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Article(id=1240929926396833856, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240929920461886112, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202401067, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1704384000000, receivedDateStr=2024-01-05, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773790349816, onlineDateStr=2026-03-18, pubDate=1717948800000, pubDateStr=2024-06-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773790349816, onlineIssueDateStr=2026-03-18, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773790349816, creator=13701087609, updateTime=1773790349816, updator=13701087609, issue=Issue{id=1240929920461886112, tenantId=1146029695717560320, journalId=1227665162245664772, year='2024', volume='51', issue='11', pageStart='1921', pageEnd='2112', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=0, createTime=1773790348400, creator=13701087609, updateTime=1773827281389, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1241084828704109275, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240929920461886112, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1241084828704109276, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240929920461886112, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=2013, endPage=2019, ext={EN=ArticleExt(id=1240929927193751711, articleId=1240929926396833856, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Analysis of epidemic status and influencing factors of mild cognitive impairment in Chinese people ≥ 65 years old, columnId=1228016572892119056, journalTitle=Modern Preventive Medicine, columnName=Primary Health Services, runingTitle=null, highlight=null, articleAbstract=

Objective To investigate the prevalence and influencing factors of mild cognitive impairment (MCI) in the elderly in China, so as to provide scientific basis for slowing down the decline of cognitive function and improving their quality of life. Methods Based on the theory of health ecology, people aged 65 and above were selected from the 2018 Chinese Longitudinal Healthy Longevity Survey (CLHLS). The research subjects with dementia and missing key variables were excluded, and finally 11 157 elderly people were included. Multivariate unconditional Logistic regression was used to analyze the influencing factors of MCI in Chinese elderly. Results In this study, 1 526 people ≥ 65 years old had MCI, and the prevalence rate of MCI was 13.7%. The results of multivariate unconditional Logistic regression showed that female (OR=1.242, 95%CI: 1.061-1.455) and advanced age (80 to 94 years old: OR=1.744, 95%CI: 1.359-2.239; ≥ 95 years old: OR=3.014, 95%CI: 2.272-3.998), self-rated worse health status (OR=2.308, 95%CI: 1.202-4.433), hearing impairment (OR=4.760, 95%CI: 4.129-5.487), no exercise(OR=1.204, 95%CI: 1.006-1.441), low score of healthy diet (1-2) (OR=1.562, 95%CI: 1.288-1.894), no social participation activities (housework, social activities, recreational activities, social activities), long sleep time (> 8 hours) (OR=1.347, 95%CI:1.156-1.569), disability (OR=2.987, 95%CI: 2.246-3.974), instrumental activity of daily living (IADL) impairment (OR=3.347,95%CI: 2.510-4.462), living in elderly care institutions (OR=1.569, 95%CI: 1.136-2.166), and poor economic accessibility of medical services (OR=1.155, 95%CI: 1.005-1.328) were risk factors for MCI among the elderly in China. Conclusion The prevalence of MCI in the elderly in China is grim. Gender, age, self-rated health status, hearing function, exercise, healthy diet score, social participation, sleep duration, ADL, IADL, living style, and accessibility of medical services are the main influencing factors of the disease in Chinese elderly. Multi-dimensional and systematic intervention measures are needed to slow down the cognitive decline of the elderly in China.

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目的 了解中国老年人轻度认知障碍（MCI）患病状况及其影响因素，为减缓老年人认知功能衰退，提高其生活质量提供科学依据。方法 以健康生态学理论为基础，利用2018年中国老年健康影响因素跟踪调查（CLHLS）中65岁及以上人群，剔除患痴呆以及关键变量缺失的样本，最终纳入11 157例老年人。采用多因素非条件logistic回归分析中国老年人轻度认知障碍的影响因素。结果 本研究≥65岁患MCI的老年人有1 526人，MCI患病率为13.7%；多因素非条件logistic回归结果显示，女性（OR=1.242，95%CI：1.061～1.455）、高龄（80～94岁：OR=1.744，95%CI：1.359～2.239；≥95岁：OR=3.014，95%CI：2.272～3.998）、自评健康状况越差（OR=2.308，95%CI：1.202～4.433）、听力功能受损（OR= 4.760，95%CI：4.129～5.487）、不锻炼（OR=1.204，95%CI：1.006～1.441）、健康饮食评分低（1～2分：OR=1.562，95%CI：1.288～1.894）、无各项社会参与活动（家务劳动、社交活动、娱乐活动、社会活动）、睡眠时间长（>8h：OR=1.347，95%CI：1.156～1.569）、失能（OR=2.987，95%CI：2.246～3.974）、IADL受损（OR=3.347，95%CI：2.510～4.462）、居住在养老机构（OR=1.569，95%CI：1.136～2.166）、医疗服务经济可及性差（OR=1.155，95%CI：1.005～1.328）均是中国老年人患MCI的危险因素。结论 中国老年人MCI患病形势严峻，性别、年龄、自评健康状况、听力功能、锻炼情况、健康饮食评分、社会参与、睡眠时长、ADL、IADL、居住方式和医疗服务可及性是中国老年人患病的主要影响因素，需多维、系统制定相关干预措施，减缓中国老年人的认知功能衰退。

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李小菊，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=nr/kS0DBEBEpOi51skdgCg==, magXml=lXWeAG4oeGoZ1d2L/8wLTw==, pdfUrl=null, pdf=6Hf3F4+44tHUM0kEES3RzQ==, pdfFileSize=829430, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=6/5Y1/DtB/tAIIT9PX2OCg==, mapNumber=null, authorCompany=null, fund=null, authors=

申小颖（2001—），女，硕士在读，研究方向：卫生政策与卫生经济

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申小颖（2001—），女，硕士在读，研究方向：卫生政策与卫生经济

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申小颖（2001—），女，硕士在读，研究方向：卫生政策与卫生经济

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Statistical bulletin on the development of national medical security in 2022[EB/OL]. [2024-04-02].http://www.nhsa.gov.cn/art/2023/7/10/art_7_10995.html., articleTitle=Statistical bulletin on the development of national medical security in 2022, refAbstract=null)], funds=null, companyList=[AuthorCompany(id=1240929928447848720, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240929926396833856, xref=null, ext=[AuthorCompanyExt(id=1240929928456237331, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240929926396833856, companyId=1240929928447848720, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Department of Preventive Medicine, School of Medicine, Shihezi University, Shihezi, Xinjiang 832000, China), AuthorCompanyExt(id=1240929928464625939, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240929926396833856, companyId=1240929928447848720, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=石河子大学医学院预防医学系，新疆生产建设兵团重要新发传染病防控与公共卫生安全重点实验室，新疆 石河子 832000)])], figs=[ArticleFig(id=1240929931660685828, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240929926396833856, language=EN, label=Table 1, caption=

Comparison of MCI prevalence among elderly people with different characteristics in China

, figureFileSmall=null, figureFileBig=null, tableContent=
特征调查人数MCI患病人数MCI患病率（%）χ2值P值
个人特质层
性别男5 1264889.5138.820<0.001
女6 0311 03817.2
年龄（岁）65～794 3731012.31 728.301<0.001
80～944 61756512.2
≥952 16786039.7
BMI（㎏/m2）正常5 43379314.6195.684<0.001
消瘦1 58336222.9
超重3 0392799.2
肥胖1 102928.3
自评健康状况很好1 294937.2125.673<0.001
好3 97643110.8
一般4 48374516.6
不好1 30123217.8
很不好1032524.3
听力功能正常9 2105986.52 307.340<0.001
受损1 94792847.7
心理及行为方式层
吸烟否9 3381 36514.642.880<0.001
是1 8191618.9
饮酒否9 4441 38314.648.686<0.001
是1 7131438.3
锻炼否7 3881 29617.5276.625<0.001
是3 7692306.1
健康饮食评分（分）0892528.1136.387<0.001
1～21 51031821.1
3～43 56154015.2
>55 99764310.7
社会参与
家务劳动否4 3731 13025.8901.119<0.001
是6 7843965.8
社交活动否3 54993726.4713.706<0.001
是7 6085897.7
娱乐活动否2 38078432.9950.879<0.001
是8 7777428.5
经济活动否8 5551 39016.2205.256<0.001
是2 6021365.2
社会活动否9 3511 44415.4152.367<0.001
是1 806824.5
定期体检情况是8 03383310.4265.863<0.001
否3 12469322.2
抑郁状况正常8 2271 05312.820.463<0.001
抑郁2 93047316.1
焦虑状况阴性9 8911 31613.310.2430.001
阳性1 26621016.6
睡眠时长（h）6～86 36169711.0133.417<0.001
<62 09028613.7
>82 70654320.1
ADL 正常9 2067678.31 440.459<0.001
轻度失能1 61255334.3
重度失能33920660.8
IADL正常4 409631.4926.308<0.001
受损6 7481 46321.7
家庭社区网络层
户籍城市3 20537111.616.826<0.001
农村7 9521 15514.5
共同居住情况与家人同住8 8971 21613.736.512<0.001
独居1 91422711.9
养老机构3468324.0
婚姻状况在婚5 1592705.2579.516<0.001
不在婚5 9981 25620.9
生活及工作环境层
社区支持
医疗保健无5 94882313.80.2730.601
有5 20970313.5
日常护理无1 66521412.91.1270.288
有9 4921 31213.8
心理照顾无2 90835912.35.9130.015
有8 2491 16714.1
法律支持无3 81547812.56.4710.011
有7 3421 04814.3
医疗服务可及性
时间可及性可及10 7601 43813.425.124<0.001
不可及3978822.2
经济可及性可及6 24670911.465.037<0.001
不可及4 91181716.6
地理可及性可及8 1551 08513.33.5670.059
不可及3 00244114.7
地区东部5 65873112.97.5820.023
中部2 92644115.1
西部2 57335413.8
政策环境层
医疗保险有10 6141 41513.322.121<0.001
无54311120.4
商业保险有75810.70.5800.446
无11 0821 51813.7
), ArticleFig(id=1240929931799097870, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240929926396833856, language=CN, label=表1, caption=

中国不同特征老年人MCI患病情况比较

, figureFileSmall=null, figureFileBig=null, tableContent=
特征调查人数MCI患病人数MCI患病率（%）χ2值P值
个人特质层
性别男5 1264889.5138.820<0.001
女6 0311 03817.2
年龄（岁）65～794 3731012.31 728.301<0.001
80～944 61756512.2
≥952 16786039.7
BMI（㎏/m2）正常5 43379314.6195.684<0.001
消瘦1 58336222.9
超重3 0392799.2
肥胖1 102928.3
自评健康状况很好1 294937.2125.673<0.001
好3 97643110.8
一般4 48374516.6
不好1 30123217.8
很不好1032524.3
听力功能正常9 2105986.52 307.340<0.001
受损1 94792847.7
心理及行为方式层
吸烟否9 3381 36514.642.880<0.001
是1 8191618.9
饮酒否9 4441 38314.648.686<0.001
是1 7131438.3
锻炼否7 3881 29617.5276.625<0.001
是3 7692306.1
健康饮食评分（分）0892528.1136.387<0.001
1～21 51031821.1
3～43 56154015.2
>55 99764310.7
社会参与
家务劳动否4 3731 13025.8901.119<0.001
是6 7843965.8
社交活动否3 54993726.4713.706<0.001
是7 6085897.7
娱乐活动否2 38078432.9950.879<0.001
是8 7777428.5
经济活动否8 5551 39016.2205.256<0.001
是2 6021365.2
社会活动否9 3511 44415.4152.367<0.001
是1 806824.5
定期体检情况是8 03383310.4265.863<0.001
否3 12469322.2
抑郁状况正常8 2271 05312.820.463<0.001
抑郁2 93047316.1
焦虑状况阴性9 8911 31613.310.2430.001
阳性1 26621016.6
睡眠时长（h）6～86 36169711.0133.417<0.001
<62 09028613.7
>82 70654320.1
ADL 正常9 2067678.31 440.459<0.001
轻度失能1 61255334.3
重度失能33920660.8
IADL正常4 409631.4926.308<0.001
受损6 7481 46321.7
家庭社区网络层
户籍城市3 20537111.616.826<0.001
农村7 9521 15514.5
共同居住情况与家人同住8 8971 21613.736.512<0.001
独居1 91422711.9
养老机构3468324.0
婚姻状况在婚5 1592705.2579.516<0.001
不在婚5 9981 25620.9
生活及工作环境层
社区支持
医疗保健无5 94882313.80.2730.601
有5 20970313.5
日常护理无1 66521412.91.1270.288
有9 4921 31213.8
心理照顾无2 90835912.35.9130.015
有8 2491 16714.1
法律支持无3 81547812.56.4710.011
有7 3421 04814.3
医疗服务可及性
时间可及性可及10 7601 43813.425.124<0.001
不可及3978822.2
经济可及性可及6 24670911.465.037<0.001
不可及4 91181716.6
地理可及性可及8 1551 08513.33.5670.059
不可及3 00244114.7
地区东部5 65873112.97.5820.023
中部2 92644115.1
西部2 57335413.8
政策环境层
医疗保险有10 6141 41513.322.121<0.001
无54311120.4
商业保险有75810.70.5800.446
无11 0821 51813.7
), ArticleFig(id=1240929931971064348, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240929926396833856, language=EN, label=Table 2, caption=

Multivariate unconditional logistic regression analysis of MCI in elderly people in China

, figureFileSmall=null, figureFileBig=null, tableContent=
变量参照组最终模型
βOR值（95%CI）P值
个人特质层
性别女性男性0.2171.242（1.061～1.455）0.007
年龄（岁）80～9465～790.5561.744（1.359～2.239）<0.001
≥951.1033.014（2.272～3.998）<0.001
BMI（㎏/m2）偏瘦正常0.0421.043（0.876～1.242）0.638
超重0.0891.093（0.915～1.305）0.328
肥胖-0.1750.840（0.641～1.100）0.204
自评健康状况好很好0.3191.375（1.045～1.809）0.023
一般0.6381.893（1.443～2.481）<0.001
不好0.8202.270（1.654～3.114）<0.001
很不好0.8372.308（1.202～4.433）0.012
听力功能受损正常1.5604.760（4.129～5.487）<0.001
心理及行为方式层
吸烟是否0.0121.012（0.809～1.266）0.918
饮酒是否0.0851.089（0.865～1.371）0.470
锻炼否是0.1851.204（1.006～1.441）0.043
健康饮食评分（分）0>50.3831.466（0.800～2.686）0.215
1～20.4461.562（1.288～1.894）<0.001
3～40.0751.078（0.922～1.260）0.346
社会参与
家务劳动否是0.3121.366（1.150～1.621）<0.001
社交活动否是0.1911.211（1.039～1.410）0.014
娱乐活动否是0.5661.761（1.517～2.046）<0.001
经济活动否是0.1461.157（0.927～1.445）0.197
社会活动否是0.2771.320（1.006～1.730）0.045
定期体检情况否是0.1201.128（0.977～1.302）0.100
抑郁状况是否-0.0990.905（0.769～1.066）0.234
焦虑状况阳性阴性0.0991.104（0.890～1.369）0.370
睡眠时长（h）<66～80.0171.017（0.846～1.222）0.857
>80.2981.347（1.156～1.569）<0.001
ADL 轻度失能正常0.3931.481（1.258～1.745）<0.001
重度失能1.0942.987（2.246～3.974）<0.001
IADL受损正常1.2083.347（2.510～4.462）<0.001
家庭社区网络层
户籍农村城市-0.0210.979（0.820～1.169）0.816
共同居住情况独居与家人同住-0.0580.944（0.775～1.149）0.565
养老机构0.4501.569（1.136～2.166）0.006
婚姻状况不在婚在婚0.1541.167（0.965～1.411）0.111
生活及工作环境层
社区支持
医疗保健无有-0.1050.900（0.771～1.051）0.183
日常护理无有0.0641.066（0.860～1.320）0.561
心理照顾无有-0.1470.863（0.710～1.049）0.140
法律支持无有0.0271.027（0.866～1.218）0.760
医疗服务可及性
时间可及性不可及可及0.1771.194（0.874～1.631）0.266
经济可及性不可及可及0.1441.155（1.005～1.328）0.042
地理可及性不可及可及-0.0770.926（0.795～1.077）0.317
地区中部东部0.1431.154（0.978～1.361）0.090
西部0.0271.027（0.860～1.227）0.769
政策环境层
医疗保险无有-0.0180.982（0.745～1.295）0.898
商业保险无有-0.2690.764（0.325～1.797）0.537
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中国老年人MCI患病的多因素非条件logistic回归分析

, figureFileSmall=null, figureFileBig=null, tableContent=
变量参照组最终模型
βOR值（95%CI）P值
个人特质层
性别女性男性0.2171.242（1.061～1.455）0.007
年龄（岁）80～9465～790.5561.744（1.359～2.239）<0.001
≥951.1033.014（2.272～3.998）<0.001
BMI（㎏/m2）偏瘦正常0.0421.043（0.876～1.242）0.638
超重0.0891.093（0.915～1.305）0.328
肥胖-0.1750.840（0.641～1.100）0.204
自评健康状况好很好0.3191.375（1.045～1.809）0.023
一般0.6381.893（1.443～2.481）<0.001
不好0.8202.270（1.654～3.114）<0.001
很不好0.8372.308（1.202～4.433）0.012
听力功能受损正常1.5604.760（4.129～5.487）<0.001
心理及行为方式层
吸烟是否0.0121.012（0.809～1.266）0.918
饮酒是否0.0851.089（0.865～1.371）0.470
锻炼否是0.1851.204（1.006～1.441）0.043
健康饮食评分（分）0>50.3831.466（0.800～2.686）0.215
1～20.4461.562（1.288～1.894）<0.001
3～40.0751.078（0.922～1.260）0.346
社会参与
家务劳动否是0.3121.366（1.150～1.621）<0.001
社交活动否是0.1911.211（1.039～1.410）0.014
娱乐活动否是0.5661.761（1.517～2.046）<0.001
经济活动否是0.1461.157（0.927～1.445）0.197
社会活动否是0.2771.320（1.006～1.730）0.045
定期体检情况否是0.1201.128（0.977～1.302）0.100
抑郁状况是否-0.0990.905（0.769～1.066）0.234
焦虑状况阳性阴性0.0991.104（0.890～1.369）0.370
睡眠时长（h）<66～80.0171.017（0.846～1.222）0.857
>80.2981.347（1.156～1.569）<0.001
ADL 轻度失能正常0.3931.481（1.258～1.745）<0.001
重度失能1.0942.987（2.246～3.974）<0.001
IADL受损正常1.2083.347（2.510～4.462）<0.001
家庭社区网络层
户籍农村城市-0.0210.979（0.820～1.169）0.816
共同居住情况独居与家人同住-0.0580.944（0.775～1.149）0.565
养老机构0.4501.569（1.136～2.166）0.006
婚姻状况不在婚在婚0.1541.167（0.965～1.411）0.111
生活及工作环境层
社区支持
医疗保健无有-0.1050.900（0.771～1.051）0.183
日常护理无有0.0641.066（0.860～1.320）0.561
心理照顾无有-0.1470.863（0.710～1.049）0.140
法律支持无有0.0271.027（0.866～1.218）0.760
医疗服务可及性
时间可及性不可及可及0.1771.194（0.874～1.631）0.266
经济可及性不可及可及0.1441.155（1.005～1.328）0.042
地理可及性不可及可及-0.0770.926（0.795～1.077）0.317
地区中部东部0.1431.154（0.978～1.361）0.090
西部0.0271.027（0.860～1.227）0.769
政策环境层
医疗保险无有-0.0180.982（0.745～1.295）0.898
商业保险无有-0.2690.764（0.325～1.797）0.537
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中国≥65岁老年人轻度认知障碍流行现状及影响因素分析
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申小颖 , 李小菊 , 李依窈 , 张宪琦 , 赵莉
现代预防医学 | 基层卫生服务 2024,51(11): 2013-2019
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现代预防医学 | 基层卫生服务 2024, 51(11): 2013-2019
中国≥65岁老年人轻度认知障碍流行现状及影响因素分析
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申小颖, 李小菊 , 李依窈, 张宪琦, 赵莉
作者信息
  • 石河子大学医学院预防医学系，新疆生产建设兵团重要新发传染病防控与公共卫生安全重点实验室，新疆 石河子 832000

    • 申小颖（2001—），女，硕士在读，研究方向：卫生政策与卫生经济

通讯作者:

李小菊，E-mail:
Analysis of epidemic status and influencing factors of mild cognitive impairment in Chinese people ≥ 65 years old
Xiao-ying SHEN, Xiao-ju LI , Yi-yao LI, Xian-qi ZHANG, Li ZHAO
Affiliations
  • Department of Preventive Medicine, School of Medicine, Shihezi University, Shihezi, Xinjiang 832000, China
出版时间: 2024-06-10 doi: 10.20043/j.cnki.MPM.202401067
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目的 了解中国老年人轻度认知障碍（MCI）患病状况及其影响因素，为减缓老年人认知功能衰退，提高其生活质量提供科学依据。方法 以健康生态学理论为基础，利用2018年中国老年健康影响因素跟踪调查（CLHLS）中65岁及以上人群，剔除患痴呆以及关键变量缺失的样本，最终纳入11 157例老年人。采用多因素非条件logistic回归分析中国老年人轻度认知障碍的影响因素。结果 本研究≥65岁患MCI的老年人有1 526人，MCI患病率为13.7%；多因素非条件logistic回归结果显示，女性（OR=1.242，95%CI：1.061～1.455）、高龄（80～94岁：OR=1.744，95%CI：1.359～2.239；≥95岁：OR=3.014，95%CI：2.272～3.998）、自评健康状况越差（OR=2.308，95%CI：1.202～4.433）、听力功能受损（OR= 4.760，95%CI：4.129～5.487）、不锻炼（OR=1.204，95%CI：1.006～1.441）、健康饮食评分低（1～2分：OR=1.562，95%CI：1.288～1.894）、无各项社会参与活动（家务劳动、社交活动、娱乐活动、社会活动）、睡眠时间长（>8h：OR=1.347，95%CI：1.156～1.569）、失能（OR=2.987，95%CI：2.246～3.974）、IADL受损（OR=3.347，95%CI：2.510～4.462）、居住在养老机构（OR=1.569，95%CI：1.136～2.166）、医疗服务经济可及性差（OR=1.155，95%CI：1.005～1.328）均是中国老年人患MCI的危险因素。结论 中国老年人MCI患病形势严峻，性别、年龄、自评健康状况、听力功能、锻炼情况、健康饮食评分、社会参与、睡眠时长、ADL、IADL、居住方式和医疗服务可及性是中国老年人患病的主要影响因素，需多维、系统制定相关干预措施，减缓中国老年人的认知功能衰退。

轻度认知障碍（MCI）  /  影响因素  /  老年人  /  健康生态学

Objective To investigate the prevalence and influencing factors of mild cognitive impairment (MCI) in the elderly in China, so as to provide scientific basis for slowing down the decline of cognitive function and improving their quality of life. Methods Based on the theory of health ecology, people aged 65 and above were selected from the 2018 Chinese Longitudinal Healthy Longevity Survey (CLHLS). The research subjects with dementia and missing key variables were excluded, and finally 11 157 elderly people were included. Multivariate unconditional Logistic regression was used to analyze the influencing factors of MCI in Chinese elderly. Results In this study, 1 526 people ≥ 65 years old had MCI, and the prevalence rate of MCI was 13.7%. The results of multivariate unconditional Logistic regression showed that female (OR=1.242, 95%CI: 1.061-1.455) and advanced age (80 to 94 years old: OR=1.744, 95%CI: 1.359-2.239; ≥ 95 years old: OR=3.014, 95%CI: 2.272-3.998), self-rated worse health status (OR=2.308, 95%CI: 1.202-4.433), hearing impairment (OR=4.760, 95%CI: 4.129-5.487), no exercise(OR=1.204, 95%CI: 1.006-1.441), low score of healthy diet (1-2) (OR=1.562, 95%CI: 1.288-1.894), no social participation activities (housework, social activities, recreational activities, social activities), long sleep time (> 8 hours) (OR=1.347, 95%CI:1.156-1.569), disability (OR=2.987, 95%CI: 2.246-3.974), instrumental activity of daily living (IADL) impairment (OR=3.347,95%CI: 2.510-4.462), living in elderly care institutions (OR=1.569, 95%CI: 1.136-2.166), and poor economic accessibility of medical services (OR=1.155, 95%CI: 1.005-1.328) were risk factors for MCI among the elderly in China. Conclusion The prevalence of MCI in the elderly in China is grim. Gender, age, self-rated health status, hearing function, exercise, healthy diet score, social participation, sleep duration, ADL, IADL, living style, and accessibility of medical services are the main influencing factors of the disease in Chinese elderly. Multi-dimensional and systematic intervention measures are needed to slow down the cognitive decline of the elderly in China.

Mild cognitive impairment (MCI)  /  Influencing factors  /  Elderly  /  Health ecology
申小颖, 李小菊, 李依窈, 张宪琦, 赵莉. 中国≥65岁老年人轻度认知障碍流行现状及影响因素分析. 现代预防医学, 2024 , 51 (11) : 2013 -2019 . DOI: 10.20043/j.cnki.MPM.202401067
Xiao-ying SHEN, Xiao-ju LI, Yi-yao LI, Xian-qi ZHANG, Li ZHAO. Analysis of epidemic status and influencing factors of mild cognitive impairment in Chinese people ≥ 65 years old[J]. Modern Preventive Medicine, 2024 , 51 (11) : 2013 -2019 . DOI: 10.20043/j.cnki.MPM.202401067
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随着社会经济水平的发展、医疗水平的提高，痴呆已经成为了继心血管、脑血管、肿瘤的第四大危害老年人健康的病因[1]，目前中国由痴呆引起的社会经济负担占国民生产总值（gross domestic product，GDP）的1.47%，高于全球平均水平（1.09%）[2]，老年痴呆形势较严峻。而轻度认知障碍（mild cognitive impairment，MCI）作为正常老化到痴呆的过渡阶段，从MCI到痴呆的年转化率为10%～15%，大约80%的MCI患者将转化为痴呆，远高于一般人群1%～2%的发病率[3]。预计2050年中国65岁及以上老年人将达3.95亿，相当于目前美国人口的1.2倍；高龄老年人（超过80岁）将达到1.35亿，超过日本目前的人口总数[4]，MCI患病问题在人口老龄化加剧的中国需更为重视。目前对老年人MCI影响因素分析集中于从心理行为、生活方式、社会经济状况等一个或多个方面展开。在此基础上，本研究从“健康三维”的角度纳入身体健康、心理健康、社会适应相关变量，细分各变量并以健康生态学为理论基础，多层次、系统探究中国老年人MCI的影响因素，以期为减缓老年人认知功能衰退，提高其生活质量提供科学依据。
1　资料与方法
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1.1　资料来源
数据来源于2018年中国老年健康影响因素跟踪调查（Chinese Longitudinal Healthy Longevity Survey，CLHLS）数据。该调查在23个调研省份中随机选择50%的市/县/区，调查地区覆盖人口约占总人口的85%。调查问卷内容主要包括老年人及其家庭的基本状况、对现状的评价及性格特征、认知测试、生活方式、日常活动能力、个人背景及家庭结构、生理健康等七个部分[5]，满足本研究的数据要求。本研究选取65岁及以上老年人为研究对象，剔除患痴呆以及关键变量缺失的样本，最终纳入样本11 157例。CLHLS研究已获得北京大学研究伦理委员会批准(IRB00001052-13074)，所有受访者在研究开始和随访期间签署了书面知情同意书。
1.2　变量选取与界定
1.2.1　因变量
因变量为老年人是否患有MCI。CLHLS中以简易智能状态检查量表（mini mental state examination，MMSE）测量老年人认知功能，该量表包括定向能力（时间、地点）、语言(复述、命名、听力理解、阅读理解、书写)、计算、记忆（即时记忆与短时记忆）、视空间等方面的测试，共包含24个条目，总计30分，分数越接近30分则认知功能水平越好。根据以往研究，将文化程度未上过学组≤17分、小学组≤20分、初中及以上组≤24分诊断为MCI[1]。
1.2.2　自变量
健康生态学理论重点关注人类健康与环境、生活方式等多种因素之间相互依赖、相互作用，并在多个层面上交互作用来影响个体和群体的健康[6]。该理论广泛应用于慢性病应用及管理方面。本研究基于健康生态学理论框架将纳入自变量分为五个层面：（1）个人特质层：性别、年龄、自评健康状况、体质指数（body mass index，BMI）、听力功能；（2）心理及行为方式层：吸烟、饮酒、锻炼、健康饮食评分、社会参与、是否定期体检、抑郁、焦虑、睡眠时间、日常生活活动能力（activities of daily living，ADL）和工具性日常生活活动能力（instrumental activity of daily living，IADL）；（3）家庭社区网络层：户籍、居住方式、婚姻状况；（4）生活及工作环境层：社区支持、医疗服务可及性、地区；（5）政策环境层：医疗保险、商业保险。部分相关指标定义如下：（1）健康饮食评分：利用食物频率问卷可评估饮食多样性，该问卷主要由健康食品组成，包括肉、鱼、蛋、豆、水果、茶、大蒜、新鲜蔬菜八项，每一项将“偶尔或很少或从不”归为0分，“经常或几乎每天”归为1分，计算八项总分，最终将饮食多样性总分分为0、1～2、3～4和5分及以上，分数越高代表饮食越健康。该评估方法已被之前的研究使用并证实了其科学性[7]。（2）社会参与类型：CLHLS数据库中与社会参与相关题目共计九项，综合分析无法分离出不同社会参与类型的具体影响，故本研究将社会参与活动具体划分为五类，包括家务劳动（从事家务）、社交活动（户外活动和打牌或打麻将等）、娱乐活动（种花养植物、阅读书报、看电视听广播）、经济活动（从事收入性工作和饲养家禽、家畜）和社会活动（参加有组织的社会活动）[8]。有任一项问题回答为“参与”，则这类活动类型为“1”，反之为“0”。（3）社区支持：由于各类社区支持间存在差异，本研究将社区支持划分为医疗保健、日常护理、心理照顾、法律支持四类[9]，若任一问题回答为“有”，则此类社区支持编码为“1”，反之为“0”。（4）医疗服务可及性：既往学者关于医疗服务可及性的衡量方式各有不同，本研究利用数据库中“到最近医疗机构的距离”“生重病时能否及时就医”“医疗费用（门诊及住院费用）是否主要由医疗保险支付”分别表征地理可及性、时间可及性以及经济可及性[10]。
1.3　统计方法
采用SPSS 27.0统计软件对数据进行整理分析，组间比较采用χ2检验，采用非条件二分类logistic回归进行多因素分析。检验水准α=0.05。
2　结果
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2.1　一般情况
本研究共纳入中国老年人11 157人，其中男性5 126人（45.9%），女性6 031人（54.1%）；年龄65～80岁4 373人（39.2%），80～95岁4 617人（41.4%），≥95岁2 167人（19.4%），其他特征见表1。
2.2　不同特征老年人MCI患病情况比较
本研究MCI患者1 526人，MCI患病率为13.7%。各层不同特征老年人比较，个人特质层、心理及行为方式层、家庭社区网络层各特征差异均有统计学意义（P<0.05）；生活及工作环境层除是否有医疗保健、日常护理类社区支持和医疗服务地理可及性，政策环境层除是否有商业保险（P>0.05），其他特征差异均有统计学意义（P<0.05）。见表1。
2.3　中国老年人MCI患病的非条件多因素logistic回归分析
基于健康生态学框架，以中国老年人认知功能（0=正常；1=轻度认知障碍）为因变量，将各层自变量依次纳入多因素非条件logistic回归分析。最后模型结果显示，女性（OR=1.242）、高龄（80～94岁：OR=1.744；≥95岁：OR=3.014）、自评健康状况越差、听力功能受损（OR=4.760）、不锻炼（OR=1.204）、健康饮食评分低（1～2分：OR=1.562）、无社会参与（家务劳动、社交活动、娱乐活动、社会活动）、睡眠时间长（>8h：OR=1.347）、失能（OR=2.987）、IADL受损（OR=3.347）、居住在养老机构（OR=1.569）、医疗服务经济可及性差（OR=1.155）均是中国老年人患MCI的危险因素。见表2。
3　讨论
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3.1　中国老年人MCI患病现状
本次调查结果显示，中国老年人MCI患病率为13.7%，低于张彧等人[11]的研究结果（15.7%）。有其他结果显示，中国MCI患病率结果并不一致，估计范围在3.2%～29.6%[12]，可能是由于生活方式、诊断标准、纳排标准等有所差异。总体上我国MCI患病率呈上升趋势，且患病形势严峻。因此，需要对患MCI的中国老年人施加干预，从而降低或延缓老年人MCI问题的发生，提高老年人的健康水平。
3.2　中国老年人MCI患病影响因素
3.2.1　个人特质
研究发现，女性是中国老年人患MCI的危险因素，与蔡少华等人[13]研究结果一致。本研究中95岁及以上长寿老人的患病风险显著增加，有研究结果显示年龄每增加5岁，老年人患MCI的风险会增加1.5倍[14]，高龄被广泛认为是MCI的独立危险因素，这可能是机体功能随年龄自然衰退的结果[13]，年龄越大衰退速度越快。自评健康状况越差会增加老年人MCI的患病风险，可能是因为此类老年人长期心理压抑，对生活不满意，会加快其认知功能的恶化。听力受损老年人MCI风险在本研究中居于首位（OR=4.760，95%CI：4.129～5.487），国内外多项研究均已证实其是MCI重要的危险因素[15-16]，鉴于听力受损改变大脑功能，使额叶、海马体等脑功能发生改变进而引起认知功能的改变，提示为听力受损老年人尽早提供助听器等改善听力功能的听力辅助器具以减缓认知功能衰退速度。
3.2.2　心理及行为方式
锻炼情况、健康饮食评分、社会参与情况、睡眠时长、ADL以及IADL均为MCI的主要影响因素。健康饮食评分作为饮食多样性以及饮食质量的评判标准[17]，本研究结果显示饮食多样性低会增加老年人MCI风险，与商茜茜等人[18]研究结果一致。应当建议老年人饮食上多摄入蔬菜水果，适量摄入坚果，延缓老年人认知功能受损的进程。既往研究表明社会参与对认知功能有一定促进作用[1]。本研究进一步细化社会参与类别，发现没有家务活动、没有社交活动、没有娱乐活动、没有社会活动等类型社会参与均为老年人患MCI的危险因素，可能是因为社会参与一定程度上可以增加老年人认知储备，而认知储备作为个人生命周期中多种刺激性活动累积产生的认知资源，与老年人的认知障碍患病风险显著相关[19]，且不同社会参与类型对MCI影响程度不同，相比之下，积极参加娱乐活动更有利于改善老年人认知功能。较多研究认为睡眠持续时间与MCI之间呈现U型模式[20-21]，而本研究中仅睡眠时长超过8h为危险因素，研究结果的差异可能与研究对象的纳入标准、对睡眠时长的评价和分类、混杂因素的调整等不同有关。与ADL正常老年人相比，轻度甚至重度失能老年人患MCI危险成倍增加。可能是年龄的增加使老年人身体各项机能衰退甚至一些器官发生退行性病变[22]，导致ADL下降从而引起感知、记忆能力下降最终损伤认知功能。而与ADL受损老年人相比，更高水平的IADL受损老年人患MCI可能性更高，可能是因为IADL测量量表中单独外出买东西、乘坐交通工具等条目与认知功能中的计算能力、记忆力等重合度较高，IADL损伤显著增加认知功能障碍的危险性。
3.2.3　家庭社区网络
住在养老机构的老年人MCI风险是与家人同住老年人的1.569倍。一方面可能是家庭可以为老年人提供经济、照料、精神等多方面的支持，减少老年人的孤独感，较大程度满足老年人的精神需求，使其积极参与社会活动，从而学习更多新知识，有更好的认知储备，有益于认知功能的维持[23]。另一方面可能根据脆弱性理论体系，在“养儿防老”观念浓厚的中国，养老模式主要以家庭照护和居家养老为主[24]，居住在养老机构会降低老年人应对风险的能力，影响其心理健康，从而加速老年人认知功能恶化。
3.2.4　生活及工作环境
本研究结果显示医疗服务可及性差也是老年人MCI的危险因素，将医疗服务可及性细分为地理、时间、经济可及性后发现，经济不可及即医疗费用并非主要由医疗保险承担的老年人患MCI的可能性相对增加15.5%，原因可能在于当就医成本较高时，老年人会选择性忽略或延迟就医，从而导致老年人认知功能恶化速度加快[13]。提示进一步健全医疗保险等保障机制，有针对性的扩大医疗保险报销覆盖面，提高老年人医疗服务可及性，减轻其就医的经济压力。
3.2.5　政策环境
研究结果显示，老年人MCI患病情况在是否有医疗保险和商业保险之间无明显差异。截至2022年底，全国基本医疗保险参保率稳定在95%[25]，中国“全民医保”目标已初步实现，所以医疗保险对老年人MCI患病情况暂无明显影响。本研究中商业保险参保率仅0.67%，可能是保险公司在销售保险产品时希望的客户群为低风险人群，而本研究纳入的研究对象以老年人尤其是长寿老人为主，导致是否有商业保险的认知功能差异无法辨识。
综上所述，作为痴呆预防干预的“重要窗口期”，中国老年人MCI患病形势尤为严峻，是我国面临的重要社会问题和公共卫生问题。在健康生态学理论模型的指导下，明确复杂的社会、行为、心理等因素对老年人认知功能的共同作用，可为有针对性的提出相关干预措施提供科学依据，从而实现“健康老龄化”。同时，本研究也存在一定局限性，数据来源于2018年CLHLS数据库的横断面数据，无法判断各因素与老年人认知功能间的详细因果关系；此外，由于MCI的影响因素具有一定复杂性，并非纳入全部因素分析，后续需对其加以补充并对锻炼、饮酒等变量进一步细分程度后深入分析。
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2024年第51卷第11期
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doi: 10.20043/j.cnki.MPM.202401067
  • 接收时间：2024-01-05
  • 首发时间：2026-03-18
  • 出版时间：2024-06-10
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    石河子大学医学院预防医学系，新疆生产建设兵团重要新发传染病防控与公共卫生安全重点实验室，新疆 石河子 832000

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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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