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Article(id=1241676531492245558, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241676522256388920, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202406059, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1717516800000, receivedDateStr=2024-06-05, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773968354342, onlineDateStr=2026-03-20, pubDate=1731168000000, pubDateStr=2024-11-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773968354342, onlineIssueDateStr=2026-03-20, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773968354342, creator=13701087609, updateTime=1773968354342, updator=13701087609, issue=Issue{id=1241676522256388920, tenantId=1146029695717560320, journalId=1227665162245664772, year='2024', volume='51', issue='21', pageStart='3841', pageEnd='4032', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773968352140, creator=13701087609, updateTime=1773968629818, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1241677686985249701, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241676522256388920, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1241677686985249702, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241676522256388920, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=3948, endPage=3955, ext={EN=ArticleExt(id=1241676532020727907, articleId=1241676531492245558, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Analysis of the impact of disability, depression symptoms, and their interaction on cognitive function in elderly individuals in China, columnId=1228016572451718132, journalTitle=Modern Preventive Medicine, columnName=Health and Social Behavior, runingTitle=null, highlight=null, articleAbstract=
Objective

To explore the factors related to cognitive impairment in elderly individuals aged 60 and above in China from the perspective of social determinants of health, providing a reference for the prevention and treatment of cognitive impairment in the elderly.

Methods

Utilizing data from the fourth wave of the 2018 China Health and Retirement Longitudinal Study, we conducted a statistical description of the cognitive status of 5 721 elderly individuals aged ≥60. A multifactor logistic regression model was employed to analyze factors affecting cognitive status in the elderly, investigating the impact of the interaction between depression symptoms and disability on cognitive impairment.

Results

Among the participants, 2 277 individuals (39.80%) were identified with cognitive impairment. Risk factors for cognitive impairment included being female (OR=1.702, 95%CI: 1.491 to 1.943), aged ≥80 years (OR=1.862, 95%CI: 1.467 to 2.364), experiencing depression (OR=1.333,95%CI: 1.173 to 1.514), having a disability (OR=2.082, 95%CI: 1.687 to 2.569), sleeping more than 8 hours (OR=1.582,95%CI: 1.288 to 1.944), and residing in central and western regions (OR=1.275, 1.538; 95%CI: 1.109-1.467, 1.337-1.771). There was a multiplicative interaction between depression and disability affecting cognitive status in the elderly (P interaction=0.005), with no additive interaction observed (RERI=-1.217, 95%CI: -2.480 to 0.046; AP=-0.522, 95%CI: -1.112 to 0.069;S = 0.523, 95%CI: 0.291 to 0.938).

Conclusion

The detection rate of cognitive impairment among elderly individuals in China is concerning. The multiplicative interaction of depression and disability on cognitive status suggests that the government should intervene from the perspective of social determinants of health, implementing multidimensional strategies to achieve an integrated approach to prevention and treatment.

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目的

基于健康社会决定因素的视角，探讨中国60岁及以上老年人认知障碍的相关因素，为老年人认知障碍的防治提供参考依据。

方法

利用2018年中国健康与养老追踪调查的第四轮随访数据，对5 721例≥60岁的老年人认知状况进行统计描述，基于多因素logistic回归模型分析影响老年人认知状况的相关因素，探究抑郁症状和失能状况交互作用对老年人认知障碍的影响。

结果

认知障碍者2 277人（39.80%）。女性（OR=1.702，95%CI: 1.491～1.943）、年龄≥80岁（OR=1.862，95%CI: 1.467～2.364）、抑郁（OR=1.333，95%CI: 1.173～1.514）、失能（OR=2.082，95%CI: 1.687～2.569）、睡眠时长>8 h（OR=1.582，95%CI: 1.288～1.944）、中部和西部地区（OR=1.275、1.538，95%CI: 1.109～1.467、1.337～1.771）均为老年人认知障碍发生的危险因素。抑郁和失能对老年人认知状况有相乘交互作用（P交互=0.005），不存在相加交互作用（RERI = -1.217，95%CI: -2.480～0.046；AP=-0.522，95%CI: -1.112～0.069；S=0.523，95%CI: 0.291～0.938）。

结论

中国老年人认知障碍检出率不容乐观，抑郁和失能对老年人认知状况有相乘交互作用，政府应从健康社会决定因素的视角出发，从多维度对老年人认知状况实施干预，以达到“防治一体”的效果。

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高杰，E-mail:；
马桂峰，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=l8/x+F4Fj0IsWBEjGr1mGg==, magXml=Kzha0YCPp9d/fTH9c/ijyw==, pdfUrl=null, pdf=V18bUezXPrtBEdEiyi/Ebw==, pdfFileSize=1165763, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=v/TbnpNrSxUOvxL8mxBq2A==, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=h4V/lcV3wxwDHAPLQszELQ==, mapNumber=null, authorCompany=null, fund=null, authors=

高杰与马桂峰为共同通信作者

葛怀举（1999—），男，硕士在读，研究方向：流行病与卫生统计，精神卫生

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Series B, Psychological Sciences and Social Sciences, 2003, 58(2): S93-S100., articleTitle=Social networks, social integration, and social engagement determine cognitive decline in community-dwelling Spanish older adults, refAbstract=null), Reference(id=1241821877803487460, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241676531492245558, doi=null, pmid=null, pmcid=null, year=2023, volume=50, issue=20, pageStart=3773, pageEnd=3778, url=null, language=null, rfNumber=[20], rfOrder=25, authorNames=陈昊, 陈娜, journalName=现代预防医学, refType=null, unstructuredReference=陈昊， 陈娜.老年人生产性活动对认知功能的影响——抑郁的中介作用[J].现代预防医学，2023，50（20）：3773-3778., articleTitle=老年人生产性活动对认知功能的影响——抑郁的中介作用, refAbstract=null), Reference(id=1241821877904150758, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241676531492245558, doi=null, pmid=null, pmcid=null, year=2023, volume=50, issue=20, pageStart=3773, pageEnd=3778, url=null, language=null, rfNumber=[20], rfOrder=26, authorNames=Chen H, Chen N, journalName=Modern Preventive Medicine, refType=null, unstructuredReference=Chen H, Chen N. The impact of the elderly productive activities on cognitive function-the meditating effect of depression[J]. 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Univariate analysis of cognitive status in older adults

, figureFileSmall=null, figureFileBig=null, tableContent=
风险因素分类变量认知障碍检出率（%）χ2值P值
否是
年龄、性别、疾病状况
性别54.717<0.001
男1 75093034.70
女1 6941 34744.29
年龄（岁）28.192<0.001
60～692 2391 40338.52
70～791 03067939.73
≥8017519552.70
慢性病0.5730.449
有3 1172 04739.64
无32723041.29
抑郁78.691<0.001
是1 3511 16446.28
否2 0931 11334.72
疼痛2.0230.155
是2 3821 61540.41
否1 06266238.40
失能99.687<0.001
是18929661.03
否3 2551 98137.83
个体生活方式
吸烟0.0680.794
是81454540.10
否2 6301 73239.71
饮酒12.902<0.001
是1 08861736.19
否2 3581 66041.31
锻炼28.221<0.001
是1 9001 09336.52
否1 5441 18443.40
睡眠时长70.162<0.001
<6h1 32099743.03
6-8h1 8781 01335.04
>8h24526752.15
生活满意度24.510<0.001
低34531647.81
中1 9311 16337.59
高1 16879840.59
自评健康15.487<0.001
差1 15187043.05
一般1 7491 04637.42
好54436139.89
社会支持网络
婚姻状况42.988<0.001
无配偶55852748.57
有配偶2 8861 75037.75
社交活跃度52.320<0.001
中低水平2 2921 71942.86
高水平1 15255832.63
社会经济地位
文化水平109.626<0.001
文盲/半文盲1 6211 27343.99
小学96936927.58
初中及以上85463542.65
地域分布35.206<0.001
东部1 23566735.07
中部1 16777439.88
西部1 04283644.52
居住地112.850<0.001
农村2 2701 79744.18
城镇1 17448029.02
其他社会结构因素
医疗保险23.591<0.001
有3 3872 19339.30
无578459.57
养老保险20.480<0.001
有3 1922 03238.90
无25224549.30
), ArticleFig(id=1241821868894785625, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241676531492245558, language=CN, label=表1, caption=

老年人认知状况的单因素分析

, figureFileSmall=null, figureFileBig=null, tableContent=
风险因素分类变量认知障碍检出率（%）χ2值P值
否是
年龄、性别、疾病状况
性别54.717<0.001
男1 75093034.70
女1 6941 34744.29
年龄（岁）28.192<0.001
60～692 2391 40338.52
70～791 03067939.73
≥8017519552.70
慢性病0.5730.449
有3 1172 04739.64
无32723041.29
抑郁78.691<0.001
是1 3511 16446.28
否2 0931 11334.72
疼痛2.0230.155
是2 3821 61540.41
否1 06266238.40
失能99.687<0.001
是18929661.03
否3 2551 98137.83
个体生活方式
吸烟0.0680.794
是81454540.10
否2 6301 73239.71
饮酒12.902<0.001
是1 08861736.19
否2 3581 66041.31
锻炼28.221<0.001
是1 9001 09336.52
否1 5441 18443.40
睡眠时长70.162<0.001
<6h1 32099743.03
6-8h1 8781 01335.04
>8h24526752.15
生活满意度24.510<0.001
低34531647.81
中1 9311 16337.59
高1 16879840.59
自评健康15.487<0.001
差1 15187043.05
一般1 7491 04637.42
好54436139.89
社会支持网络
婚姻状况42.988<0.001
无配偶55852748.57
有配偶2 8861 75037.75
社交活跃度52.320<0.001
中低水平2 2921 71942.86
高水平1 15255832.63
社会经济地位
文化水平109.626<0.001
文盲/半文盲1 6211 27343.99
小学96936927.58
初中及以上85463542.65
地域分布35.206<0.001
东部1 23566735.07
中部1 16777439.88
西部1 04283644.52
居住地112.850<0.001
农村2 2701 79744.18
城镇1 17448029.02
其他社会结构因素
医疗保险23.591<0.001
有3 3872 19339.30
无578459.57
养老保险20.480<0.001
有3 1922 03238.90
无25224549.30
), ArticleFig(id=1241821870438289504, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241676531492245558, language=EN, label=Table 2, caption=

Multi-factorial logistic regression analysis of cognitive status in older adults

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风险因素（参照）模型1模型2模型3模型4模型5OR值
βP值βP值βP值βP值βP值
年龄、性别、疾病状况
性别（男）
女0.380<0.0010.388<0.0010.385<0.0010.525<0.0010.532<0.0011.702
年龄（岁，60～69）
70～790.0280.6510.0170.786-0.0320.6120.0380.5570.0230.7251.023
≥800.584<0.0010.546<0.0010.448<0.0010.644<0.0010.622<0.0011.862
抑郁（否）
是0.379<0.0010.362<0.0010.332<0.0010.288<0.0010.287<0.0011.333
失能（否）
是0.790<0.0010.722<0.0010.682<0.0010.735<0.0010.733<0.0012.082
个体生活方式
饮酒（否）
是0.0240.7150.0490.4640.0620.3690.0620.3651.064
锻炼（否）
是-0.221<0.001-0.1930.001-0.1660.004-0.1610.0060.851
睡眠时长（<6h）
6～8h-0.1690.005-0.1680.006-0.1500.016-0.1480.0180.862
>8h0.490<0.0010.492<0.0010.468<0.0010.459<0.0011.582
生活满意度（低）
中-0.1660.072-0.1470.113-0.1530.108-0.1430.1340.867
高-0.0310.759-0.0110.915-0.0070.9430.0110.9181.011
自评健康（差）
一般-0.0110.8680.0010.9920.0210.7570.0130.8441.013
好0.1080.2260.1240.1660.1670.0690.1590.0841.172
社会支持网络
婚姻状况（无配偶）
有配偶-0.312<0.001-0.343<0.001-0.326<0.0010.722
社交活跃度（中低水平）
高水平-0.396<0.001-0.389<0.001-0.386<0.0010.679
社会经济地位
文化水平（文盲/半文盲）
小学-0.423<0.001-0.408<0.0010.665
初中及以上-0.679<0.001-0.715<0.0010.844
地域分布（东部）
中部0.2410.0010.2430.0011.275
西部0.434<0.0010.431<0.0011.538
现居地（农村）
城镇-0.800<0.001-0.795<0.0010.452
其他社会结构因素
医疗保险（无）
有-0.5470.0030.579
养老保险（无）
有-0.3170.0020.729
准确度预测率（%）62.5163.0563.5966.1266.32
AUC值0.6050.6260.6410.6870.691
H-L拟合优度检验（P值）0.0550.4760.2180.3330.461
), ArticleFig(id=1241821870597673060, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241676531492245558, language=CN, label=表2, caption=

老年人认知状况的多因素logistic回归分析

, figureFileSmall=null, figureFileBig=null, tableContent=
风险因素（参照）模型1模型2模型3模型4模型5OR值
βP值βP值βP值βP值βP值
年龄、性别、疾病状况
性别（男）
女0.380<0.0010.388<0.0010.385<0.0010.525<0.0010.532<0.0011.702
年龄（岁，60～69）
70～790.0280.6510.0170.786-0.0320.6120.0380.5570.0230.7251.023
≥800.584<0.0010.546<0.0010.448<0.0010.644<0.0010.622<0.0011.862
抑郁（否）
是0.379<0.0010.362<0.0010.332<0.0010.288<0.0010.287<0.0011.333
失能（否）
是0.790<0.0010.722<0.0010.682<0.0010.735<0.0010.733<0.0012.082
个体生活方式
饮酒（否）
是0.0240.7150.0490.4640.0620.3690.0620.3651.064
锻炼（否）
是-0.221<0.001-0.1930.001-0.1660.004-0.1610.0060.851
睡眠时长（<6h）
6～8h-0.1690.005-0.1680.006-0.1500.016-0.1480.0180.862
>8h0.490<0.0010.492<0.0010.468<0.0010.459<0.0011.582
生活满意度（低）
中-0.1660.072-0.1470.113-0.1530.108-0.1430.1340.867
高-0.0310.759-0.0110.915-0.0070.9430.0110.9181.011
自评健康（差）
一般-0.0110.8680.0010.9920.0210.7570.0130.8441.013
好0.1080.2260.1240.1660.1670.0690.1590.0841.172
社会支持网络
婚姻状况（无配偶）
有配偶-0.312<0.001-0.343<0.001-0.326<0.0010.722
社交活跃度（中低水平）
高水平-0.396<0.001-0.389<0.001-0.386<0.0010.679
社会经济地位
文化水平（文盲/半文盲）
小学-0.423<0.001-0.408<0.0010.665
初中及以上-0.679<0.001-0.715<0.0010.844
地域分布（东部）
中部0.2410.0010.2430.0011.275
西部0.434<0.0010.431<0.0011.538
现居地（农村）
城镇-0.800<0.001-0.795<0.0010.452
其他社会结构因素
医疗保险（无）
有-0.5470.0030.579
养老保险（无）
有-0.3170.0020.729
准确度预测率（%）62.5163.0563.5966.1266.32
AUC值0.6050.6260.6410.6870.691
H-L拟合优度检验（P值）0.0550.4760.2180.3330.461
), ArticleFig(id=1241821870769639533, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241676531492245558, language=EN, label=Table 3, caption=

Analysis of the additive interaction of depressive symptoms and disability status on cognitive status in older adults

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变量βWald χ2值P值OR值（95%CI）
抑郁症状失能状况
否正常———1.000
失能1.16334.894<0.0013.198（2.175～4.703）
是正常0.30223.024<0.0011.352（1.195～1.530）
失能0.84747.292<0.0012.333（1.833～2.970）
RERI-1.217（-2.480～0.046）
AP-0.522（-1.112～0.069）
S0.523（0.291～0.938）
), ArticleFig(id=1241821870891274355, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241676531492245558, language=CN, label=表3, caption=

老年人抑郁症状与失能状况对认知状况的相加交互作用分析

, figureFileSmall=null, figureFileBig=null, tableContent=
变量βWald χ2值P值OR值（95%CI）
抑郁症状失能状况
否正常———1.000
失能1.16334.894<0.0013.198（2.175～4.703）
是正常0.30223.024<0.0011.352（1.195～1.530）
失能0.84747.292<0.0012.333（1.833～2.970）
RERI-1.217（-2.480～0.046）
AP-0.522（-1.112～0.069）
S0.523（0.291～0.938）
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中国老年人失能、抑郁症状及其交互作用对认知功能的影响分析
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葛怀举 1 , 官为民 1 , 苏文钰 1 , 董士红 1 , 于晴 1 , 张效亮 2 , 高杰 3 , 马桂峰 1
现代预防医学 | 健康与社会行为 2024,51(21): 3948-3955
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现代预防医学 | 健康与社会行为 2024, 51(21): 3948-3955
中国老年人失能、抑郁症状及其交互作用对认知功能的影响分析
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葛怀举1, 官为民1, 苏文钰1, 董士红1, 于晴1, 张效亮2, 高杰3 , 马桂峰1
作者信息
  • 1.山东第二医科大学公共卫生学院，山东 潍坊 261053
  • 2.潍坊市高新区人民医院
  • 3.潍坊市市直机关医院，山东 潍坊 261041

    • 葛怀举（1999—），男，硕士在读，研究方向：流行病与卫生统计，精神卫生

通讯作者:

高杰，E-mail:；
马桂峰，E-mail:；
Analysis of the impact of disability, depression symptoms, and their interaction on cognitive function in elderly individuals in China
Huai-ju GE1, Wei-min GUAN1, Wen-yu SU1, Shi-hong DONG1, Qing YU1, Xiao-liang ZHANG2, Jie GAO3 , Gui-feng MA1
Affiliations
  • School of Public Health, Shandong Second Medical University, Weifang, Shandong 261053, China
出版时间: 2024-11-10 doi: 10.20043/j.cnki.MPM.202406059
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摘要
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目的

基于健康社会决定因素的视角，探讨中国60岁及以上老年人认知障碍的相关因素，为老年人认知障碍的防治提供参考依据。

方法

利用2018年中国健康与养老追踪调查的第四轮随访数据，对5 721例≥60岁的老年人认知状况进行统计描述，基于多因素logistic回归模型分析影响老年人认知状况的相关因素，探究抑郁症状和失能状况交互作用对老年人认知障碍的影响。

结果

认知障碍者2 277人（39.80%）。女性（OR=1.702，95%CI: 1.491～1.943）、年龄≥80岁（OR=1.862，95%CI: 1.467～2.364）、抑郁（OR=1.333，95%CI: 1.173～1.514）、失能（OR=2.082，95%CI: 1.687～2.569）、睡眠时长>8 h（OR=1.582，95%CI: 1.288～1.944）、中部和西部地区（OR=1.275、1.538，95%CI: 1.109～1.467、1.337～1.771）均为老年人认知障碍发生的危险因素。抑郁和失能对老年人认知状况有相乘交互作用（P交互=0.005），不存在相加交互作用（RERI = -1.217，95%CI: -2.480～0.046；AP=-0.522，95%CI: -1.112～0.069；S=0.523，95%CI: 0.291～0.938）。

结论

中国老年人认知障碍检出率不容乐观，抑郁和失能对老年人认知状况有相乘交互作用，政府应从健康社会决定因素的视角出发，从多维度对老年人认知状况实施干预，以达到“防治一体”的效果。

老年人  /  认知障碍  /  健康社会决定因素  /  交互作用  /  相关因素
Objective

To explore the factors related to cognitive impairment in elderly individuals aged 60 and above in China from the perspective of social determinants of health, providing a reference for the prevention and treatment of cognitive impairment in the elderly.

Methods

Utilizing data from the fourth wave of the 2018 China Health and Retirement Longitudinal Study, we conducted a statistical description of the cognitive status of 5 721 elderly individuals aged ≥60. A multifactor logistic regression model was employed to analyze factors affecting cognitive status in the elderly, investigating the impact of the interaction between depression symptoms and disability on cognitive impairment.

Results

Among the participants, 2 277 individuals (39.80%) were identified with cognitive impairment. Risk factors for cognitive impairment included being female (OR=1.702, 95%CI: 1.491 to 1.943), aged ≥80 years (OR=1.862, 95%CI: 1.467 to 2.364), experiencing depression (OR=1.333,95%CI: 1.173 to 1.514), having a disability (OR=2.082, 95%CI: 1.687 to 2.569), sleeping more than 8 hours (OR=1.582,95%CI: 1.288 to 1.944), and residing in central and western regions (OR=1.275, 1.538; 95%CI: 1.109-1.467, 1.337-1.771). There was a multiplicative interaction between depression and disability affecting cognitive status in the elderly (P interaction=0.005), with no additive interaction observed (RERI=-1.217, 95%CI: -2.480 to 0.046; AP=-0.522, 95%CI: -1.112 to 0.069;S = 0.523, 95%CI: 0.291 to 0.938).

Conclusion

The detection rate of cognitive impairment among elderly individuals in China is concerning. The multiplicative interaction of depression and disability on cognitive status suggests that the government should intervene from the perspective of social determinants of health, implementing multidimensional strategies to achieve an integrated approach to prevention and treatment.

Elderly  /  Cognitive impairment  /  Social determinants of health  /  Interaction  /  Related factors
葛怀举, 官为民, 苏文钰, 董士红, 于晴, 张效亮, 高杰, 马桂峰. 中国老年人失能、抑郁症状及其交互作用对认知功能的影响分析. 现代预防医学, 2024 , 51 (21) : 3948 -3955 . DOI: 10.20043/j.cnki.MPM.202406059
Huai-ju GE, Wei-min GUAN, Wen-yu SU, Shi-hong DONG, Qing YU, Xiao-liang ZHANG, Jie GAO, Gui-feng MA. Analysis of the impact of disability, depression symptoms, and their interaction on cognitive function in elderly individuals in China[J]. Modern Preventive Medicine, 2024 , 51 (21) : 3948 -3955 . DOI: 10.20043/j.cnki.MPM.202406059
正文
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认知障碍（cognitive impairment，COI）是指机体在认知功能方面出现障碍的一种症状，主要表现为记忆力减退、注意力不集中、思维迟缓和语言障碍等症状，被认为是认知正常和痴呆之间的中间过程[1]。随着中国老龄化进程的不断加深，与年龄相关的认知能力下降，如轻度认知障碍和痴呆症的发病率不断上升[2]，现已成为亟待解决的重大公共卫生问题。既往对老年人认知障碍的研究多集中于社会人口学特征、健康状况、生活习惯等一个或多个方面[3-5]，但对影响因素多维度，多层次的系统性研究，尤其是涉及政策、生活环境等方面的研究十分匮乏。健康社会决定因素（social determinants of health, SDH）是决定人们健康与疾病的根本原因，对患者个人行为、社会及经济环境等进行多维度的探究，多用于疾病诱因的追溯[2,6-7]。因此，本研究在分析中国老年人认知障碍流行现状的基础上，利用SDH，从不同维度探讨中国老年人认知障碍的相关因素，以期为老年人认知障碍的管理和防控提供参考依据。
1　资料与方法
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1.1　数据来源
本研究数据源自于中国健康与养老追踪调查（China Health and Retirement Longitudinal Study, CHARLS）的第四轮调查数据。CHARLS是由北京大学国家发展研究院主持的一项针对中国45岁及以上人群进行的具有全国代表性的纵向调查，调查采用多阶段抽样方法，覆盖了1.24万户家庭中的1.90万名受访者，现已完成2011、2013、2015、2018和2020年五轮调查，所有受访者均已签署知情同意书。研究纳入第四轮调查中年龄≥60岁的老年人作为研究对象，剔除日常生活活动能力、抑郁和认知等模块问题的异常或缺失样本，最终纳入样本5 721例。
1.2　研究方法
1.2.1　认知状况
本研究的结局变量为老年人的认知功能状况，采用“Cognition and Depression”模块的简易精神状况量表（mini mental state exam，MMSE）进行评估。MMSE量表共11个条目从方向感、记忆力、注意力和执行力等多个方面进行综合评估，答对一题计1分，答错或不知道不计分，最高30分。研究对象的文化程度为文盲或半文盲且MMSE≤17分、小学且MMSE≤20分和初中及以上且MMSE≤24分判定为认知障碍。
1.2.2　自变量
健康社会决定因素包括不同个体（年龄、性别、疾病状况等）、个体生活方式、社会支持网络、社会经济地位和其他社会结构因素五个维度，本研究基于SDH的五个纳入可能影响我国老年人认知状况的相关因素。（1）不同个体（年龄、性别、疾病状况等）：性别、年龄、慢性病、抑郁、疼痛、失能；（2）个体生活方式：吸烟、饮酒、锻炼、睡眠时长、生活满意度、自评健康；（3）社会支持网络：婚姻状况、社交活跃度；（4）社会经济地位：文化水平、地域分布、居住地；（5）其他社会结构因素：医疗保险、养老保险。
对部分自变量的定义：（1）慢性病：研究对象是否患有“Health Status and Functioning”模块中除与记忆相关疾病的13种慢性病。（2）抑郁症状：由CESD-10量表测定，对10个条目的各个选项分别赋值0、1、2、3，其中第5、8条目反向计分，总分为0～30分，≥10分判断为有抑郁症状。（3）失能状况：日常生活活动能力由BADL和IADL综合评估，按照功能独立性量表对12个条目的各个选项分别赋值1.5、4.0、6.0、7.0，总分为18～84分，<72分判定为失能。（4）社交活跃度：根据“研究对象过去一个月是否进行了下列社交活动？”和“您每隔多长时间会参加一次活动？”进行测量，每参加一种社交活动计1分，共11种。对每种活动的社交频率分别赋值1、2和3分。Ai为社交活动，取值为0～1。Fi为每项活动的频率，取值为1～3。C为社交活跃度，取值为0～33分，计算得出实际取值范围为0～20分[8]；C<3分定义为中低水平社交活跃度，≥3分为高水平社交活跃度，见公式（1）。
1.3　统计学方法
使用Stata 17.0软件对CHARLS数据库进行筛选和整理，应用SPSS 25.0软件对数据进行统计分析。采用（）对计量资料进行描述、采用构成比或率对计数资料进行描述。采用χ2检验进行变量间的差异分析；基于健康社会决定因素的五个维度建立五个相关因素模型，利用多因素logistic回归进行分析，使用H-L拟合优度检验评估每个模型的拟合质量，通过模型准确度预测率和受试者工作特征（ROC）曲线进一步评估模型性能。控制混杂因素，利用抑郁症状和失能状况的乘积项评估相乘交互作用（P<0.05）;使用Andersson等人[9]编制的Excel表计算变量间的相加交互作用，若两因素间存在相加交互作用，则超危险度比（RERI）和交互作用的归因比（AP）的可信区间不能包含0，交互作用指数（S）的可信区间不能包含1。检验水准α=0.05。
2　结果
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2.1　我国老年人基本情况
本研究共纳入5 721例有效样本，MMSE量表得分范围（20.94±5.32）分，其中认知障碍者2 277人（39.80%），认知正常者3 444人（60.20%）；男性2 680人（46.84%），女性3 041人（53.16%）；年龄以60～69岁为主，共3 642人（63.66%）；文盲/半文盲2 894人（50.59%），小学1 338人（23.39%），初中及以上1 489人（26.03%）；CESD量表得分范围（9.67±6.82）分，有抑郁症状者2 515人（44.00%），无抑郁症状者3 206人（56.00%）；失能状况方面，ADL量表得分范围（80.54±6.83）分，有失能状况者485人（8.50%），无失能状况者5 236人（91.50%）。见表1。
2.2　不同特征老年人认知状况比较
不同性别、年龄、抑郁状况、失能状况、饮酒、锻炼、睡眠时长、生活满意度、自评健康、婚姻状况、社交活跃度、文化水平、地域分布、居住地、医疗保险和养老保险的老年人认知状况比较，差异具有统计学意义（P<0.05）;不同慢性病患病情况、疼痛状况和吸烟情况的老年人认知状况比较，差异无统计学意义（P>0.05）。见表1。
2.3　不同特征老年人认知状况的多因素logistic回归分析
以认知状况作为因变量，以不同特征老年人认知状况单因素分析有统计学意义的变量作为自变量，按照SDH的五个维度依次纳入相应变量，进行多因素logistic回归分析。结果显示，纳入更多的维度可以改善模型的适应度，提高模型预测结果的准确性，见图1。模型1～5的准确预测率依次为62.51%、63.05%、63.59%、66.12%和66.32%，AUC值为0.605、0.626、0.641、0.687和0.691，H-L拟合优度检验良好（P>0.05），模型5是最拟合和最准确的模型，具有较好的判别和校准能力，见表2。女性、年龄≥80岁、有抑郁症状、失能、睡眠时长>8 h、中部和西部地区与老年人认知障碍的发生呈正相关。锻炼、睡眠时长6～8 h、有配偶、高水平社交活跃度、小学和初中及以上文化水平、城镇、有医疗保险、有养老保险与老年人认知障碍的发生呈负相关。有抑郁症状的老年人发生认知障碍的概率是正常人的1.333倍（OR= 1.333，95%CI: 1.173～1.514），失能老年人发生认知障碍的风险是正常老年人的2.082倍（OR=2.082，95%CI:1.687～2.569）。见图2。
2.4　抑郁症状和失能状况对老年人认知状况的交互作用分析
构建老年人抑郁症状和失能状况的乘积项，将抑郁症状、失能状况和二者的乘积项纳入logistic回归模型后，调整混杂因素，结果显示抑郁症状和失能状况对老年人认知状况有负向相乘交互作用（OR<1，P<0.05）。以无抑郁症状和失能状况的老年人作为参照组，控制混杂因素，分析抑郁和失能与老年人认知状况的相加交互作用，结果显示抑郁症状和失能状况与认知状况之间没有相加交互作用（RERI=-1.217，95%CI: -2.480～0.046；AP=-0.522，95%CI: -1.112～0.069；S=0.523，95%CI: 0.291～0.938）。见表3。
3　讨论
收起
本研究基于SDH，从五个维度把可能影响老年人认知状况的因素进行划分，探讨影响我国老年人认知状况的相关因素。研究结果显示，我国老年人认知障碍检出率为39.80%，略低于BAIANO等[10]（40.00%）和YAP等[11]（41.42%）的研究结果，但略高于马佳等[12]（39.30%）和刘文增等[13]（22.00%）的研究，这可能与研究对象的选取方式和认知障碍的划分标准有关。
3.1　年龄、性别、疾病状况维度对认知状况的影响
本研究发现，老年女性认知障碍的发生风险是男性的1.702倍，与贺舒凝等[14]研究结果相反，可能与研究人群的差异有关，女性绝经后卵巢会停止雌激素和孕激素等性类固醇激素分泌，导致激素水平持续下降，而是性类固醇激素分泌是影响认知功能和脑功能的关键因素[3]。年龄增长会增加老年人认知障碍的发生风险，随着年龄的增长，大脑可能会出现神经元损伤和突触退化，造成神经元功能受损，进而影响认知功能。抑郁是认知障碍发生的危险因素，可能是由于抑郁会引起炎性细胞因子水平增高，而炎症标志物的升高会导致认知能力下降[15]。失能老年人出现认知障碍的风险是正常老年人的2.082倍，与既往研究一致[16]，日常生活活动能力受限，老年人容易产生孤独、焦虑等负面情绪，出现抑郁症状，进而影响认知功能。本研究结果虽然证实抑郁症状和失能状况是老年人认知状况的危险因素，但二者之间仅存在负向相乘交互作用，不存在相加交互作用。
3.2　个体生活方式维度对认知状况的影响
锻炼是老年人认知障碍的保护因素，适度锻炼可以促进神经元生成与连接和多巴胺、肾上腺素等神经递质的释放，提高大脑的活跃度和反应速度[17]。睡眠时间过长（>8 h）或过短（<6 h）是老年人认知障碍发生的危险因素，睡眠时间过长可能会导致白介素-6和C-反应蛋白炎症通路的活性升高，导致认知功能受损[18]。老年人睡眠时间过短（<6 h）可能会引起大脑额颞区的皮质变薄，导致神经元损失或突出连接异常，进而影响认知功能。
3.3　社会支持网络维度对认知状况的影响
有配偶的老年人发生认知障碍的风险相对较低，生活中配偶可以相互照顾彼此，提供精神慰藉和社会支持，减少焦虑、孤独和抑郁等负面情绪，进而降低认知功能损伤的风险。高水平社交活跃度是老年人认知障碍发生的保护因素，积极参加社交活动可以提供认知刺激和记忆训练，使神经系统获得更好的突触密度和神经生长，改善免疫和神经内分泌系统[19]，进而影响老年人的认知功能。
3.4　社会经济地位维度对认知状况的影响
受教育程度较低的老年人认知障碍发生风险较高，可能是由于早年较长受教育年限增加大脑的认知储备，促进大脑突触数量增多，突触间连接变强，改善大脑老化的代偿功能[1]，降低认知障碍的发生风险。居住在我国中西部地区老年人认知障碍的发生风险高于东部地区，原因可能是我国东部地区经济相对发达，受教育水平相对较高，医疗卫生资源更加充足，社会支持体系也相对完善，对老年人认知功能的提高具有正向作用。农村与城镇相比也是如此。
3.5　其他社会结构因素维度对认知状况的影响
健全的医疗保险和养老保险制度对老年人的认知健康至关重要，医疗保险和养老保险是老年人认知状况的保护因素，原因可能是医疗保险和养老保险能够通过提供医疗服务、预防保健、经济支持和减轻家庭负担等方面的支持，对老年人认知功能发挥着积极的影响[20]，进而延缓认知功能衰退，提高老年人生活质量
本研究的局限性：本研究为横断面研究，仅使用2018年CHARLS数据无法确定变量之间的因果关系，后续研究可以考虑结合CHARLS的五轮调查数据，利用纵向数据进行分析；其次部分数据是通过老年人自报方式获取，可能存在报告偏倚的问题。
综上所述，我国老年人认知现状不容乐观，亟待采取相应的措施加以防治。通过SDH分析得出我国老年人认知障碍的影响因素是多维度、多方面的，政府应重点关注女性、年龄≥80岁、无配偶、农村、受教育程度较低、有抑郁症状、失能等认知状况相对较差的老年人群，从不同层次采取有针对性的措施加以干预，对老年人认知障碍进行防治，提高老年人生活质量。
基金
收起
  • 国家自然科学基金面上项目(71673202)
  • 国家食品安全风险中心联合攻关计划项目(LH2022GG06)
  • 潍坊医学院教学改革项目(2023YBC008)
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2024年第51卷第21期
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doi: 10.20043/j.cnki.MPM.202406059
  • 接收时间：2024-06-05
  • 首发时间：2026-03-20
  • 出版时间：2024-11-10
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  • 收稿日期：2024-06-05
基金
国家自然科学基金面上项目(71673202)
国家食品安全风险中心联合攻关计划项目(LH2022GG06)
潍坊医学院教学改革项目(2023YBC008)
作者信息
    1.山东第二医科大学公共卫生学院，山东 潍坊 261053
    2.潍坊市高新区人民医院
    3.潍坊市市直机关医院，山东 潍坊 261041

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鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
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红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
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