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Article(id=1240738484839830011, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240738480549065614, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202408240, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1723651200000, receivedDateStr=2024-08-15, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773744706592, onlineDateStr=2026-03-17, pubDate=1746806400000, pubDateStr=2025-05-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773744706592, onlineIssueDateStr=2026-03-17, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773744706592, creator=13701087609, updateTime=1773744706592, updator=13701087609, issue=Issue{id=1240738480549065614, tenantId=1146029695717560320, journalId=1227665162245664772, year='2025', volume='52', issue='9', pageStart='1537', pageEnd='1728', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773744705569, creator=13701087609, updateTime=1773744787657, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1240738824918192654, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240738480549065614, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1240738824922386959, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240738480549065614, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=1648, endPage=1655, ext={EN=ArticleExt(id=1240738486140064345, articleId=1240738484839830011, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Relationship between comorbidity patterns and subjective life expectancy in middle-aged and older adults: the mediating role of depression, columnId=1228016572451718132, journalTitle=Modern Preventive Medicine, columnName=Health and Social Behavior, runingTitle=null, highlight=null, articleAbstract=
Objective

To explore the comorbidity patterns in middle-aged and older adults and their relationship with subjective life expectancy, as well as to investigate the mediating role of depression.

Methods

Using data from the 2020 CHARLS, latent class analysis (LCA) was employed to identify comorbidity patterns in individuals aged 45 and older. Ordered logistic regression was used to analyze the association between comorbidity patterns and subjective life expectancy, while stepwise regression and the KHB method were utilized to assess the mediating effect of depression.

Results

A total of 13 815 middle-aged and older participants were included, with a comorbidity rate of 48.17%. LCA identified four comorbidity patterns: relatively healthy, gastrointestinal-arthritis, cardiovascular-metabolic, and respiratory system. The gastrointestinal-arthritis (OR=0.652, 95%CI: 0.592 to 0.717), cardiovascular-metabolic (OR=0.727, 95%CI: 0.669 to 0.791), and respiratory system (OR=0.518, 95%CI: 0.592-0.717) patterns were negatively associated with subjective life expectancy. Depression acted as a mediator, with heterogeneity in the mediating effect across different comorbidity patterns; the strongest effect was observed in the gastrointestinal-arthritis group, with an indirect effect value of -0.110 (-0.144 to -0.076), accounting for 27.72% of the mediating effect, followed by the cardiovascular-metabolic group (18.05%).

Conclusion

Compared to the relatively healthy group, the other three comorbidity patterns were associated with more negative subjective life expectancy, with depression mediating the relationship between comorbidity patterns and subjective life expectancy.

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目的

探究中老年人的共病模式及其与主观预期寿命的关系，并探究抑郁的中介作用。

方法

基于CHARLS 2020年数据，通过潜在类别分析（LCA）识别45岁及以上中老年人的共病模式，使用有序logistic回归分析共病模式与主观预期寿命的关联，利用逐步回归法和KHB法评估抑郁的中介作用。

结果

纳入了13 815名中老年参与者，共病率为48.17%。LCA确定了四类共病模式：相对健康类、胃-关节炎类、心脑血管与代谢类、呼吸系统类。胃-关节炎类（OR=0.652, 95%CI:0.592～0.717）、心脑血管与代谢类（OR=0.727, 95%CI:0.669～0.791）、呼吸系统类（OR=0.518, 95%CI:0.592～0.717）与主观预期寿命负向关联；抑郁发挥中介作用，中介效应在不同共病模式中存在异质性，在胃-关节炎类中最强，间接效应值为-0.110(95%CI:-0.144～-0.076)，中介效应占比27.72%，在心脑血管与代谢类中（18.05%）次之。

结论

以相对健康类为参照，其他三类共病模式都与更消极的主观预期寿命相关，抑郁在共病模式与主观预期寿命的关系中发挥中介作用。

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汤少梁，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=JCgkeMABk3iSZzu9/HPUJg==, magXml=mR1c8X4kOQvjjK4EsBpl3A==, pdfUrl=null, pdf=xXvZ6mQ8oJ2uC/E0aEBALg==, pdfFileSize=1041049, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=5t7ZEfGasJh6cqTtakl8XQ==, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=n9pj9Fvz6p5M9jG6brJ8BA==, mapNumber=null, authorCompany=null, fund=null, authors=

毛晓艳（2000—），女，硕士在读，研究方向：公共管理

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毛晓艳（2000—），女，硕士在读，研究方向：公共管理

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毛晓艳（2000—），女，硕士在读，研究方向：公共管理

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Study on the mediating effect of activities of daily living between arthritis and depressive symptoms in the elderly[J].Modern Preventive Medicine, 2024, 51(1): 123-126, 155.(In Chinese), articleTitle=Study on the mediating effect of activities of daily living between arthritis and depressive symptoms in the elderly, refAbstract=null)], funds=[Fund(id=1241081873212960852, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240738484839830011, awardId=72074125, language=CN, fundingSource=国家自然科学基金项目(72074125), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1241081864706912904, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240738484839830011, xref=null, ext=[AuthorCompanyExt(id=1241081864719495818, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240738484839830011, companyId=1241081864706912904, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=School of Health Economics and Management, Nanjing University of Chinese Medicine, Nanjing, Jiangsu 210023, China), AuthorCompanyExt(id=1241081864727884427, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240738484839830011, companyId=1241081864706912904, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=南京中医药大学卫生经济管理学院，江苏 南京 210023)])], figs=[ArticleFig(id=1241081869148681073, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240738484839830011, language=EN, label=Figure 1, caption=Data screening process, figureFileSmall=7876P61RxLOgSbSvYIyFyA==, figureFileBig=kcOFGTcqFxx1739RQjpxWA==, tableContent=null), ArticleFig(id=1241081869257732988, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240738484839830011, language=CN, label=图1, caption=数据筛选过程, figureFileSmall=7876P61RxLOgSbSvYIyFyA==, figureFileBig=kcOFGTcqFxx1739RQjpxWA==, tableContent=null), ArticleFig(id=1241081869438088071, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240738484839830011, language=EN, label=Figure 2, caption=Mediated effects model, figureFileSmall=kXEmk8qxg1ITIXbNegP7UQ==, figureFileBig=KO+Ig443UimhMB8cR2cfCg==, tableContent=null), ArticleFig(id=1241081869551334286, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240738484839830011, language=CN, label=图2, caption=中介效应模型, figureFileSmall=kXEmk8qxg1ITIXbNegP7UQ==, figureFileBig=KO+Ig443UimhMB8cR2cfCg==, tableContent=null), ArticleFig(id=1241081869672969112, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240738484839830011, language=EN, label=Figure 3, caption=Prevalence of 13 chronic diseases, figureFileSmall=DVpbaDNb7ruLsDeCNWqlaQ==, figureFileBig=oKWYeInR3U7NNdzzdnSMOA==, tableContent=null), ArticleFig(id=1241081869794603937, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240738484839830011, language=CN, label=图3, caption=13种慢性病的患病率, figureFileSmall=DVpbaDNb7ruLsDeCNWqlaQ==, figureFileBig=oKWYeInR3U7NNdzzdnSMOA==, tableContent=null), ArticleFig(id=1241081869907850154, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240738484839830011, language=EN, label=Figure 4, caption=Conditional probability plot for multimorbidity patterns, figureFileSmall=nHOL/7g08nD2w06Lg9ZAWA==, figureFileBig=rZgSZLbnLFpn+tT42LyNSQ==, tableContent=null), ArticleFig(id=1241081871413605303, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240738484839830011, language=CN, label=图4, caption=慢性病共病模式的条件概率图, figureFileSmall=nHOL/7g08nD2w06Lg9ZAWA==, figureFileBig=rZgSZLbnLFpn+tT42LyNSQ==, tableContent=null), ArticleFig(id=1241081871577183164, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240738484839830011, language=EN, label=Table 1, caption=

Comparison table between current age and target age (years)

, figureFileSmall=null, figureFileBig=null, tableContent=
当前年龄（岁）<6565～6970～7475～7980～8485～8990～9495～99≥100
目标年龄（岁）7580859095100105110115
), ArticleFig(id=1241081871715595208, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240738484839830011, language=CN, label=表1, caption=

当前年龄与目标年龄对照表（岁）

, figureFileSmall=null, figureFileBig=null, tableContent=
当前年龄（岁）<6565～6970～7475～7980～8485～8990～9495～99≥100
目标年龄（岁）7580859095100105110115
), ArticleFig(id=1241081871807869910, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240738484839830011, language=EN, label=Table 2, caption=

Description of variables and assignments

, figureFileSmall=null, figureFileBig=null, tableContent=
变量赋值说明
共病模式1=相对健康类，2=胃-关节炎类，3=心脑血管与代谢类，4=呼吸系统类
主观预期寿命1=几乎不太可能，2=不太可能，3=有可能，4=很可能，5=简直一定
抑郁1=是，2=否
年龄（岁）1=[45,55), 2=[55,65), 3=[65,75), 4=[75,85), 5=[85,110]
性别1=男性，2=女性
受教育程度1=文盲，2=未读完小学；3=小学毕业，4=初中毕业，5=高中毕业及以上
户口1=农业，2=非农业
婚姻状况1=已婚，2=未婚、离异或丧偶
医保类型1=城镇职工医疗保险，2=城乡居民医疗保险，3=城镇居民医疗保险，4=新型农村合作医疗保险，5=公费医疗，6=其他
吸烟1=是，2=否
饮酒1=是，2=否
ADL1=完好，2=受损
IADL1=完好，2=受损
门诊服务利用1=是，2=否
住院服务利用1=是，2=否
), ArticleFig(id=1241081871933699042, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240738484839830011, language=CN, label=表2, caption=

变量及赋值说明

, figureFileSmall=null, figureFileBig=null, tableContent=
变量赋值说明
共病模式1=相对健康类，2=胃-关节炎类，3=心脑血管与代谢类，4=呼吸系统类
主观预期寿命1=几乎不太可能，2=不太可能，3=有可能，4=很可能，5=简直一定
抑郁1=是，2=否
年龄（岁）1=[45,55), 2=[55,65), 3=[65,75), 4=[75,85), 5=[85,110]
性别1=男性，2=女性
受教育程度1=文盲，2=未读完小学；3=小学毕业，4=初中毕业，5=高中毕业及以上
户口1=农业，2=非农业
婚姻状况1=已婚，2=未婚、离异或丧偶
医保类型1=城镇职工医疗保险，2=城乡居民医疗保险，3=城镇居民医疗保险，4=新型农村合作医疗保险，5=公费医疗，6=其他
吸烟1=是，2=否
饮酒1=是，2=否
ADL1=完好，2=受损
IADL1=完好，2=受损
门诊服务利用1=是，2=否
住院服务利用1=是，2=否
), ArticleFig(id=1241081872059528175, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240738484839830011, language=EN, label=Table 3, caption=

Basic characteristics of participants ［n（%）］

, figureFileSmall=null, figureFileBig=null, tableContent=
变量总人群男性女性P值
主观预期寿命
几乎不可能1 805(13.07)823(12.01)982(14.1)
不太可能1 981(14.34)823(12.01)1 518(16.63)
有可能5 715(41.37)2 898(42.31)2 817(40.45)
很可能1 855(13.43)1 013(14.79)842(12.09)
简直一定2 459(17.80)1 293(18.88)1 166(16.47)<0.001
共病
否7 161(51.83)3 669(53.56)3 492(50.14)
是6 654(48.17)3 181(46.44)3 473(49.86)<0.001
抑郁
否8 053(58.29)4 554(66.48)3 499(50.24)
是5 762(41.71)2 296(33.52)3 466(49.76)<0.001
年龄（岁）
45～544 209(30.47)1 947(28.42)2 262(32.84)
55～644 927(35.66)2 491(36.36)2 436(34.97)
65～743 519(25.47)1 829(26.70)1 690(24.26)
75～841 053(7.62)537(7.84)516(7.41)
≥85107(0.77)46(0.67)61(0.88)<0.001
受教育程度
文盲2 599(18.81)548(8.00)2 051(29.45)
未读完小学2 754(19.93)1 239(18.09)1 515(21.75)
小学毕业3 099(22.43)1 761(25.71)1 338(19.21)
初中毕业3 384(24.50)2 036(29.72)1 348(19.35)
高中毕业及以上1 979(14.33)1 266(18.48)713(10.24)<0.001
户口
农业10 209(73.90)4 964(72.47)5 245(75.31)
非农业3 606(26.10)1 886(27.53)1 720(24.69)<0.001
婚姻状况
已婚11 867(85.90)6 177(90.18)5 690(81.69)
未婚、离异或丧偶1 948(14.10)673(9.82)1 275(18.31)<0.001
医保类型
城镇职工医疗保险2 029(14.69)1 186(17.31)843(12.10)
城乡居民医疗保险1 824(13.20)867(12.66)957(13.74)
城镇居民医疗保险596(4.31)239(3.49)357(5.13)
新农合9 065(65.62)4 368(63.77)4 697(67.44)
公费医疗145(1.05)110(1.61)35(0.50)
其他156(1.13)80(1.17)76(1.09)<0.001
吸烟
否9 929(71.87)3 273(47.78)6 656(95.56)
是3 886(28.13)3 577(52.22)309(4.44)<0.001
饮酒
否8 483(61.40)2 763(40.34)5 720(82.12)
是5 332(38.60)4 087(59.66)1 245(17.88)<0.001
ADL
完好13 069(94.60)6 568(95.88)6 501(93.34)
受损746(5.40)282(4.12%)464(6.66)<0.001
IADL
完好11 667(84.45)6 056(88.41)5 611(80.56)
受损2 148(15.55)794(11.59)1 354(19.44)<0.001
门诊服务利用
否11 111(80.43)5 643(82.38)5 468(78.51)
是2 704(19.57)1 207(17.62)1 497(21.49)<0.001
住院服务利用
否11 360(82.23)5 609(81.88)5 751(82.57)
是2 455(17.77)1 241(18.12)1 214(17.43)<0.001
N13 8156 8506 965
), ArticleFig(id=1241081872181163003, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240738484839830011, language=CN, label=表3, caption=

参与者的基本特征［n（%）］

, figureFileSmall=null, figureFileBig=null, tableContent=
变量总人群男性女性P值
主观预期寿命
几乎不可能1 805(13.07)823(12.01)982(14.1)
不太可能1 981(14.34)823(12.01)1 518(16.63)
有可能5 715(41.37)2 898(42.31)2 817(40.45)
很可能1 855(13.43)1 013(14.79)842(12.09)
简直一定2 459(17.80)1 293(18.88)1 166(16.47)<0.001
共病
否7 161(51.83)3 669(53.56)3 492(50.14)
是6 654(48.17)3 181(46.44)3 473(49.86)<0.001
抑郁
否8 053(58.29)4 554(66.48)3 499(50.24)
是5 762(41.71)2 296(33.52)3 466(49.76)<0.001
年龄（岁）
45～544 209(30.47)1 947(28.42)2 262(32.84)
55～644 927(35.66)2 491(36.36)2 436(34.97)
65～743 519(25.47)1 829(26.70)1 690(24.26)
75～841 053(7.62)537(7.84)516(7.41)
≥85107(0.77)46(0.67)61(0.88)<0.001
受教育程度
文盲2 599(18.81)548(8.00)2 051(29.45)
未读完小学2 754(19.93)1 239(18.09)1 515(21.75)
小学毕业3 099(22.43)1 761(25.71)1 338(19.21)
初中毕业3 384(24.50)2 036(29.72)1 348(19.35)
高中毕业及以上1 979(14.33)1 266(18.48)713(10.24)<0.001
户口
农业10 209(73.90)4 964(72.47)5 245(75.31)
非农业3 606(26.10)1 886(27.53)1 720(24.69)<0.001
婚姻状况
已婚11 867(85.90)6 177(90.18)5 690(81.69)
未婚、离异或丧偶1 948(14.10)673(9.82)1 275(18.31)<0.001
医保类型
城镇职工医疗保险2 029(14.69)1 186(17.31)843(12.10)
城乡居民医疗保险1 824(13.20)867(12.66)957(13.74)
城镇居民医疗保险596(4.31)239(3.49)357(5.13)
新农合9 065(65.62)4 368(63.77)4 697(67.44)
公费医疗145(1.05)110(1.61)35(0.50)
其他156(1.13)80(1.17)76(1.09)<0.001
吸烟
否9 929(71.87)3 273(47.78)6 656(95.56)
是3 886(28.13)3 577(52.22)309(4.44)<0.001
饮酒
否8 483(61.40)2 763(40.34)5 720(82.12)
是5 332(38.60)4 087(59.66)1 245(17.88)<0.001
ADL
完好13 069(94.60)6 568(95.88)6 501(93.34)
受损746(5.40)282(4.12%)464(6.66)<0.001
IADL
完好11 667(84.45)6 056(88.41)5 611(80.56)
受损2 148(15.55)794(11.59)1 354(19.44)<0.001
门诊服务利用
否11 111(80.43)5 643(82.38)5 468(78.51)
是2 704(19.57)1 207(17.62)1 497(21.49)<0.001
住院服务利用
否11 360(82.23)5 609(81.88)5 751(82.57)
是2 455(17.77)1 241(18.12)1 214(17.43)<0.001
N13 8156 8506 965
), ArticleFig(id=1241081872319574024, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240738484839830011, language=EN, label=Table 4, caption=

Fitness indicators for different potential types

, figureFileSmall=null, figureFileBig=null, tableContent=
模型aBICAICBICEntropyLMR类别概率
1类别124 792.969124 736.347124 834.282---
2类别120 569.298120 451.697120 655.1020.547<0.000 10.30/0.70
3类别119 546.71119 368.131119 677.0040.630<0.000 10.70/0.19/0.11
4类别119 119.417118 879.859119 294.2020.620<0.000 10.61/0.13/0.19/0.07
5类别118 921.163118 620.626119 140.4380.6170.215 50.04/0.18/0.16/0.59/0.04
), ArticleFig(id=1241081872474763285, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240738484839830011, language=CN, label=表4, caption=

不同潜在类型的适配指标

, figureFileSmall=null, figureFileBig=null, tableContent=
模型aBICAICBICEntropyLMR类别概率
1类别124 792.969124 736.347124 834.282---
2类别120 569.298120 451.697120 655.1020.547<0.000 10.30/0.70
3类别119 546.71119 368.131119 677.0040.630<0.000 10.70/0.19/0.11
4类别119 119.417118 879.859119 294.2020.620<0.000 10.61/0.13/0.19/0.07
5类别118 921.163118 620.626119 140.4380.6170.215 50.04/0.18/0.16/0.59/0.04
), ArticleFig(id=1241081872621563934, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240738484839830011, language=EN, label=Table 5, caption=

Logistic regression analysis of multimorbidity patterns and subjective life expectancy

, figureFileSmall=null, figureFileBig=null, tableContent=
变量模型1模型2
OR值（95%CI）P值OR值（95%CI）P值
共病模式（相对健康类为参照）
胃-关节炎类0.652(0.592～0.717)<0.0010.753(0.683～0.831)<0.001
心脑血管与代谢类0.727(0.669～0.791)<0.0010.766(0.703～0.836)<0.001
呼吸系统类0.518(0.457～0.588)<0.0010.580(0.508～0.661)<0.001
抑郁症状（否为参照）
是0.932(0.927～0.937)<0.001
年龄（岁，45～54为参照）
55～641.251(1.159～1.350)<0.0011.286(1.190～1.391)<0.001
65～740.624(0.571～0.681)<0.0010.635(0.580～0.696)<0.001
75～840.283(0.247～0.325)<0.0010.274(0.237～0.318)<0.001
≥850.221(0.152～0.321)<0.0010.164(0.105～0.258)<0.001
性别（男性为参照）
女性0.898(0.829～0.973)0.0090.993(0.913～1.079)0.534
受教育程度（文盲为参照）
未读完小学0.905(0.817～1.003)0.0560.871(0.781～0.971)0.057
小学毕业0.950(0.858～1.052)0.3260.855(0.768～0.952)0.152
初中毕业1.146(1.032～1.274)0.0110.986(0.883～1.101)0.148
高中毕业及以上1.376(1.211～1.563)<0.0011.167(1.022～1.332)<0.001
户口（农业为参照）
非农业1.193(1.081～1.316)<0.0011.138(1.028～1.260)0.006
婚姻状况（已婚为参照）
未婚、离异或丧偶0.867(0.788～0.593)0.0030.981(0.888～1.085)0.061
医保类型（以城镇职工医疗保险为参照）
城乡居民医疗保险0.634(0.555～0.724)<0.0010.704(0.614～0.807)<0.001
城镇居民医疗保险0.745(0.631～0.878)<0.0010.753(0.635～0.891)0.001
新农合0.604(0.535～0.681)<0.0010.663(0.585～0.750)<0.001
公费医疗1.000(0.735～1.361)0.9980.936(0.683～1.283)0.680
其他0.757(0.558～1.027)0.0740.786(0.571～1.082)0.155
吸烟（否非参照）
是0.897(0.827～0.973)0.0080.893(0.821～0.970)0.028
饮酒（否为参照）
是1.214(1.131～1.303)<0.0011.196(1.112～1.287)<0.001
ADL（完好为参照）
受损0.738(0.633～0.860)<0.0010.863(0.732～1.017)0.001
IADL（完好为参照）
受损0.580(0.525～0.641)<0.0010.692(0.868～1.024)<0.001
门诊服务利用（否为参照）
是0.871(0.804～0.943)0.0010.942(0.868～1.024)<0.001
住院服务利用（否为参照）
是0.722(0.663～0.785)<0.0010.754(0.691～0.823)0.040
), ArticleFig(id=1241081872722227244, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240738484839830011, language=CN, label=表5, caption=

慢性病共病模式与主观预期寿命的logistic回归分析

, figureFileSmall=null, figureFileBig=null, tableContent=
变量模型1模型2
OR值（95%CI）P值OR值（95%CI）P值
共病模式（相对健康类为参照）
胃-关节炎类0.652(0.592～0.717)<0.0010.753(0.683～0.831)<0.001
心脑血管与代谢类0.727(0.669～0.791)<0.0010.766(0.703～0.836)<0.001
呼吸系统类0.518(0.457～0.588)<0.0010.580(0.508～0.661)<0.001
抑郁症状（否为参照）
是0.932(0.927～0.937)<0.001
年龄（岁，45～54为参照）
55～641.251(1.159～1.350)<0.0011.286(1.190～1.391)<0.001
65～740.624(0.571～0.681)<0.0010.635(0.580～0.696)<0.001
75～840.283(0.247～0.325)<0.0010.274(0.237～0.318)<0.001
≥850.221(0.152～0.321)<0.0010.164(0.105～0.258)<0.001
性别（男性为参照）
女性0.898(0.829～0.973)0.0090.993(0.913～1.079)0.534
受教育程度（文盲为参照）
未读完小学0.905(0.817～1.003)0.0560.871(0.781～0.971)0.057
小学毕业0.950(0.858～1.052)0.3260.855(0.768～0.952)0.152
初中毕业1.146(1.032～1.274)0.0110.986(0.883～1.101)0.148
高中毕业及以上1.376(1.211～1.563)<0.0011.167(1.022～1.332)<0.001
户口（农业为参照）
非农业1.193(1.081～1.316)<0.0011.138(1.028～1.260)0.006
婚姻状况（已婚为参照）
未婚、离异或丧偶0.867(0.788～0.593)0.0030.981(0.888～1.085)0.061
医保类型（以城镇职工医疗保险为参照）
城乡居民医疗保险0.634(0.555～0.724)<0.0010.704(0.614～0.807)<0.001
城镇居民医疗保险0.745(0.631～0.878)<0.0010.753(0.635～0.891)0.001
新农合0.604(0.535～0.681)<0.0010.663(0.585～0.750)<0.001
公费医疗1.000(0.735～1.361)0.9980.936(0.683～1.283)0.680
其他0.757(0.558～1.027)0.0740.786(0.571～1.082)0.155
吸烟（否非参照）
是0.897(0.827～0.973)0.0080.893(0.821～0.970)0.028
饮酒（否为参照）
是1.214(1.131～1.303)<0.0011.196(1.112～1.287)<0.001
ADL（完好为参照）
受损0.738(0.633～0.860)<0.0010.863(0.732～1.017)0.001
IADL（完好为参照）
受损0.580(0.525～0.641)<0.0010.692(0.868～1.024)<0.001
门诊服务利用（否为参照）
是0.871(0.804～0.943)0.0010.942(0.868～1.024)<0.001
住院服务利用（否为参照）
是0.722(0.663～0.785)<0.0010.754(0.691～0.823)0.040
), ArticleFig(id=1241081872860639286, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240738484839830011, language=EN, label=Table 6, caption=

KHB test results for subjective life expectancy

, figureFileSmall=null, figureFileBig=null, tableContent=
共病模式β（95%CI） P值中介效应占比（%）
胃-关节炎类
总效应-0.397(-0.491～-0.303)0.048<0.001
直接效应-0.287(-0.381～-0.192)0.048<0.001
间接效应-0.110(-0.144～-0.076)0.018<0.00127.72
心脑血管与代谢类
总效应-0.280(-0.364～-0.197)0.064<0.001
直接效应-0.230(-0.313～-0.146)0.064<0.001
间接效应-0.051(-0.084～-0.017)0.0170.00318.05
呼吸系统类
总效应-0.646(-0.772～-0.521)0.064<0.001
直接效应-0.553(-0.679～-0.428)0.064<0.001
间接效应-0.093(-0.127～-0.059)0.017<0.00114.39
), ArticleFig(id=1241081872973885504, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240738484839830011, language=CN, label=表6, caption=

主观预期寿命的KHB检验结果

, figureFileSmall=null, figureFileBig=null, tableContent=
共病模式β（95%CI） P值中介效应占比（%）
胃-关节炎类
总效应-0.397(-0.491～-0.303)0.048<0.001
直接效应-0.287(-0.381～-0.192)0.048<0.001
间接效应-0.110(-0.144～-0.076)0.018<0.00127.72
心脑血管与代谢类
总效应-0.280(-0.364～-0.197)0.064<0.001
直接效应-0.230(-0.313～-0.146)0.064<0.001
间接效应-0.051(-0.084～-0.017)0.0170.00318.05
呼吸系统类
总效应-0.646(-0.772～-0.521)0.064<0.001
直接效应-0.553(-0.679～-0.428)0.064<0.001
间接效应-0.093(-0.127～-0.059)0.017<0.00114.39
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中老年人共病模式与主观预期寿命的关系——抑郁的中介作用
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毛晓艳 , 汤少梁 , 徐靖宇 , 焦慧霖
现代预防医学 | 健康与社会行为 2025,52(9): 1648-1655
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现代预防医学 | 健康与社会行为 2025, 52(9): 1648-1655
中老年人共病模式与主观预期寿命的关系——抑郁的中介作用
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毛晓艳, 汤少梁 , 徐靖宇, 焦慧霖
作者信息
  • 南京中医药大学卫生经济管理学院，江苏 南京 210023

    • 毛晓艳（2000—），女，硕士在读，研究方向：公共管理

通讯作者:

汤少梁，E-mail:
Relationship between comorbidity patterns and subjective life expectancy in middle-aged and older adults: the mediating role of depression
Xiao-yan MAO, Shao-liang TANG , Jing-yu XU, Hui-lin JIAO
Affiliations
  • School of Health Economics and Management, Nanjing University of Chinese Medicine, Nanjing, Jiangsu 210023, China
出版时间: 2025-05-10 doi: 10.20043/j.cnki.MPM.202408240
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摘要
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目的

探究中老年人的共病模式及其与主观预期寿命的关系，并探究抑郁的中介作用。

方法

基于CHARLS 2020年数据，通过潜在类别分析（LCA）识别45岁及以上中老年人的共病模式，使用有序logistic回归分析共病模式与主观预期寿命的关联，利用逐步回归法和KHB法评估抑郁的中介作用。

结果

纳入了13 815名中老年参与者，共病率为48.17%。LCA确定了四类共病模式：相对健康类、胃-关节炎类、心脑血管与代谢类、呼吸系统类。胃-关节炎类（OR=0.652, 95%CI:0.592～0.717）、心脑血管与代谢类（OR=0.727, 95%CI:0.669～0.791）、呼吸系统类（OR=0.518, 95%CI:0.592～0.717）与主观预期寿命负向关联；抑郁发挥中介作用，中介效应在不同共病模式中存在异质性，在胃-关节炎类中最强，间接效应值为-0.110(95%CI:-0.144～-0.076)，中介效应占比27.72%，在心脑血管与代谢类中（18.05%）次之。

结论

以相对健康类为参照，其他三类共病模式都与更消极的主观预期寿命相关，抑郁在共病模式与主观预期寿命的关系中发挥中介作用。

共病模式  /  主观预期寿命  /  抑郁  /  潜在类别分析  /  中介作用
Objective

To explore the comorbidity patterns in middle-aged and older adults and their relationship with subjective life expectancy, as well as to investigate the mediating role of depression.

Methods

Using data from the 2020 CHARLS, latent class analysis (LCA) was employed to identify comorbidity patterns in individuals aged 45 and older. Ordered logistic regression was used to analyze the association between comorbidity patterns and subjective life expectancy, while stepwise regression and the KHB method were utilized to assess the mediating effect of depression.

Results

A total of 13 815 middle-aged and older participants were included, with a comorbidity rate of 48.17%. LCA identified four comorbidity patterns: relatively healthy, gastrointestinal-arthritis, cardiovascular-metabolic, and respiratory system. The gastrointestinal-arthritis (OR=0.652, 95%CI: 0.592 to 0.717), cardiovascular-metabolic (OR=0.727, 95%CI: 0.669 to 0.791), and respiratory system (OR=0.518, 95%CI: 0.592-0.717) patterns were negatively associated with subjective life expectancy. Depression acted as a mediator, with heterogeneity in the mediating effect across different comorbidity patterns; the strongest effect was observed in the gastrointestinal-arthritis group, with an indirect effect value of -0.110 (-0.144 to -0.076), accounting for 27.72% of the mediating effect, followed by the cardiovascular-metabolic group (18.05%).

Conclusion

Compared to the relatively healthy group, the other three comorbidity patterns were associated with more negative subjective life expectancy, with depression mediating the relationship between comorbidity patterns and subjective life expectancy.

Comorbidity patterns  /  Subjective life expectancy  /  Depression  /  Latent class analysis  /  Mediating effect
毛晓艳, 汤少梁, 徐靖宇, 焦慧霖. 中老年人共病模式与主观预期寿命的关系——抑郁的中介作用. 现代预防医学, 2025 , 52 (9) : 1648 -1655 . DOI: 10.20043/j.cnki.MPM.202408240
Xiao-yan MAO, Shao-liang TANG, Jing-yu XU, Hui-lin JIAO. Relationship between comorbidity patterns and subjective life expectancy in middle-aged and older adults: the mediating role of depression[J]. Modern Preventive Medicine, 2025 , 52 (9) : 1648 -1655 . DOI: 10.20043/j.cnki.MPM.202408240
正文
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WHO将共病定义为同时患有两种或以上慢性病[1]。老龄化进程加速背景下，中老年群体慢性病患病率持续攀升，共病成为常态。以往研究揭示了共病与抑郁、衰弱及生活质量降低相关，还会提升死亡风险[2-3]。
老年人口增长伴随着人口平均预期寿命的延长[4]，但这并不等同于主观预期寿命的增长。主观预期寿命是衡量个人对剩余寿命年限期望的指标，反映个体身体健康状况的同时还能折射出人们的心理健康状态，与一系列健康结局密切相关[5]，主观预期寿命受到健康状况和慢性病等因素的影响[6]。一些慢性病因存在相似的病理机制、致病因素，往往展现出高度关联性，进而形成特定的共病模式。尽管慢性病与主观预期寿命缩短相关，但中老年人共病模式与主观预期寿命之间的关系尚不明确。研究显示抑郁可能使人们低估自己的主观预期寿命低估，较长的主观预期寿命通常伴随着较少的负面情绪[7]，但抑郁如何调节共病模式与主观预期寿命的关系仍需探究。
本研究旨在探究中国45岁及以上中老年人的共病模式，以及不同共病模式与主观预期寿命的关联，并探究抑郁的中介作用。为针对不同共病群体制定干预措施，改善患者健康状况并提高其主观预期寿命提供依据。
1　资料与方法
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1.1　数据来源
本研究的数据源自2020年中国健康与养老追踪调查（China Health and Retirement Longitudinal Study, CHARLS）。使用CHARLS 2013—2018中记录的慢性病信息对缺失慢性病数据进行插补，因为患慢性病后通常难以彻底治愈。剔除患有情感及精神问题和与记忆有关的疾病、小于45岁、慢性病及主观预期寿命信息缺失的参与者，最终纳入13 815名参与者，数据筛选过程见图1。
CHARLS获北京大学伦理委员会批准（IRB00001052-11015），受访者均签署了书面知情同意书。
1.2　变量选取
自变量为共病模式。参考Zhao等[8]的研究，我们剔除了自我报告患有情感及精神问题和与记忆有关的疾病的参与者。使用CHARLS 2020数据库中记录的13种慢性病识别共病模式，将每位参与者划分到所属的唯一共病模式中。
因变量为主观预期寿命。CHARLS问卷中包含了主观预期寿命的相关问题，询问每一年龄段的受访者设想活到某一指定目标年龄的可能。结果包括几乎不可能、不太可能、有可能、很可能、简直一定，分别赋值为1～5[9]。目标年龄对照见表1。
中介变量为抑郁，使用流行病学研究中心抑郁量表（CES-D-10）进行测量。CHARLS问卷中包含10个相关问题，每个问题的评分从0～3（很少或根本不=0，不太多=1，有时或一半时间=2，大部分时间=3）。将10个问题的得分加总（其中有两道题目为反向提问，故反向计分），总分为0～30分。得分≥10分时，认为受访者存在抑郁症状[10]。见图2。
控制变量包括年龄、性别、受教育程度、户口、婚姻状况、医保类型、吸烟、饮酒、日常生活活动能力（ADL）、工具性日常生活活动能力（IADL）、门诊服务利用及住院服务利用。变量赋值及说明见表2。
1.3　统计学方法
使用潜在类别分析（latent class analysis, LCA）识别共病模式。LCA模型的适配指标包括赤池信息准则（AIC）、贝叶斯信息准则（BIC）、校正的贝叶斯信息准则（aBIC）、罗蒙代尔-鲁本校正似然比（LMR）、基于bootstrap的似然比检验（BLRT）及熵（Entropy）。AIC和BIC准则是模型选择过程中应用最广泛的评价标准，值越小表示模型拟合程度越好[11]。Entropy表示分类的精确程度，取值范围为[0,1]，越接近1表明分类越精确；Entropy会受样本量影响，在其他条件不变的情况下，样本量越大，Entropy值越小，当Entropy≥0.6时，表示超过80%的个案分类正确；LMRT和BLRT的P<0.05时表示k个类别的模型优于k-1个类别的模型[12]。
通过χ2检验和Kruskal-Wallis检验比较组间差异。使用有序logistic回归分析共病模式与主观预期寿命的关系，采用逐步回归法和KHB法检验抑郁的中介效应。LCA使用Mplus8.0进行，其余统计分析使用Stata17.0，双侧检验，检验水准α=0.05。
2　结果
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2.1　样本特征
参与者的基本特征见表3。共纳入13 815名参与者，平均年龄为60.67岁。相较于女性，男性的主观预期寿命更加积极，75.98%的男性认为自己有可能、很可能或简直一定活到目标年龄，而女性的比例为69.27%，男性的抑郁比例也同样低于女性。此外，中老年男性已婚、吸烟、饮酒、ADL和IADL完好的比例均显著高于女性，差异均具有统计学意义（P<0.01）。见表3。
2.2　中老年人慢性病及共病患病情况
中老年人的慢性病患病率为74.01%，患病率最高的5种慢性病分别为关节炎或风湿病、高血压、胃部或消化系统疾病、血脂异常及心脏病，见图3。共病率为48.17%，且女性的共病率高于男性（男性：46.44%，女性：49.86%，P<0.001），见表3。
2.3　LCA结果
LCA分别拟合了1～5类别模型，模型拟合指数见表4。当类别数≥3时，Entropy>0.6，模型的精确程度较优。当类别数为5时，BIC最小，但此时LMR>0.05，这表明4类别模型优于5类别模型，应减少类别。综合考虑各项模型拟合的适配指标，选择4类别模型作为本研究的最佳模型。
4类别模型的条件概率图见图4，将4个潜在类别分别命名为：相对健康类、胃-关节炎类、心脑血管与代谢类、呼吸系统类。相对健康类参与者各种慢性病患病率均较低；胃-关节炎类以胃部或消化系统疾病、关节炎或风湿病高发为特征；心脑血管与代谢类以高血压、血脂异常、糖尿病或血糖升高、中风及心脏病等高发为特征；呼吸系统类以慢性肺部疾病、心脏病和哮喘高发为特征。相对健康类、胃-关节炎类、心脑血管与代谢类、呼吸系统类的概率分别为61%、13%、19%、7%。
2.4　共病模式与主观预期寿命的关系
模型1分析了共病模式与中老年人主观预期寿命的关系，在加入控制变量后，以相对健康类为参照，患有胃-关节炎类（OR=0.652, 95%CI:0.592～0.717）、心脑血管与代谢类（OR=0.727, 95%CI:0.669～0.791）、呼吸系统类（OR=0.518, 95%CI:0.592～0.717）共病均与主观预期寿命负向关联，呼吸系统类患者的主观预期寿命最为消极。
年龄≥65岁群体的主观预期寿命随年龄增长而愈发消极，而55～64岁群体（OR=1.251, 95%CI:1.159～1.350）的主观预期寿命较45～54岁群体更为乐观。女性的主观预期寿命低于男性（OR=0.898, 95%CI:0.829～0.973），此外，初中及以上学历、非农业户口、饮酒、已婚与积极的主观预期寿命相关。相比之下，吸烟、ADL受损、IADL受损、门诊服务利用和住院服务利用是主观预期寿命的危险因素，见表5。
2.5　抑郁的中介作用检验
模型2在模型1的基础上加入了抑郁这一变量，回归结果显示，共病模式与主观预期寿命之间的关系仍然显著。但与模型1相比，胃-关节炎类（OR=0.753,95%CI:0.683～0.831）、心脑血管与代谢类（OR=0.766, 95%CI:0.703～0.836）、呼吸系统类（OR=0.580, 95%CI:0.508～0.661）与主观预期寿命的关联相对减弱。同时，共病模式与抑郁之间的关系同样显著，这表明抑郁可能发挥部分中介效应。即患有胃-关节炎类、心脑血管与代谢类、呼吸系统类共病的中老年人更有可能存在抑郁症状，并通过抑郁这一路径负向影响主观预期寿命。
2.6　KHB检验
使用KHB法再次验证抑郁的中介效应，结果同样显著。抑郁的中介作用在胃-关节炎类中最强，间接效应为-0.110(95%CI:-0.144～-0.076)，抑郁中介效应占比27.72%；其次是心脑血管与代谢类，中介效应占比18.05%。见表6。
3　讨论
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基于CHARLS 2020数据，本研究通过LCA识别了中老年人的主要共病模式，分析了共病模式与主观预期寿命的关系，发现相较于相对健康类，患有胃-关节炎类、心脑血管与代谢类、呼吸系统类共病的中老年人主观预期寿命更消极，尤其是呼吸系统类。抑郁在共病模式与主观预期寿命的关系中起中介作用，且中介效应在不同共病模式中存在差异。
本研究确定了四类共病模式，与以往研究相似。Zhang等[13]的研究表明，中国老年人常见的共病模式有相对健康类、血管类、呼吸类、胃关节炎类和多系统发病类；顾冯霞等[14]的研究确定了心血管-代谢类、脏器-骨关节类、呼吸系统类与免疫系统类四类共病模式。
既往研究表明慢性病会降低患者的主观预期寿命[15]，本研究进一步发现特定共病模式同样与主观预期寿命相关。呼吸系统类共病患者的主观预期寿命最消极，可能是由于此类疾病（如慢阻肺、哮喘）不仅会导致呼吸困难、活动能力下降，还会引发各类并发症[16]，严重影响患者的睡眠和生活质量，使其因难以忍受病痛折磨而降低长寿预期。而心脑血管与代谢类虽有猝死风险[17]，但其症状隐匿性、病程渐进性等病理特征弱化了患者的主观感知，患者往往不会面临持久性疼痛及功能障碍，故对主观预期寿命的负面效应弱于其他共病模式。
共病模式会通过抑郁影响主观预期寿命，即抑郁在共病模式与主观预期寿命的关系中发挥中介作用。因此应当强化对共病患者的心理干预，预防抑郁等心理疾病的发生或降低抑郁水平，帮助患者建立积极的生活态度，改善其主观预期寿命并提升生活质量。我们还发现抑郁的中介效应在不同共病模式中存在差异，在胃-关节炎类中中介效应占比最高。这与胃-关节炎类共病带来的长期疼痛和不适有关[18]。因此，在治疗胃关节炎类共病时，应格外关注患者的心理健康状态，通过疼痛管理与心理干预协同策略提高患者的主观预期寿命。
本研究存在一些潜在局限：其一，本研究为横断面研究，无法建立共病模式与主观预期寿命之间的因果联系；其二，CHARLS包含的慢性病信息有限，无法涵盖临床常见的所有慢性病病种，故确定的共病模式可能不够全面。
综上所述，中国中老年人主要存在四类共病模式，且与主观预期寿命密切相关，抑郁起中介作用。因此，需加强共病中老年群体的健康管理，针对不同共病群体制定针对性干预与预后管理方案。同时，高度重视共病患者的心理健康维护，强化抑郁防治，提升其对长寿的积极预期，增进中老年人的主观福祉与长寿观念，促进积极老龄化建设。
基金
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  • 国家自然科学基金项目(72074125)
文献
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2025年第52卷第9期
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doi: 10.20043/j.cnki.MPM.202408240
  • 接收时间：2024-08-15
  • 首发时间：2026-03-17
  • 出版时间：2025-05-10
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  • 收稿日期：2024-08-15
基金
国家自然科学基金项目(72074125)
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    南京中医药大学卫生经济管理学院，江苏 南京 210023

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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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