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Article(id=1311350440848093583, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1311350363295417204, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202603251, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1773676800000, receivedDateStr=2026-03-17, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1790579908810, onlineDateStr=2026-09-28, pubDate=1787587200000, pubDateStr=2026-08-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1790579908810, onlineIssueDateStr=2026-09-28, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1790579908810, creator=13701087609, updateTime=1790579908810, updator=13701087609, issue=Issue{id=1311350363295417204, tenantId=1146029695717560320, journalId=1227665162245664772, year='2026', volume='53', issue='16', pageStart='2881', pageEnd='3072', issueExtLink='null', onlineDate='null', pubDate='1787587200000', pubDateStr='2026-08-25', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=1, specialIssue=null, createTime=1790579890321, creator='13701087609', updateTime=1790584112451, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1311368072267653663, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1311350363295417204, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1311368072267653664, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1311350363295417204, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=2887, endPage=2892, ext={EN=ArticleExt(id=1311350441141694864, articleId=1311350440848093583, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Factors influencing survival in dementia patients covered by long-term care insurance, Chengdu City, columnId=1228016567443718970, journalTitle=Modern Preventive Medicine, columnName=Epidemiology and Statistical Methods Advances, runingTitle=null, highlight=null, articleAbstract=
Objective

To systematically investigate the independent factors influencing the life expectancy of patients with dementia enrolled in the Chengdu Long-Term Care Insurance (hereinafter referred to as “LTCI”) system, and to provide high-quality evidence for implementing precision care, developing a risk stratification management system, and optimizing LTCI policies.

Methods

A retrospective cohort study design was employed. A total of 10 108 patients with dementia enrolled in Chengdu LTCI from January 2018 to April 2022 were included and followed up until July 2025. Baseline demographic characteristics, comorbidities, adverse events, and assessment data on cognitive function, activities of daily living, and neuropsychiatric behaviors were extracted. Using Python software, descriptive analysis, univariate tests, multicollinearity tests, multivariate logistic regression, Cox proportional hazards regression, and model performance evaluation were conducted.

Results

Among the 10 108 patients, 5 435(53.8%) died. Multivariate logistic regression indicated that age (OR=1.64, 95%CI：1.56-1.72), male gender (OR=1.63, 95%CI：1.47-1.80), mild dysphagia (OR=4.01, 95%CI：3.30-4.88), and >2 comorbidities (OR=1.50, 95%CI：1.31-1.73) were independent risk factors for mortality, while moderate cognitive impairment (OR=0.29, 95%CI：0.18-0.46) and higher education level (OR=0.77, 95%CI：0.64-0.91) were independent protective factors (all P<0.05). Multivariate Cox regression showed that gender (male: HR=1.412, 95%CI:1.336-1.491), age (HR=1.039, 95%CI:1.036-1.042), number of comorbidities (HR=1.226, 95%CI:1.143-1.316), adverse events (HR=1.293, 95%CI:1.141-1.466), and swallowing function (HR=1.092, 95%CI:1.059-1.126) were risk factors for survival, whereas better cognitive function (HR=0.399, 95%CI:0.357-0.446), activities of daily living (HR=0.948, 95%CI:0.911-0.985), higher education level (HR=0.964, 95%CI:0.944-0.985), and history of surgery (HR=0.789, 95%CI:0.661-0.940) were protective factors (all P<0.05). The AUC of the logistic regression model was 0.7315, and the Cox regression model showed good calibration and discrimination (24-month calibration slope=1.084) with strong stability.

Conclusion

The life expectancy of patients with dementia under long-term care is influenced by multidimensional factors. Abnormal swallowing function, advanced age, and male gender are core risk factors, while family care, higher education level, and better functional status are key protective factors. The constructed Cox regression model can be effectively used for clinical risk assessment, and targeted interventions are expected to improve patient prognosis.

, authors=Zhu ZHOU1, Hong-shan PU1, Li-sha HOU1, Shu-juan YANG2, Qing-yu DOU1, authorsList=Zhu ZHOU, Hong-shan PU, Li-sha HOU, Shu-juan YANG, Qing-yu DOU, authorCompany=null, correspAuthors=Qing-yu DOU, 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=1311350442228019603, articleId=1311350440848093583, tenantId=1146029695717560320, journalId=1227665162245664772, language=CN, title=成都市长期照护险失智人群生存影响因素分析, columnId=1228016567632462653, journalTitle=现代预防医学, columnName=流行病与统计方法, runingTitle=null, highlight=null, articleAbstract=
目的

系统探究成都市长照护保险（以下简称“长照险”）参保失智症患者预期寿命的独立影响因素，为临床实施精准照护、构建风险分层管理体系及优化长照险政策提供高质量循证依据。

方法

采用回顾性队列研究设计，纳入2018年1月至2022年4月成都市参保并确诊为失智症的10 108例患者， 随访至2025年7月，提取基线人口学特征、共病、不良事件及认知功能、日常生活能力及精神行为评估数据，通过Python软件开展描述性分析、单因素检验、多重共线性检验、多因素logistic回归、COX 比例风险回归及模型效能评价。

结果

10 108例患者中，死亡5 435例（53.8%）。多因素logistic回归表明年龄（OR=1.64，95%CI：1.56～1.72）、男性（OR=1.63，95%CI：1.47～1.80）、吞咽轻度困难（OR=4.01，95%CI：3.30～4.88）、共病>2种（OR=1.50，95%CI：1.31～1.73）等为死亡风险独立危险因素，认知功能中度受损（OR=0.29，95%CI：0.18～0.46）、高教育水平（OR=0.77，95%CI：0.64～0.91）等为独立保护因素（均P<0.05）。多因素COX回归显示性别（男性HR=1.412，95%CI：1.336～1.491）、年龄（HR=1.039，95%CI：1.036～1.042）、共病数（HR=1.226，95%CI：1.143～1.316）、不良事件（HR=1.293，95%CI：1.141～1.466）、吞咽功能（HR=1.092，95%CI：1.059～1.126）等为生存的危险因素，较好的认知功能（HR=0.399，95%CI：0.357～0.446）、日常生活能力（HR=0.948，95%CI：0.911～0.985）、较高教育水平（HR=0.964，95%CI：0.944～0.985）、手术史（HR=0.789，95%CI：0.661～0.940）等为保护因素（均 P<0.05）。Logistic回归模型 AUC=0.7315，COX回归模型校准度与判别能力良好（24个月校准斜率=1.084），稳定性强。

结论

长期照护下失智症患者预期寿命受多维度因素影响，吞咽功能异常、高龄、男性是核心危险因素，家庭照护、高教育水平、良好功能状态是关键保护因素。构建的COX回归模型可有效用于临床风险评估，针对性干预措施有望改善患者预后。

, authors=周著1, 蒲虹杉1, 侯利莎1, 杨淑娟2, 窦青瑜1, authorsList=周著, 蒲虹杉, 侯利莎, 杨淑娟, 窦青瑜, authorCompany=null, correspAuthors=窦青瑜, authorNote=

周著（1999—），男，硕士在读，研究方向：老年心血管疾病

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窦青瑜，E-mail：
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BMC Nursing, 2025, 24(1): 37., articleTitle=Mediating effect of social support on the relationships between caregiver burden and quality of life in family caregivers of people with dementia: a cross-sectional study in rural China, refAbstract=null), Reference(id=1311350450297860564, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350440848093583, doi=null, pmid=null, pmcid=null, year=2025, volume=21, issue=5, pageStart=null, pageEnd=null, url=null, language=null, rfNumber=[15], rfOrder=15, authorNames=Kim S, Yoo J, journalName=Alzheimers Dement, refType=null, unstructuredReference=Kim S, Yoo J. Association of health-care and long-term care resources for patients with dementia with institutionalization and death: evidence from South Korea［J］. Alzheimers Dement, 2025, 21(5): e70271., articleTitle=Association of health-care and long-term care resources for patients with dementia with institutionalization and death: evidence from South Korea, refAbstract=null), Reference(id=1311350450381746645, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350440848093583, doi=null, pmid=null, pmcid=null, year=2025, volume=9, issue=Supplement_2, pageStart=4218, pageEnd=null, url=null, language=null, rfNumber=[16], rfOrder=16, authorNames=Kong D, journalName=Innov Aging, refType=null, unstructuredReference=Kong D. Training dementia care partners in rural China: a mixed-methods randomized controlled feasibility trial［J］. Innov Aging, 2025, 9(Supplement_2): 4218., articleTitle=Training dementia care partners in rural China: a mixed-methods randomized controlled feasibility trial, refAbstract=null), Reference(id=1311350450436272598, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350440848093583, doi=null, pmid=null, pmcid=null, year=2025, volume=73, issue=4, pageStart=1179, pageEnd=1188, url=null, language=null, rfNumber=[17], rfOrder=17, authorNames=Hunt LJ, Morrison RS, Gan S, journalName=Journal of the American Geriatrics Society, refType=null, unstructuredReference=Hunt LJ, Morrison RS, Gan S, et al. Mortality and function after hip fracture or pneumonia in people with and without dementia［J］. Journal of the American Geriatrics Society, 2025, 73(4): 1179-1188., articleTitle=Mortality and function after hip fracture or pneumonia in people with and without dementia, refAbstract=null)], funds=[Fund(id=1311350447307321796, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350440848093583, awardId=2023YFC3604701, language=CN, fundingSource=国家重点研发项目(2023YFC3604701), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1311350442462900628, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350440848093583, xref=1., ext=[AuthorCompanyExt(id=1311350442471289237, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350440848093583, companyId=1311350442462900628, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Center for Gerontology and Geriatrics, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China), AuthorCompanyExt(id=1311350442479677846, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350440848093583, companyId=1311350442462900628, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1.四川大学华西医院老年医学中心，国家老年疾病临床医学研究中心，四川 成都 610041)]), AuthorCompany(id=1311350442567758231, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350440848093583, xref=2., ext=[AuthorCompanyExt(id=1311350442580341144, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350440848093583, companyId=1311350442567758231, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2.四川大学华西公共卫生学院)])], figs=[ArticleFig(id=1311350446262940092, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350440848093583, language=EN, label=Fig, caption=Calibration curve of the survival prediction model for dementia patients, figureFileSmall=8IK+Auz1mFP0IQ2rjgFl6Q==, figureFileBig=pxYhd5pBHkRmrD1tkVEJwA==, tableContent=null), ArticleFig(id=1311350446330048957, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350440848093583, language=CN, label=图1, caption=失智人群生存预测模型的校准曲线, figureFileSmall=8IK+Auz1mFP0IQ2rjgFl6Q==, figureFileBig=pxYhd5pBHkRmrD1tkVEJwA==, tableContent=null), ArticleFig(id=1311350446539764158, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350440848093583, language=EN, label=Table 1, caption=

Univariate analysis of characteristics between survival and death groups［n(%)］

, figureFileSmall=null, figureFileBig=null, tableContent=
变量类别生存组
(n=5 435)		死亡组
(n=4 673)		χ2dfP
性别71.1921<0.001
女3 078(56.6)3 032(64.9)
男2 357(43.4)1 641(35.1)
年龄（岁）381.9551<0.001
<801 579(29.1)2 242(48.0)
≥803 856(70.9)2 431(52.0)
教育水平9.12820.01
低学历3 714(68.3)3 063(65.5)
中学历1 286(23.7)1 190(25.5)
高学历435(8.0)420(9.0)
照护模式21.0671<0.001
家庭照护4 392(80.8)3 940(84.3)
机构照护1 043(19.2)733(15.7)
吞咽功能435.3034<0.001
无问题3 985(73.3)4 182(89.5)
轻度困难874(16.1)265(5.7)
中度困难322(5.9)151(3.2)
重度困难189(3.5)60(1.3)
无法吞咽65(1.2)15(0.3)
失语症170.1683<0.001
无4 571(84.1)4 310(92.2)
轻度467(8.6)241(5.2)
中度242(4.5)82(1.8)
重度155(2.9)40(0.9)
日常生活能力343.2583<0.001
完好37(0.7)21(0.4)
轻度受损1 453(26.7)2 064(44.2)
中度受损3 165(58.2)2 142(45.8)
重度受损780(14.4)446(9.5)
精神行为能力69.3363<0.001
完好235(4.3)147(3.1)
轻度受损4 198(77.2)3 358(71.9)
中度受损948(17.4)1 103(23.6)
重度受损54(1.0)65(1.4)
认知功能378.9892<0.001
完好/轻度受损44(0.8)33(0.7)
中度受损208(3.8)697(14.9)
重度受损5 183(95.4)3 943(84.4)
共病数（种）105.7851<0.001
≤24 470(82.2)4 181(89.5)
>2965(17.8)492(10.5)
手术史5.31910.021
无5 289(97.3)4 581(98.0)
有146(2.7)92(2.0)
), ArticleFig(id=1311350446619455935, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350440848093583, language=CN, label=表1, caption=

生存组与死亡组各指标单因素分析比较［n(%)］

, figureFileSmall=null, figureFileBig=null, tableContent=
变量类别生存组
(n=5 435)		死亡组
(n=4 673)		χ2dfP
性别71.1921<0.001
女3 078(56.6)3 032(64.9)
男2 357(43.4)1 641(35.1)
年龄（岁）381.9551<0.001
<801 579(29.1)2 242(48.0)
≥803 856(70.9)2 431(52.0)
教育水平9.12820.01
低学历3 714(68.3)3 063(65.5)
中学历1 286(23.7)1 190(25.5)
高学历435(8.0)420(9.0)
照护模式21.0671<0.001
家庭照护4 392(80.8)3 940(84.3)
机构照护1 043(19.2)733(15.7)
吞咽功能435.3034<0.001
无问题3 985(73.3)4 182(89.5)
轻度困难874(16.1)265(5.7)
中度困难322(5.9)151(3.2)
重度困难189(3.5)60(1.3)
无法吞咽65(1.2)15(0.3)
失语症170.1683<0.001
无4 571(84.1)4 310(92.2)
轻度467(8.6)241(5.2)
中度242(4.5)82(1.8)
重度155(2.9)40(0.9)
日常生活能力343.2583<0.001
完好37(0.7)21(0.4)
轻度受损1 453(26.7)2 064(44.2)
中度受损3 165(58.2)2 142(45.8)
重度受损780(14.4)446(9.5)
精神行为能力69.3363<0.001
完好235(4.3)147(3.1)
轻度受损4 198(77.2)3 358(71.9)
中度受损948(17.4)1 103(23.6)
重度受损54(1.0)65(1.4)
认知功能378.9892<0.001
完好/轻度受损44(0.8)33(0.7)
中度受损208(3.8)697(14.9)
重度受损5 183(95.4)3 943(84.4)
共病数（种）105.7851<0.001
≤24 470(82.2)4 181(89.5)
>2965(17.8)492(10.5)
手术史5.31910.021
无5 289(97.3)4 581(98.0)
有146(2.7)92(2.0)
), ArticleFig(id=1311350446711730624, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350440848093583, language=EN, label=Table 2, caption=

Multivariate logistic regression analysis of factors influencing survival in dementia patients

, figureFileSmall=null, figureFileBig=null, tableContent=
变量变量分类系数标准误z值POR（95%CI）
性别女----参考
男0.4880.0529.374<0.001 01.63(1.47～1.80)
年龄年龄0.4950.02619.386<0.001 01.64（1.56～1.72）
教育水平低学历----参考
中学历0.0060.0630.0980.921 71.01(0.89～1.14)
高学历-0.2670.089-3.0120.002 60.77(0.64～0.91)
照护模式居家照护----参考
机构照护0.1820.0662.7430.006 11.20(1.05～1.37)
共病数≤2种----参考
>2种0.4090.0725.682<0.001 01.50(1.31～1.73)
吞咽功能无问题----参考
轻度困难1.3890.10013.93<0.001 04.01(3.30～4.88)
中度困难0.9310.1396.699<0.001 02.54(1.93～3.33)
重度困难0.9670.195.100<0.001 02.63(1.81～3.81)
无法吞咽0.9410.3432.7430.006 12.56(1.31～5.02)
失语症无----参考
轻度-0.3540.118-2.9900.002 80.70(0.56～0.89)
中度0.2590.1711.5130.130 31.65(1.03～2.62)
重度0.5000.2372.1030.035 41.30(0.93～1.81)
认知功能完好/轻度受损----参考
中度受损-1.2430.237-5.237<0.001 00.29(0.18～0.46)
重度受损0.0720.2390.3020.762 81.07(0.67～1.72)
精神行为能力完好/轻度受损----参考
中度受损-0.4300.056-7.672<0.001 00.65(0.58～0.73)
重度受损-0.6290.201-3.1340.001 70.53(0.36～0.79)
日常生活能力完好/轻度受损----参考
中度受损0.5880.05410.825<0.001 01.80(1.62～2.00)
重度受损0.7480.0868.701<0.001 02.11(1.79～2.50)
手术史无----参考
有-0.3210.186-1.7240.084 70.73(0.50～1.04)
不良事件无----参考
有0.3420.1452.3660.018 01.41(1.06～1.87)
), ArticleFig(id=1311350446908862913, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350440848093583, language=CN, label=表2, caption=

影响失智人群生存的多因素logistic回归分析

, figureFileSmall=null, figureFileBig=null, tableContent=
变量变量分类系数标准误z值POR（95%CI）
性别女----参考
男0.4880.0529.374<0.001 01.63(1.47～1.80)
年龄年龄0.4950.02619.386<0.001 01.64（1.56～1.72）
教育水平低学历----参考
中学历0.0060.0630.0980.921 71.01(0.89～1.14)
高学历-0.2670.089-3.0120.002 60.77(0.64～0.91)
照护模式居家照护----参考
机构照护0.1820.0662.7430.006 11.20(1.05～1.37)
共病数≤2种----参考
>2种0.4090.0725.682<0.001 01.50(1.31～1.73)
吞咽功能无问题----参考
轻度困难1.3890.10013.93<0.001 04.01(3.30～4.88)
中度困难0.9310.1396.699<0.001 02.54(1.93～3.33)
重度困难0.9670.195.100<0.001 02.63(1.81～3.81)
无法吞咽0.9410.3432.7430.006 12.56(1.31～5.02)
失语症无----参考
轻度-0.3540.118-2.9900.002 80.70(0.56～0.89)
中度0.2590.1711.5130.130 31.65(1.03～2.62)
重度0.5000.2372.1030.035 41.30(0.93～1.81)
认知功能完好/轻度受损----参考
中度受损-1.2430.237-5.237<0.001 00.29(0.18～0.46)
重度受损0.0720.2390.3020.762 81.07(0.67～1.72)
精神行为能力完好/轻度受损----参考
中度受损-0.4300.056-7.672<0.001 00.65(0.58～0.73)
重度受损-0.6290.201-3.1340.001 70.53(0.36～0.79)
日常生活能力完好/轻度受损----参考
中度受损0.5880.05410.825<0.001 01.80(1.62～2.00)
重度受损0.7480.0868.701<0.001 02.11(1.79～2.50)
手术史无----参考
有-0.3210.186-1.7240.084 70.73(0.50～1.04)
不良事件无----参考
有0.3420.1452.3660.018 01.41(1.06～1.87)
), ArticleFig(id=1311350447005331906, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350440848093583, language=EN, label=Table 3, caption=

Multivariate cox regression analysis of factors influencing survival time in dementia patients

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变量HR值（95%CI）P
性别1.412(1.336~1.491)<0.001
年龄1.039(1.036~1.042)<0.001
教育水平0.964(0.944~0.985)0.001
照护模式1.097(1.024~1.175)0.008
共病数1.226(1.143~1.316)<0.001
吞咽功能1.092(1.059~1.126)<0.001
失语症1.031(0.985~1.079)0.193
认知功能0.399(0.357~0.446)<0.001
精神行为能力0.955(0.912~1.001)0.055
日常生活能力0.948(0.911~0.985)0.007
手术史0.789(0.661~0.940)0.008
不良事件1.293(1.141~1.466)<0.001
), ArticleFig(id=1311350447089217987, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350440848093583, language=CN, label=表3, caption=

影响失智人群生存时间的多因素COX分析

, figureFileSmall=null, figureFileBig=null, tableContent=
变量HR值（95%CI）P
性别1.412(1.336~1.491)<0.001
年龄1.039(1.036~1.042)<0.001
教育水平0.964(0.944~0.985)0.001
照护模式1.097(1.024~1.175)0.008
共病数1.226(1.143~1.316)<0.001
吞咽功能1.092(1.059~1.126)<0.001
失语症1.031(0.985~1.079)0.193
认知功能0.399(0.357~0.446)<0.001
精神行为能力0.955(0.912~1.001)0.055
日常生活能力0.948(0.911~0.985)0.007
手术史0.789(0.661~0.940)0.008
不良事件1.293(1.141~1.466)<0.001
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成都市长期照护险失智人群生存影响因素分析
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周著 1 , 蒲虹杉 1 , 侯利莎 1 , 杨淑娟 2 , 窦青瑜 1
现代预防医学 | 流行病与统计方法 2026,53(16): 2887-2892
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现代预防医学 |流行病与统计方法 2026 , 53 (16) : 2887 -2892
成都市长期照护险失智人群生存影响因素分析
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周著（1999—），男，硕士在读，研究方向：老年心血管疾病

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周著（1999—），男，硕士在读，研究方向：老年心血管疾病

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周著1, 蒲虹杉1, 侯利莎1, 杨淑娟2, 窦青瑜1
作者信息
  • 1.四川大学华西医院老年医学中心，国家老年疾病临床医学研究中心，四川 成都 610041
  • 2.四川大学华西公共卫生学院
通讯作者:
窦青瑜，E-mail：
作者简介:

周著（1999—），男，硕士在读，研究方向：老年心血管疾病

Factors influencing survival in dementia patients covered by long-term care insurance, Chengdu City
Zhu ZHOU1, Hong-shan PU1, Li-sha HOU1, Shu-juan YANG2, Qing-yu DOU1
Affiliations
  • Center for Gerontology and Geriatrics, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
出版时间: 2026-08-25 doi: 10.20043/j.cnki.MPM.202603251
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摘要
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目的

系统探究成都市长照护保险（以下简称“长照险”）参保失智症患者预期寿命的独立影响因素，为临床实施精准照护、构建风险分层管理体系及优化长照险政策提供高质量循证依据。

方法

采用回顾性队列研究设计，纳入2018年1月至2022年4月成都市参保并确诊为失智症的10 108例患者， 随访至2025年7月，提取基线人口学特征、共病、不良事件及认知功能、日常生活能力及精神行为评估数据，通过Python软件开展描述性分析、单因素检验、多重共线性检验、多因素logistic回归、COX 比例风险回归及模型效能评价。

结果

10 108例患者中，死亡5 435例（53.8%）。多因素logistic回归表明年龄（OR=1.64，95%CI：1.56～1.72）、男性（OR=1.63，95%CI：1.47～1.80）、吞咽轻度困难（OR=4.01，95%CI：3.30～4.88）、共病>2种（OR=1.50，95%CI：1.31～1.73）等为死亡风险独立危险因素，认知功能中度受损（OR=0.29，95%CI：0.18～0.46）、高教育水平（OR=0.77，95%CI：0.64～0.91）等为独立保护因素（均P<0.05）。多因素COX回归显示性别（男性HR=1.412，95%CI：1.336～1.491）、年龄（HR=1.039，95%CI：1.036～1.042）、共病数（HR=1.226，95%CI：1.143～1.316）、不良事件（HR=1.293，95%CI：1.141～1.466）、吞咽功能（HR=1.092，95%CI：1.059～1.126）等为生存的危险因素，较好的认知功能（HR=0.399，95%CI：0.357～0.446）、日常生活能力（HR=0.948，95%CI：0.911～0.985）、较高教育水平（HR=0.964，95%CI：0.944～0.985）、手术史（HR=0.789，95%CI：0.661～0.940）等为保护因素（均 P<0.05）。Logistic回归模型 AUC=0.7315，COX回归模型校准度与判别能力良好（24个月校准斜率=1.084），稳定性强。

结论

长期照护下失智症患者预期寿命受多维度因素影响，吞咽功能异常、高龄、男性是核心危险因素，家庭照护、高教育水平、良好功能状态是关键保护因素。构建的COX回归模型可有效用于临床风险评估，针对性干预措施有望改善患者预后。

长期照护保险  /  失智症  /  生存  /  影响因素  /  COX比例风险回归
Objective

To systematically investigate the independent factors influencing the life expectancy of patients with dementia enrolled in the Chengdu Long-Term Care Insurance (hereinafter referred to as “LTCI”) system, and to provide high-quality evidence for implementing precision care, developing a risk stratification management system, and optimizing LTCI policies.

Methods

A retrospective cohort study design was employed. A total of 10 108 patients with dementia enrolled in Chengdu LTCI from January 2018 to April 2022 were included and followed up until July 2025. Baseline demographic characteristics, comorbidities, adverse events, and assessment data on cognitive function, activities of daily living, and neuropsychiatric behaviors were extracted. Using Python software, descriptive analysis, univariate tests, multicollinearity tests, multivariate logistic regression, Cox proportional hazards regression, and model performance evaluation were conducted.

Results

Among the 10 108 patients, 5 435(53.8%) died. Multivariate logistic regression indicated that age (OR=1.64, 95%CI：1.56-1.72), male gender (OR=1.63, 95%CI：1.47-1.80), mild dysphagia (OR=4.01, 95%CI：3.30-4.88), and >2 comorbidities (OR=1.50, 95%CI：1.31-1.73) were independent risk factors for mortality, while moderate cognitive impairment (OR=0.29, 95%CI：0.18-0.46) and higher education level (OR=0.77, 95%CI：0.64-0.91) were independent protective factors (all P<0.05). Multivariate Cox regression showed that gender (male: HR=1.412, 95%CI:1.336-1.491), age (HR=1.039, 95%CI:1.036-1.042), number of comorbidities (HR=1.226, 95%CI:1.143-1.316), adverse events (HR=1.293, 95%CI:1.141-1.466), and swallowing function (HR=1.092, 95%CI:1.059-1.126) were risk factors for survival, whereas better cognitive function (HR=0.399, 95%CI:0.357-0.446), activities of daily living (HR=0.948, 95%CI:0.911-0.985), higher education level (HR=0.964, 95%CI:0.944-0.985), and history of surgery (HR=0.789, 95%CI:0.661-0.940) were protective factors (all P<0.05). The AUC of the logistic regression model was 0.7315, and the Cox regression model showed good calibration and discrimination (24-month calibration slope=1.084) with strong stability.

Conclusion

The life expectancy of patients with dementia under long-term care is influenced by multidimensional factors. Abnormal swallowing function, advanced age, and male gender are core risk factors, while family care, higher education level, and better functional status are key protective factors. The constructed Cox regression model can be effectively used for clinical risk assessment, and targeted interventions are expected to improve patient prognosis.

Long-term care insurance  /  Dementia  /  Survival  /  Influencing factors  /  Cox proportional hazards regression
周著, 蒲虹杉, 侯利莎, 杨淑娟, 窦青瑜. 成都市长期照护险失智人群生存影响因素分析. 现代预防医学, 2026 , 53 (16) : 2887 -2892 . DOI: 10.20043/j.cnki.MPM.202603251
Zhu ZHOU, Hong-shan PU, Li-sha HOU, Shu-juan YANG, Qing-yu DOU. Factors influencing survival in dementia patients covered by long-term care insurance, Chengdu City[J]. Modern Preventive Medicine, 2026 , 53 (16) : 2887 -2892 . DOI: 10.20043/j.cnki.MPM.202603251
正文
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随着我国人口老龄化进程持续加速，失智症已成为威胁老年人群健康与生命质量的重大疾病，其不可逆的认知功能衰退、进行性日常生活能力丧失，不仅给患者家庭带来沉重照护负担，也对长期照护保险制度的可持续发展提出严峻挑战［1］。长期照护保险作为应对人口老龄化的重要制度安排，重点覆盖失智、失能等需长期照护的特殊人群，而该群体的生存寿命直接关联照护资源配置、服务模式优化及保险基金管控效率。
目前，国内外关于失智人群预期寿命影响因素的研究多聚焦于单一病理类型或个别功能指标，对长期照护保险覆盖下失智人群的针对性研究较为匮乏。与普通失智患者相比，长期照护险参保失智人群需同时满足临床诊断标准与照护需求评估，其生存结局受人口学特征、共病情况、认知功能、日常生活能力和精神行为能力、不良事件及照护模式等多维度因素共同影响，机制更为复杂。
基于此，本研究以成都市长照护保险参保失智患者为研究对象，通过系统的基线分析、单因素比较及多因素回归分析，全面识别影响其生存寿命的核心因素，为开展精准化照护干预、实施风险分层管理及优化长期照护保险政策提供科学的循证依据。
1　资料与方法
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本研究为回顾性队列研究，研究数据均依托成都市长照护保险参保评估体系及管理数据库，基线资料为老年人首次完成成都市长照护保险纳入评估并成功参保之时的状态，生存结局数据通过公安机关户籍死亡登记系统导出，全程严格遵循回顾性队列研究的设计规范与数据溯源要求。
1.1　研究对象
本研究以2018年1月至2025年7月期间，成都市长期照护保险参保人群中经临床确诊的15 797例失智症患者为研究对象。研究纳入标准包括：（1）符合《国际疾病分类第十版》（ICD-10）中阿尔茨海默病、血管性痴呆等痴呆诊断标准；（2）完成成都市长照险正式纳入评估并成功参保，且评估及参保状态在观察期内持续有效；（3）长照险评估档案中人口学特征、共病情况、认知功能、日常生活能力及精神行为能力、不良事件、照护模式等数据完整，并有明确的公安机关生存随访结局记录。排除标准为：（1）诊断为短暂性认知障碍或由代谢、中毒等因素导致的可逆性认知损害者；（2）合并严重肝肾功能衰竭、恶性肿瘤晚期等预计生存期不足3个月的终末期疾病患者；（3）长照险关键评估资料缺失、中途退保或公安机关无明确生存状态记录的失访者。
在初步筛选的队列中，进一步排除纳入后30天内死亡者（3 183人）、无法提供受教育水平者（2 150人）以及缺失数值超过半数（57项）者（356人），最终纳入10 108例患者进行分析。死亡数据来源于成都市医保数据库及死因监测系统。随访终点定义为全因死亡，随访时间自患者首次完成长照险纳入评估并参保之日起，至死亡日期、失访日期或研究截止日期（2025年7月）止，以最先发生者为准。本研究最终纳入的10 108例患者均具有完整的随访结局，中位随访时间为664天。
1.2　研究指标
所有研究指标均基于成都市长照护保险纳入评估内容及标准化数据库提取，无额外人工补充指标，具体分为基线暴露指标和结局指标两类：
基线暴露指标（入长照险时评估）：（1）人口学特征：性别、年龄、教育水平、照护模式。其中，照护模式分为家庭照护与机构照护：家庭照护指独居，或主要由家属、保姆在家中提供日常照护，以及由社区人员提供社区日常照护；机构照护指患者在养老院、护理院、福利中心等专业照护机构中接受集中照护；（2）健康相关特征：1个月内意外事件发生情况（包括：烫伤、走失、跌倒、坠床、噎食、自杀、压疮等）、基础疾病、共病数量；（3）手术史：指纳入评估前（即首次参保评估时）患者自报或病历记录的任一手术操作史，不限定手术类型及发生时间；（4）功能状态评估：认知功能、日常生活活动能力、精神行为能力、吞咽功能、失语症。其中认知功能评估依据简易精神状态检查表（Mini-Mental State Examination, MMSE），日常生活能力依据调整后的日常生活能力（Activity of Daily Living,ADL）评定量表，精神行为能力依据调整后的神经精神症状问卷（Neuropsychiatric Inventory, NPI）。
结局指标：（1）生存状态：存活/死亡，作为分类结局指标；（2）生存时间：从老年人首次完成长照险纳入评估并参保之日起，至公安机关登记的死亡日期或研究截止日期（2025年7月），作为时间结局指标，单位为天。
1.3　研究方法
基线描述性分析：采用描述性统计学方法，对全部研究对象的基线人口学、健康相关及功能状态指标进行统计描述，计数资料以例数（百分比）［n(%)］表示。
单因素分析：以老年人最终生存状态（存活=0，死亡=1）为二分类因变量，将所有基线暴露指标作为自变量，进行单因素logistic回归分析，筛选出P<0.1的有统计学意义的变量，作为后续多因素分析的候选变量。
共线性分析：对单因素分析筛选出的候选变量进行多重共线性检验，排除方差膨胀因子（VIF）>10的高度共线性变量，保证后续回归模型的稳定性。
多因素logistic回归分析：将经共线性检验后的候选变量纳入多因素logistic回归模型，分析影响失智症患者生存状态（死亡）的独立影响因素，计算各因素的比值比（OR）及其95%置信区间（95%CI）。
COX比例风险回归分析：以生存时间为因变量，以患者是否发生死亡为结局事件（删失=0，死亡=1），将上述候选变量纳入COX比例风险回归模型，检验并满足比例风险假定后，分析影响失智症患者生存时间的独立危险因素，计算各因素的风险比（HR）及其95%置信区间（95%CI）。
1.4　统计学处理
采用Python软件（版本号3.10.11）进行全部数据分析，使用pandas（数据清洗与整理）、scipy（单因素检验与共线性分析）、statsmodels（logistic回归与COX回归建模）、sklearn（模型评价与交叉验证）等数据分析库。所有假设检验均为双侧检验，检验水准α设定为0.05，P<0.05为差异具有统计学意义；单因素筛选阶段放宽检验水准至P<0.1，以减少潜在影响因素的遗漏。
2　结果
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2.1　基线资料特征
本研究纳入10 108例长照险参保失智症患者，随访期内死亡5 435例（53.8%），存活4 673例（46.2%）。人群特征：女性占60.4%，80岁以上占62.2%，低学历占67.0%，独居占82.4%。功能状态方面，吞咽功能正常占80.8%，认知重度缺损占90.3%，日常生活能力中重度缺损占64.6%。
2.2　单因素logistics分析结果
单因素分析显示，存活组与死亡组在性别、年龄、教育水平、居住状态、吞咽功能、失语症、日常生活能力、精神行为能力、认知功能、共病数及意外事件方面差异均有统计学意义（P<0.05）。死亡组中男性、高龄、共病>2种、有意外事件者占比更高；吞咽功能正常、认知重度缺损者在死亡组中比例更高。见表1。
2.3　多因素logistic回归分析
进入多因素logistic回归前，对所有候选变量进行多重共线性检验。结果显示，各变量的方差膨胀因子（VIF）介于1.06至1.11之间，均小于预先设定的阈值10（实际均<5），提示不存在显著的多重共线性问题，因此未剔除任何变量。模型稳定性良好(AUC=0.731 5)。分析结果显示，年龄、性别、吞咽功能、共病数、照护方案、教育水平、失语症、不良事件、日常生活能力、精神行为能力（中度/重度受损）、认知功能（中度受损）是影响失智症患者死亡风险的独立因素（均P<0.05）。见表2。
2.4　多因素COX分析
COX回归模型校准度与判别能力良好（24 个月校准斜率=1.084）。多因素分析显示，生存的独立危险因素为：男性（HR=1.412）、年龄（HR=1.039）、共病>2种（HR=1.226）、不良事件（HR=1.293）、机构照护（HR=1.097）、吞咽功能异常（HR=1.092）；保护因素为：认知功能（HR=0.399）、日常生活能力（HR=0.948）、教育水平（HR=0.964）、手术史（HR=0.789）（均P<0.05）。失语症与精神行为能力无显著影响（P>0.05）。见表3。
3　讨论
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本研究基于成都市长照险10108例失智症患者的长期随访数据，通过多因素COX回归模型系统识别了影响预期寿命的独立因素。结果显示，较好的认知功能、较高的日常生活能力、较高的教育水平以及有手术史是延长生存时间的保护因素；而男性、增龄、共病数量较多、发生不良事件、机构照护（相对于家庭照护）及吞咽功能异常则显著缩短生存时间。
认知功能是影响生存时间的最强保护因素（HR=0.399），重度认知缺损患者因完全依赖照护、易发并发症而死亡风险倍增，这与认知储备理论一致［2-3］。日常生活能力维持［4］（HR=0.948）可减少卧床相关并发症，教育水平（HR=0.964）通过增强神经可塑性延缓功能衰退［5］。手术史与较低的死亡风险存在统计关联（HR=0.789）可能反映既往良好的医疗可及性或健康意识［6］，此外，不能排除反向因果或残余混杂的可能，手术史的具体类型、时机及与失智症的关联仍需进一步研究验证。。男性死亡风险高于女性（HR=1.412），可能因男性健康行为较差、共病负担重［7］；年龄和共病>2种（HR=1.226）均增加死亡风险。
不良事件是本研究识别出的重要可干预危险因素。失智症患者因认知功能缺损，易发生跌倒［8］、坠床、烫伤、噎食、走失及压疮等不良事件，这些事件不仅直接威胁患者生命（如跌倒导致骨折后卧床并发感染、噎食导致窒息或吸入性肺炎），还可能引发连锁性的功能衰退和照护负担加重［9］。Morrison等研究证实，失智患者发生急性不良事件后，其1年死亡率显著升高［10］。本研究结果进一步提示，在长期照护管理中，应建立系统性的不良事件风险评估与预警机制，针对高风险患者强化环境安全改造、照护者技能培训及日常巡查，切实降低可预防性不良事件的发生率。
吞咽功能障碍是仅次于年龄、性别的核心死亡危险因素，其机制在于导致营养不良、脱水并显著增加吸入性肺炎风险［11］。值得关注的是，本研究中多因素logistic回归结果显示，重度吞咽困难患者的死亡风险反而低于轻度困难者，这一看似矛盾的现象可能与临床干预的选择效应有关——重度吞咽障碍患者更易被临床识别并早期接受管饲喂养、吞咽康复等针对性干预，从而有效规避了吸入性肺炎等致命并发症。Nakajoh等研究证实，对重度吞咽困难患者早期实施管饲喂养可使肺炎发生率从54.3%降至13.2%［12］。这一发现提示，临床实践中应高度重视吞咽功能的早期筛查与分级干预，对轻度吞咽困难患者同样应加强监测和预防性训练，避免因干预滞后导致不良结局。
本研究发现机构照护较居家照护死亡风险增加，这一结果可能主要源于“选择效应”——入住机构的患者本身功能状态更差、照护需求更高，其不良预后更多由基础疾病严重程度驱动，而非机构照护本身所致［13］。家庭照护作为主要模式（82.4%）虽具情感优势，但照护者普遍面临巨大身心负荷［14-15］。国内研究表明，失智老人家庭照护者的生活质量处于中等偏下水平，照护负担通过社会支持的中介作用间接影响照护者生活质量，强化正式与非正式社会支持网络对减轻照护负担至关重要［14］。未来提升照护质量应着力于以下方面：一是强化家庭照护者支持体系，依托长照险政策推广上门照护服务、喘息服务和照护技能培训，减轻家庭照护者负担［16］；二是提升机构照护专业化水平，重点加强吞咽功能评估与干预、不良事件防控、认知康复训练等专项服务能力；三是建立基于风险评估的照护模式动态调整机制，根据患者功能状态和照护需求变化，在家庭与机构照护间实现有序衔接。成都市长照险已开展的上门照护服务实践表明，将专业照护资源延伸至家庭场景，可有效弥补家庭照护者的专业能力短板，是提升整体照护质量的重要路径。
本研究构建的COX模型校准度良好，可用于临床风险分层。建议对高风险人群（高龄、男性、共病多、吞咽异常者）加强评估，重点防控吸入性肺炎、跌倒等不良事件，推广吞咽训练与认知康复，优化共病管理，维持日常生活能力，并完善长照险政策支持预防性服务［17］，不断提高失智人群生活质量和尊严。
基金
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  • 国家重点研发项目(2023YFC3604701)
文献
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2026年第53卷第16期
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doi: 10.20043/j.cnki.MPM.202603251
  • 接收时间：2026-03-17
  • 首发时间：2026-09-28
  • 出版时间：2026-08-25
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  • 收稿日期：2026-03-17
基金
国家重点研发项目(2023YFC3604701)
作者信息
    1.四川大学华西医院老年医学中心，国家老年疾病临床医学研究中心，四川 成都 610041
    2.四川大学华西公共卫生学院

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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
红菇属 Russula 17 8.13
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