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Article(id=1228016568441963336, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1228016566646801206, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202503096, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1741104000000, receivedDateStr=2025-03-05, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1770711565360, onlineDateStr=2026-02-10, pubDate=1758729600000, pubDateStr=2025-09-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1770711565360, onlineIssueDateStr=2026-02-10, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1770711565360, creator=13701087609, updateTime=1770711565360, updator=13701087609, issue=Issue{id=1228016566646801206, tenantId=1146029695717560320, journalId=1227665162245664772, year='2025', volume='52', issue='18', pageStart='3265', pageEnd='3456', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1770711564932, creator=13701087609, updateTime=1770711815039, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1228017615784833769, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1228016566646801206, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1228017615784833770, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1228016566646801206, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=3282, endPage=3289, ext={EN=ArticleExt(id=1228016568727176017, articleId=1228016568441963336, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Analysis of the influencing factors of comorbidities of chronic diseases in middle-aged and elderly people on general self-efficacy based on latent class analysis, columnId=1228016567443718970, journalTitle=Modern Preventive Medicine, columnName=Epidemiology and Statistical Methods Advances, runingTitle=null, highlight=null, articleAbstract=
Objective

To classify the general self-efficacy of patients with chronic comorbidities by using latent class analysis, thereby to analyze the influencing factors which affect the general self-efficacy of middle-aged and elderly patients with chronic disease comorbidities based on the results of category analysis, and to provide references for improving the mental health in the multi-dimensional health of the elderly in China and realizing “healthy aging”.

Methods

Based on the Ningxia Natural Science Foundation project in 2023, a multi-level stratified random sampling method was adopted to screen out 967 comorbidity patients. Latent class analysis and logistic regression analysis were used to explore the current situation and influencing factors of the general self-efficacy of patients with chronic comorbidities in Ningxia.

Results

Among the 967 study subjects, the diseases with the highest prevalence rates among patients with comorbidities were hypertension, musculoskeletal disorders, and diabetes. The latent class analysis revealed that 402 individuals had low general self-efficacy, 161 had high general self-efficacy, and 403 had moderate general self-efficacy.The C2 “High Self-Efficacy Group” consisted of individuals aged 45 to 59 years (with OR values and 95% CI intervals being 0.374, 0.188; 0.208-0.671; 0.085-0.418), had lower educational levels (with OR values and 95% CI intervals being 0.192, 0.157; 0.041-0.893; 0.011-0.297), and those who received some financial support from their children (with OR values and 95% CI intervals being 0.491, 0.340; 0.328-0.736; 0.209-0.553) generally had lower general self-efficacy (all OR values <1). Among the middle-aged and elderly with two chronic diseases in their comorbidity status, those from C2 “High Self-Efficacy Group” had higher general self-efficacy (with OR values being 6.709, 3.303, both >1, and 95% CI intervals being 4.397-10.138; 2.468-4.421). In addition to the above factors, middle-aged and elderly living in rural areas (with an OR value of 0.616 and a 95% CI range of 0.402-0.944) in C1 “Moderate Self-Efficacy Group” generally had lower general self-efficacy, while those who occasionally Participated in activities from C2 “High Self-Efficacy Group” generally had lower general self-efficacy (with an OR value of 0.377 and a 95% CI range of 0.191-0.744).

Conclusion

In Ningxia, there are more middle-aged and elderly with moderate to low general self-efficacy. Age, educational level, residence,Participation in activities, financial support from children, and comorbidity status all affect the general self-efficacy of middle-aged and elderly in Ningxia. It is recommended to improve the elderly health service system in rural areas, establish elderly activity centers, encourage older people to Participate in more activities, form good exercise habits, and focus on rural Patients with lower educational levels. A series of health activities should be carried out in combination with the characteristics of comorbidities such as hypertension, arthritis, diabetes, etc., to helppatients manage with a positive attitude.

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目的

运用潜在类别分析，将慢性病共病患者的一般自我效能感分类，从而根据类别分析结果分析影响中老年慢性病共病患者一般自我效能感的影响因素，为提高我国老年人多维健康中的心理健康，为实现“健康老龄化”提供参考。

方法

基于2023年宁夏自然科学基金项目，采取多级分层随机抽样，筛选出967名共病患者，采用潜在类别分析法和logistic回归分析，探讨宁夏慢性病共病患者一般自我效能的现状及影响因素。

结果

967名研究对象中，共病患者中患病率最高的疾病分别是高血压，肌肉骨骼疾病，糖尿病。潜在类别分析得出一般自我效能感较低者402人，较高者161人，中等者403人；回归结果显示，与C3“低自我效能组”相比，C1“中等自我效能组”，C2“高自我效能组”年龄为45~59岁(OR值及95% CI区间分别为0.374，0.188，0.208~0.671，0.085~0.418)，文化程度较低(OR值及95% CI区间分别为0.192，0.157，0.041~0.893，0.011~0.297)，儿女给予一定经济支持(OR值及95% CI区间分别为0.491，0.340，0.328~0.736，0.209~0.553)的中老年（OR值均<1）一般自我效能感较低，慢性病共病状况中患两种慢性病的中老年人（OR值分别为6.709，3.303，均>1，95% CI区间分别为4.397~10.138，2.468~4.421）一般自我效能感较高，C1“中等自我效能组”除上述因素外，居住地在农村的中老年人（OR值为0.616，95% CI范围为0.402~0.944）一般自我效能感较低，C2“高自我效能组”偶尔参加活动的中老年人，一般自我效能感较低（OR值为0.377，95% CI范围为0.191~0.744）。

结论

宁夏中老年人一般自我效能处于中等及较低的人数较多，年龄，文化程度，居住地，是否参与活动，子女的经济支持，慢性病共病状况均影响宁夏中老年一般自我效能感，建议完善农村地区老年健康服务体系，建立老年人活动中心，鼓励老年人多多参加活动，形成良好的锻炼习惯，同时重点关注文化程度较低的农村共病患者，结合高血压，关节炎，糖尿病等共病特点展开一系列健康活动，帮助患者以积极的心态进行管理。

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汤榕，E-mail：
, copyrightStatement=本刊刊出的所有文章不代表中华预防医学会和本刊编委会的观点，除非特别声明。, copyrightOwner=中华预防医学会和四川大学华西公共卫生学院, extLink=null, articleAbsUrl=null, sourceXml=uoizewhWsRPHZGrycaKEKQ==, magXml=KDfJj5ld+Fl6u9KtfN6ljw==, pdfUrl=null, pdf=zvbsIRM+hYGeh+E7huHO4w==, pdfFileSize=862609, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=nhcNCWmZ3OLCfMUbf1Y5UQ==, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=PyREGdoHiShQkSHppB0bKw==, mapNumber=null, authorCompany=null, fund=null, authors=

李楚楚（2002—），女，硕士在读，研究方向：社会医学与卫生事业管理

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李楚楚（2002—），女，硕士在读，研究方向：社会医学与卫生事业管理

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李楚楚（2002—），女，硕士在读，研究方向：社会医学与卫生事业管理

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BMC Health Services Research, 2023, 23(1): 923., articleTitle=Exploring the relationships between health literacy, social support, self-efficacy and self-management in adults with multiple chronic diseases, refAbstract=null)], funds=[Fund(id=1228016575123488947, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1228016568441963336, awardId=2023AAC03233, language=CN, fundingSource=宁夏自然科学基金项目(2023AAC03233), fundOrder=null, country=null), Fund(id=1228016575278678205, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1228016568441963336, awardId=XZ2024022, language=CN, fundingSource=宁夏医科大学科学研究项目(XZ2024022), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1228016570811745154, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1228016568441963336, xref=null, ext=[AuthorCompanyExt(id=1228016570820133763, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1228016568441963336, companyId=1228016570811745154, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=School of Humanities and Management, Ningxia Medical University, Yinchuan, Ningxia Hui Autonomous Region 750004, China), AuthorCompanyExt(id=1228016570828522373, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1228016568441963336, companyId=1228016570811745154, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=宁夏医科大学人文与管理学院，宁夏回族自治区　银川市　750004)])], figs=[ArticleFig(id=1228016573085057058, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1228016568441963336, language=EN, label=Fig.1, caption=Conditional probabilities of the three categories for each item in the chronic disease comorbidity General Self-Efficacy scale, figureFileSmall=3dz4Z4QIOIg72Dgoa37E5Q==, figureFileBig=nhcNCWmZ3OLCfMUbf1Y5UQ==, tableContent=null), ArticleFig(id=1228016573156360234, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1228016568441963336, language=CN, label=图1, caption=慢性病共病一般自我效能感量表各条目3类别条件概率, figureFileSmall=3dz4Z4QIOIg72Dgoa37E5Q==, figureFileBig=nhcNCWmZ3OLCfMUbf1Y5UQ==, tableContent=null), ArticleFig(id=1228016573420601402, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1228016568441963336, language=EN, label=Table 1, caption=

General demographic characteristics

, figureFileSmall=null, figureFileBig=null, tableContent=
变量分组数量构成比(%)
性别男51052.70
女45747.30
年龄（岁）45~5945046.50
60~7943645.10
≥80818.40
文化程度小学及以下78781.40
初/高中12713.10
大专及以上535.50
婚姻状况有配偶81183.90
无配偶15616.10
就业状况在业15716.20
离退休12913.30
无业68170.40
居住地农村70072.40
城市26727.60
月平均收入 (元)<2 00067069.30
2 000~3 99918919.50
4 000~5 999363.70
≥6 000727.40
是否为低保户是23624.40
否73175.60
), ArticleFig(id=1228016573579984959, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1228016568441963336, language=CN, label=表1, caption=

一般人口学特征

, figureFileSmall=null, figureFileBig=null, tableContent=
变量分组数量构成比(%)
性别男51052.70
女45747.30
年龄（岁）45~5945046.50
60~7943645.10
≥80818.40
文化程度小学及以下78781.40
初/高中12713.10
大专及以上535.50
婚姻状况有配偶81183.90
无配偶15616.10
就业状况在业15716.20
离退休12913.30
无业68170.40
居住地农村70072.40
城市26727.60
月平均收入 (元)<2 00067069.30
2 000~3 99918919.50
4 000~5 999363.70
≥6 000727.40
是否为低保户是23624.40
否73175.60
), ArticleFig(id=1228016573672259654, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1228016568441963336, language=EN, label=Table 2, caption=

Distribution of chronic disease commor biditios

, figureFileSmall=null, figureFileBig=null, tableContent=
疾病名称患2种慢性病患≥3种慢性病慢性病共病［n(%)］
高血压296487783（81.00）
糖尿病71323394(41.00)
血脂异常58204262(27.10)
冠心病62124186(19.20)
癌症516(0.60)
精神障碍44145(4.70)
肌肉骨骼疾病222443665（68.80）
呼吸道疾病3983122（12.60）
肾脏疾病147387（9.00）
肝脏疾病195271（7.30）
消化系统疾病60200260（26.90）
), ArticleFig(id=1228016573789700174, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1228016568441963336, language=CN, label=表2, caption=

慢性病共病分布情况

, figureFileSmall=null, figureFileBig=null, tableContent=
疾病名称患2种慢性病患≥3种慢性病慢性病共病［n(%)］
高血压296487783（81.00）
糖尿病71323394(41.00)
血脂异常58204262(27.10)
冠心病62124186(19.20)
癌症516(0.60)
精神障碍44145(4.70)
肌肉骨骼疾病222443665（68.80）
呼吸道疾病3983122（12.60）
肾脏疾病147387（9.00）
肝脏疾病195271（7.30）
消化系统疾病60200260（26.90）
), ArticleFig(id=1228016573919723607, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1228016568441963336, language=EN, label=Table 3, caption=

Fit results of latent class model

, figureFileSmall=null, figureFileBig=null, tableContent=
类别AICBICABICLMR(P)BLRT(P)ENTROPY潜类别概率
123 009.18423 155.41023 060.130--1.000
219 799.54920 096.87619 903.1400.0000.0000.9060.415/0.585
318 241.00018 689.42718 397.2360.0000.0000.9320.417/0.167/0.416
417 595.59418 195.12017 804.4740.8430.0000.9420.128/0.428/0.274/0.170
517 144.21717 894.84417 405.7420.7500.0000.9420.274/0.142/0.062/0.124/0.398
616 878.47817 780.20417 192.6470.7620.0000.9420.142/0.059/0.380/0.132/0.130/0.157
), ArticleFig(id=1228016574083301478, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1228016568441963336, language=CN, label=表3, caption=

潜在类别模型拟合结果

, figureFileSmall=null, figureFileBig=null, tableContent=
类别AICBICABICLMR(P)BLRT(P)ENTROPY潜类别概率
123 009.18423 155.41023 060.130--1.000
219 799.54920 096.87619 903.1400.0000.0000.9060.415/0.585
318 241.00018 689.42718 397.2360.0000.0000.9320.417/0.167/0.416
417 595.59418 195.12017 804.4740.8430.0000.9420.128/0.428/0.274/0.170
517 144.21717 894.84417 405.7420.7500.0000.9420.274/0.142/0.062/0.124/0.398
616 878.47817 780.20417 192.6470.7620.0000.9420.142/0.059/0.380/0.132/0.130/0.157
), ArticleFig(id=1228016574204936304, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1228016568441963336, language=EN, label=Table 4, caption=

Average membership probabilities of three latent classes of patients with comorbid chronic diseases

, figureFileSmall=null, figureFileBig=null, tableContent=
平均归属概率C1(%)C2(%)C3(%)
C10.9690.0110.021
C20.0370.9630.000
C30.0260.0000.979
), ArticleFig(id=1228016574334959738, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1228016568441963336, language=CN, label=表4, caption=

慢性病共病患者3个潜在类别的平均归属概率

, figureFileSmall=null, figureFileBig=null, tableContent=
平均归属概率C1(%)C2(%)C3(%)
C10.9690.0110.021
C20.0370.9630.000
C30.0260.0000.979
), ArticleFig(id=1228016574477566082, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1228016568441963336, language=EN, label=Table 5, caption=

General Self-Efficacy of elderly patients with multiple chronic diseases with different socio-demographic characteristics

, figureFileSmall=null, figureFileBig=null, tableContent=
变量分组一般自我效能潜在类别χ2值P值
C3（低）C1（中）C2（高）
一般人口学特征
性别男2332086911.2930.004
女16919593
年龄（岁）45~5926813151113.74<0.001
60~7910823296
≥80264015
文化程度小学及以下37330910589.795<0.001
初/高中267130
大专及以上32327
婚姻状况有配偶3343321454.6460.098
无配偶687117
就业状况在业52594676.714<0.001
离退休187833
失业33226683
居住地农村34125210753.961<0.001
城市6115155
月平均收入（元）<2 00031025810266.085<0.001
2 000~3 999778725
4 000~5 9997254
≥6 00083331
是否为低保户否9687537.8580.020
是306316109
社会支持
儿女是否给予经济支持是3502949771.693<0.001
否5210965
是否独居是1737127.8650.020
否385366150
参加活动状况不参加2831998081.334<0.001
偶尔参加8513427
经常参加347055
慢性病共病状况2种11498213111.224<0.001
≥3种32041181
), ArticleFig(id=1228016574586617991, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1228016568441963336, language=CN, label=表5, caption=

不同社会人口学特征老年慢性病共病患者一般自我效能感情况

, figureFileSmall=null, figureFileBig=null, tableContent=
变量分组一般自我效能潜在类别χ2值P值
C3（低）C1（中）C2（高）
一般人口学特征
性别男2332086911.2930.004
女16919593
年龄（岁）45~5926813151113.74<0.001
60~7910823296
≥80264015
文化程度小学及以下37330910589.795<0.001
初/高中267130
大专及以上32327
婚姻状况有配偶3343321454.6460.098
无配偶687117
就业状况在业52594676.714<0.001
离退休187833
失业33226683
居住地农村34125210753.961<0.001
城市6115155
月平均收入（元）<2 00031025810266.085<0.001
2 000~3 999778725
4 000~5 9997254
≥6 00083331
是否为低保户否9687537.8580.020
是306316109
社会支持
儿女是否给予经济支持是3502949771.693<0.001
否5210965
是否独居是1737127.8650.020
否385366150
参加活动状况不参加2831998081.334<0.001
偶尔参加8513427
经常参加347055
慢性病共病状况2种11498213111.224<0.001
≥3种32041181
), ArticleFig(id=1228016574712447122, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1228016568441963336, language=EN, label=Table 6, caption=

Multifactorial analysis of General Self-Efficacy in elderly patients with chronic comorbidities

, figureFileSmall=null, figureFileBig=null, tableContent=
分组变量βSEWald χ2P值OR值(95%CI)
C1：C3
年龄（岁）（≥80）
45~59-0.9850.29910.8670.0010.374(0.208~0.671)
60~790.3930.2941.7870.1811.481(0.833~2.635)
文化程度（大专及以上）
小学及以下-1.6480.7834.4310.0350.192(0.041~0.893)
初/高中-0.9150.7691.4170.2340.400(0.089~1.807)
就业状况（失业）
在业0.3710.2522.1640.1411.449(0.884~2.375)
离退休0.4090.3311.5270.2161.506(0.787~2.881)
居住地（城市）
农村-0.4840.2174.9560.0260.616(0.402~0.944)
月平均收入（元）(≥6 000）
<2 0000.5820.5781.0150.3141.790(0.577~5.555)
2 000~3 9990.6810.5841.3600.2441.975(0.629~6.203)
4 000~5 9990.9070.6891.7350.1882.478(0.642~9.561)
参加活动状况（经常参加)
不参加-0.2010.2640.5800.4460.818(0.487~1.372)
偶尔参加0.1060.2760.1480.7011.112(0.648~1.909)
儿女是否给予经济支持（否）
是-0.7110.20611.9150.0010.491(0.328~0.736)
慢性病共病状况（≥3种）
2种1.9040.21677.9370.0016.709（4.397~10.138）
C2：C3
年龄（≥80）
45~59-1.6700.40716.8600.0000.188(0.085~0.418)
60~790.2310.3740.3810.5371.260(0.605~2.620)
文化程度（大专及以上）
小学及以下-2.8640.84111.5990.0010.057(0.011~0.297)
初/高中-1.6630.8154.1670.0410.190(0.038~0.936)
就业状况（失业）
离退休0.4760.4041.3850.2391.609(0.729~3.553)
居住地（城市）
农村0.1420.3150.2030.6521.152(0.622~2.137)
月平均收入（元）(≥6 000）
<2 0000.3940.6650.3500.5541.483(0.402~5.462)
2 000~3 9990.1450.6670.0470.8281.156(0.313~4.275)
4 000~5 999-0.5390.8620.3910.5320.583(0.108~3.158)
参加活动状况（经常参加)
不参加-0.4740.3112.3140.1280.623(0.338~1.146)
偶尔参加-0.9760.3477.9100.0050.377(0.191~0.744)
儿女是否给予经济支持（否）
是-1.0800.24918.8040.0000.340(0.209~0.553)
慢性病共病状况（≥3种）
2种1.1950.14964.5593.303（2.468~4.421）
), ArticleFig(id=1228016574922162338, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1228016568441963336, language=CN, label=表6, caption=

中老年慢性病共病一般自我效能多因素分析

, figureFileSmall=null, figureFileBig=null, tableContent=
分组变量βSEWald χ2P值OR值(95%CI)
C1：C3
年龄（岁）（≥80）
45~59-0.9850.29910.8670.0010.374(0.208~0.671)
60~790.3930.2941.7870.1811.481(0.833~2.635)
文化程度（大专及以上）
小学及以下-1.6480.7834.4310.0350.192(0.041~0.893)
初/高中-0.9150.7691.4170.2340.400(0.089~1.807)
就业状况（失业）
在业0.3710.2522.1640.1411.449(0.884~2.375)
离退休0.4090.3311.5270.2161.506(0.787~2.881)
居住地（城市）
农村-0.4840.2174.9560.0260.616(0.402~0.944)
月平均收入（元）(≥6 000）
<2 0000.5820.5781.0150.3141.790(0.577~5.555)
2 000~3 9990.6810.5841.3600.2441.975(0.629~6.203)
4 000~5 9990.9070.6891.7350.1882.478(0.642~9.561)
参加活动状况（经常参加)
不参加-0.2010.2640.5800.4460.818(0.487~1.372)
偶尔参加0.1060.2760.1480.7011.112(0.648~1.909)
儿女是否给予经济支持（否）
是-0.7110.20611.9150.0010.491(0.328~0.736)
慢性病共病状况（≥3种）
2种1.9040.21677.9370.0016.709（4.397~10.138）
C2：C3
年龄（≥80）
45~59-1.6700.40716.8600.0000.188(0.085~0.418)
60~790.2310.3740.3810.5371.260(0.605~2.620)
文化程度（大专及以上）
小学及以下-2.8640.84111.5990.0010.057(0.011~0.297)
初/高中-1.6630.8154.1670.0410.190(0.038~0.936)
就业状况（失业）
离退休0.4760.4041.3850.2391.609(0.729~3.553)
居住地（城市）
农村0.1420.3150.2030.6521.152(0.622~2.137)
月平均收入（元）(≥6 000）
<2 0000.3940.6650.3500.5541.483(0.402~5.462)
2 000~3 9990.1450.6670.0470.8281.156(0.313~4.275)
4 000~5 999-0.5390.8620.3910.5320.583(0.108~3.158)
参加活动状况（经常参加)
不参加-0.4740.3112.3140.1280.623(0.338~1.146)
偶尔参加-0.9760.3477.9100.0050.377(0.191~0.744)
儿女是否给予经济支持（否）
是-1.0800.24918.8040.0000.340(0.209~0.553)
慢性病共病状况（≥3种）
2种1.1950.14964.5593.303（2.468~4.421）
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基于潜在类别分析中老年慢性病共病对一般自我效能的影响因素分析
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李楚楚 , 党媛媛 , 史晓洁 , 马春芳 , 汤榕
现代预防医学 | 流行病与统计方法 2025,52(18): 3282-3289
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现代预防医学 | 流行病与统计方法 2025, 52(18): 3282-3289
基于潜在类别分析中老年慢性病共病对一般自我效能的影响因素分析
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李楚楚, 党媛媛, 史晓洁, 马春芳, 汤榕
作者信息
  • 宁夏医科大学人文与管理学院，宁夏回族自治区　银川市　750004

    • 李楚楚（2002—），女，硕士在读，研究方向：社会医学与卫生事业管理

通讯作者:

汤榕，E-mail：
Analysis of the influencing factors of comorbidities of chronic diseases in middle-aged and elderly people on general self-efficacy based on latent class analysis
Chu-chu LI, Yuan-yuan DANG, Xiao-jie SHI, Chun-fang MA, Rong TANG
Affiliations
  • School of Humanities and Management, Ningxia Medical University, Yinchuan, Ningxia Hui Autonomous Region 750004, China
出版时间: 2025-09-25 doi: 10.20043/j.cnki.MPM.202503096
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摘要
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目的

运用潜在类别分析，将慢性病共病患者的一般自我效能感分类，从而根据类别分析结果分析影响中老年慢性病共病患者一般自我效能感的影响因素，为提高我国老年人多维健康中的心理健康，为实现“健康老龄化”提供参考。

方法

基于2023年宁夏自然科学基金项目，采取多级分层随机抽样，筛选出967名共病患者，采用潜在类别分析法和logistic回归分析，探讨宁夏慢性病共病患者一般自我效能的现状及影响因素。

结果

967名研究对象中，共病患者中患病率最高的疾病分别是高血压，肌肉骨骼疾病，糖尿病。潜在类别分析得出一般自我效能感较低者402人，较高者161人，中等者403人；回归结果显示，与C3“低自我效能组”相比，C1“中等自我效能组”，C2“高自我效能组”年龄为45~59岁(OR值及95% CI区间分别为0.374，0.188，0.208~0.671，0.085~0.418)，文化程度较低(OR值及95% CI区间分别为0.192，0.157，0.041~0.893，0.011~0.297)，儿女给予一定经济支持(OR值及95% CI区间分别为0.491，0.340，0.328~0.736，0.209~0.553)的中老年（OR值均<1）一般自我效能感较低，慢性病共病状况中患两种慢性病的中老年人（OR值分别为6.709，3.303，均>1，95% CI区间分别为4.397~10.138，2.468~4.421）一般自我效能感较高，C1“中等自我效能组”除上述因素外，居住地在农村的中老年人（OR值为0.616，95% CI范围为0.402~0.944）一般自我效能感较低，C2“高自我效能组”偶尔参加活动的中老年人，一般自我效能感较低（OR值为0.377，95% CI范围为0.191~0.744）。

结论

宁夏中老年人一般自我效能处于中等及较低的人数较多，年龄，文化程度，居住地，是否参与活动，子女的经济支持，慢性病共病状况均影响宁夏中老年一般自我效能感，建议完善农村地区老年健康服务体系，建立老年人活动中心，鼓励老年人多多参加活动，形成良好的锻炼习惯，同时重点关注文化程度较低的农村共病患者，结合高血压，关节炎，糖尿病等共病特点展开一系列健康活动，帮助患者以积极的心态进行管理。

慢性病共病  /  一般自我效能  /  潜在类别分析
Objective

To classify the general self-efficacy of patients with chronic comorbidities by using latent class analysis, thereby to analyze the influencing factors which affect the general self-efficacy of middle-aged and elderly patients with chronic disease comorbidities based on the results of category analysis, and to provide references for improving the mental health in the multi-dimensional health of the elderly in China and realizing “healthy aging”.

Methods

Based on the Ningxia Natural Science Foundation project in 2023, a multi-level stratified random sampling method was adopted to screen out 967 comorbidity patients. Latent class analysis and logistic regression analysis were used to explore the current situation and influencing factors of the general self-efficacy of patients with chronic comorbidities in Ningxia.

Results

Among the 967 study subjects, the diseases with the highest prevalence rates among patients with comorbidities were hypertension, musculoskeletal disorders, and diabetes. The latent class analysis revealed that 402 individuals had low general self-efficacy, 161 had high general self-efficacy, and 403 had moderate general self-efficacy.The C2 “High Self-Efficacy Group” consisted of individuals aged 45 to 59 years (with OR values and 95% CI intervals being 0.374, 0.188; 0.208-0.671; 0.085-0.418), had lower educational levels (with OR values and 95% CI intervals being 0.192, 0.157; 0.041-0.893; 0.011-0.297), and those who received some financial support from their children (with OR values and 95% CI intervals being 0.491, 0.340; 0.328-0.736; 0.209-0.553) generally had lower general self-efficacy (all OR values <1). Among the middle-aged and elderly with two chronic diseases in their comorbidity status, those from C2 “High Self-Efficacy Group” had higher general self-efficacy (with OR values being 6.709, 3.303, both >1, and 95% CI intervals being 4.397-10.138; 2.468-4.421). In addition to the above factors, middle-aged and elderly living in rural areas (with an OR value of 0.616 and a 95% CI range of 0.402-0.944) in C1 “Moderate Self-Efficacy Group” generally had lower general self-efficacy, while those who occasionally Participated in activities from C2 “High Self-Efficacy Group” generally had lower general self-efficacy (with an OR value of 0.377 and a 95% CI range of 0.191-0.744).

Conclusion

In Ningxia, there are more middle-aged and elderly with moderate to low general self-efficacy. Age, educational level, residence,Participation in activities, financial support from children, and comorbidity status all affect the general self-efficacy of middle-aged and elderly in Ningxia. It is recommended to improve the elderly health service system in rural areas, establish elderly activity centers, encourage older people to Participate in more activities, form good exercise habits, and focus on rural Patients with lower educational levels. A series of health activities should be carried out in combination with the characteristics of comorbidities such as hypertension, arthritis, diabetes, etc., to helppatients manage with a positive attitude.

Chronic comorbidities  /  General self-efficacy  /  Latent class analysis
李楚楚, 党媛媛, 史晓洁, 马春芳, 汤榕. 基于潜在类别分析中老年慢性病共病对一般自我效能的影响因素分析. 现代预防医学, 2025 , 52 (18) : 3282 -3289 . DOI: 10.20043/j.cnki.MPM.202503096
Chu-chu LI, Yuan-yuan DANG, Xiao-jie SHI, Chun-fang MA, Rong TANG. Analysis of the influencing factors of comorbidities of chronic diseases in middle-aged and elderly people on general self-efficacy based on latent class analysis[J]. Modern Preventive Medicine, 2025 , 52 (18) : 3282 -3289 . DOI: 10.20043/j.cnki.MPM.202503096
正文
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第七次全国人口普查数据显示，2020年我国45岁及以上中老年人口为6亿，占总人口的近43%，人口老龄化的进程进一步加剧，同时老年人的失能和患病情况会随着年龄的增大愈加严重。当老年人生理功能衰退，社会交往逐渐减少，缺乏精神慰藉和关怀，心理自我调适能力减弱，很容易产生无助、失落、自我价值感降低等不良情绪[1]。老龄化带来的一个突出问题就是老年人群的健康问题，《中国健康老龄化发展蓝皮书（2023-2024）》[2]指出：健康老龄化是应对人口老龄化国家战略成本最低，效益最好的途径。并且由于疾病谱的改变，慢性病成为危害老年人健康的主要因素，慢性病不再是以单一病种的形式孤立存在，慢性病共病愈发普遍。国家卫生健康委员会提供的数据显示，我国超过1.8亿老年人患有慢性病，其中50%以上老年人患有2种及以上的慢性疾病[3]，慢性病共病的老年人身体机能愈发下降，又由于老年人处于人生发展的后期，社会价值的降低，也对老年人的心理造成冲击并且产生焦虑[4]。自我效能感(Self-efficacy)最早由班杜拉提出是指一个人对自己组织和执行某些行为能力的信念，后来也称为一般自我效能感(General Self-efficacy)[5]。一般自我效能感对个体行为有关键作用，反映在慢性病人身上，可以促使其形成健康行为，预防或抑制疾病的进展[6]。研究表明慢性病共病患者的自我效能评分普遍低于单一慢性病患者[7]。基于此本研究将自我效能进行潜类别分析，来探讨慢性病共病对自我效能的影响及影响因素，希望为慢性病共病患者的健康管理提供一定依据。
1　资料与方法
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1.1　资料来源
本研究数据采用多阶段分层抽样方法开展现场问卷调查。第一阶段：按照宁夏的经济发展水平和地域分布特点，选取固原市、吴忠市、银川市作为样本调查地区；第二阶段：在第一阶段抽样的基础上，随机选取固原市原州区、彭阳县，吴忠市红寺堡区、同心县、青铜峡，银川市金凤区、西夏区、兴庆区、永宁县、贺兰县共计10个区/县开展调查，第三阶段：以≥45岁的慢性病共病中老年人群为研究对象，采取方便抽样方法开展现场问卷调查。
本研究经宁夏医科大学伦理委员会审查（审批号：宁医大伦理第2022-N149号）
1.2　样本量计算
样本量计算公示如下：
公式中，α=0.05,Z=1.96，d=5%，d为抽样误差，p为慢性病共病发生率，基于以往研究，p值选取宁夏2022年中老年人慢性病共病发生率[8]，p=0.2093，deff为设计效应，deff=2，计算得出宁夏地区总样本量为780例，考虑到存在无效问卷，共发放1 000份，最终回收996份问卷。
1.3　变量选择与定义
1.3.1　自变量
本研究自变量为慢性病多病共存（以下简称共病），WHO将其定义为同一个体患有两个及以上慢性非传染性疾病[9]，本研究基于问卷中疾病病种维度的变量，包括高血压，糖尿病，血脂异常，冠心病，癌症，精神障碍，肌肉骨骼疾病，呼吸系统疾病，肾脏疾病，肝脏疾病，消化系统疾病在内的11种慢性病，并通过慢性病患病数反映慢性病基本情况，同时通过潜在类别分析共病模式综合反映共病情况,调查中慢性病患病情况主要以患者自述并且有医生诊断为主，同时依据患者所提供的病历和服用药物判断。
1.3.2　因变量
本研究因变量为一般自我效能，采用一股自我效能感量表(General Self-Efficacy Scale，GSES)测量多重慢性病患者的一般自我效能感情况。该量表由张建新引进并应用，已被证明有良好的信度和效度[10]。此量表为单维量表，量表共有10个条目，采用4级计分，答案“完全不正确”、“有点正确”、“多数正确”或“完全正确”分别记1、2、3、4分，总分为40分，得分越高，一般自我效能感越高，本研究量表Cronbach α为0.922。
1.4　调查与控制
在正式调查前，招募沟通能力，专业水平适配的调查员，对所招募的调查员进行培训，使其熟悉问卷内容，并掌握提问技巧与方法，全体调查员经培训、考核合格后展开调查。现场调查必须征得被调查者同意，由调查员询问相关问题后直接填写调查问卷。为确保问卷内容的完整性和逻辑性，调查完成后当日进行问卷核查
1.5　统计学方法
运用SPSS 27.0和MPlus 8.3进行分析，对慢性病共病中老年人基本情况进行描述性分析，一般自我效能分类用潜在类别分析法进行分析，分类资料采用频数和百分比描述，连续资料采用均数±标准差描述,正态分布资料用均数与标准差来描述，非正态分布用四分位数间距来描述。
2　结果
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2.1　慢性病共病患者中老年基本情况
本研究共计纳入967名慢性病共病患者，男性510人,占总人数52.7%，女性457人,占总人数47.3%，其中年龄在45~59岁的中年人450人，60~79岁老年人436人，≥80岁老年人81人，其中文化程度小学及以下787人，初/高中有127人，大专及以上53人,已婚811人，无业者681人，居住在农村700人，详见表1。慢性病共病中高血压，糖尿病，肌肉骨骼疾病（如关节炎，风湿病等）的共病率占比前三，分别为81%，41%，68.8%，详见表2。
2.2　中老年慢性病共病患者一般自我效能状况
慢性病共病中老年人一般自我效能感得分的平均分值为21.23±6.398分，最小值10分，最大值40分，偏度值为0.717，峰度值为0.350，数据分布基本符合正态分布。
2.2.1　潜在类别分析结果
表3中列出了6个模型的拟合结果，在潜在类别模型中，主要统计AIC、BIC、aBIC、Entropy、LMR(P)、BLRT(P)指标。从表中可以看出，当分类数目逐渐增多，AIC、BIC、aBIC的值趋于减少，当类别数取4，5，6时AIC、BIC、aBIC较小，而且LMR并不显著，因此排除4，5，6。相较之2分类AIC,BIC虽较大于3，但ENTROPY较小于3,因此综合来看选择3类别。
中老年慢性病共病患者在3个类别的平均归属概率为96.3%到97.9%，见下表4，说明正确归类的可靠性较高。图1是中老年慢性病共病患者一般自我效能感量表各条目3类模型的条件概率，观察可知，C1组在所有条目中出现体现较好自我效能的选项概率较高，将其命名为高一般自我效能组，占比16.7%；C2组中一般自我效能感水平上处于中等，占比41.7%，C3在在所有条目中出现体现较差自我效能的选项概率较高，因此一般自我效能水平上处于低等，占比41.6%。
2.3　单因素分析
根据潜在类别分析结果将一般自我效能感分为3类，以其为因变量，以社会人口学特征、社会支持情况为自变量进行单因素分析，结果如下。
2.4　多因素分析
以一般自我效能感的潜在类别3分类作为因变量，将单因素分析有统计学意义的变量纳入多元logistic回归模型，包括年龄，文化程度，就业状况，居住地，月平均收入，参加活动状况，儿女是否给予经济支持。参照组为C3组，结果显示，C1组与C3组在不同年龄，文化程度，居住地，儿女是否给予经济支持具有统计学意义上的差异，45~59，农村，儿女给予经济支持的中老年慢性病共病患者一般自我效能较低。
C2组与C3组在不同年龄，文化程度，就业状况，参加活动状况，儿女是否给予经济支持具有统计意义上的差异，45~59岁，小学及以下，偶尔参加活动，儿女给予一定经济支持的中老年慢性病共病患者一般自我效能低，在业及离退休患者，一般自我效能感较高，见下表6。
3　讨论
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3.1　慢性病共病一般自我效能基本情况
本研究结果显示，宁夏中老年慢性病共病患者中高血压，肌肉骨骼疾病（关节炎），糖尿病位列共病总数前三，中老年慢性病共病患者一般自我效能感得分为21.23±6.398。中老年处于人生的中后期，随着年龄的增长，躯体功能的下降，社会价值的丧失，会使人产生悲观的负面情绪[11]。同时身患慢性病除去给人带来病痛折磨，还有治疗疾病本身的花费，尤其是农村，失业且月收入低于2 000元的人来说更是带来心理负担，都会造成中老年人自我效能感降低。
3.2　潜在类别分析结果
本研究通过潜在类别分析确定中老年慢性病共病患者一般自我效能感水平分为三类：高自我效能，中等自我效能，低自我效能[12]。类别1在所有条目中得分普遍为2,3中等水平，命名为“中等自我效能”，人数占总人数41.7%，是三类人群中占比最高的一类，究其原因可能是患者内心的不确定性或矛盾心理，患者对于自身的能力缺乏明确的判断，同时东亚地区文化强调谦逊和集体主义，患者就会倾向避免选择“完全正确”这类的高分数[13]；确实由于患病所导致自身处理问题，面对困难时难以解决，从而选择较低分数。类别2在所有条目中普遍得分较高，命名为“高自我效能”，人数占总人数16.7%，这类人群虽身患多种慢性病，但仍积极面对，勇敢正视困难，积极调整自己的心态[14]。类别3在所有条目中得分及总体水平普遍较低，命名为“低自我效能”，人数占总人数41.6%，表明这部分患者对于自身信心不足，自我效能感较低[15]。
3.3　慢性病共病对一般自我效能感状况影响因素分析
本研究结果显示，C1,C2组与C3组相比，不同年龄,文化程度，社会支持，慢性病患病数量的患者之间一般自我效能感差异具有统计学意义，45岁~59岁患者一般自我效能感低于60岁以上老年患者，原因可能是45~59岁中年人正是家中上有老，下有小的顶梁支柱，但由于身患多种慢性病导致其生理功能下降，从而导致焦虑，不安等负面情绪，因此一般自我效能较低。受教育程度高的人对于疾病的危害性，如何预防，了解程度更高，因此更有可能坚持促进健康的行为，因此，一般自我效能更高[16]。社会支持中儿女给予经济支持的中老年一般自我效能感更低，原因可能是由于儿女的经济支持使得老年人觉得自己对于家庭的贡献减少，认为自身面对困境的能力减少，从而一般自我效能感降低[17-19]；慢性病共病状况中患两种慢性病的患者一般自我效能较高，因为患两种慢性病的患者通常疾病经济负担较轻，同时他们因患病数量较少能够更积极的应对疾病，生理功能相对下降较少，社会活动等参加更为容易，因此一般自我效能感更高[20]。
另外C1组和C3组除年龄，文化程度，子女的经济支持以外，居住地对一般自我效能感的影响也具有统计学意义，居住于城市的患者一般自我效能水平更高，其原因可能是.城市中老年人相比于农村的收入，消费水平较高，生活质量较好，应对困难时的信心相对更高，一般自我效能感水平更高[21]；医疗保健体系城市相比于农村更加完善，更加有利于健康管理，帮助老人应对由于疾病带来的悲观情绪，一般自我效能更高[22]。
同时研究发现，C2组中偶尔参加组织活动的患者，一般自我效能较低，可能原因是偶尔参加活动无法形成持续的行为模式，老人难以通过短期活动感受到身体的显著改变，反而可能因为体力不支或活动后不适导致自我怀疑[23]；轻度失能或日常活动能力缺陷的老年人更容易因活动中的微笑失败（如无法完成简单动作）而自我否定，进一步降低效能感[24]。综上所述，我国中老年一般自我效能受多种因素影响，因此为提高老年人多维健康，推进“健康老龄化”，因针对主要因素进行干预[24-25]。
此外，本文具有一定的局限性，首先本研究仅选择了宁夏地区部分中老年人，未来可选择纳入总数据库纵向年份数据展开研究以弥补不足，其次本研究为横断面研究仅能分析各变量之间的关联性，难以推断其因果关系。最后本研究样本中大多为无业，农村地区居民，这可能限制结果对城市或在职人群的适用性。
基金
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  • 宁夏自然科学基金项目(2023AAC03233)
  • 宁夏医科大学科学研究项目(XZ2024022)
文献
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2025年第52卷第18期
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doi: 10.20043/j.cnki.MPM.202503096
  • 接收时间：2025-03-05
  • 首发时间：2026-02-10
  • 出版时间：2025-09-25
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  • 收稿日期：2025-03-05
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宁夏自然科学基金项目(2023AAC03233)
宁夏医科大学科学研究项目(XZ2024022)
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    宁夏医科大学人文与管理学院，宁夏回族自治区　银川市　750004

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汤榕，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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