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Article(id=1240929929756463180, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240929920461886112, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202312298, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1702915200000, receivedDateStr=2023-12-19, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773790350617, onlineDateStr=2026-03-18, pubDate=1717948800000, pubDateStr=2024-06-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773790350617, onlineIssueDateStr=2026-03-18, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773790350617, creator=13701087609, updateTime=1773790350617, 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=2055, endPage=2060, ext={EN=ArticleExt(id=1240929930121367659, articleId=1240929929756463180, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=A study on the relationship between social participation, cognitive function and frailty of middle-aged and elderly groups in China, columnId=1228016572451718132, journalTitle=Modern Preventive Medicine, columnName=Health and Social Behavior, runingTitle=null, highlight=null, articleAbstract=

Objective To investigate whether there is a mediating effect of cognitive function between social participation and frailty. Methods Using the China Health and Retirement Longitudinal Survey (CHARLS) database, three rounds of survey data in 2011, 2013, and 2015 were selected for the study. The data in 2011 were the baseline data, and the ID number was used to match the participants in the follow-up in 2013 and 2015. A total of 3 139 people were enrolled in this cohort study. Cox regression model and simple mediating effect model were used to analyze the relationship among social participation, cognitive function, and frailty. Results A total of 259 patients had frailty during the follow-up period. The results of multivariate Cox regression model adjusting social demography and lifestyle showed that social participation (HR=0.641, 95%CI: 0.496-0.829)and cognitive function (HR=0.952, 95%CI: 0.928-0.977) were associated with frailty. The results of the intermediary model with relevant covariates showed that cognitive function has a significant mediating effect between social participation and frailty. Conclusion Social participation and cognitive function are associated with frailty, and cognitive function has some mediating effect between social participation and frailty.

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目的 了解认知功能在社会参与和衰弱之间是否存在中介效应。方法 利用“中国健康与养老追踪调查”（China Health and Retirement Longitudinal Survey, CHARLS）数据库，选择2011、2013和2015年三轮调查数据进行研究，2011年的数据为入组基线数据，并以ID号匹配2013和2015年参与随访的研究对象，筛选过后共有3 139人纳入本次队列研究。采用Cox回归模型和简单中介效应模型来分析社会参与、认知功能和衰弱发生之间的关系。结果 在随访期间共有259人出现了新发衰弱，调整了社会人口学和生活方式的多因素Cox回归模型结果显示，社会参与（HR=0.641，95%CI: 0.496～0.829）和认知功能（HR=0.952，95%CI:0.928～0.977）与衰弱发生相关。纳入相关协变量的中介模型结果显示，认知功能在社会参与和衰弱之间的中介效应显著。结论 社会参与和认知功能与衰弱发生相关，认知功能在社会参与和衰弱之间存在部分中介效应。

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黄志刚，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=Hax6bHsvSfr+0kL0dQEWAg==, magXml=qYBZHCAImlFemQU0zgNi6g==, pdfUrl=null, pdf=qMo9fkGNhv5bmeMUhaE92w==, pdfFileSize=728779, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=OT9rwxv0QP6wJpEUt+kLRQ==, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=C4hN7EU5jwgcBuYCbvC6DQ==, mapNumber=null, authorCompany=null, fund=null, authors=

高苗（1996—），女，硕士在读，研究方向：疾病预防与控制

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高苗（1996—），女，硕士在读，研究方向：疾病预防与控制

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高苗（1996—），女，硕士在读，研究方向：疾病预防与控制

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Journal of Epidemiology and Community Health, 2016, 70(7): 716-721., articleTitle=Association between frailty and quality of Life among community-dwelling older People: a systematic review and meta-analysis, refAbstract=null)], funds=null, companyList=[AuthorCompany(id=1240929931878781196, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240929929756463180, xref=null, ext=[AuthorCompanyExt(id=1240929931887169805, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240929929756463180, companyId=1240929931878781196, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Department of Epidemiology and Health Statistics, School of Public Health, Guangdong Medical University, Dongguan,Guangdong 523000, China), AuthorCompanyExt(id=1240929931895558414, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240929929756463180, companyId=1240929931878781196, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=广东医科大学公共卫生学院流行病与卫生统计学系，广东 东莞 523000)])], figs=[ArticleFig(id=1240929936060502582, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240929929756463180, language=EN, label=Figure 1, caption=Diagram of the mediating effect model of cognitive functioning, figureFileSmall=7qY2OHhDdUvaiQwTbxGWRQ==, figureFileBig=OT9rwxv0QP6wJpEUt+kLRQ==, tableContent=null), ArticleFig(id=1240929936148582972, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240929929756463180, language=CN, label=图1, caption=认知功能的中介效应模型图

注：***表示P<0.001，**表示P<0.05。

, figureFileSmall=7qY2OHhDdUvaiQwTbxGWRQ==, figureFileBig=OT9rwxv0QP6wJpEUt+kLRQ==, tableContent=null), ArticleFig(id=1240929936341520960, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240929929756463180, language=EN, label=Table 1, caption=

Comparison of baseline information ［n（%），（）]

, figureFileSmall=null, figureFileBig=null, tableContent=
变量总数（n=3 139）非衰弱组（n=2 880）衰弱组（n=259）检验值P值
主要变量
社会参与25.630a<0.001
没有1 509(48.1)1 345(89.1)164(10.9)
有1 630(51.9)1 535(94.2)95(5.8)
认知功能13.38±5.7013.63±5.6710.67±5.26131.655b<0.001
协变量
社会人口学特征
年龄（岁）61.45±8.6461.17±8.6064.66±8.50398.361b<0.001
性别0.688a0.407
男1 550(49.4)1 429(92.2)121(7.8)
女1 589(50.6)1 451(91.3)138(8.7)
同居状态1.078a0.299
是2 646(84.3)2 434(92.0)212(8.0)
否493(15.7)446(90.5)47(9.5)
户口现状11.856a0.001
农业户口2 570(81.9)2 337(90.9)233(9.1)
非农业户口569(18.1)543(95.4)26(4.6)
教育程度49.623a<0.001
文盲905(28.8)788(87.1)117(12.9)
小学1 392(44.3)1 281(92.0)111(8.0)
初中564(18.0)542(96.1)22(3.9)
高中及以上278(8.9)269(96.8)9(3.2)
生活方式特征
饮酒7.248a0.007
是1 030(32.8)965(93.7)65(6.3)
否2 109(67.2)1 915(90.8)194(9.2)
吸烟3.185a0.074
是1 002(31.9)906(90.4)96(9.6)
否2 137(68.1)1 974(92.4)163(7.6)
健康相关指标
自评健康38.467a<0.001
好481(15.3)460(95.6)21(4.4)
一般991(31.6)938(94.7)53(5.3)
差1 667(53.1)1 482(88.9)185(11.1)
主观记忆35.138a<0.001
良好及以上609(19.4)575(94.4)34(5.6)
一般1 410(44.9)1 321(93.7)89(6.3)
差1 120(35.7)984(87.9)136(12.1)
夜间睡眠时间（h）6.194a0.045
≤61 328(42.3)1 203(90.6)125(9.4)
7～91 692(53.9)1 571(92.8)121(7.2)
≥10119(3.8)106(89.1)13(10.9)
慢性病13.643a<0.001
有2 172(69.2)1 966(90.5)206(9.5)
无967(30.8)914(94.5)53(5.5)
ADL困难29.781a<0.001
有523(16.7)448(85.7)75(14.3)
无2 616(83.3)2 432(93.0)184(7.0)
IADL困难23.325a<0.001
有647(20.6)563(87.0)84(13.0)
无2 492(79.4)2 317(93.0)175(7.0)
), ArticleFig(id=1240929936429601349, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240929929756463180, language=CN, label=表1, caption=

基线资料比较［n（%），（）]

, figureFileSmall=null, figureFileBig=null, tableContent=
变量总数（n=3 139）非衰弱组（n=2 880）衰弱组（n=259）检验值P值
主要变量
社会参与25.630a<0.001
没有1 509(48.1)1 345(89.1)164(10.9)
有1 630(51.9)1 535(94.2)95(5.8)
认知功能13.38±5.7013.63±5.6710.67±5.26131.655b<0.001
协变量
社会人口学特征
年龄（岁）61.45±8.6461.17±8.6064.66±8.50398.361b<0.001
性别0.688a0.407
男1 550(49.4)1 429(92.2)121(7.8)
女1 589(50.6)1 451(91.3)138(8.7)
同居状态1.078a0.299
是2 646(84.3)2 434(92.0)212(8.0)
否493(15.7)446(90.5)47(9.5)
户口现状11.856a0.001
农业户口2 570(81.9)2 337(90.9)233(9.1)
非农业户口569(18.1)543(95.4)26(4.6)
教育程度49.623a<0.001
文盲905(28.8)788(87.1)117(12.9)
小学1 392(44.3)1 281(92.0)111(8.0)
初中564(18.0)542(96.1)22(3.9)
高中及以上278(8.9)269(96.8)9(3.2)
生活方式特征
饮酒7.248a0.007
是1 030(32.8)965(93.7)65(6.3)
否2 109(67.2)1 915(90.8)194(9.2)
吸烟3.185a0.074
是1 002(31.9)906(90.4)96(9.6)
否2 137(68.1)1 974(92.4)163(7.6)
健康相关指标
自评健康38.467a<0.001
好481(15.3)460(95.6)21(4.4)
一般991(31.6)938(94.7)53(5.3)
差1 667(53.1)1 482(88.9)185(11.1)
主观记忆35.138a<0.001
良好及以上609(19.4)575(94.4)34(5.6)
一般1 410(44.9)1 321(93.7)89(6.3)
差1 120(35.7)984(87.9)136(12.1)
夜间睡眠时间（h）6.194a0.045
≤61 328(42.3)1 203(90.6)125(9.4)
7～91 692(53.9)1 571(92.8)121(7.2)
≥10119(3.8)106(89.1)13(10.9)
慢性病13.643a<0.001
有2 172(69.2)1 966(90.5)206(9.5)
无967(30.8)914(94.5)53(5.5)
ADL困难29.781a<0.001
有523(16.7)448(85.7)75(14.3)
无2 616(83.3)2 432(93.0)184(7.0)
IADL困难23.325a<0.001
有647(20.6)563(87.0)84(13.0)
无2 492(79.4)2 317(93.0)175(7.0)
), ArticleFig(id=1240929936530264649, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240929929756463180, language=EN, label=Table 2, caption=

Multifactorial Cox regression analysis of the effects of social participation and cognitive functioning on the onset of frailty

, figureFileSmall=null, figureFileBig=null, tableContent=
变量HR值（95%CI）P值
模型1
社会参与0.627（0.485～0.810）<0.001
认知功能0.923（0.903～0.943）<0.001
模型2
社会参与0.641（0.496～0.829）<0.001
认知功能0.952（0.927～0.977）<0.001
模型3
社会参与0.641（0.496～0.829）<0.001
认知功能0.952（0.928～0.977）<0.001
模型4
社会参与0.649（0.502～0.839）<0.001
认知功能0.970（0.944～0.997）0.028
), ArticleFig(id=1240929936622539342, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240929929756463180, language=CN, label=表2, caption=

社会参与、认知功能对衰弱发生影响的多因素Cox回归分析

, figureFileSmall=null, figureFileBig=null, tableContent=
变量HR值（95%CI）P值
模型1
社会参与0.627（0.485～0.810）<0.001
认知功能0.923（0.903～0.943）<0.001
模型2
社会参与0.641（0.496～0.829）<0.001
认知功能0.952（0.927～0.977）<0.001
模型3
社会参与0.641（0.496～0.829）<0.001
认知功能0.952（0.928～0.977）<0.001
模型4
社会参与0.649（0.502～0.839）<0.001
认知功能0.970（0.944～0.997）0.028
), ArticleFig(id=1240929936735785556, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240929929756463180, language=EN, label=Table 3, caption=

Mediating effects of cognitive functioning between social participation and frailty

, figureFileSmall=null, figureFileBig=null, tableContent=
路径β（95%CI）P值OR值（95%CI）P值
中介效应模型
社会参与→认知功能（a）0.946（0.618～1.273 ）<0.001
认知功能→衰弱（b）-0.035（-0.063～-0.007）0.0160.966（0.939～0.993）0.014
社会参与→衰弱（c’）-0.475（-0.747～-0.203）0.0010.622（0.474～0.817）<0.001
总效应模型
社会参与→衰弱（c）-0.510（-0.780～-0.239）<0.0010.601（0.458～0.787）<0.001
), ArticleFig(id=1240929936857420373, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240929929756463180, language=CN, label=表3, caption=

认知功能在社会参与和衰弱之间的中介效应

, figureFileSmall=null, figureFileBig=null, tableContent=
路径β（95%CI）P值OR值（95%CI）P值
中介效应模型
社会参与→认知功能（a）0.946（0.618～1.273 ）<0.001
认知功能→衰弱（b）-0.035（-0.063～-0.007）0.0160.966（0.939～0.993）0.014
社会参与→衰弱（c’）-0.475（-0.747～-0.203）0.0010.622（0.474～0.817）<0.001
总效应模型
社会参与→衰弱（c）-0.510（-0.780～-0.239）<0.0010.601（0.458～0.787）<0.001
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我国中老年群体社会参与和认知功能与衰弱发生关系的研究
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高苗 , 潘荣玲 , 陈梓旋 , 彭鑫 , 梁国潇 , 钟金麟 , 莫宇倩 , 杜进林 , 黄志刚
现代预防医学 | 健康与社会行为 2024,51(11): 2055-2060
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现代预防医学 | 健康与社会行为 2024, 51(11): 2055-2060
我国中老年群体社会参与和认知功能与衰弱发生关系的研究
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高苗, 潘荣玲, 陈梓旋, 彭鑫, 梁国潇, 钟金麟, 莫宇倩, 杜进林, 黄志刚
作者信息
  • 广东医科大学公共卫生学院流行病与卫生统计学系，广东 东莞 523000

    • 高苗（1996—），女，硕士在读，研究方向：疾病预防与控制

通讯作者:

黄志刚，E-mail:
A study on the relationship between social participation, cognitive function and frailty of middle-aged and elderly groups in China
Miao GAO, Rong-ling PAN, Zi-xuan CHEN, Xin PENG, Guo-xiao LIANG, Jin-lin ZHONG, Yu-qian MO, Jin-lin DU, Zhi-gang HUANG
Affiliations
  • Department of Epidemiology and Health Statistics, School of Public Health, Guangdong Medical University, Dongguan,Guangdong 523000, China
出版时间: 2024-06-10 doi: 10.20043/j.cnki.MPM.202312298
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目的 了解认知功能在社会参与和衰弱之间是否存在中介效应。方法 利用“中国健康与养老追踪调查”（China Health and Retirement Longitudinal Survey, CHARLS）数据库，选择2011、2013和2015年三轮调查数据进行研究，2011年的数据为入组基线数据，并以ID号匹配2013和2015年参与随访的研究对象，筛选过后共有3 139人纳入本次队列研究。采用Cox回归模型和简单中介效应模型来分析社会参与、认知功能和衰弱发生之间的关系。结果 在随访期间共有259人出现了新发衰弱，调整了社会人口学和生活方式的多因素Cox回归模型结果显示，社会参与（HR=0.641，95%CI: 0.496～0.829）和认知功能（HR=0.952，95%CI:0.928～0.977）与衰弱发生相关。纳入相关协变量的中介模型结果显示，认知功能在社会参与和衰弱之间的中介效应显著。结论 社会参与和认知功能与衰弱发生相关，认知功能在社会参与和衰弱之间存在部分中介效应。

衰弱  /  认知功能  /  社会参与  /  CHARLS

Objective To investigate whether there is a mediating effect of cognitive function between social participation and frailty. Methods Using the China Health and Retirement Longitudinal Survey (CHARLS) database, three rounds of survey data in 2011, 2013, and 2015 were selected for the study. The data in 2011 were the baseline data, and the ID number was used to match the participants in the follow-up in 2013 and 2015. A total of 3 139 people were enrolled in this cohort study. Cox regression model and simple mediating effect model were used to analyze the relationship among social participation, cognitive function, and frailty. Results A total of 259 patients had frailty during the follow-up period. The results of multivariate Cox regression model adjusting social demography and lifestyle showed that social participation (HR=0.641, 95%CI: 0.496-0.829)and cognitive function (HR=0.952, 95%CI: 0.928-0.977) were associated with frailty. The results of the intermediary model with relevant covariates showed that cognitive function has a significant mediating effect between social participation and frailty. Conclusion Social participation and cognitive function are associated with frailty, and cognitive function has some mediating effect between social participation and frailty.

Frailty  /  Cognitive function  /  Social participation  /  CHARLS
高苗, 潘荣玲, 陈梓旋, 彭鑫, 梁国潇, 钟金麟, 莫宇倩, 杜进林, 黄志刚. 我国中老年群体社会参与和认知功能与衰弱发生关系的研究. 现代预防医学, 2024 , 51 (11) : 2055 -2060 . DOI: 10.20043/j.cnki.MPM.202312298
Miao GAO, Rong-ling PAN, Zi-xuan CHEN, Xin PENG, Guo-xiao LIANG, Jin-lin ZHONG, Yu-qian MO, Jin-lin DU, Zhi-gang HUANG. A study on the relationship between social participation, cognitive function and frailty of middle-aged and elderly groups in China[J]. Modern Preventive Medicine, 2024 , 51 (11) : 2055 -2060 . DOI: 10.20043/j.cnki.MPM.202312298
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衰弱是老年人群中常见的一种临床综合征，其特点是机体生理系统功能的减退和储备下降，使机体应对各种健康风险时敏感性和脆弱性增加[1]。衰弱是老年人发生各种不良健康后果的重要危险因素，如跌倒风险增加、住院治疗增多、发病率和死亡率的上升以及生活质量降低等[2-3]。有研究显示衰弱在65岁以上人群中的患病率达到10%以上[4]，随着全球老龄人口的持续增长，衰弱的患病率预计将会持续上升。目前，衰弱已成为影响老年人群健康的重要公共卫生问题之一。认知功能下降和衰弱的流行趋势一样，在中老年人群中更常见，有研究表明[5]认知功能下降是衰弱发生的危险因素之一。为应对人口老龄化的不断加剧，WHO提出“积极老龄化”这一概念，积极老龄化主要包含三个层面，即健康、参与和保障，其中“参与”是指老年群体在健康的基础上积极参与社会活动，以保障和提高其生活质量，“参与”这一层面更能体现老年群体本身的“积极”应对老龄化，是积极老龄化的关键内容[6-7]。社会参与度低可能是导致衰弱发生的重要危险因素，并与后期衰弱的加重有关[8-10]。积极参与社会活动的老年人身体活动能力相对较强，自评健康状况和认知功能较好，并且生活质量水平更高，死亡率较低，同时有助于延缓机体认知功能的下降以及晚年发生老年痴呆的风险[11-13]。综上可知，社会参与可能会通过延缓认知水平下降，从而影响衰弱的发生，即认知功能在社会参与和衰弱发生之间可能存在潜在的中介效应影响。因此本研究的目的是分析社会参与、认知功能和衰弱发生的关系，以及认知功能是否在社会参与和衰弱之间存在中介效应。
1　对象与方法
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1.1　研究对象
数据选取自CHARLS数据库2011、2013和2015年的三轮调查数据。在本次研究中，2011年的数据作为入组基线数据，随访2013和2015年人群的衰弱状态。纳入标准：（1）2011年调查时年龄≥45岁；（2）研究人群个人资料数据完整准确。排除标准：（1）年龄<45岁者；（2）在2011年未能成功测量衰弱的人，以及在2011年已经是衰弱状态的人；（3）在2013和2015年中没有成功随访的人。
1.2　变量的测量
1.2.1　衰弱状态
本研究选用衰弱表型量表（fried frailty phenotype，FFP）作为衰弱状态的评估工具，这是目前最广泛使用的衰弱评估量表，该表型先前已在其他CHARLS队列研究中得到过验证[14-15]。该量表包含五个要素：低握力、步速减慢、疲乏、低体力活动、体重减轻。以上五个要素每个记1分，衰弱测量的得分范围在0～5分之间，当得分大于等于3时记为衰弱，取值为“1”，否则为“0”。为保留最大数据量当缺失条目大于等于2时，该研究对象将被排除，但不包括缺失条目为2，同时得分为3的研究对象。
1.2.2　认知功能
认知功能的测量包括两个部分：情景记忆和精神状态[16]。情景记忆分为即时记忆和延迟回忆，得分范围为0～20分。精神状态的测量包括时间定向力、计算能力和画图能力三个方面，得分范围是0～11分。为了评估整体认知功能，我们将取情景记忆和认知功能的总分，总体得分范围是0～31分，分数越高表示认知功能越好。
1.2.3　社会参与
有关社会活动参与情况的数据来自于CHARLS问卷中的“您过去一个月是否进行了下列活动（可多选）”，答案有：（1）串门、跟朋友交往；（2）打麻将、下棋、打牌、去社区活动室；（3）无偿向与您不住在一起的亲人、朋友或者邻居提供帮助；（4）去公园或者其他场所跳舞、健身、练气功等；（5）参加社区组织活动；（6）志愿者活动或者慈善活动；（7）无偿照顾与您不住在一起的病人或残疾人；（8）上学或者参加培训课程；（9）炒股（基金及其他金融证券）；（10）上网；（11）其他；（12）均没有。对于以上12个选项，选择（1）～（11）任意一项的认定为有活动参与，记作“1”，选择（12）的认定为没有参与社会活动，记作“0”。
1.2.4　协变量
根据以往文献梳理[14，17]，本研究的协变量包括社会人口学特征、生活方式、健康相关指标三类。社会人口特征包括年龄、性别、同居状态、受教育程度和户口现状；生活方式包括吸烟和饮酒；健康相关指标包括慢性非传染性疾病患病情况、自评健康状况、主观记忆力评价、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（instrumental activities of daily living，IADL）。慢性非传染性疾病患病情况是指患有CHARLS家户问卷中DA007这一问题的答案中14类疾病的任意一种。睡眠时间分为三类[15，17]：短时间睡眠（每晚睡眠时间≤6 h）、正常睡眠时间（每晚7～9 h）、长时间睡眠（每晚睡眠时间≥10 h）。ADL困难是指日常活动中洗澡、穿衣、吃饭、如厕、控制排尿六项中的任何一项有困难；而IADL困难是指在做家务、准备热饭、购物、处理财务和服药五项之中的任何一项出现困难[18]。
1.3　统计学方法
数据处理使用的软件有SPSS 25.0和Mplus 8。服从正态分布的计量资料以（）表示，两组间比较采用独立样本 t检验；不服从正态分布以［M（P25，P75）］表示，两组间比较采用秩和检验；计数资料以百分比或频率表示，采用χ2检验分析组间有无差异。使用Cox回归模型研究社会参与、认知功能与衰弱发生之间的关系[14]，以风险比（hazard ratio，HR）和其95%置信区间来表示；在多因素Cox回归中通过控制不同协变量进行敏感性分析。使用Mplus 8软件构建简单中介效应模型，通过依次检验法分析相关系数是否显著来判定认知功能在社会参与和衰弱发生之间是否存在中介效应[19]。所有分析均为双侧分析，检验水准α=0.05。
2　结果
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2.1　基线资料
根据纳入排除标准筛选过后，在2011年中入组的共有3 139人，平均年龄为61.5岁。在随访中，在2013年出现新发衰弱的有110人，在2015年出现新发衰弱的有149人，在4年的随访中共有259人出现了新发衰弱，衰弱的患病率为8.25%。基线特征的比较分析显示，新发衰弱的参与者在基线入组时更有可能没有社会参与、认知功能评分相对较低、年龄较大、户口现状为农业户口、受教育处程度较低、不喝酒、自评健康和主观记忆较差、患有慢性病、夜间睡眠时间相对较短、ADL有困难、IADL有困难。见表1。
2.2　社会参与、认知功能对衰弱发生的影响
根据基线资料分析结果来筛选与因变量相关的协变量，通过纳入不同的协变量构建四个水平的多因素Cox回归模型来验证社会参与、认知功能对衰弱发生的影响。多因素Cox回归结果显示（模型3），社会参与和认知功能对衰弱的发生有着显著的影响，HR（95% CI）分别为0.641（0.496～0.829）、0.952（0.928～0.9,77），社会参与少的以及认知功能评分越低的人群更有可能发生衰弱。在调整了社会人口学、生活方式以及健康相关指标后的模型4中结果依然显著，表明研究结果稳健。见表2。
2.3　认知功能在社会参与和衰弱之间的中介效应分析
控制了相关混杂因素的简单中介模型分析结果显示，在中介效应模型中社会参与对认知功能的路径系数（β=0.946, 95%CI: 0.618～1.273）、认知功能对衰弱的路径系数（β=-0.035, 95%CI: -0.063～-0.007）、社会参与对衰弱的路径系数（β=-0.475,95%CI:-0.747～-0.203）均显著；在总效应模型中社会参与对认知功能的路径系数（β=-0.510, 95%CI: -0.780～-0.239）同样显著。由此可知，认知功能在社会参与和衰弱之间存在显著的中介效应，社会参与和认知功能正向相关，社会参与通过认知功能影响衰弱的发生；衰弱状态发生的风险随着认知功能评分的上升而降低（OR=0.966, 95%CI: 0.939～0.993）；有社会参与的人群患有衰弱的概率是没有社会参与的人群的0.622倍（OR=0.622, 95%CI: 0.474～0.817）。见图1、表3。
3　讨论
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关于衰弱的患病率，不同国家和地区衰弱患病率存在着一定的差距。有学者对欧洲22个国家的研究资料进行meta分析，结果显示衰弱的总体患病率约为18%[20]，非洲的衰弱患病率为22%，相较于欧洲要高出8%[21]，关于拉丁美洲的调查研究显示衰弱的患病率为19.6%[22]。国内多项研究显示[9，23-24]，我国衰弱的患病率是8%～14.8%。本研究结果显示衰弱的患病率为8.25%，这与我国相关的研究结果对比来看是一致的。衰弱患病风险的增加与年龄的上升有关[25-27]，本研究的衰弱患病率相对较低，可能与纳入的人群为中老年有关。
在调整不同水平协变量的多因素Cox回归模型中，社会参与与衰弱发生显著相关，这一结果与之前的国内多项队列研究结果一致[14，28-29]，适当的社会参与是影响衰弱发生的保护性因素。国外也有研究表明[30-31]，社会参与频率的增加与低水平的身体衰弱显著相关，另外有一项纵向研究[32]表明不同类型的社会参与对衰弱的影响不同，其中运动类型社会参与可以延缓身体衰弱的发展和恶化。因此，社会参与作为积极老龄化的重要内容，社区和家庭应当积极促进中老年人群参与各项社会活动，以降低衰弱患病的风险。
认知功能下降和衰弱一样，都是老年群体常见的健康问题，多项研究表明[33-35]，认知功能下降与身体衰弱之间存在密切联系，患有衰弱的个体比非衰弱的发生认知功能下降的风险增加3倍以上[36]，发生老年痴呆的风险高1～2倍[37]；同时Wu等人[5]研究指出患有认知功能障碍的老年人也是衰弱发生的危险因素。本研究结果显示在基线入组时存在认知功能下降的人更易发生衰弱，与以往研究一致。
中介效应分析结果明确显示了认知功能在社会参与和衰弱之间存在显著的中介作用，社会参与通过认知功能影响衰弱的发生。在本研究中，社会参与和认知功能正向相关，认知功能评分越高，衰弱发生风险越低，这与之前的研究一致[6，38-39]。积极参与各项社会活动的老年人，更有利于保持健康的生理和心理状态，如棋牌类游戏、打麻将、广场舞等，这些社会活动有利于中老年人保持良好的认知水平，进而减少衰弱的发生。这提示我们要综合衡量老年人的生活和健康状况，在积极促进中老年群体参与社会活动，注重身体健康的同时，也不能忽略精神和心理健康。
总的来说，本研究利用具有全国代表性的CHARLS数据库中的样本，探讨了社会参与、认知功能和衰弱发生的关系，首次对认知功能是否在社会参与和衰弱之间存在中介效应进行分析。研究发现，社会参与和认知功能与新发衰弱显著相关，社会参与较少的人群以及认知功能评分越低的人群更有可能发生衰弱。中介效应分析结果显示，认知功能在社会参与和衰弱之间存在显著的中介作用，认知功能评分每上升一分，衰弱发生的风险就降低3.4%，有社会参与的人群患有衰弱的概率是没有社会参与的人群的0.622倍。综上所述，社会参与是认知功能的相关因素，同时也是衰弱发生的影响因素，认知功能在社会参与和衰弱发生之间存在部分中介作用，进一步扩充了相关研究结果，为综合制定预防衰弱发生的措施提供了相关依据。
本研究也存在一定的局限性，一方面，未纳入相关精神心理因素如抑郁症状来验证其对衰弱发生的影响；另一方面，除了研究选定的协变量之外，仍存在混杂因素对衰弱的发生存在一定的影响，无法控制所有相关的混杂因素。未来仍可以进一步探索其他心理因素和生理健康指标对衰弱发生的影响机制。
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2024年第51卷第11期
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doi: 10.20043/j.cnki.MPM.202312298
  • 接收时间：2023-12-19
  • 首发时间：2026-03-18
  • 出版时间：2024-06-10
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  • 收稿日期：2023-12-19
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    广东医科大学公共卫生学院流行病与卫生统计学系，广东 东莞 523000

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黄志刚，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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