov(MSM)model was used to analyze the conversion patterns of the three quality of life statuses, namely low, medium, and high.

Results

For individuals with moderate quality of life, the estimated probabilities of deteriorating to low quality of life, remaining at moderate quality of life, and improving to high quality of life were 0.220, 0.648, and 0.132 respectively in the 1-year observation, and evolved to 0.405, 0.448, and 0.148 respectively within the 5-year observation. The results of the multivariable MSM model analysis revealed the key factors influencing the dynamic transition of the quality of life of the elderly. Age is a negative predictor of the improvement of quality of life. Compared with the 60-69-year-old group, the probability of transition from low quality of life to moderate quality of life in the 70-79-year-old group(HR=0.638, 95% CI:0.484-0.841)and the group aged 80 and above(HR=0.404, 95% CI:0.255-0.641)decreased successively. Conversely, a higher level of education was a significant promoting factor. Compared with the illiterate group, those with primary school/junior high school education(HR=1.467, 95% CI: 1.089-1.975)and those with senior high school/junior college or above education(HR=1.909, 95% CI:1.282-2.844)were more likely to achieve an improvement in quality of life. In addition, having multiple chronic diseases(≥3 types)had a dual negative impact on the quality of life. It reduced the possibility of improving the quality of life(for example, from moderate to high quality of life, HR=0.638, 95% CI:0.417-0.877)and also increased the risk of deteriorating the quality of life(for example, from high to moderate quality of life, HR=1.512, 95% CI:1.156-2.625). Factors such as marital status, smoking, living alone, and physical exercise also had a significant impact on the transition of the quality of life status.

Conclusion

This study uses a multi-state model to reveal the dynamic evolution law of the quality of life of the elderly. The high-quality-of-life state is unstable, but the low-quality-of-life state is reversible. Prospective intervention strategies should be formulated for high-risk groups to delay the decline process of their quality of life.

Quality of life  /  Markov models  /  State transition  /  Aging  /  Longitudinal studies
许愿, 梁雨婷, 王勤, 黄芬, 李杰, 秦其荣. 基于多态Markov模型的社区老年人生活质量状态转变及其影响因素研究. 现代预防医学, 2025 , 52 (22) : 4097 -4104 . DOI: 10.20043/j.cnki.MPM.202503130
Yuan XU, Yu-ting LIANG, Qin WANG, Fen HUANG, Jie LI, Qi-rong QIN. Research on the transition of the quality of life status of the elderly in communities and its influencing factors based on the multi-stage Markov Models[J]. Modern Preventive Medicine, 2025 , 52 (22) : 4097 -4104 . DOI: 10.20043/j.cnki.MPM.202503130
生活质量是一个多维度的概念,涵盖身体健康、心理健康、社会参与度以及生活满意度等方面[1]。随着我国人口老龄化驶入高龄化、失能化的快车道,预计将于2035年前后步入重度老龄化社会,老年生活质量问题愈发严峻[2]。有关预测数据显示2020—2050年中国失能老人总量将持续增长,总体失能率在9.28%~11.15%之间变动[3]。据统计,全球≥65岁老年人多重慢性病率为40%~60%,而我国≥60岁居民慢性病患病率高达69.13%[4]。较差的生活质量不仅意味着个体在日常生活中面临更多的困难和挑战,还与一系列健康风险紧密相关,例如慢性疾病的高发、认知能力衰退以及心理疾病的易感性增加[5-6]。因此,改善生活质量、增进老年福祉成为积极应对人口老龄化的首要任务。深入了解影响老年人生活质量的关键因素,对于精准识别高风险人群、制定针对性的改善措施以及提升老年人的整体生活品质具有重要意义。
老年人的生活质量并非一成不变,而是一个动态变化的过程。它会随着时间推移、健康状况改变、社会环境变迁等因素而发生波动[7-8]。近年来,多态马尔可夫(multi-stage Markov,MSM)模型可以通过不同状态之间的转换强度来展示多状态过程,动态预测不同疾病状态之间转换的概率,并估计协变量对特定疾病状态下个体转换的影响[9]。目前关于生活质量状态之间的过渡缺乏明确性。
本研究使用MSM模型分析了马鞍山市健康老龄化纵向调查数据,旨在揭示生活质量的进展和波动过程,并提供有关生活质量状态之间转换概率、协变量对转换的影响的信息。研究成果预期能够丰富和完善现有的老年人生活质量理论体系,为制定切实可行的公共政策和社会干预措施提供有力的数据支持和理论依据。
本研究数据来自马鞍山健康老龄化队列,经安徽医科大学伦理委员会审批(批号:81220341)。通过分层整群抽样法,于2016年基线调查选取马鞍山市3个行政区24个社区的3 476名≥60岁常住老年人。分别在2018年、2021年进行随访,排除失访及数据不全者后,最终纳入2 495名研究对象。所有参与者签署知情同意书。
世界卫生组织生活质量测定简表(World Health Organization Quality of Life Scale Abbreviated Version,WHOQOL-BREF):包含26个条目,从生理、心理、社会关系和环境4个维度评估生活质量,总分转换为百分制[10]。
一般情况调查表涵盖以下信息:年龄、性别、婚姻状况、受教育程度、是否吸烟、是否饮酒、是否独居、参加体育锻炼。其中BMI的分类遵循中国分类系统[11]:体重过轻:BMI <18.5 kg/m2;正常体重:18.5≤BMI<24 kg/m2;超重/肥胖:BMI≥24 kg/m2;为了评估身体功能,使用了六项日常生活活动量表,参与者需说明他们在完成如穿衣、洗澡等日常任务时面临的困难。评分范围为0到6分;0分表示无困难,1到2分表示轻度困难,3分及以上则表示显著功能障碍[12]。采用简易智力状态检查量表(mini-mental state examina-tion,MMSE)评估老年人认知功能。MMSE 量表是国内外常用的认知筛查量表之一。该量表共19项30个条目,总分范围为0~30分,得分越低认知功能越差。国内评分标准受老年人文化水平影响,文盲组≤17分、小学组≤20分、中学或以上组<24分者判定为认知功能受损[13]。慢性健康问题包括高血压、糖尿病、心血管疾病、呼吸系统疾病、中风病史以及医生诊断的癌症。我们评估了慢性合并症的数量,并将其分为三类:“无疾病”、“一种或两种疾病”和“三种及以上疾病”。
MSM是一组用于多态建模的函数,可在连续时间内为一般 MSM 模型执行最大似然估计[10]。我们定义了三种可能的状态(低生活质量标记为状态 1,中等生活质量标记为 2,高生活质量标记为 3)个体可以在相邻的疾病状态之间进展或恢复。马尔可夫假设声称从一种状态到另一种状态的转换速率仅取决于当前状态。确定这些跃迁的跃迁强度矩阵表示为 Q,如下所示:
这就形成了一个3 x 3的矩阵,其中每一行的和等于零。对角线元素是qrr=-Σs≠rqrs。qrs表示离开一个状态的瞬时速率。设a(t)=r表示t时刻的状态。一个个体移动到状态s(其中s=1,2,3,4)的过渡强度是根据时间间隔(t,t+Δt)计算的。一个人在状态r过渡到状态s的可能性由-qrs/qrr表示。
采用SPSS 25.0和R 4.2.0软件进行数据分析。对基线老年人WHOQOL-BREF总分进行Shapiro - Wilk正态性检验,结果显示数据呈正态分布(P>0.05)。因此,本研究采用K-means聚类方法对生活质量进行分类。采用MSM模型分析生活质量状态转移规律,进行了多变量 MSM 模型以检查协变量对状态转换的影响。分类变量以频数(百分比)表示,组间比较采用χ2检验,检验水准α=0.05。
本研究主要评估生活质量状态之间转变,因此采用肘部法来确定最佳聚类数为3类,并根据K-means聚类将基线老年人WHOQOL-BREF得分为低(<53.71分)、中(53.71~62.60分)、高(>62.60分)3类;聚类中心分别为49.37、58.24和67.00分,见图1。
本研究共纳入2 495名老年人,其中女性占56.2%。表1显示,2016年基线调查时低、中、高生活质量者分别为695人(27.9%)、1 122人(45.0%)和678人(27.2%)。到最后一次随访时,1 102人(44.2%)为低生活质量,1 129人(49.3%)为中等生活质量,164人(6.6%)为高生活质量。表2总结了每波老年人生活质量状态的分布。
表3总结了随访时观察到的从当前状态到下一个状态的转变。在处于低生活质量状态的老年人中,57.6%的人在下次随访时维持该状态,但也有33.5%成功恢复至中等生活质量,8.9%甚至进展为高生活质量。相比之下,处于中等生活质量的老年人面临着双向转变的可能:49.0%的人维持原状态,但也有35.4%恶化为低生活质量,同时有15.6%改善为高生活质量。值得注意的是,高生活质量状态最难维持,该组中有53.3%的人转为中等生活质量,19.0%的人甚至恶化为低生活质量。
生活质量状态之间的过渡强度如表4所示。对于中等生活质量的老年人,恶化到低生活质量的过渡强度(0.776,95% CI:0.710~0.848)是改善为高生活质量的过渡强度(0.599,95% CI:0.518~0.694)的1.30倍。从高生活质量恶化为中等生活质量的转变强度(1.830,95% CI:1.638~2.044)是从中等生活质量恶化为低生活质量的转变强度(0.776,95% CI:0.710~0.848)的2.36倍。
图2估计了不同生活质量状态的老年人在1、3、5和10年的观察间隔内状态转换的概率。对于低生活质量状态的个体,观察到保持为低生活质量、改善到中等生活质量、改善为高生活质量的估计概率在1年观察中分别为0.750、0.226和 0.024,并在5年观察内分别演变为0.465、0.416和0.120。对于中等生活质量的个体,观察到恶化为低生活质量、保持为中等生活质量和改善到高生活质量的估计概率在1年观察中分别为0.220、0.648和0.132,并在5年观察内分别演变为0.405、0.448和0.148。对于高生活质量个体,观察到恶化为低生活质量、恶化为中等生活质量和保持高生活质量的估计概率在1年观察内为0.075、0.415和0.510,并在5年观察内分别演变为0.367、0.464和0.168。
表5估计了协变量对不同生活质量状态之间转换的风险比 (HR) 的影响。年龄与生活质量的改善转变有关。与60~69岁组相比,低生活质量状态改善转变的可能性随着年龄的增长而降低,70~79岁组从低生活质量转变为中等生活质量的HR为0.638(95% CI:“0.484~0.841”),而80岁及以上组的HR仅为0.404(95% CI:“0.255~0.641”)。与文盲组相比,文化程度高的个体更有可能表现出更高的改善可能性,小学/初中组和高中/大专及以上组从低生活质量到中等生活质量的转变HR分别为1.467(95% CI:“1.089~1.975”)和1.909(95% CI:“1.282~2.844”)。与无慢性病组相比,慢性病患病数量≥3组不利于生活质量的改善,从低生活质量到中等生活质量和从中等生活质量到高生活质量的转变HR分别为0.879(95% CI:“0.625~0.985”)和0.638(95% CI:“0.417~0.877”),从高生活质量到中等生活质量和从中等生活质量到低生活质量的转变HR分别为1.512(95% CI:“1.156~2.625”)和1.282(95% CI:“1.005~1.661”)。其他因素,包括婚姻状况、吸烟、独居和体育锻炼也对生活质量状态的转变产生影响。
本研究基于马鞍山健康老龄化前瞻性队列数据,首次运用多状态马尔可夫模型系统揭示了我国社区老年人生活质量的动态演变规律。研究发现,老年人生活质量状态呈现显著的流动性与不稳定性,其中高生活质量状态尤为脆弱;同时,生活质量的转变是双向的,低生活质量状态同样存在改善的可能。年龄、受教育程度及慢性病共病是驱动状态转变的关键因素。本研究深化了对老年生活质量动态本质的理解,为我国积极应对人口老龄化背景下的老年健康促进工作提供了重要的循证支持。
本研究的核心发现之一是高生活质量状态的脆弱性。模型预测显示,初始为高生活质量的个体,5年内维持该状态的概率不足两成,绝大多数会向中、低状态滑落。这与既往多项研究仅报告老年人生活质量有所改善的结论不同[14-16],本研究从纵向轨迹视角证实了维持理想生活质量状态的艰巨性。这种现象可能反映了老年个体生理储备下降,在面对新增健康冲击(如新发疾病、功能衰退)时,其健康韧性与抗逆能力减弱,生活质量随之快速衰退,这与衰弱理论的核心观点相契合[17]。这提示我们,老年健康工作的重点不仅在于“提升”生活质量,更在于如何“维持”和“稳固”已达到的良好状态,防止其向差的状态迁移。
与高生活质量的脆弱性相对应,本研究也发现了生活质量改善的积极信号。即使是处于低生活质量状态的老年人,在随访期内仍有相当比例实现了向中、高生活质量的“逆转”。这表明低生活质量并非一个不可逆的终点,有效的干预措施能够促进其恢复。研究证实,较高的受教育程度是促进生活质量改善的显著保护因素[18],这可能是因为教育不仅与更高的社会经济地位和健康素养相关,还可能赋予个体更强的心理韧性与社会适应能力[19]。这一发现的公共卫生学意义在于,针对低学历老年群体的健康教育、技能培训和社会参与促进项目,可能是阻断生活质量下行轨迹、促进其向上流动的有效干预路径。
本研究利用MSM模型,精准量化了协变量对生活质量转变的影响,提供了比传统回归模型更为精细的证据。结果凸显,多病共存是驱动生活质量恶化、阻碍其改善的核心风险因素。我国超过78%的老年人至少患有一种慢性病[20],失能风险持续增长[21],本研究证实慢性病负担的加重会显著加速生活质量从优到差的转变,同时抑制其从差到优的恢复,其负面效应具有“双重打击”特征。这为当前我国以慢性病管理为核心的老年健康服务体系建设提供了坚实的理论依据,即对老年人尤其是共病患者实施一体化的、连续性的健康管理,是稳定其生活质量、延缓失能进程的关键所在。
综上所述,本研究揭示了我国社区老年人生活质量是一个高度动态且脆弱的过程。未来的公共卫生政策与临床实践应转变观念,从关注生活质量的静态水平转向管理其动态轨迹。应重点针对高龄、低学历、多病共存的高危人群,建立早期预警和筛查机制,通过加强慢性病综合管理、促进健康教育和提升功能独立性等综合性干预措施,努力延缓生活质量的恶化进程,促进其向积极方向转变,从而真正实现健康老龄化的战略目标。
  • 中国安徽省自然科学基金重点项目(KJ2021A0231)
  • 安徽医科大学公共卫生学院高峰学科项目(2024GWXTYRZ001)
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doi: 10.20043/j.cnki.MPM.202503130
  • 接收时间:2025-03-06
  • 首发时间:2026-10-29
  • 出版时间:2025-11-25
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  • 收稿日期:2025-03-06
基金
中国安徽省自然科学基金重点项目(KJ2021A0231)
安徽医科大学公共卫生学院高峰学科项目(2024GWXTYRZ001)
作者信息
    1.安徽医科大学公共卫生学院流行病学与卫生统计学系,安徽 合肥 230032
    2.安徽医科大学公共卫生学院健康促进与行为科学系
    3.马鞍山市疾病预防控制中心,慢性非传染病疾病防控科
    4.安徽医科大学附属马鞍山疾病预防控制中心,慢性非传染病疾病防控科

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秦其荣,E-mail:
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2种不同金属材料的力学参数
科
Family
属数
Number of
genus
种数
Number of
species
占总种数比例
Percentage of
total species (%)
属
Genus
种数
Number of
species
占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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