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Article(id=1324078453598855700, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1324078333767594037, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202506479, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1750780800000, receivedDateStr=2025-06-25, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1793614503525, onlineDateStr=2026-11-02, pubDate=1767974400000, pubDateStr=2026-01-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793614503525, onlineIssueDateStr=2026-11-02, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793614503525, creator=13701087609, updateTime=1793614503525, updator=13701087609, issue=Issue{id=1324078333767594037, tenantId=1146029695717560320, journalId=1227665162245664772, year='2026', volume='53', issue='1', pageStart='1', pageEnd='192', issueExtLink='null', onlineDate='null', pubDate='1767974400000', pubDateStr='2026-01-10', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=0, createTime=1793614474956, creator='13701087609', updateTime=1793614571752, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1324078739914621270, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1324078333767594037, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1324078739914621271, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1324078333767594037, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=88, endPage=93, ext={EN=ArticleExt(id=1324078455398212117, articleId=1324078453598855700, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=The moderating role of social participation and education level in the impact of adverse childhood experiences on frailty, columnId=1228016568949474136, journalTitle=Modern Preventive Medicine, columnName=Child and Adolescent Health, Maternal and Child Health, runingTitle=null, highlight=null, articleAbstract=
Objective

To examine whether adverse childhood experiences(ACEs) predict frailty in middle-aged and elderly Chinese adults, and whether social participation or education level moderates this association.

Methods

Four waves (2011—2018) of the China Health and Retirement Longitudinal Study were combined with the 2014 life-history module to construct panel data. Based on the Hausman test(χ2=261.490, P<0.001), a fixed-effects model was applied to examine the association between ACEs and frailty, with particular attention to social participation and educational attainment and potential moderating effects.

Results

A total of 9 354 individuals were retained, 61.71% had experienced two or more ACEs, and the prevalence of frailty was 15.01%. A significant positive correlation was observed between ACEs and frailty, with the effect intensifying as the number of ACEs increased (ACEs=2: β=1.45, 95% CI: 0.64~-2.26; ACEs=3: β=2.90, 95% CI: 2.00-3.86; ACEs=4: β=3.52,95% CI: 2.48-4.56). Social participation (β=-0.50, 95% CI: -0.63-0.30) and high school or vocational education (β=-1.71, 95% CI: -2.62-0.80) were cross-sectionally associated with lower frailty. However, neither social participation nor education level significantly moderated the relationship between ACEs and frailty (P>0.05).

Conclusion

Within the middle-aged and elderly population in China, ACEs had been identified as a significant risk factor for the development of frailty. Although both social participation and high school or vocational education were negatively associated with frailty, neither of these factors significantly moderated the relationship between ACEs and frailty.

, authors=Fei PENG1, 2, Yu-fen LI3, Lin-lin ZHANG1, authorsList=Fei PENG, Yu-fen LI, Lin-lin ZHANG, authorCompany=null, correspAuthors=Lin-lin ZHANG, 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=1324078456698446362, articleId=1324078453598855700, tenantId=1146029695717560320, journalId=1227665162245664772, language=CN, title=童年不良经历对衰弱的影响——基于社会参与和受教育程度的调节作用研究, columnId=1228016570031604578, journalTitle=现代预防医学, columnName=儿少卫生与妇幼保健, runingTitle=null, highlight=null, articleAbstract=
目的

探讨童年不良经历（adverse childhood experiences, ACEs）对中老年人衰弱的影响，并探讨社会参与和受教育程度是否调节两者的关系。

方法

利用中国健康与养老追踪调查2011—2018四期数据，结合2014年生命历程专项调查构成面板数据，经豪斯曼检验显示χ2=261.490（P<0.001），故采用固定效应模型来探索ACEs与衰弱的关联，重点关注社会参与及受教育程度与衰弱间的关系，并探讨潜在的调节效应。

结果

共纳入9 354名研究对象，其中，约61.71%的个体经历过2种以上ACEs，衰弱患病率为15.01%，ACEs与衰弱呈显著正相关关系（ACEs=2:β=1.45,95% CI:0.64～2.26;ACEs=3:β=2.9,95% CI:2.00～3.86;ACEs=4:β=3.52,95% CI:2.48～4.56），且效应随ACEs数量升高而增强。横截面分析发现社会参与与衰弱呈显著负相关关系（β=-0.50,95% CI:-0.63～-0.30），高中或职业教育与衰弱呈显著负相关关系（β=-1.71,95% CI:-2.62～-0.80）。社会参与和受教育程度未显著调节ACEs与衰弱的关系（P>0.05）。

结论

我国中老年人群中，ACEs是影响衰弱发生的重要风险因素。社会参与及高中或职业教育与衰弱呈负相关关系，但两者并未显著调节ACEs与衰弱之间的关系。

, authors=彭飞1, 2, 李玉芬3, 张琳琳1, authorsList=彭飞, 李玉芬, 张琳琳, authorCompany=null, correspAuthors=张琳琳, authorNote=

彭飞（1980—），女，硕士在读，主管护师，研究方向：社区慢性病管理，老年健康行为机制研究

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张琳琳，E-mail:
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彭飞（1980—），女，硕士在读，主管护师，研究方向：社区慢性病管理，老年健康行为机制研究

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refs=[Reference(id=1324078461953909316, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078453598855700, doi=null, pmid=null, pmcid=null, year=2023, volume=29, issue=7, pageStart=1639, pageEnd=1648, url=null, language=null, rfNumber=[1], rfOrder=0, authorNames=Bhutta ZA, Bhavnani S, Betancourt TS, journalName=Nature Medicine, refType=null, unstructuredReference=Bhutta ZA, Bhavnani S, Betancourt TS, et al. Adverse childhood experiences and lifelong health[J]. Nature Medicine, 2023, 29(7): 1639-1648., articleTitle=Adverse childhood experiences and lifelong health, refAbstract=null), Reference(id=1324078462083932741, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078453598855700, doi=null, pmid=null, pmcid=null, year=2022, volume=68, issue=10, pageStart=1091, pageEnd=1100, url=null, language=null, rfNumber=[2], rfOrder=1, authorNames=Mian O, Anderson LN, Belsky DW, journalName=Gerontology, refType=null, unstructuredReference=Mian O, Anderson LN, Belsky DW, et al. Associations of adverse childhood experiences with frailty in older adults: a Cross-Sectional analysis of data from the Canadian longitudinal study on aging[J]. Gerontology, 2022,68(10): 1091-1100., articleTitle=Associations of adverse childhood experiences with frailty in older adults: a Cross-Sectional analysis of data from the Canadian longitudinal study on aging, refAbstract=null), Reference(id=1324078462385922630, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078453598855700, doi=null, pmid=null, pmcid=null, year=2022, volume=41, issue=5, pageStart=503, pageEnd=511, url=null, language=null, rfNumber=[3], rfOrder=2, authorNames=中华医学会老年医学分会, 《中华老年医学杂志》编辑委员会, journalName=中华老年医学杂志, refType=null, unstructuredReference=中华医学会老年医学分会，《中华老年医学杂志》编辑委员会.老年人衰弱预防中国专家共识(2022)[J].中华老年医学杂志，2022，41（5）：503-511., articleTitle=老年人衰弱预防中国专家共识(2022), refAbstract=null), Reference(id=1324078462469808711, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078453598855700, doi=null, pmid=null, pmcid=null, year=2022, volume=41, issue=5, pageStart=503, pageEnd=511, url=null, language=null, rfNumber=[3], rfOrder=3, authorNames=Chinese Geriatrics Society, Editorial Board of Chinese Journal of Geriatrics, journalName=Chinese Journal of Geriatrics, refType=null, unstructuredReference=Chinese Geriatrics Society, Editorial Board of Chinese Journal of Geriatrics.Chinese expert consensus on prevention of frailty in the elderly(2022)[J]. Chinese Journal of Geriatrics, 2022, 41(5): 503-511. (In Chinese), articleTitle=Chinese expert consensus on prevention of frailty in the elderly(2022), refAbstract=null), Reference(id=1324078464126558792, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078453598855700, doi=null, pmid=null, pmcid=null, year=2024, volume=28, issue=12, pageStart=null, pageEnd=null, url=null, language=null, rfNumber=[4], rfOrder=4, authorNames=Li JJ, Pei HM, Yan XJ, journalName=Journal of Nutrition Health & Aging, refType=null, unstructuredReference=Li JJ, Pei HM, Yan XJ, et al. Adverse childhood experiences and social participation on frailty state transitions among middle-aged and older adults:evidence from a 10-year prospective study in China[J]. Journal of Nutrition Health & Aging, 2024, 28(12): 100400., articleTitle=Adverse childhood experiences and social participation on frailty state transitions among middle-aged and older adults:evidence from a 10-year prospective study in China, refAbstract=null), Reference(id=1324078464214639177, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078453598855700, doi=null, pmid=null, pmcid=null, year=2024, volume=25, issue=7, pageStart=null, pageEnd=null, url=null, language=null, rfNumber=[5], rfOrder=5, authorNames=Tao YM, Wang HY, Luo JS, journalName=Journal of the American Medical Directors Association, refType=null, unstructuredReference=Tao YM, Wang HY, Luo JS, et al. The association between adverse childhood experiences and frailty: a systematic review[J]. Journal of the American Medical Directors Association, 2024, 25(7): 105042., articleTitle=The association between adverse childhood experiences and frailty: a systematic review, refAbstract=null), Reference(id=1324078464323691082, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078453598855700, doi=null, pmid=null, pmcid=null, year=2022, volume=null, issue=6, pageStart=97, pageEnd=110, url=null, language=null, rfNumber=[6], rfOrder=6, authorNames=盛亦男, 刘远卓, journalName=中国人口科学, refType=null, unstructuredReference=盛亦男，刘远卓.社会参与对老年人健康的影响[J].中国人口科学，2022,（6）：97-110., articleTitle=社会参与对老年人健康的影响, refAbstract=null), Reference(id=1324078464432742987, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078453598855700, doi=null, pmid=null, pmcid=null, year=2022, volume=null, issue=6, pageStart=97, pageEnd=110, url=null, language=null, rfNumber=[6], rfOrder=7, authorNames=Sheng YN, Liu YZ, journalName=Chinese Journal of Population Science, refType=null, unstructuredReference=Sheng YN, Liu YZ. The impact of social participation on the health of older adults[J]. Chinese Journal of Population Science, 2022, (6): 97-110. (In Chinese), articleTitle=The impact of social participation on the health of older adults, refAbstract=null), Reference(id=1324078464516629068, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078453598855700, doi=null, pmid=null, pmcid=null, year=2023, volume=52, issue=2, pageStart=null, pageEnd=null, url=null, language=null, rfNumber=[7], rfOrder=8, authorNames=Dimitriadis MM, Jeuring HW, Marijnissen RM, journalName=Age and Ageing, refType=null, unstructuredReference=Dimitriadis MM, Jeuring HW, Marijnissen RM, et al. Adverse childhood experiences and frailty in 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=1324078464587932237, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078453598855700, doi=null, pmid=null, pmcid=null, year=2023, volume=14, issue=1, pageStart=632, pageEnd=641, url=null, language=null, rfNumber=[8], rfOrder=9, authorNames=He D, Qiu YW, Yan MS, journalName=Journal of Cachexia, Sarcopenia and Muscle, refType=null, unstructuredReference=He D, Qiu YW, Yan MS, et al. Associations of metabolic heterogeneity of obesity with frailty progression: Results from two prospective cohorts[J]. Journal of Cachexia, Sarcopenia and Muscle, 2023, 14(1): 632-641., articleTitle=Associations of metabolic heterogeneity of obesity with frailty progression: Results from two prospective cohorts, refAbstract=null), Reference(id=1324078464655041102, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078453598855700, doi=null, pmid=null, pmcid=null, year=2021, volume=4, issue=10, pageStart=null, pageEnd=null, url=null, language=null, rfNumber=[9], rfOrder=10, authorNames=Lin L, Wang HH, Lu CY, journalName=JAMA Netw Open, refType=null, unstructuredReference=Lin L, Wang HH, Lu CY, et al. Adverse childhood experiences and subsequent chronic diseases among middle-aged or older adults in China and associations with demographic and socioeconomic characteristics[J]. JAMA Netw Open, 2021, 4(10): e2130143., articleTitle=Adverse childhood experiences and subsequent chronic diseases among middle-aged or older adults in China and associations with demographic and socioeconomic characteristics, refAbstract=null), Reference(id=1324078464726344271, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078453598855700, doi=null, pmid=null, pmcid=null, year=2020, volume=8, issue=1, pageStart=55, pageEnd=72, url=null, language=null, rfNumber=[10], rfOrder=11, authorNames=Dehi Aroogh M, Mohammadi Shahboulaghi F, journalName=Int J Community Based Nurs Midwifery, refType=null, unstructuredReference=Dehi Aroogh M, Mohammadi Shahboulaghi F. Social participation of older adults: a concept analysis[J]. Int J Community Based Nurs Midwifery, 2020, 8(1): 55-72., articleTitle=Social participation of older adults: a concept analysis, refAbstract=null), Reference(id=1324078464797647440, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078453598855700, doi=null, pmid=null, pmcid=null, year=2024, volume=95, issue=null, pageStart=null, pageEnd=null, url=null, language=null, rfNumber=[11], rfOrder=12, authorNames=Ng YX, Cheng LJ, Quek YY, journalName=Ageing Research Reviews, refType=null, unstructuredReference=Ng YX, Cheng LJ, Quek YY, et al. The measurement properties and feasibility of FRAIL scale in older adults: A systematic review and meta-analysis[J]. Ageing Research Reviews, 2024, 95: 102243., articleTitle=The measurement properties and feasibility of FRAIL scale in older adults: A systematic review and meta-analysis, refAbstract=null), Reference(id=1324078464873144913, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078453598855700, doi=null, pmid=null, pmcid=null, year=2023, volume=50, issue=13, pageStart=2389, pageEnd=2395, url=null, language=null, rfNumber=[12], rfOrder=13, authorNames=崔亚男, 宫春博, 王文燕, journalName=现代预防医学, refType=null, unstructuredReference=崔亚男，宫春博，王文燕，等.中老年慢性病患者卫生服务利用影响因素分析——基于CHARLS数据实证分析[J].现代预防医学，2023，50（13）：2389-2395., articleTitle=中老年慢性病患者卫生服务利用影响因素分析——基于CHARLS数据实证分析, refAbstract=null), Reference(id=1324078464944448082, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078453598855700, doi=null, pmid=null, pmcid=null, year=2023, volume=50, issue=13, pageStart=2389, pageEnd=2395, url=null, language=null, rfNumber=[12], rfOrder=14, authorNames=Cui YN, Gong CB, Wang WY, journalName=Modern Preventive Medicine, refType=null, unstructuredReference=Cui YN, Gong CB, Wang WY, et al. Analysis on influencing factors of health service utilization in middle-aged and elderly patients with chronic diseases: an empirical analysis based on CHARLS data[J]. Modern Preventive Medicine, 2023,50(13): 2389-2395. (In Chinese), articleTitle=Analysis on influencing factors of health service utilization in middle-aged and elderly patients with chronic diseases: an empirical analysis based on CHARLS data, refAbstract=null), Reference(id=1324078465032528467, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078453598855700, doi=null, pmid=null, pmcid=null, year=2024, volume=32, issue=1, pageStart=71, pageEnd=82, url=null, language=null, rfNumber=[13], rfOrder=15, authorNames=Yang G, Cao XQ, Yu J, journalName=The American Journal of Geriatric Psychiatry, refType=null, unstructuredReference=Yang G, Cao XQ, Yu J, et al. Association of childhood adversity with frailty and the mediating role of unhealthy lifestyle: a lifespan analysis[J]. The American Journal of Geriatric Psychiatry, 2024, 32(1): 71-82., articleTitle=Association of childhood adversity with frailty and the mediating role of unhealthy lifestyle: a lifespan analysis, refAbstract=null), Reference(id=1324078465133191764, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078453598855700, doi=null, pmid=null, pmcid=null, year=2023, volume=145, issue=null, pageStart=null, pageEnd=null, url=null, language=null, rfNumber=[14], rfOrder=16, authorNames=Laricchiuta D, Panuccio A, Picerni E, journalName=Neuroscience & Biobehavioral Reviews, refType=null, unstructuredReference=Laricchiuta D, Panuccio A, Picerni E, et al. The body keeps the score: The neurobiological profile of traumatized adolescents[J].Neuroscience & Biobehavioral Reviews, 2023, 145: 105033., articleTitle=The body keeps the score: The neurobiological profile of traumatized adolescents, refAbstract=null), Reference(id=1324078465196106325, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078453598855700, doi=null, pmid=null, pmcid=null, year=2021, volume=48, issue=22, pageStart=4145, pageEnd=4151, url=null, language=null, rfNumber=[15], rfOrder=17, authorNames=谢瑞瑞, 刘晨, 王琼, journalName=现代预防医学, refType=null, unstructuredReference=谢瑞瑞，刘晨，王琼，等.退休后工作参与和老年人自评健康状况的关联效应分析[J]. 现代预防医学，2021，48（22）：4145-4151., articleTitle=退休后工作参与和老年人自评健康状况的关联效应分析, refAbstract=null), Reference(id=1324078465271603798, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078453598855700, doi=null, pmid=null, pmcid=null, year=2021, volume=48, issue=22, pageStart=4145, pageEnd=4151, url=null, language=null, rfNumber=[15], rfOrder=18, authorNames=Xie RR, Liu C, Wang Q, journalName=Modern Preventive Medicine, refType=null, unstructuredReference=Xie RR, Liu C, Wang Q, et al. Correlation effect between post retirement work participation and self-rated health status of the elderly[J]. Modern Preventive Medicine, 2021, 48(22): 4145-4151. (In Chinese), articleTitle=Correlation effect between post retirement work participation and self-rated health status of the elderly, refAbstract=null), Reference(id=1324078465351295575, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078453598855700, doi=null, pmid=null, pmcid=null, year=2024, volume=40, issue=6, pageStart=129, pageEnd=135, url=null, language=null, rfNumber=[16], rfOrder=19, authorNames=何江泓, 邝博咏, 孙晓翠, journalName=广东药科大学学报, refType=null, unstructuredReference=何江泓，邝博咏，孙晓翠，等.中老年人童年不良经历与健康状况的关联研究[J].广东药科大学学报，2024，40（6）：129-135., articleTitle=中老年人童年不良经历与健康状况的关联研究, refAbstract=null), Reference(id=1324078465426793048, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078453598855700, doi=null, pmid=null, pmcid=null, year=2024, volume=40, issue=6, pageStart=129, pageEnd=135, url=null, language=null, rfNumber=[16], rfOrder=20, authorNames=He JH, Kuang BY, Sun XC, journalName=Journal of Guangdong Pharmaceutical University, refType=null, unstructuredReference=He JH, Kuang BY, Sun XC, et al. The association between adverse childhood experiences and health outcomes in middle-aged and elderly individuals[J]. Journal of Guangdong Pharmaceutical University, 2024, 40(6): 129-135. (In Chinese), articleTitle=The association between adverse childhood experiences and health outcomes in middle-aged and elderly individuals, refAbstract=null), Reference(id=1324078465535844953, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078453598855700, doi=null, pmid=null, pmcid=null, year=2023, volume=36, issue=4, pageStart=null, pageEnd=null, url=null, language=null, rfNumber=[17], rfOrder=21, authorNames=Ren ZY, Luo YN, Zheng XY, journalName=Gen Psychiatr, refType=null, unstructuredReference=Ren ZY, Luo YN, Zheng XY, et al. Adverse childhood experiences from family and society contribute to increased risk of depressive symptoms and cognitive impairment: a cross-sectional study[J]. Gen Psychiatr, 2023, 36(4): e101039., articleTitle=Adverse childhood experiences from family and society contribute to increased risk of depressive symptoms and cognitive impairment: a cross-sectional study, refAbstract=null)], funds=[Fund(id=1324078461769359939, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078453598855700, awardId=22CSH057, language=CN, fundingSource=国家社会科学基金项目青年项目(22CSH057), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1324078457050767899, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078453598855700, xref=1., ext=[AuthorCompanyExt(id=1324078457059156508, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078453598855700, companyId=1324078457050767899, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=School of Medical and Health Engineering, Changzhou University, Changzhou, Jiangsu 213164, China), AuthorCompanyExt(id=1324078457071739421, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078453598855700, companyId=1324078457050767899, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1.常州大学医学与健康工程学院，江苏 常州213164)]), AuthorCompany(id=1324078457138848286, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078453598855700, xref=2., ext=[AuthorCompanyExt(id=1324078457143042591, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078453598855700, companyId=1324078457138848286, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2.常州市西太湖医院门诊部，江苏 常州 213149)]), AuthorCompany(id=1324078457247900192, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078453598855700, xref=3., ext=[AuthorCompanyExt(id=1324078457323397665, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078453598855700, companyId=1324078457247900192, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=3.常州大学瞿秋白政府管理学院)])], figs=[ArticleFig(id=1324078460829835836, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078453598855700, language=EN, label=Table 1, caption=

General information of the study subjects [n=9 354，（），n（%），M（P25，P75）]

, figureFileSmall=null, figureFileBig=null, tableContent=
变量统计描述变量统计描述
年龄（岁）59.41±8.34吸烟
性别曾经吸烟3 427(34.71)
男5 117(54.7)现在吸烟2 093(22.38)
女4 237(45.3)饮酒
居住地曾经饮酒4 056(43.36)
城市3 438(36.75)现在饮酒3 198(34.19)
农村5 916(63.25)衰弱指数15.07±11.15
婚姻前衰弱4 468(47.77)
已婚8 553(91.44)衰弱1 404(15.01)
离异/丧偶/从未结婚801(8.56)ACEs指数2.14±1.22
是否工作1种ACEs3 577(38.24)
是6 603(70.59)2种ACEs2 857(30.50)
否2 751(29.41)3种ACEs1 613(17.24)
是否子女同住4种及以上ACEs1 307(13.97)
是4 898(52.36)社会参与类型
否4 456(47.64)串门、跟朋友交往3 743(40.01)
教育程度打麻将/下棋/打牌等2 134(22.81)
低于初中8 273(88.44)为朋友提供帮助1 345(14.38)
高中/职业培训969(10.36)公共场所跳舞、唱歌等821(8.78)
高等教育112(1.2)参加社团活动243(2.60)
BMI（kg/m2）23.69 (21.41, 26.34)志愿或慈善活动297(3.18)
低体重442 (4.73)上学或者参加培训课程54(0.58)
正常体重4 458 (47.66)社会参与频率
超重3 159 (33.77)差不多每天1(0.01)
肥胖1 295 (13.84)差不多每周184 (1.97)
家庭人均消费（元）6 188.22(3 587.23, 10 761.13)不经常5 127 (54.81)
慢性病数量（个）1(1, 3)没有4 042(43.21)
社会参与频数之和8.78±2.15
), ArticleFig(id=1324078461152797246, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078453598855700, language=CN, label=表1, caption=

研究对象的一般资料[n=9 354，（），n（%），M（P25，P75）]

, figureFileSmall=null, figureFileBig=null, tableContent=
变量统计描述变量统计描述
年龄（岁）59.41±8.34吸烟
性别曾经吸烟3 427(34.71)
男5 117(54.7)现在吸烟2 093(22.38)
女4 237(45.3)饮酒
居住地曾经饮酒4 056(43.36)
城市3 438(36.75)现在饮酒3 198(34.19)
农村5 916(63.25)衰弱指数15.07±11.15
婚姻前衰弱4 468(47.77)
已婚8 553(91.44)衰弱1 404(15.01)
离异/丧偶/从未结婚801(8.56)ACEs指数2.14±1.22
是否工作1种ACEs3 577(38.24)
是6 603(70.59)2种ACEs2 857(30.50)
否2 751(29.41)3种ACEs1 613(17.24)
是否子女同住4种及以上ACEs1 307(13.97)
是4 898(52.36)社会参与类型
否4 456(47.64)串门、跟朋友交往3 743(40.01)
教育程度打麻将/下棋/打牌等2 134(22.81)
低于初中8 273(88.44)为朋友提供帮助1 345(14.38)
高中/职业培训969(10.36)公共场所跳舞、唱歌等821(8.78)
高等教育112(1.2)参加社团活动243(2.60)
BMI（kg/m2）23.69 (21.41, 26.34)志愿或慈善活动297(3.18)
低体重442 (4.73)上学或者参加培训课程54(0.58)
正常体重4 458 (47.66)社会参与频率
超重3 159 (33.77)差不多每天1(0.01)
肥胖1 295 (13.84)差不多每周184 (1.97)
家庭人均消费（元）6 188.22(3 587.23, 10 761.13)不经常5 127 (54.81)
慢性病数量（个）1(1, 3)没有4 042(43.21)
社会参与频数之和8.78±2.15
), ArticleFig(id=1324078461236683327, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078453598855700, language=EN, label=Table 2, caption=

Fixed-effects model for repeated measures

, figureFileSmall=null, figureFileBig=null, tableContent=
变量基准模型（无控制变量）基准模型（含控制变量）调节效应模型（交互项模型）
β（95%CI）P值β（95%CI）P值β（95%CI）P值
2种ACEs1.45 (0.64～2.26)<0.0010.59 (-0.03～1.20)0.0630.59 (-0.07～1.24)0.081
3种ACEs2.93 (2.00～3.86)<0.0011.59 (0.88～2.31)<0.0011.67 (0.92～2.43)<0.001
4种及以上ACEs3.52 (2.48～4.56)<0.0011.96 (1.16～2.76)<0.0012.02 (1.19～2.86)<0.001
社会参与（中心化）-0.01 (-0.09～0.11)0.861-0.43 (-0.63～-0.22)<0.001
高中和职业培训学习-1.71 (-2.62～ -0.80)<0.001-1.60 (-2.97～-0.24)0.021
高等教育-2.01 (-4.08～0.06)0.057-1.60 (-4.46～1.27)0.275
年龄（中心化）0.42 (0.33～0.52)<0.0010.42 (0.32～0.52)<0.001
性别（男）-3.49 (-4.28～-2.71)<0.001-3.48 (-4.27～-2.69)<0.001
婚姻（已婚）-0.14 (-1.55～1.27)0.843-0.15 (-1.56～1.26)0.836
居住地（农村）2.38 (1.82～2.93)<0.0012.38 (1.82～2.93)<0.001
BMI正常-1.21 (-2.48～0.06)0.062-1.21 (-2.48～0.05)0.061
BMI超重-1.09 (-2.49～0.31)0.128-1.10 (-2.50～0.30)0.124
BMI肥胖-1.04 (-2.65～0.57)0.206-1.06 (-2.68～0.55)0.197
慢性病数量2.29 (2.00～2.58)<0.0012.29 (2.00～2.58)<0.001
与子女同住0.25 (-0.18～0.68)0.2560.25 (-0.19～0.68)0.265
工作-1.15 (-1.66～-0.64)<0.001-1.16 (-1.67～-0.65)<0.001
家庭人均消费（中心化）0.00 (-0.00～0.00)0.2590.00 (-0.00～0.00)0.249
曾经吸烟0.37 (-0.72～1.46)0.5020.38 (-0.71～1.48)0.489
现在吸烟-0.75 (-1.72～0.23)0.134-0.75 (-1.72～0.22)0.132
曾经饮酒1.24 (0.55～1.92)<0.0011.23 (0.55～1.92)<0.001
现在饮酒0.29 (-0.42～1.00)0.4250.29 (-0.42～1.00)0.422
2种ACEs×社会参与0.14 (-0.10～0.38)0.263
3种ACEs×社会参与0.19 (-0.10～0.47)0.203
4种及以上ACEs×社会参与0.02 (-0.29～0.33)0.895
2种ACEs×高中和职业培训学习0.18 (-1.90～2.25)0.868
3种ACEs×高中和职业培训学习-0.64 (-3.17～1.90)0.623
4种及以上ACEs×高中和职业培训学习-0.59 (-3.77～2.59)0.718
2种ACEs×高等教育-0.25 (-6.29～5.80)0.936
3种ACEs×高等教育-1.72 (-7.07～3.64)0.530
3种ACEs×高等教育-0.54 (-6.79～5.71)0.866
R20.0010.1330.134
调整后R2-0.807-0.571-0.572
AIC55 953.354 648.454 650.2
BIC55 967.654 755.554 778.8
RMSE4.814.484.48
), ArticleFig(id=1324078461320569408, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078453598855700, language=CN, label=表2, caption=

多次观测样本的固定效应模型

, figureFileSmall=null, figureFileBig=null, tableContent=
变量基准模型（无控制变量）基准模型（含控制变量）调节效应模型（交互项模型）
β（95%CI）P值β（95%CI）P值β（95%CI）P值
2种ACEs1.45 (0.64～2.26)<0.0010.59 (-0.03～1.20)0.0630.59 (-0.07～1.24)0.081
3种ACEs2.93 (2.00～3.86)<0.0011.59 (0.88～2.31)<0.0011.67 (0.92～2.43)<0.001
4种及以上ACEs3.52 (2.48～4.56)<0.0011.96 (1.16～2.76)<0.0012.02 (1.19～2.86)<0.001
社会参与（中心化）-0.01 (-0.09～0.11)0.861-0.43 (-0.63～-0.22)<0.001
高中和职业培训学习-1.71 (-2.62～ -0.80)<0.001-1.60 (-2.97～-0.24)0.021
高等教育-2.01 (-4.08～0.06)0.057-1.60 (-4.46～1.27)0.275
年龄（中心化）0.42 (0.33～0.52)<0.0010.42 (0.32～0.52)<0.001
性别（男）-3.49 (-4.28～-2.71)<0.001-3.48 (-4.27～-2.69)<0.001
婚姻（已婚）-0.14 (-1.55～1.27)0.843-0.15 (-1.56～1.26)0.836
居住地（农村）2.38 (1.82～2.93)<0.0012.38 (1.82～2.93)<0.001
BMI正常-1.21 (-2.48～0.06)0.062-1.21 (-2.48～0.05)0.061
BMI超重-1.09 (-2.49～0.31)0.128-1.10 (-2.50～0.30)0.124
BMI肥胖-1.04 (-2.65～0.57)0.206-1.06 (-2.68～0.55)0.197
慢性病数量2.29 (2.00～2.58)<0.0012.29 (2.00～2.58)<0.001
与子女同住0.25 (-0.18～0.68)0.2560.25 (-0.19～0.68)0.265
工作-1.15 (-1.66～-0.64)<0.001-1.16 (-1.67～-0.65)<0.001
家庭人均消费（中心化）0.00 (-0.00～0.00)0.2590.00 (-0.00～0.00)0.249
曾经吸烟0.37 (-0.72～1.46)0.5020.38 (-0.71～1.48)0.489
现在吸烟-0.75 (-1.72～0.23)0.134-0.75 (-1.72～0.22)0.132
曾经饮酒1.24 (0.55～1.92)<0.0011.23 (0.55～1.92)<0.001
现在饮酒0.29 (-0.42～1.00)0.4250.29 (-0.42～1.00)0.422
2种ACEs×社会参与0.14 (-0.10～0.38)0.263
3种ACEs×社会参与0.19 (-0.10～0.47)0.203
4种及以上ACEs×社会参与0.02 (-0.29～0.33)0.895
2种ACEs×高中和职业培训学习0.18 (-1.90～2.25)0.868
3种ACEs×高中和职业培训学习-0.64 (-3.17～1.90)0.623
4种及以上ACEs×高中和职业培训学习-0.59 (-3.77～2.59)0.718
2种ACEs×高等教育-0.25 (-6.29～5.80)0.936
3种ACEs×高等教育-1.72 (-7.07～3.64)0.530
3种ACEs×高等教育-0.54 (-6.79～5.71)0.866
R20.0010.1330.134
调整后R2-0.807-0.571-0.572
AIC55 953.354 648.454 650.2
BIC55 967.654 755.554 778.8
RMSE4.814.484.48
), ArticleFig(id=1324078461534478913, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078453598855700, language=EN, label=Table 3, caption=

Random-effects model for repeated measures

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变量基准模型（无控制变量）基准模型（含控制变量）调节效应模型（交互项模型）
β（95%CI）P值β（95%CI）P值β（95%CI）P值
2种ACEs0.83 (0.13～1.54)0.0200.41 (-0.11～0.92)0.1220.43 (-0.12～0.98)0.122
3种ACEs2.32 (1.48～3.16)<0.0011.05 (0.44～1.67)0.0011.05 (0.39～1.71)0.002
4种及以上ACEs4.35 (3.44～5.25)<0.0012.18 (1.52～2.85)<0.0012.26 (1.56～2.97)<0.001
社会参与（中心化）-0.21 (-0.29～-0.14)<0.001-0.23 (-0.36～-0.11)<0.001
高中和职业培训学习-2.94 (-3.66～-2.23)<0.001-2.75 (-3.87～-1.62)<0.001
高等教育-3.87 (-5.84～-1.91)<0.001-3.96 (-6.89～-1.03)0.008
年龄（中心化）0.14 (0.11～0.17)<0.0010.14 (0.11～0.17)<0.001
婚姻（婚）-0.35 (-1.07～0.36)0.335-0.38 (-1.09～0.34)0.302
BMI正常-1.40 (-2.26～-0.54)0.001-1.39 (-2.25～-0.53)0.001
BMI超重-1.44 (-2.33～-0.54)0.002-1.43 (-2.33～-0.53)0.002
BMI肥胖-0.92 (-1.90～0.07)0.068-0.92 (-1.90～0.07)0.069
慢性病数量3.71 (3.58～3.84)<0.0013.71 (3.58～3.84)<0.001
与子女同住0.30 (-0.05～0.64)0.0890.30 (-0.04～0.64)0.086
工作-1.47 (-1.87～-1.08)<0.001-1.48 (-1.87～-1.09)<0.001
家庭人均消费（中心化）-0.00 (-0.00～0.00)0.555-0.00 (-0.00～0.00)0.560
曾经吸烟-1.04 (-1.63～-0.45)0.001-1.03 (-1.62～-0.44)0.001
现在吸烟-0.78 (-1.41～-0.15)0.015-0.79 (-1.42～-0.16)0.014
曾经饮酒0.63 (0.08～1.18)0.0250.63 (0.08～1.18)0.025
现在饮酒-0.69 (-1.26～-0.12)0.018-0.69 (-1.26～-0.12)0.017
2种ACEs×社会参与0.06 (-0.12～0.25)0.502
3种ACEs×社会参与0.03 (-0.19～0.26)0.760
4种及以上ACEs×社会参与-0.05 (-0.29～0.19)0.695
2种ACEs×高中和职业培训学习-0.38 (-2.08～1.32)0.659
3种ACEs×高中和职业培训学习-0.12 (-2.07～1.83)0.904
4种及以上ACEs×高中和职业培训学习-0.47 (-2.84～1.91)0.700
2种ACEs×高等教育1.36 (-3.41～6.14)0.575
3种ACEs×高等教育1.11 (-4.83～7.04)0.714
4种及以上ACEs×高等教育-3.14 (-9.17～2.88)0.307
R20.0190.3320.332
调整后R20.0180.3310.330
AIC61 560.40060 449.60060 460.200
BIC61 603.30060 599.60060 674.500
RMSE6.4906.1106.110
), ArticleFig(id=1324078461626753602, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324078453598855700, language=CN, label=表3, caption=

多次观测样本的随机效应模型

, figureFileSmall=null, figureFileBig=null, tableContent=
变量基准模型（无控制变量）基准模型（含控制变量）调节效应模型（交互项模型）
β（95%CI）P值β（95%CI）P值β（95%CI）P值
2种ACEs0.83 (0.13～1.54)0.0200.41 (-0.11～0.92)0.1220.43 (-0.12～0.98)0.122
3种ACEs2.32 (1.48～3.16)<0.0011.05 (0.44～1.67)0.0011.05 (0.39～1.71)0.002
4种及以上ACEs4.35 (3.44～5.25)<0.0012.18 (1.52～2.85)<0.0012.26 (1.56～2.97)<0.001
社会参与（中心化）-0.21 (-0.29～-0.14)<0.001-0.23 (-0.36～-0.11)<0.001
高中和职业培训学习-2.94 (-3.66～-2.23)<0.001-2.75 (-3.87～-1.62)<0.001
高等教育-3.87 (-5.84～-1.91)<0.001-3.96 (-6.89～-1.03)0.008
年龄（中心化）0.14 (0.11～0.17)<0.0010.14 (0.11～0.17)<0.001
婚姻（婚）-0.35 (-1.07～0.36)0.335-0.38 (-1.09～0.34)0.302
BMI正常-1.40 (-2.26～-0.54)0.001-1.39 (-2.25～-0.53)0.001
BMI超重-1.44 (-2.33～-0.54)0.002-1.43 (-2.33～-0.53)0.002
BMI肥胖-0.92 (-1.90～0.07)0.068-0.92 (-1.90～0.07)0.069
慢性病数量3.71 (3.58～3.84)<0.0013.71 (3.58～3.84)<0.001
与子女同住0.30 (-0.05～0.64)0.0890.30 (-0.04～0.64)0.086
工作-1.47 (-1.87～-1.08)<0.001-1.48 (-1.87～-1.09)<0.001
家庭人均消费（中心化）-0.00 (-0.00～0.00)0.555-0.00 (-0.00～0.00)0.560
曾经吸烟-1.04 (-1.63～-0.45)0.001-1.03 (-1.62～-0.44)0.001
现在吸烟-0.78 (-1.41～-0.15)0.015-0.79 (-1.42～-0.16)0.014
曾经饮酒0.63 (0.08～1.18)0.0250.63 (0.08～1.18)0.025
现在饮酒-0.69 (-1.26～-0.12)0.018-0.69 (-1.26～-0.12)0.017
2种ACEs×社会参与0.06 (-0.12～0.25)0.502
3种ACEs×社会参与0.03 (-0.19～0.26)0.760
4种及以上ACEs×社会参与-0.05 (-0.29～0.19)0.695
2种ACEs×高中和职业培训学习-0.38 (-2.08～1.32)0.659
3种ACEs×高中和职业培训学习-0.12 (-2.07～1.83)0.904
4种及以上ACEs×高中和职业培训学习-0.47 (-2.84～1.91)0.700
2种ACEs×高等教育1.36 (-3.41～6.14)0.575
3种ACEs×高等教育1.11 (-4.83～7.04)0.714
4种及以上ACEs×高等教育-3.14 (-9.17～2.88)0.307
R20.0190.3320.332
调整后R20.0180.3310.330
AIC61 560.40060 449.60060 460.200
BIC61 603.30060 599.60060 674.500
RMSE6.4906.1106.110
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童年不良经历对衰弱的影响——基于社会参与和受教育程度的调节作用研究
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彭飞 1, 2 , 李玉芬 3 , 张琳琳 1
现代预防医学 | 儿少卫生与妇幼保健 2026,53(1): 88-93
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现代预防医学 |儿少卫生与妇幼保健 2026 , 53 (1) : 88 -93
童年不良经历对衰弱的影响——基于社会参与和受教育程度的调节作用研究
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彭飞1, 2, 李玉芬3, 张琳琳1
作者信息
  • 1.常州大学医学与健康工程学院，江苏 常州213164
  • 2.常州市西太湖医院门诊部，江苏 常州 213149
  • 3.常州大学瞿秋白政府管理学院
通讯作者:
张琳琳，E-mail:
作者简介:

彭飞（1980—），女，硕士在读，主管护师，研究方向：社区慢性病管理，老年健康行为机制研究

The moderating role of social participation and education level in the impact of adverse childhood experiences on frailty
Fei PENG1, 2, Yu-fen LI3, Lin-lin ZHANG1
Affiliations
  • School of Medical and Health Engineering, Changzhou University, Changzhou, Jiangsu 213164, China
出版时间: 2026-01-10 doi: 10.20043/j.cnki.MPM.202506479
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摘要
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目的

探讨童年不良经历（adverse childhood experiences, ACEs）对中老年人衰弱的影响，并探讨社会参与和受教育程度是否调节两者的关系。

方法

利用中国健康与养老追踪调查2011—2018四期数据，结合2014年生命历程专项调查构成面板数据，经豪斯曼检验显示χ2=261.490（P<0.001），故采用固定效应模型来探索ACEs与衰弱的关联，重点关注社会参与及受教育程度与衰弱间的关系，并探讨潜在的调节效应。

结果

共纳入9 354名研究对象，其中，约61.71%的个体经历过2种以上ACEs，衰弱患病率为15.01%，ACEs与衰弱呈显著正相关关系（ACEs=2:β=1.45,95% CI:0.64～2.26;ACEs=3:β=2.9,95% CI:2.00～3.86;ACEs=4:β=3.52,95% CI:2.48～4.56），且效应随ACEs数量升高而增强。横截面分析发现社会参与与衰弱呈显著负相关关系（β=-0.50,95% CI:-0.63～-0.30），高中或职业教育与衰弱呈显著负相关关系（β=-1.71,95% CI:-2.62～-0.80）。社会参与和受教育程度未显著调节ACEs与衰弱的关系（P>0.05）。

结论

我国中老年人群中，ACEs是影响衰弱发生的重要风险因素。社会参与及高中或职业教育与衰弱呈负相关关系，但两者并未显著调节ACEs与衰弱之间的关系。

童年不良经历  /  衰弱  /  社会参与  /  教育  /  调节作用
Objective

To examine whether adverse childhood experiences(ACEs) predict frailty in middle-aged and elderly Chinese adults, and whether social participation or education level moderates this association.

Methods

Four waves (2011—2018) of the China Health and Retirement Longitudinal Study were combined with the 2014 life-history module to construct panel data. Based on the Hausman test(χ2=261.490, P<0.001), a fixed-effects model was applied to examine the association between ACEs and frailty, with particular attention to social participation and educational attainment and potential moderating effects.

Results

A total of 9 354 individuals were retained, 61.71% had experienced two or more ACEs, and the prevalence of frailty was 15.01%. A significant positive correlation was observed between ACEs and frailty, with the effect intensifying as the number of ACEs increased (ACEs=2: β=1.45, 95% CI: 0.64~-2.26; ACEs=3: β=2.90, 95% CI: 2.00-3.86; ACEs=4: β=3.52,95% CI: 2.48-4.56). Social participation (β=-0.50, 95% CI: -0.63-0.30) and high school or vocational education (β=-1.71, 95% CI: -2.62-0.80) were cross-sectionally associated with lower frailty. However, neither social participation nor education level significantly moderated the relationship between ACEs and frailty (P>0.05).

Conclusion

Within the middle-aged and elderly population in China, ACEs had been identified as a significant risk factor for the development of frailty. Although both social participation and high school or vocational education were negatively associated with frailty, neither of these factors significantly moderated the relationship between ACEs and frailty.

Adverse childhood experiences  /  Frailty  /  Social participation  /  Education  /  Moderation
彭飞, 李玉芬, 张琳琳. 童年不良经历对衰弱的影响——基于社会参与和受教育程度的调节作用研究. 现代预防医学, 2026 , 53 (1) : 88 -93 . DOI: 10.20043/j.cnki.MPM.202506479
Fei PENG, Yu-fen LI, Lin-lin ZHANG. The moderating role of social participation and education level in the impact of adverse childhood experiences on frailty[J]. Modern Preventive Medicine, 2026 , 53 (1) : 88 -93 . DOI: 10.20043/j.cnki.MPM.202506479
正文
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童年不良经历（adverse childhood experiences,ACEs）指在儿童期经历消极或创伤性暴露事件，包括身体、情感和性虐待，身体和情感忽视以及家庭功能障碍等[1]。研究表明，相较未暴露于ACEs的个体，暴露于多个ACEs的个体衰弱水平更高[2]。衰弱是老年人生理储备下降致机体易损性增加，抗应激能力减退的非特异性状态[3]。有研究探讨对ACEs与衰弱之间关联的潜在因素进行干预，以降低暴露于ACEs引起的衰弱风险，而人口统计学和社会学因素常被用来研究它们是否与ACEs相关的不良健康结果有关[4]。生物学研究显示，儿童期经历较多ACEs的个体缺乏社会参与活动[5]，而社会参与活动每增加1个单位，衰弱指数可降低0.006[6]；研究表明ACEs与受教育程度低相关[1]，受教育程度较低的中老年人衰弱的风险增加[7]。基于此，假设社会参与及受教育程度在ACEs与衰弱间起负向调节作用。在健康老龄化背景下，本研究利用中国健康与养老追踪调查（China Health and Retirement Longitudinal Study,CHARLS）数据，分析中老年人ACEs对衰弱的影响，探讨社会参与及受教育程度的调节作用，以期调节社会参与及受教育程度来降低或延缓ACEs导致的衰弱风险，为改善老年人衰弱现状提供思路。
1　资料与方法
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1.1　数据来源
本文数据来源于CHARLS数据库，该数据由北京大学国家发展研究院发布。本研究收集2011、2013、2015和2018年数据，结合2014年生命历程专项调查构成面板数据，调查45岁以上的受访样本，经剔除缺失的关键变量，共筛选获得9 354个有效样本。CHARLS数据的收集获得了北京大学伦理审查委员会的伦理批准（IRB00001052-11015）。
1.2　变量选取与界定
参照既往研究[8]，本研究采用衰弱指数（frailty index）来评估衰弱。选取32项与年龄相关的健康缺陷构建衰弱指数：包括慢性病（高血压、心脏病、糖尿病、中风、癌症、关节炎、肺病、哮喘、精神疾病、记忆疾病）及自评健康状况，日常生活自理能力（穿衣、沐浴、进食、上下床、入厕）和工具性日常生活自理能力（做饭、打扫房屋、购物、服药、管理资金），残疾（视力、听力），步行100 m，从椅子上站起来，不休息爬几层楼梯，举起>5 kg的重物，从椅子上捡起硬币，弯腰跪下或蹲下，手臂举起过肩，抑郁和认知等变量。每个项目根据特定的临界值分为0或1，值为0表示不存在缺陷，1表示存在，当前健康缺陷之和除以32再乘以100，得出衰弱指数从0～100的数值。以衰弱指数 <10表示健康，衰弱指数在10～24之间为衰弱前状态，衰弱指数≥25为衰弱[7]，值越高表示衰弱程度越严重，以此作为本研究的被解释变量。
参照既往研究[9]，从CHARLS数据库提取12类不良经历构建本研究的ACEs指数：研究对象在17岁之前经历过身体虐待、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、父母分居或离婚、邻里不安全、被欺凌、父母或兄弟姐妹死亡及父母长期卧床。针对每一类不良经历，若受访者在童年时期曾发生任一事件，则该条目赋值为1分，否则赋值为0分，将12个二分类条目得分相加，得到ACEs指数，用以衡量ACEs的累积暴露水平；依据ACEs指数，将研究对象按暴露数量划分为四个等级：1级=经历过1种ACEs，2级=经历过2种ACEs，3级=经历过3种ACEs，4级=经历过4种及以上ACEs，以评估ACEs不同累积暴露水平对衰弱的剂量-反应关系。
社会参与是指有意识地、积极地与他人进行户外活动，从而带来个人满足感[10]。参照既往研究[4]，本研究采用七项社会参与活动的频数总和来描述社会参与情况，将社会参与活动的频率分四个等级并赋值（1=差不多每天，2=差不多每周，3=不经常，4=没有），社会参与频数总和为7～28分。根据1997年国际标准教育分类（ISCED-97）简化版，将受教育程度分为三个等级并赋值（1=低于初中学历，2=高中或职业培训学习，3=高等教育），以此作为本研究的调节变量。
根据既往研究[3]，将可能影响衰弱的年龄、性别、婚姻、居住地、是否子女同住、是否工作、身体质量指数（body mass index，BMI）（BMI分类：<18.5 kg/m2为低体重，18.5～23.9 kg/m2为标准体重，24 kg/m2≤BMI<27.9 kg/m2为超重，≥28 kg/m2为肥胖）、慢性病数量、家庭人均消费、曾经及现在吸烟饮酒史等作为本研究的控制变量。
1.3　统计方法
采用R 4.3.2进行统计分析。本研究构建了固定效应模型和随机效应模型，经豪斯曼检验（χ2=261.490，P<0.001）发现固定效应模型更适合本次研究数据。因此，采用固定效应模型来分析ACEs与中老年人衰弱的关系，并探讨社会参与及受教育程度在ACEs与衰弱之间的调节作用。以ACEs作为解释变量，构建基准模型，分析ACEs对衰弱的影响；随后加入年龄、性别、工作状态、婚姻状况、吸烟、饮酒、BMI、居住地、慢性病、家庭人均消费、是否与子女同住等控制变量，提高解释变量ACEs效应的准确性；分别加入ACEs与社会参与及ACEs与受教育程度交互项，建立调节效应模型。检验水准 α=0.05。
2　结果
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2.1　中老年人基本情况
从表1统计结果来看，研究人群的平均年龄（59.41±8.34）岁；衰弱指数平均（15.07±11.15）分，衰弱患病率15.01%；61.71%的人群有2种以上ACEs经历；63.25%的人群居住在农村，有52.36%的个体与子女同住；吸烟和饮酒的比例较低；88.44%的个体接受初中以下学历，10.36%的个体接受高中或职业教育；在参加社会活动的人群中，仅0.58%的个体参加继续教育或培训类社会活动。约43.21%的人群几乎不参加社会活动。
2.2　基准回归结果
从表2和表3的结果来看，本研究构建了考虑时间效应的固定效应和随机效应模型，经豪斯曼检验（χ2=261.490，P<0.001）发现固定效应模型更适合本次研究数据。仅将ACEs作为自变量进行回归，结果发现ACEs等级与衰弱指数呈显著正相关关系，表明童年不良经历越多，个体的衰弱程度越高。在加入年龄、性别、工作、婚姻、吸烟、饮酒、BMI、居住地、慢性病、家庭人均消费、是否与子女同住等控制变量后，ACEs对衰弱的正向作用依然显著。年龄每增加1个标准差，衰弱指数升高0.42，提示年龄是衰弱的风险因素；女性、无工作、居住在农村的个体衰弱程度较高；曾经饮酒的个体衰弱风险较高；横截面分析发现：超重的个体衰弱程度相对较低（β=-1.32,95% CI:-2.45～-0.19），未婚的个体衰弱程度相对较高（β=0.81,95% CI:0.01～1.61），现饮酒的个体衰弱风险降低（β=-1.67,95% CI:-2.53～-0.81），社会参与（中心化）与衰弱呈显著负相关关系（β=-0.50,95% CI:-0.63～-0.37），但在纵向固定效应模型中效应均消失；每增加1种慢性病，衰弱指数升高2.29，说明慢性病是衰弱的强预测因素；高中或职业教育与衰弱呈显著负相关关系（β=-1.71,95% CI:-2.62～-0.80），但接受高等教育的个体对衰弱的影响不显著。
2.3　调节效应结果
由表2及表3可知，在基准回归模型中加入“ACEs与社会参与的交互项”“ACEs与受教育程度的交互项”，并未发现统计学上显著的调节效应（P>0.05），说明社会参与及受教育程度未显著调节ACEs与衰弱的关系。
3　讨论
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3.1　我国中老年人衰弱特征及其影响因素
本研究发现衰弱的发生率为15.01%，比He等[8]研究的中国社区居民衰弱发生率的16.70%略低，这可能是由于本研究与He等研究的纳入对象年龄构成不同所致。He等的研究对象为≥50岁，本研究对象为45岁以上人群，低年龄段人群的衰弱发生率通常较低，因此低龄可能在整体上稀释了衰弱的发生率。约61.71%的人群有2种以上ACEs经历，经历ACEs越多，衰弱程度越重，与既往研究类似，因ACEs可能导致人体的应激反应失调、炎症水平增加及皮质醇水平增高，这些生理机制也参与了衰弱的发生发展[7]。随着年龄的增长，体内多种激素水平降低，线粒体功能障碍，诱发基因组不稳定和细胞损伤，进而导致肌肉萎缩和退化，更容易出现衰弱状态[11]。男性和女性在应对压力时性腺激素和神经内分泌功能的差异，以及女性绝经后体内睾酮素下降，影响神经肌肉平衡，导致肌肉水平低，可能导致女性衰弱发生率高[5]。居住在城市、教育水平高、有工作的个体衰弱程度相对较低，可能因较好的社会经济状况，能提供更好的医疗资源及经济收入，有助于维持健康状态[12]。本研究中慢性病数量是衰弱的最强预测因素，且随着疾病数量增多衰弱患病率有升高趋势，可能与多种慢性病患者自理能力下降、少动、营养不良、多重用药等相关[3]。
3.2　ACEs与中老年人衰弱呈正相关关系
本研究显示，经历不良事件越多衰弱程度越严重，在控制其他因素后ACEs对衰弱的促进作用依然显著，与以往研究一致[13]。童年时期暴露于ACEs，缺乏足够的保护机制会导致应激反应，损害大脑结构的发育，影响大脑边缘和前额叶皮层的神经生物改变，导致认知功能下降及成年后焦虑、抑郁增加，增加衰弱的风险[14]。因此，需要重视ACEs的长期危害，制定针对ACEs的早期干预策略，减轻ACEs带给个体的长期负面影响，促进儿童青少年健康成长和健康老龄化进展。
3.3　社会参与在ACEs与衰弱间的调节效应
本研究显示，中老年人几乎很少参加志愿活动（3.18%）或学习培训（0.58%），仅有2%的个体会经常参加社会活动，总体来说，中老年人的社会参与程度不高。本研究横截面分析证实社会参与与衰弱的负相关关系，但纵向固定效应模型中该效应消失，提示其影响可能受个体稳定特征（如基线健康）混淆，需进一步验证动态关联。有研究表明，社会参与可显著缓解ACEs对老年衰弱的影响，对改善高龄及居住在农村老人的衰弱状态更明显[6]；退休后进行工作参与能显著提高老年人的自评健康水平[15]。但在本研究中未发现社会参与显著调节ACEs与衰弱的关系，与既往研究不同，可能因为本研究人群的社会参与类型多为娱乐性活动，且参与频率不高，相对于参加志愿活动和学习培训类活动产生的调节效应不显著；此外，社会参与和老年人的健康可能存在互为因果关系，参与社会活动需要一定的体力和精力，而健康状况不佳会显著减少老年人参与社会活动的机会。因此，社会参与可能通过其他路径影响衰弱，而非调节ACEs与衰弱的路径。
3.4　受教育程度在ACEs与衰弱间的调节效应
本研究的中老年人约10.36%接受过高中/职业教育，仅1.2%的个体接受过高等教育。研究表明，ACEs与较低的教育程度相关[1]，受过高等教育的个体通常能获得更好的生活质量、社会支持和广泛的社交，使他们能够有效地应对ACEs带来的困难[16-17]。本研究证实了受教育程度与衰弱呈显著负相关关系，相对于接受初中教育的个体，接受高中/职业教育的个体其衰弱水平相对较低，但在本研究中未观测到接受过高等教育对衰弱的显著保护效应，可能因接受高等教育的个体所占比例较低有关。早期ACEs增加教育困难，在一定程度上影响后期知识的学习与积累能力，提升教育能显著提高中老年人的健康水平，改善衰弱状况[14]。但在本研究中未发现受教育程度显著调节ACEs与衰弱的关系，可能受数据库的限制，本研究仅包含早期学校教育，且研究对象成年后参加继续学习、培训的比例较低。
综上所述，本研究基于生命历程视角揭示了ACEs与衰弱发生风险之间的关联。需要指出的是，ACEs仅是生命历程早期暴露的一部分，而近期负性事件（如丧偶、失业等）可能通过累积效应或交互作用进一步加剧衰弱风险。未来研究需纳入近远期负性生活事件的时序效应分析，以构建全生命周期的衰弱风险预测模型，为分级干预提供科学依据。虽然一定程度的社会参与及教育是衰弱的保护因素，但在本研究中，他们并未显示出对ACEs与衰弱关系的显著调节作用，可能与变量构建的方法有关。本研究提示预防衰弱需从生命早期开始：增加养育照料、儿童安全保护方面的投资；为弱势儿童增加教育机会，有助于预防ACEs，并减轻其影响。同时，需关注成人职业技能培训，开设老年大学等，为老年人提供再学习及再就业的机会，使下一代在年老时能够提高自身的健康水平；鼓励相关部门加强老年志愿服务体系建设，将老年人志愿参与同社区治理相结合，使老年人在参与过程中获得成就感和幸福感，减缓衰老过程。未来应尝试开展持续的社会参与（如退休再就业）研究来进一步探讨ACEs对衰弱发生风险的因果路径，进一步阐明ACEs与衰弱的潜在关联，为制定预防或降低中老年人衰弱风险的干预措施提供依据。
尽管CHARLS数据库在老年健康研究领域具有权威地位，但ACEs的数据基于受访者的回忆获取，可能存在回忆偏差和选择性遗忘。目前，国内外对ACEs的测量方法不统一；且社会参与内容丰富、测量方式不同，可能影响结果的可比性。
基金
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  • 国家社会科学基金项目青年项目(22CSH057)
文献
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参考文献 引证文献
排序方式：
[1]
Bhutta ZA, Bhavnani S, Betancourt TS, et al. Adverse childhood experiences and lifelong health[J]. Nature Medicine, 2023, 29(7): 1639-1648.
[2]
Mian O, Anderson LN, Belsky DW, et al. Associations of adverse childhood experiences with frailty in older adults: a Cross-Sectional analysis of data from the Canadian longitudinal study on aging[J]. Gerontology, 2022,68(10): 1091-1100.
[3]
中华医学会老年医学分会，《中华老年医学杂志》编辑委员会.老年人衰弱预防中国专家共识(2022)[J].中华老年医学杂志，2022，41（5）：503-511.
Chinese Geriatrics Society, Editorial Board of Chinese Journal of Geriatrics.Chinese expert consensus on prevention of frailty in the elderly(2022)[J]. Chinese Journal of Geriatrics, 2022, 41(5): 503-511. (In Chinese)
[4]
Li JJ, Pei HM, Yan XJ, et al. Adverse childhood experiences and social participation on frailty state transitions among middle-aged and older adults:evidence from a 10-year prospective study in China[J]. Journal of Nutrition Health & Aging, 2024, 28(12): 100400.
[5]
Tao YM, Wang HY, Luo JS, et al. The association between adverse childhood experiences and frailty: a systematic review[J]. Journal of the American Medical Directors Association, 2024, 25(7): 105042.
[6]
盛亦男，刘远卓.社会参与对老年人健康的影响[J].中国人口科学，2022,（6）：97-110.
Sheng YN, Liu YZ. The impact of social participation on the health of older adults[J]. Chinese Journal of Population Science, 2022, (6): 97-110. (In Chinese)
[7]
Dimitriadis MM, Jeuring HW, Marijnissen RM, et al. Adverse childhood experiences and frailty in later Life: a prospective population-based cohort study[J]. Age and Ageing, 2023, 52(2): afad010.
[8]
He D, Qiu YW, Yan MS, et al. Associations of metabolic heterogeneity of obesity with frailty progression: Results from two prospective cohorts[J]. Journal of Cachexia, Sarcopenia and Muscle, 2023, 14(1): 632-641.
[9]
Lin L, Wang HH, Lu CY, et al. Adverse childhood experiences and subsequent chronic diseases among middle-aged or older adults in China and associations with demographic and socioeconomic characteristics[J]. JAMA Netw Open, 2021, 4(10): e2130143.
[10]
Dehi Aroogh M, Mohammadi Shahboulaghi F. Social participation of older adults: a concept analysis[J]. Int J Community Based Nurs Midwifery, 2020, 8(1): 55-72.
[11]
Ng YX, Cheng LJ, Quek YY, et al. The measurement properties and feasibility of FRAIL scale in older adults: A systematic review and meta-analysis[J]. Ageing Research Reviews, 2024, 95: 102243.
[12]
崔亚男，宫春博，王文燕，等.中老年慢性病患者卫生服务利用影响因素分析——基于CHARLS数据实证分析[J].现代预防医学，2023，50（13）：2389-2395.
Cui YN, Gong CB, Wang WY, et al. Analysis on influencing factors of health service utilization in middle-aged and elderly patients with chronic diseases: an empirical analysis based on CHARLS data[J]. Modern Preventive Medicine, 2023,50(13): 2389-2395. (In Chinese)
[13]
Yang G, Cao XQ, Yu J, et al. Association of childhood adversity with frailty and the mediating role of unhealthy lifestyle: a lifespan analysis[J]. The American Journal of Geriatric Psychiatry, 2024, 32(1): 71-82.
[14]
Laricchiuta D, Panuccio A, Picerni E, et al. The body keeps the score: The neurobiological profile of traumatized adolescents[J].Neuroscience & Biobehavioral Reviews, 2023, 145: 105033.
[15]
谢瑞瑞，刘晨，王琼，等.退休后工作参与和老年人自评健康状况的关联效应分析[J]. 现代预防医学，2021，48（22）：4145-4151.
Xie RR, Liu C, Wang Q, et al. Correlation effect between post retirement work participation and self-rated health status of the elderly[J]. Modern Preventive Medicine, 2021, 48(22): 4145-4151. (In Chinese)
[16]
何江泓，邝博咏，孙晓翠，等.中老年人童年不良经历与健康状况的关联研究[J].广东药科大学学报，2024，40（6）：129-135.
He JH, Kuang BY, Sun XC, et al. The association between adverse childhood experiences and health outcomes in middle-aged and elderly individuals[J]. Journal of Guangdong Pharmaceutical University, 2024, 40(6): 129-135. (In Chinese)
[17]
Ren ZY, Luo YN, Zheng XY, et al. Adverse childhood experiences from family and society contribute to increased risk of depressive symptoms and cognitive impairment: a cross-sectional study[J]. Gen Psychiatr, 2023, 36(4): e101039.
2026年第53卷第1期
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doi: 10.20043/j.cnki.MPM.202506479
  • 接收时间：2025-06-25
  • 首发时间：2026-11-02
  • 出版时间：2026-01-10
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  • 收稿日期：2025-06-25
基金
国家社会科学基金项目青年项目(22CSH057)
作者信息
    1.常州大学医学与健康工程学院，江苏 常州213164
    2.常州市西太湖医院门诊部，江苏 常州 213149
    3.常州大学瞿秋白政府管理学院

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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
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