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Article(id=1241522924750959603, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241522919977841545, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202308485, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1692892800000, receivedDateStr=2023-08-25, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773931731641, onlineDateStr=2026-03-19, pubDate=1710000000000, pubDateStr=2024-03-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773931731641, onlineIssueDateStr=2026-03-19, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773931731641, creator=13701087609, updateTime=1773931731641, updator=13701087609, issue=Issue{id=1241522919977841545, tenantId=1146029695717560320, journalId=1227665162245664772, year='2024', volume='51', issue='5', pageStart='769', pageEnd='960', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773931730503, creator=13701087609, updateTime=1773931880386, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1241523548695622547, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241522919977841545, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1241523548695622548, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241522919977841545, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=803, endPage=810, ext={EN=ArticleExt(id=1241522925602402321, articleId=1241522924750959603, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Analysis on the current situation and influencing factors of overweight and obesity among the elderly in China based on the theory of health ecology, columnId=1240413921954295836, journalTitle=Modern Preventive Medicine, columnName=Epidemiology and Statistical Methods, runingTitle=null, highlight=null, articleAbstract=
Objective

To understand the current situation, influencing factors, and urban-rural heterogeneity of overweight/obesity among the elderly in China, so as to provide basis for formulating corresponding intervention measures.

Methods

The data of people age ≥ 60 years old in China Family Panel Studies (CFPS) database in 2020 were used. Unconditional binary logistic regression was used to analyze the influencing factors of overweight/obesity in the elderly.

Results

A total of 4 870 eligible samples were included in this study, of which 1 903 were overweight/obese, and the overweight/obesity rate was 39.08%(33.10% in rural areas and 36.56% in urban areas). People aged 60-69 (OR = 2.145, 95%CI: 1.559-2.951), 70-79 years old (OR = 1.752, 95%CI: 1.270-2.416), suffering from chronic diseases (OR = 1.215, 95%CI: 1.061-1.392), smoking (OR = 0.651,95%CI: 0.556-0.763), living in the central China (OR = 1.255, 95%CI: 1.052-1.498), eastern China (OR = 1.378, 95%CI:1.169-1.623), living in town (OR = 1.366, 95%CI: 1.193-1.565), with primary school education (OR = 1.214, 95%CI: 1.034-1.427), retirement pension (OR = 1.342, 95%CI: 1.126-1.599), and endowment insurance (OR = 0.841, 95%CI: 0.739-0.956) were the influencing factors of overweight/obesity in the elderly. People aged 60- 69 (OR = 2.333, 95%CI: 1.561-3.487), 70-79 years old (OR = 2.057, 95%CI: 1.372-3.084), suffering from chronic diseases (OR = 1.364, 95%CI: 1.132-1.645), smoking (OR = 0.705, 95%CI: 0.563-0.881), living in the eastern region (OR = 1.278, 95%CI: 1.006-1.623). with primary school education (OR = 1.397, 95%CI: 1.104-1.768), and retirement pension (OR = 1.284, 95%CI: 1.046-1.577) were the influencing factors of overweight/obesity of the urban elderly. People aged 60-69 years old (OR = 1.779, 95%CI: 1.048-3.021), smoking (OR =0.594, 95%CI: 0.473-0.747), living in central China (OR = 1.28, 95%CI: 1.010-1.647), eastern China (OR = 1.481, 95%CI:1.176-1.867), retirement pension (OR = 1.424, 95%CI: 1.003-2.022), and new rural cooperative medical system (NCMS) (OR =0.475, 95%CI: 0.261-0.862) and health insurance for urban/rural residents (OR = 0.615, 95%CI: 0.380-0.995) were the influencing factors of overweight/obesity of the rural elderly.

Conclusion

The influencing factors of overweight/obesity in the elderly are multi-level and multi-dimensional and vary between urban and rural areas. Timely and targeted preventive strategies and preventive measures should be taken from individual to macro dimensions, based on the current situation of urban-rural differences in China.

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目的

了解中国老年人超重/肥胖的现状、影响因素及其城乡异质性，为制定相应的干预措施提供依据。

方法

利用2020年中国家庭追踪调查（CFPS）数据库中年龄≥60岁的样本数据。采用非条件二分类logistic回归分析老年人发生超重/肥胖的影响因素。

结果

本研究共纳入符合条件的样本4 870，其中超重/肥胖有1 903人，超重/肥胖率为39.08%，农村老年人超重/肥胖率为33.10%，城镇老年人超重/肥胖率为36.56%。60～69岁（OR=2.145，95%CI：1.559～2.951）、70～79岁（OR=1.752，95%CI：1.270～2.416）、患有慢性病（OR=1.215，95%CI：1.061～1.392）、吸烟（OR=0.651，95%CI：0.556～0.763）、生活在中部地区（OR=1.255，95%CI：1.052～1.498）、生活在东部地区（OR=1.378，95%CI：1.169～1.623）、居住在城镇（OR=1.366，95%CI：1.193～1.565）、小学及以下的受教育程度（OR=1.214，95%CI：1.034～1.427）、有离退休金（OR=1.342，95%CI：1.126～1.599）、有养老保险（OR=0.841，95%CI：0.739～0.956）是老年人超重/肥胖的影响因素。60～69岁（OR=2.333，95%CI：1.561～3.487）、70～79岁（OR=2.057，95%CI：1.372～3.084）、患有慢性病（OR=1.364，95%CI：1.132～1.645）、吸烟（OR=0.705，95%CI：0.563～0.881）、生活在东部地区（OR=1.278，95%CI：1.006～1.623）、小学及以下的受教育程度（OR=1.397，95%CI：1.104～1.768）、有离退休金（OR=1.284，95%CI：1.046～1.577）是城镇老年人超重/肥胖的影响因素；60～69岁（OR=1.779，95%CI：1.048～3.021）、吸烟（OR=0.594，95%CI：0.473～0.747）、生活在中部地区（OR=1.289，95%CI：1.010～1.647）、生活在东部地区（OR=1.481，95%CI：1.176～1.867）、有离退休金（OR=1.424，95%CI：1.003～2.022）、有新农合（OR=0.475，95%CI：0.261～0.862）、有城镇/城乡居民医保（OR=0.615，95%CI：0.380～0.995）是农村老年人超重/肥胖的影响因素。

结论

老年人超重/肥胖的影响因素是多层次、多维度的，且城乡间的影响因素不尽相同，应立足中国城乡差异现状，从个体到宏观不同的维度采取及时、有针对性的干预策略与防范措施。

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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=jOmEgExQDD5sGgR3U310vA==, magXml=O+7iijMOjovoImXM1Rzexg==, pdfUrl=null, pdf=5Q+VwVkbk5efpge7AIwKFA==, pdfFileSize=782707, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=sRgUX9Xi50SFl7jXGfRrUA==, mapNumber=null, authorCompany=null, fund=null, authors=

张宪琦（1998—），女，硕士在读，研究方向：卫生政策与卫生经济

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张宪琦（1998—），女，硕士在读，研究方向：卫生政策与卫生经济

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张宪琦（1998—），女，硕士在读，研究方向：卫生政策与卫生经济

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Medical consumption behavior of the rural elderly under the strategy of "Healthy China" -based on the perspective of income inequality and basic medical insurance[J]. Journal of Central China Normal University: Humanities and Social Sciences, 2020, 59(5): 25-34., articleTitle=Medical consumption behavior of the rural elderly under the strategy of "Healthy China" -based on the perspective of income inequality and basic medical insurance, refAbstract=null), Reference(id=1241678353581798351, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522924750959603, doi=null, pmid=null, pmcid=null, year=2017, volume=18, issue=7, pageStart=715, pageEnd=723, url=null, language=null, rfNumber=[31], rfOrder=50, authorNames=Bray GA, Kim KK, Wilding JPH, journalName=Obesity Reviews, refType=null, unstructuredReference=Bray GA, Kim KK, Wilding JPH, et al. Obesity: a chronic relapsing progressive disease process. A position statement of the World Obesity Federation[J]. Obesity Reviews, 2017, 18(7): 715-723., articleTitle=Obesity: a chronic relapsing progressive disease process. A position statement of the World Obesity Federation, refAbstract=null), Reference(id=1241678353946702802, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522924750959603, doi=null, pmid=null, pmcid=null, year=2021, volume=9, issue=6, pageStart=373, pageEnd=392, url=null, language=null, rfNumber=[32], rfOrder=51, authorNames=Pan XF, Wang LM, Pan A, journalName=The Lancet Diabetes & Endocrinology, refType=null, unstructuredReference=Pan XF, Wang LM, Pan A. Epidemiology and determinants of obesity in China[J]. The Lancet Diabetes & Endocrinology, 2021, 9(6): 373-392., articleTitle=Epidemiology and determinants of obesity in China, refAbstract=null)], funds=null, companyList=[AuthorCompany(id=1241678284308672802, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522924750959603, xref=null, ext=[AuthorCompanyExt(id=1241678284312867107, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522924750959603, companyId=1241678284308672802, 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=1241678284321255716, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522924750959603, companyId=1241678284308672802, 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兵团重点实验室，新疆 石河子 832000)])], figs=[ArticleFig(id=1241678311806530155, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522924750959603, language=EN, label=Table 1, caption=

Variable assignments

, figureFileSmall=null, figureFileBig=null, tableContent=
变量名称变量赋值变量名称变量赋值
个人特质因素居住地农村=0，城镇=1
年龄（岁）≥80=1，70～79=2，60～69=3婚姻状况单身=0，已婚=1
性别男=1，女=2受教育程度没上过学=1，小学及以下=2，初中及高中=3，专科及以上=4
慢性病无=0，有=1生活环境条件
自评健康不健康=0，健康=1工作状况否=0，是=1
行为心理因素收入水平低收入=0，高收入=1
吸烟状况否=0，是=1离退休金无=0，有=1
饮酒状况否=0，是=1医疗服务可及性综合医院=1，专科医院=2，社区卫生服务中心/乡镇=3，社区卫生服务站/村卫生=4，诊所=5
抑郁否=0，是=1政策环境层面
睡眠时间（h）≥8=0，<8=1养老保险无=0，有=1
家庭社区网络医疗保险无=1，新农合=2，城镇/城乡居民医保=3，职工医保=4，
地区西部=1，中部=2，东部=3
), ArticleFig(id=1241678315484934769, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522924750959603, language=CN, label=表1, caption=

变量赋值情况

, figureFileSmall=null, figureFileBig=null, tableContent=
变量名称变量赋值变量名称变量赋值
个人特质因素居住地农村=0，城镇=1
年龄（岁）≥80=1，70～79=2，60～69=3婚姻状况单身=0，已婚=1
性别男=1，女=2受教育程度没上过学=1，小学及以下=2，初中及高中=3，专科及以上=4
慢性病无=0，有=1生活环境条件
自评健康不健康=0，健康=1工作状况否=0，是=1
行为心理因素收入水平低收入=0，高收入=1
吸烟状况否=0，是=1离退休金无=0，有=1
饮酒状况否=0，是=1医疗服务可及性综合医院=1，专科医院=2，社区卫生服务中心/乡镇=3，社区卫生服务站/村卫生=4，诊所=5
抑郁否=0，是=1政策环境层面
睡眠时间（h）≥8=0，<8=1养老保险无=0，有=1
家庭社区网络医疗保险无=1，新农合=2，城镇/城乡居民医保=3，职工医保=4，
地区西部=1，中部=2，东部=3
), ArticleFig(id=1241678316588036731, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522924750959603, language=EN, label=Table 2, caption=

General information of the study subjects

, figureFileSmall=null, figureFileBig=null, tableContent=
变量类别人数构成比（%）变量类别人数构成比（%）
个人特质因素婚姻状况单身68113.98
性别男2 55052.36已婚4 18986.02
女2 32047.64受教育程度没上过学1 93039.63
年龄（岁）60～693 17965.28小学及以下1 09622.51
70～791 46130.00初中及高中1 70234.95
≥802304.72专科及以上1422.92
慢性病无3 41070.02生活环境因素
有1 46029.98工作状况不工作2 73656.18
自评健康不健康2 07242.55工作2 13443.82
健康2 79857.45收入水平低收入3 24266.57
行为心理因素高收入1 62833.43
吸烟否3 51772.22离退休金无3 77177.43
是1 35327.78有1 09922.57
饮酒否4 09484.07医疗服务可及性综合医院1 87138.42
是77615.93专科医院2986.12
抑郁否3 73176.61社区/乡镇卫生服务中心1 17624.15
是1 13923.39社区卫生服务站/村卫生室73315.05
睡眠时间（h）≥82 08342.77诊所79216.26
<82 78757.23政策环境因素
家庭网络因素养老保险无1 57032.24
地区东部2 39649.20有3 30067.76
中部1 43729.51医疗保险无4158.52
西部1 03721.29新农合3 02362.07
居住地农村2 40249.32城镇/城乡居民医保64913.33
城镇2 46850.68职工医保78316.08
), ArticleFig(id=1241678319452746369, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522924750959603, language=CN, label=表2, caption=

研究对象的疾病特征

, figureFileSmall=null, figureFileBig=null, tableContent=
变量类别人数构成比（%）变量类别人数构成比（%）
个人特质因素婚姻状况单身68113.98
性别男2 55052.36已婚4 18986.02
女2 32047.64受教育程度没上过学1 93039.63
年龄（岁）60～693 17965.28小学及以下1 09622.51
70～791 46130.00初中及高中1 70234.95
≥802304.72专科及以上1422.92
慢性病无3 41070.02生活环境因素
有1 46029.98工作状况不工作2 73656.18
自评健康不健康2 07242.55工作2 13443.82
健康2 79857.45收入水平低收入3 24266.57
行为心理因素高收入1 62833.43
吸烟否3 51772.22离退休金无3 77177.43
是1 35327.78有1 09922.57
饮酒否4 09484.07医疗服务可及性综合医院1 87138.42
是77615.93专科医院2986.12
抑郁否3 73176.61社区/乡镇卫生服务中心1 17624.15
是1 13923.39社区卫生服务站/村卫生室73315.05
睡眠时间（h）≥82 08342.77诊所79216.26
<82 78757.23政策环境因素
家庭网络因素养老保险无1 57032.24
地区东部2 39649.20有3 30067.76
中部1 43729.51医疗保险无4158.52
西部1 03721.29新农合3 02362.07
居住地农村2 40249.32城镇/城乡居民医保64913.33
城镇2 46850.68职工医保78316.08
), ArticleFig(id=1241678319905731211, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522924750959603, language=EN, label=Table 3, caption=

Comparison of overweight/obesity among older adults with different characteristics

, figureFileSmall=null, figureFileBig=null, tableContent=
变量类别超重/肥胖χ2 /Z值P值
人数构成比（%）
个人特质因素
性别女97940.7018.144<0.001
男92437.37
年龄（岁）60～691 29427.3961.630<0.001
70～7954642.20
≥806336.24
慢性病无1 29137.867.0730.008
有61241.92
自评健康不健康79538.370.7580.384
健康1 10839.60
行为心理因素
吸烟否1 48442.2051.732<0.001
是41930.97
饮酒否1 61739.501.9120.167
是28636.86
抑郁否1 49640.106.9790.008
是40735.73
睡眠时间（h）≥876336.639.1480.002
<81 14040.90
家庭网络因素
地区东部1 01542.3637.607<0.001
中部56439.25
西部32431.24
居住地农村79533.1071.163<0.001
城镇1 10844.89
婚姻状况单身24936.562.0990.147
已婚1 65439.48
受教育程度没上过学68035.2359.900<0.001
小学及以下44540.60
初中及高中71241.83
专科及以上6646.48
生活环境因素
工作状况否1 13641.5215.672<0.001
是76735.94
收入水平低收入1 27339.270.1470.701
高收入63038.70
离退休金无1 36736.2556.043<0.001
有53648.77
医疗服务可及性综合医院77741.5312.8440.012
专科医院12842.95
社区/乡镇卫生服务中心44237.59
社区卫生服务站/村卫生室25935.33
诊所29737.50
政策环境因素
养老保险无68643.6920.758<0.001
有1 21736.88
医疗保险无16940.7243.335<0.001
新农合1 08035.73
城镇/城乡居民医保28243.45
职工医保37247.51
), ArticleFig(id=1241678320325161617, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522924750959603, language=CN, label=表3, caption=

不同特征老年人超重/肥胖情况比较

, figureFileSmall=null, figureFileBig=null, tableContent=
变量类别超重/肥胖χ2 /Z值P值
人数构成比（%）
个人特质因素
性别女97940.7018.144<0.001
男92437.37
年龄（岁）60～691 29427.3961.630<0.001
70～7954642.20
≥806336.24
慢性病无1 29137.867.0730.008
有61241.92
自评健康不健康79538.370.7580.384
健康1 10839.60
行为心理因素
吸烟否1 48442.2051.732<0.001
是41930.97
饮酒否1 61739.501.9120.167
是28636.86
抑郁否1 49640.106.9790.008
是40735.73
睡眠时间（h）≥876336.639.1480.002
<81 14040.90
家庭网络因素
地区东部1 01542.3637.607<0.001
中部56439.25
西部32431.24
居住地农村79533.1071.163<0.001
城镇1 10844.89
婚姻状况单身24936.562.0990.147
已婚1 65439.48
受教育程度没上过学68035.2359.900<0.001
小学及以下44540.60
初中及高中71241.83
专科及以上6646.48
生活环境因素
工作状况否1 13641.5215.672<0.001
是76735.94
收入水平低收入1 27339.270.1470.701
高收入63038.70
离退休金无1 36736.2556.043<0.001
有53648.77
医疗服务可及性综合医院77741.5312.8440.012
专科医院12842.95
社区/乡镇卫生服务中心44237.59
社区卫生服务站/村卫生室25935.33
诊所29737.50
政策环境因素
养老保险无68643.6920.758<0.001
有1 21736.88
医疗保险无16940.7243.335<0.001
新农合1 08035.73
城镇/城乡居民医保28243.45
职工医保37247.51
), ArticleFig(id=1241678320690066073, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522924750959603, language=EN, label=Table 4, caption=

Logistic regression analysis of overweight/obesity in older adults with different characteristics

, figureFileSmall=null, figureFileBig=null, tableContent=
变量β OR值（95%CI）P值
个人特质因素
性别（对照：男）0.0980.0761.103（0.951～1.279）0.194
年龄（岁，对照：≥80）
70～790.5610.1641.752（1.270～2.416）0.001
60～690.7630.1632.145（1.559～2.951）<0.001
慢性病（对照：无）0.1950.0691.215（1.061～1.392）0.005
自评健康（对照：不健康）0.0790.0661.082（0.951～1.231）0.233
行为心理因素
吸烟（对照：无）0.4290.0810.651（0.556～0.763）<0.001
饮酒（对照：无）0.0210.0891.021（0.858～1.216）0.814
抑郁（对照：否）0.1060.0760.900（0.775～1.044）0.165
睡眠时间（h，对照：≥8）0.0500.0631.051（0.930～1.189）0.426
家庭网络因素
地区（对照：西部）
中部0.2270.0901.255（1.052～1.498）0.012
东部0.3200.0841.378（1.169～1.623）<0.001
居住地（对照：农村）0.3120.0691.366（1.193～1.565）<0.001
婚姻状况（对照：单身）0.0630.0911.065（0.891～1.274）0.489
受教育程度（对照：没上过学）
小学及以下0.1940.0821.214（1.034～1.427）0.018
初中及高中0.0410.0811.042（0.889～1.221）0.614
专科及以上0.0850.1931.089（0.745～1.591）0.660
生活环境因素
工作状态（对照：否）0.0010.0701.000（0.871～1.148）0.997
收入状况（对照：低收入）0.0130.0651.013（0.891～1.152）0.838
离退休金（对照：无）0.2940.0891.342（1.126～1.599）0.001
医疗服务可及性（对照：综合医院）
专科医院0.0330.1300.968（0.751～1.248）0.802
社区卫生服务中心/乡镇卫生院0.0460.0800.955（0.816～1.117）0.561
社区卫生服务站/村卫生室0.0970.0960.908（0.752～1.095）0.313
诊所0.0490.0920.952（0.795～1.140）0.592
政策环境因素
养老保险（对照：无）0.1730.0660.841（0.739～0.956）0.008
医疗保险（对照：无）
新农合0.0710.1150.932（0.744～1.167）0.538
城镇/城乡居民医保0.0650.1110.937（0.753～1.165）0.556
职工医保0.0060.1381.006（0.767～1.319）0.965
), ArticleFig(id=1241678321558287007, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522924750959603, language=CN, label=表4, caption=

不同特征老年人超重/肥胖的logistic回归分析

, figureFileSmall=null, figureFileBig=null, tableContent=
变量β OR值（95%CI）P值
个人特质因素
性别（对照：男）0.0980.0761.103（0.951～1.279）0.194
年龄（岁，对照：≥80）
70～790.5610.1641.752（1.270～2.416）0.001
60～690.7630.1632.145（1.559～2.951）<0.001
慢性病（对照：无）0.1950.0691.215（1.061～1.392）0.005
自评健康（对照：不健康）0.0790.0661.082（0.951～1.231）0.233
行为心理因素
吸烟（对照：无）0.4290.0810.651（0.556～0.763）<0.001
饮酒（对照：无）0.0210.0891.021（0.858～1.216）0.814
抑郁（对照：否）0.1060.0760.900（0.775～1.044）0.165
睡眠时间（h，对照：≥8）0.0500.0631.051（0.930～1.189）0.426
家庭网络因素
地区（对照：西部）
中部0.2270.0901.255（1.052～1.498）0.012
东部0.3200.0841.378（1.169～1.623）<0.001
居住地（对照：农村）0.3120.0691.366（1.193～1.565）<0.001
婚姻状况（对照：单身）0.0630.0911.065（0.891～1.274）0.489
受教育程度（对照：没上过学）
小学及以下0.1940.0821.214（1.034～1.427）0.018
初中及高中0.0410.0811.042（0.889～1.221）0.614
专科及以上0.0850.1931.089（0.745～1.591）0.660
生活环境因素
工作状态（对照：否）0.0010.0701.000（0.871～1.148）0.997
收入状况（对照：低收入）0.0130.0651.013（0.891～1.152）0.838
离退休金（对照：无）0.2940.0891.342（1.126～1.599）0.001
医疗服务可及性（对照：综合医院）
专科医院0.0330.1300.968（0.751～1.248）0.802
社区卫生服务中心/乡镇卫生院0.0460.0800.955（0.816～1.117）0.561
社区卫生服务站/村卫生室0.0970.0960.908（0.752～1.095）0.313
诊所0.0490.0920.952（0.795～1.140）0.592
政策环境因素
养老保险（对照：无）0.1730.0660.841（0.739～0.956）0.008
医疗保险（对照：无）
新农合0.0710.1150.932（0.744～1.167）0.538
城镇/城乡居民医保0.0650.1110.937（0.753～1.165）0.556
职工医保0.0060.1381.006（0.767～1.319）0.965
), ArticleFig(id=1241678321981911719, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522924750959603, language=EN, label=Table 5, caption=

Logistic regression analysis of overweight/obesity in older adults with different characteristics based on urban and rural stratification

, figureFileSmall=null, figureFileBig=null, tableContent=
变量城镇农村
OR值（95%CI）P值OR值（95%CI）P值
个人特质因素
年龄（岁，对照：≥80）
70～792.057（1.372～3.084）<0.0011.312（0.770～2.236）0.319
60～692.333（1.561～3.487）<0.0011.779（1.048～3.021）0.033
慢性病（对照：无）1.364（1.132～1.645）0.0011.088（0.890～1.329）0.412
行为心理因素
吸烟（对照：无）0.705（0.563～0.881）0.0020.594（0.473～0.747）<0.001
家庭网络因素
地区（对照：西部）
中部1.218（0.935～1.585）0.1431.289（1.010～1.647）0.042
东部1.278（1.006～1.623）0.0451.481（1.176～1.867）0.001
受教育程度（对照：没上过学）
小学及以下1.397（1.104～1.768）0.0051.085（0.865～1.362）0.479
初中及高中1.048（0.840～1.307）0.6811.053（0.832～1.333）0.666
专科及以上1.202（0.793～1.822）0.3860.451（0.124～1.640）0.227
生活环境因素
离退休金（对照：无）1.284（1.046～1.577）0.0171.424（1.003～2.022）0.048
政策环境因素
养老保险（对照：无）0.841（0.707～1.001）0.0510.849（0.699～1.030）0.098
医疗保险（对照：无）
新农合1.052（0.822～1.346）0.6860.475（0.261～0.862）0.014
城镇/城乡居民医保1.011（0.777～1.315）0.9350.615（0.380～0.995）0.047
职工医保1.125（0.807～1.568）0.4890.600（0.344～1.044）0.071
), ArticleFig(id=1241678322397147821, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522924750959603, language=CN, label=表5, caption=

基于城乡分层不同特征老年人超重/肥胖的logistic回归分析

, figureFileSmall=null, figureFileBig=null, tableContent=
变量城镇农村
OR值（95%CI）P值OR值（95%CI）P值
个人特质因素
年龄（岁，对照：≥80）
70～792.057（1.372～3.084）<0.0011.312（0.770～2.236）0.319
60～692.333（1.561～3.487）<0.0011.779（1.048～3.021）0.033
慢性病（对照：无）1.364（1.132～1.645）0.0011.088（0.890～1.329）0.412
行为心理因素
吸烟（对照：无）0.705（0.563～0.881）0.0020.594（0.473～0.747）<0.001
家庭网络因素
地区（对照：西部）
中部1.218（0.935～1.585）0.1431.289（1.010～1.647）0.042
东部1.278（1.006～1.623）0.0451.481（1.176～1.867）0.001
受教育程度（对照：没上过学）
小学及以下1.397（1.104～1.768）0.0051.085（0.865～1.362）0.479
初中及高中1.048（0.840～1.307）0.6811.053（0.832～1.333）0.666
专科及以上1.202（0.793～1.822）0.3860.451（0.124～1.640）0.227
生活环境因素
离退休金（对照：无）1.284（1.046～1.577）0.0171.424（1.003～2.022）0.048
政策环境因素
养老保险（对照：无）0.841（0.707～1.001）0.0510.849（0.699～1.030）0.098
医疗保险（对照：无）
新农合1.052（0.822～1.346）0.6860.475（0.261～0.862）0.014
城镇/城乡居民医保1.011（0.777～1.315）0.9350.615（0.380～0.995）0.047
职工医保1.125（0.807～1.568）0.4890.600（0.344～1.044）0.071
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基于健康生态学理论的中国老年人超重/肥胖现状及影响因素分析
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张宪琦 , 李小菊 , 赵莉 , 樊荣 , 董嘉鑫 , 申小颖 , 李依窈
现代预防医学 | 流行病与统计方法 2024,51(5): 803-810
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现代预防医学 | 流行病与统计方法 2024, 51(5): 803-810
基于健康生态学理论的中国老年人超重/肥胖现状及影响因素分析
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张宪琦, 李小菊 , 赵莉, 樊荣, 董嘉鑫, 申小颖, 李依窈
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兵团重点实验室，新疆 石河子 832000

    • 张宪琦（1998—），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 on the current situation and influencing factors of overweight and obesity among the elderly in China based on the theory of health ecology
Xian-qi ZHANG, Xiao-ju LI , Li ZHAO, Rong FAN, Jia-xin DONG, Xiao-ying SHEN, Yi-yao LI
Affiliations
  • Department of Preventive Medicine, School of Medicine, Shihezi University, Shihezi, Xinjiang 832000, China
出版时间: 2024-03-10 doi: 10.20043/j.cnki.MPM.202308485
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摘要
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目的

了解中国老年人超重/肥胖的现状、影响因素及其城乡异质性，为制定相应的干预措施提供依据。

方法

利用2020年中国家庭追踪调查（CFPS）数据库中年龄≥60岁的样本数据。采用非条件二分类logistic回归分析老年人发生超重/肥胖的影响因素。

结果

本研究共纳入符合条件的样本4 870，其中超重/肥胖有1 903人，超重/肥胖率为39.08%，农村老年人超重/肥胖率为33.10%，城镇老年人超重/肥胖率为36.56%。60～69岁（OR=2.145，95%CI：1.559～2.951）、70～79岁（OR=1.752，95%CI：1.270～2.416）、患有慢性病（OR=1.215，95%CI：1.061～1.392）、吸烟（OR=0.651，95%CI：0.556～0.763）、生活在中部地区（OR=1.255，95%CI：1.052～1.498）、生活在东部地区（OR=1.378，95%CI：1.169～1.623）、居住在城镇（OR=1.366，95%CI：1.193～1.565）、小学及以下的受教育程度（OR=1.214，95%CI：1.034～1.427）、有离退休金（OR=1.342，95%CI：1.126～1.599）、有养老保险（OR=0.841，95%CI：0.739～0.956）是老年人超重/肥胖的影响因素。60～69岁（OR=2.333，95%CI：1.561～3.487）、70～79岁（OR=2.057，95%CI：1.372～3.084）、患有慢性病（OR=1.364，95%CI：1.132～1.645）、吸烟（OR=0.705，95%CI：0.563～0.881）、生活在东部地区（OR=1.278，95%CI：1.006～1.623）、小学及以下的受教育程度（OR=1.397，95%CI：1.104～1.768）、有离退休金（OR=1.284，95%CI：1.046～1.577）是城镇老年人超重/肥胖的影响因素；60～69岁（OR=1.779，95%CI：1.048～3.021）、吸烟（OR=0.594，95%CI：0.473～0.747）、生活在中部地区（OR=1.289，95%CI：1.010～1.647）、生活在东部地区（OR=1.481，95%CI：1.176～1.867）、有离退休金（OR=1.424，95%CI：1.003～2.022）、有新农合（OR=0.475，95%CI：0.261～0.862）、有城镇/城乡居民医保（OR=0.615，95%CI：0.380～0.995）是农村老年人超重/肥胖的影响因素。

结论

老年人超重/肥胖的影响因素是多层次、多维度的，且城乡间的影响因素不尽相同，应立足中国城乡差异现状，从个体到宏观不同的维度采取及时、有针对性的干预策略与防范措施。

超重/肥胖  /  老年人  /  健康生态学理论  /  影响因素分析
Objective

To understand the current situation, influencing factors, and urban-rural heterogeneity of overweight/obesity among the elderly in China, so as to provide basis for formulating corresponding intervention measures.

Methods

The data of people age ≥ 60 years old in China Family Panel Studies (CFPS) database in 2020 were used. Unconditional binary logistic regression was used to analyze the influencing factors of overweight/obesity in the elderly.

Results

A total of 4 870 eligible samples were included in this study, of which 1 903 were overweight/obese, and the overweight/obesity rate was 39.08%(33.10% in rural areas and 36.56% in urban areas). People aged 60-69 (OR = 2.145, 95%CI: 1.559-2.951), 70-79 years old (OR = 1.752, 95%CI: 1.270-2.416), suffering from chronic diseases (OR = 1.215, 95%CI: 1.061-1.392), smoking (OR = 0.651,95%CI: 0.556-0.763), living in the central China (OR = 1.255, 95%CI: 1.052-1.498), eastern China (OR = 1.378, 95%CI:1.169-1.623), living in town (OR = 1.366, 95%CI: 1.193-1.565), with primary school education (OR = 1.214, 95%CI: 1.034-1.427), retirement pension (OR = 1.342, 95%CI: 1.126-1.599), and endowment insurance (OR = 0.841, 95%CI: 0.739-0.956) were the influencing factors of overweight/obesity in the elderly. People aged 60- 69 (OR = 2.333, 95%CI: 1.561-3.487), 70-79 years old (OR = 2.057, 95%CI: 1.372-3.084), suffering from chronic diseases (OR = 1.364, 95%CI: 1.132-1.645), smoking (OR = 0.705, 95%CI: 0.563-0.881), living in the eastern region (OR = 1.278, 95%CI: 1.006-1.623). with primary school education (OR = 1.397, 95%CI: 1.104-1.768), and retirement pension (OR = 1.284, 95%CI: 1.046-1.577) were the influencing factors of overweight/obesity of the urban elderly. People aged 60-69 years old (OR = 1.779, 95%CI: 1.048-3.021), smoking (OR =0.594, 95%CI: 0.473-0.747), living in central China (OR = 1.28, 95%CI: 1.010-1.647), eastern China (OR = 1.481, 95%CI:1.176-1.867), retirement pension (OR = 1.424, 95%CI: 1.003-2.022), and new rural cooperative medical system (NCMS) (OR =0.475, 95%CI: 0.261-0.862) and health insurance for urban/rural residents (OR = 0.615, 95%CI: 0.380-0.995) were the influencing factors of overweight/obesity of the rural elderly.

Conclusion

The influencing factors of overweight/obesity in the elderly are multi-level and multi-dimensional and vary between urban and rural areas. Timely and targeted preventive strategies and preventive measures should be taken from individual to macro dimensions, based on the current situation of urban-rural differences in China.

Overweight/obesity  /  Elderly  /  Theory of health ecology  /  Analysis of influencing factors
张宪琦, 李小菊, 赵莉, 樊荣, 董嘉鑫, 申小颖, 李依窈. 基于健康生态学理论的中国老年人超重/肥胖现状及影响因素分析. 现代预防医学, 2024 , 51 (5) : 803 -810 . DOI: 10.20043/j.cnki.MPM.202308485
Xian-qi ZHANG, Xiao-ju LI, Li ZHAO, Rong FAN, Jia-xin DONG, Xiao-ying SHEN, Yi-yao LI. Analysis on the current situation and influencing factors of overweight and obesity among the elderly in China based on the theory of health ecology[J]. Modern Preventive Medicine, 2024 , 51 (5) : 803 -810 . DOI: 10.20043/j.cnki.MPM.202308485
正文
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随着中国社会经济的发展以及人们生活水平的不断改善，中国的超重/肥胖人群数量迅速增长，超重/肥胖已成为当前中国面临的重大公共卫生问题[1]，且存在明显的城乡差异[2]。预计2030年，中国成年人超重/肥胖的总患病率将达到70.5%[3]，将会给居民带来较大的健康困扰和经济负担。中国老龄化的加剧，使得老年人群健康问题日益突出，超重/肥胖的老年人患慢性病的概率是正常人的1.361倍[4]，因超重/肥胖产生的医疗费用约占全国医疗费用总额的21.5%[5]，中国老年人的超重/肥胖问题亟需重视及改善。现有关于中国超重/肥胖的研究多为对青少年、不同省市成年人的研究[6-8]，且有关老年人超重/肥胖影响因素的研究中主要以个体、家庭、社会经济因素等单一层面开展的单因素或多因素分析为主[9-11]，较为局限。健康生态学理论强调环境与个体健康相互影响的多层次性、复杂性，主张从个体和环境等多个层面分析健康或疾病的影响因素，从不同维度为个体提供健康信息，进而促进人类健康目标的实现[12]。该理论已经被广泛应用于个体疾病或健康的影响因素分析。因此，本研究基于健康生态学理论模型，从个体特征、行为心理、家庭社区、生活环境、政策环境等层面综合探讨中国老年人的超重/肥胖现状、影响因素及其城乡异质性，为改善老年人的健康水平提供科学依据。
1　资料与方法
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1.1　资料来源
本研究利用2020年中国家庭追踪调查数据库(Chinese Family Panel Studies, CFPS)数据，筛选年龄≥60岁的对象，剔除身高、体重等重要变量缺失的数据，最终纳入研究对象4 870例。
1.2　分析指标定义
1.2.1　因变量
本研究的因变量为是否超重/肥胖，计算体质指数（body mass index，BMI）=体重（kg）/身高的二次方（m）2，将研究对象BMI≥24.0 kg/m2定义为超重/肥胖[2]。
1.2.2　自变量
本研究将自变量分为五个维度。（1）个人特征：性别、年龄、慢病情况、自评健康;（2）行为生活方式：吸烟、饮酒、抑郁状况、睡眠时间；（3）家庭社区网络：地区、居住地、婚姻状况以及受教育程度;（4）工作和生活的条件：工作状况、收入水平、是否有离退休金、医疗服务可及性；（5）政策环境层：养老保险、医疗保险。对部分自变量的定义为：（1）自评健康：以CFPS中“您认为自己的健康状况如何”来衡量自评健康状况，并将“一般”“不健康”定义为“不健康”，“非常健康”“很健康”“比较健康”定义为“健康”；（2）抑郁状况：以8项抑郁量表(CES-D8)衡量抑郁状况，每项按照“几乎没有（不到一天）”“有些时候（1～2 d）”“经常有（3～4 d）”“大多数时候有（5～7 d）”赋予1～4分，以得分8分及以下判定为存在抑郁[13]；（3）地区：按照中国经济发展水平及地理位置[12]，将省份划分为东部、中部和西部；（4）居住地：根据国家统计局发布的标准，由家庭社区一级地址来判断城乡属性，农村包括乡中心区和村庄两种类型，其余属于城镇地区。根据居住地址划分为城镇和农村两种[14]；（5）医疗服务可及性：根据既往研究[15]，选定数据库中“您若找医生看病，一般去哪儿”作为衡量医疗服务可及性的标准。具体赋值情况见表1。
1.3　统计学方法
采用Stata 17.0和SPSS 23.0统计软件对2020年CFPS数据进行整理与分析，对于研究对象的基本特征，采用频数和构成比来展示分类变量。组间差异比较，分类变量采用χ2检验，等级变量采用秩和检验，采用非条件二分类logistic回归进行多因素分析探究影响中国老年人超重/肥胖的因素，检验水准α=0.05。
2　结果
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2.1　基本特征
本研究共纳入中国老年人4 870人，具体见表2。
2.2　不同特征老年人的超重/肥胖现状
本研究老年人超重/肥胖的有1 903人，超重/肥胖率为39.08%。女性的超重/肥胖率为42.20%，高于男性的36.24%；年龄分组的超重/肥胖率：60～70岁为40.70%，70～79岁为37.37%，80及以上为27.39%；患慢性病的超重/肥胖率为41.92%。吸烟人群的超重/肥胖率为30.97%。地区分布的超重/肥胖率：东部地区为42.36%，中部地区为39.25%，西部地区为31.24%；农村居民的超重/肥胖率为33.10%，城镇居民的的超重/肥胖率为36.56%。领取离退休金的超重/肥胖率为48.77%。有养老保险的超重/肥胖率为36.88%，医保分组：参加新农合的超重/肥胖率为35.73%，参加城镇/城乡居民医保为43.45%，参加职工医保为47.51%。见表3。
2.3　不同特征老年人超重/肥胖的单因素分析
基于健康生态学理论框架，不同性别、年龄、是否患有慢性病、是否吸烟、是否抑郁、不同睡眠时间、地区、居住地、受教育程度、是否领取离退休金、是否领取养老保险、不同医疗保险与老年人是否存在超重/肥胖差异均具有统计学意义（P<0.05）。见表3。
2.4　不同特征老年人超重/肥胖多因素非条件logistic回归分析
以是否超重/肥胖为因变量（否=0，是=1），基于健康生态学框架，将自变量纳入模型。结果显示，70～79岁、60～69岁、患有慢性病、吸烟、生活在中部或东部地区、居住在城镇、小学及以下的受教育程度、有离退休金、有养老保险是老年人超重/肥胖的影响因素。见表4。
2.5　基于城乡分层的不同特征老年人超重/肥胖多因素非条件logistic回归分析
根据老年人居住地将其分为城镇和农村，以是否超重/肥胖为因变量（否=0，是=1），基于健康生态学理论，将研究变量纳入其中。有意义结果显示，70～79岁、小学及以下的受教育程度是仅对城镇老年人超重/肥胖有影响的因素；生活在中部地区、有新农合、城镇/城乡居民医保是仅对农村老年人超重/肥胖有影响的因素。见表5。
3　讨论
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3.1　中国老年人超重/肥胖现状
《中国居民营养与慢性病状况报告（2020年）》显示，各年龄组城乡居民超重肥胖率持续上升[16]，超重、肥胖问题突出，是当前中国面临的一项重大健康问题。本研究结果显示，中国60岁及以上老年人的超重/肥胖率为39.08%，略高于Xu等[17]利用CFPS（2018）数据和Jiesisibieke等[18]利用中国老年健康影响因素跟踪调查（CLHLS）数据得出的中国老年人超重/肥胖率（33.40%～37.30%），所以需要重点关注老年人的超重/肥胖问题。这可能是中国社会转型与经济持续发展带来的物质财富不断增长，使人民生活水平提高，在外就餐次数增加以及中国传统饮食对油、盐、糖的过量摄入等长期不良饮食行为综合作用所致[19-20]。
3.2　影响中国老年人超重/肥胖的社会因素
本研究发现个体特质层面60～69岁、70～79岁、患有慢性病是老年人超重/肥胖的共同危险因素。进一步城乡分层发现，患有慢性病的城镇老年人出现超重/肥胖的可能性更高。随着老年人年龄增长，超重/肥胖情况有所缓解，这与其他相关研究结果保持一致[21]。一方面可能因为随着年龄增长带来的社会阅历增加，使得老年人健康意识提高，增加对超重肥胖等健康问题的关注[22]；另一方面，可能与年龄增长，老年人机体不断衰老，调节代谢能力下降，热量摄入降低有关[21]。患有慢性病的老年人更容易发生超重/肥胖问题，与郑新等人[23]的结果一致。城乡分层后发现患有慢性病的城镇老年人超重/肥胖情况不容乐观，一方面可能由于中国老年人口规模扩大、慢性病高发，老年人带病时间延长，加剧健康损失的同时身体活动不足，带来超重肥胖风险[24]；另一方面因为城镇地区心脏病、糖尿病等常见慢性病的患病率高于农村地区[14]，这些慢性病又与城镇居民长期高糖高钠等不健康饮食习惯有关，从而使患有慢性病的城镇老年人更容易发生超重肥胖。孙雨丹等人[4]研究发现老年人BMI增长是老年人患慢性病的危险因素，提示慢性病与超重/肥胖相互影响，叠加疾病与死亡风险。
行为心理因素中，吸烟是老年人超重/肥胖的保护因素。吸烟的老年人出现超重/肥胖的可能性比不吸烟低，与Bonnefond等[25]的研究一致，可能与吸烟导致食欲下降的同时代谢率增加有关。但Cleven等人[26]研究发现吸烟作为心血管疾病，癌症和呼吸系统疾病等慢性病的危险因素，增加慢性病的发病率。这可能是因为吸烟对食欲和代谢的直接作用[21]比通过增加慢性病发病风险[4]进而影响超重/肥胖的间接作用要快。
家庭网络因素中，生活在东部、中部地区的老年人更容易出现超重/肥胖，可能因资源禀赋、对外开放与交流程度、财政支出等[27]使地区经济发展不平衡，抑制地区经济健康可持续发展所致。本研究中城镇老年人的超重/肥胖率为44.89%，高于农村老年人的超重/肥胖的33.10%。但Shen等[28]研究发现城镇、农村地区的肥胖差距有所缩小，农村居民的中心性肥胖高于城镇居民，与本研究结果相反，这可能跟研究人群特征、肥胖的选取标准不同有关。城镇居民由于长期以来的城乡二元结构异质性，生活条件优越，饮食模式丰富，信息化的高速发展使得超重/肥胖问题相对农村更高；又因为中国处于加快推进城镇化和乡村振兴、实现共同富裕的大背景下，农村居民的生活水平的提高，使得农村地区老年人超重/肥胖率也不断提高。
生活环境因素中，有离退休金的老年人出现超重/肥胖的可能性是没有离退休金老人的1.342倍，这可能是因为离退休金不仅是老年群体主要经济保障，更是老年人经济水平和社会地位的代表。与没有离退休金相比，拥有离退休金的老年人由于优渥的生活条件，较高的社会地位，使其拥有更好的生活质量[29]，增加营养物质的摄入，从而导致超重/肥胖的发生。
政策环境因素中，养老保险是老年人出现超重/肥胖的危险因素，且有新农合与居民医保的农村老年人出现超重/肥胖的可能性更低。这可能是因为养老保险、医疗保险作为老年人基本的生活、医疗保障，能够满足老年人的基本需要。有医保的老年人有着主动就医或住院倾向[30]，缓解了老年人“看病难、看病贵”的现实，使得老年人的健康状况得到了改善，超重/肥胖问题有所缓解。
由于超重/肥胖既是一个慢性、复发性、进行性的疾病过程，又是一个棘手的社会问题[31-32]。因此，除了超重/肥胖的生理因素之外，明确超重/肥胖相关的个人特征、行为心理、生活环境、政策环境等社会因素，利用健康生态学的理念，从个体到宏观不同的维度采取及时、有针对性的干预策略与防范措施。根据城乡差异特点，加强社区、村委会有关控制体重的宣传教育，指导城镇、农村老年人选择更健康的行为生活方式，促进超重肥胖患者对慢性病预防和控制意识的加强，减轻老年人因超重/肥胖产生的经济负担，对老年人超重/肥胖的预防有着指导性的作用。
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2024年第51卷第5期
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doi: 10.20043/j.cnki.MPM.202308485
  • 接收时间：2023-08-25
  • 首发时间：2026-03-19
  • 出版时间：2024-03-10
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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兵团重点实验室，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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