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Article(id=1322608097449849269, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1322608013010120712, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202505220, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1747065600000, receivedDateStr=2025-05-13, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1793263943302, onlineDateStr=2026-10-29, pubDate=1762704000000, pubDateStr=2025-11-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793263943302, onlineIssueDateStr=2026-10-29, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793263943302, creator=13701087609, updateTime=1793263943302, updator=13701087609, issue=Issue{id=1322608013010120712, tenantId=1146029695717560320, journalId=1227665162245664772, year='2025', volume='52', issue='21', pageStart='3841', pageEnd='4032', issueExtLink='null', onlineDate='null', pubDate='1762704000000', pubDateStr='2025-11-10', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1793263923169, creator='13701087609', updateTime=1793264266929, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1322609454932149086, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1322608013010120712, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1322609454932149087, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1322608013010120712, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=3866, endPage=3871, ext={EN=ArticleExt(id=1322608097676341686, articleId=1322608097449849269, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=The impact of arthritis and depression and their interaction on disability risk in Chinese elderly, columnId=1240413921954295836, journalTitle=Modern Preventive Medicine, columnName=Epidemiology and Statistical Methods, runingTitle=null, highlight=null, articleAbstract=
Objective

To explore the impact of arthritis, depression and their interaction on the disability risk in Chinese elderly.

Methods

Using data from the China Health and Retirement Longitudinal Study (CHARLS), eligible participants were enrolled, and 2015 baseline data and incident disability during the 5-year follow-up were collected. Multivariable cox regression models were established to analyze the effects of arthritis and depression on disability risk among Chinese elderly and to assess, on the multiplicative and additive scales, the impact of their interaction on disability risk.

Results

A total of 7 875 participants were included, and 586 new cases of disability occurred during the 5-year follow-up period, with an incidence rate of 7.4%.The multivariable cox regression analysis showed that arthritis (HR=1.92, 95% CI: 1.63-2.26) and depression (HR=2.65, 95% CI: 2.22-3.16) were both risk factors for disability. The interaction analysis showed that there was no multiplicative interaction between arthritis and depression on the disability risk (P>0.05), but there was an additive interaction effect (P<0.05), with the relative excess risk due to interaction (RERI) of 1.08 (95% CI: 0.32-1.85), the attributable proportion of interaction (AP) of 0.26 (95% CI: 0.09-0.42), and the synergy index (SI) of 1.51 (95% CI: 1.09-2.08).

Conclusion

Both arthritis and depression are risk factors for disability in Chinese elderly, and there is an additive interaction between them. We should pay more attention to elderly people with comorbid arthritis and depression and take active measures to reduce the disability risk in Chinese elderly.

, authors=De-zhi WANG, Wen-rong PU, Ming ZHU, Quan-chao XIN, Yu-long LIU, Guo-hua DONG, authorsList=De-zhi WANG, Wen-rong PU, Ming ZHU, Quan-chao XIN, Yu-long LIU, Guo-hua DONG, authorCompany=null, correspAuthors=Guo-hua DONG, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1322608099656053175, articleId=1322608097449849269, tenantId=1146029695717560320, journalId=1227665162245664772, language=CN, title=关节炎和抑郁及其交互作用对中国老年人失能风险的影响, columnId=1228016567632462653, journalTitle=现代预防医学, columnName=流行病与统计方法, runingTitle=null, highlight=null, articleAbstract=
目的

探究关节炎和抑郁及其交互作用对中国老年人失能风险的影响。

方法

基于中国健康与养老追踪调查（China health and retirement longitudinal study，CHARLS），纳入符合标准的研究对象，收集2015年基线数据，五年随访期间统计失能发生情况。建立多因素Cox回归模型分析关节炎和抑郁与中国老年人失能风险的关联效应，并运用相乘模型和相加模型分析关节炎和抑郁的交互作用对中国老年人失能风险的影响。

结果

共纳入7 875例研究对象，在五年随访期间，新发生失能586例，发生率7.4%。多因素Cox回归分析结果显示，关节炎（HR=1.92，95% CI：1.63～2.26）和抑郁（HR=2.65，95% CI：2.22～3.16）均是失能的危险因素。交互作用分析显示，关节炎和抑郁对中国老年人失能风险不存在相乘交互作用（P>0.05），但存在相加交互作用（P<0.05），超额相对危险度（RERI）为1.08(95% CI：0.32～1.85)，交互作用归因百分比为0.26(95% CI：0.09～0.42)，协同指数为1.51(95% CI：1.09～2.08)。

结论

关节炎和抑郁均是中国老年人失能的危险因素，且二者存在相加交互作用。我们应对关节炎抑郁共病老年人群加强关注，采取积极措施降低中国老年人失能风险。

, authors=王德志, 蒲文荣, 朱明, 辛全超, 刘玉龙, 董国华, authorsList=王德志, 蒲文荣, 朱明, 辛全超, 刘玉龙, 董国华, authorCompany=null, correspAuthors=董国华, authorNote=

王德志（1988—），男，硕士，主治医师，研究方向：骨关节疾病的基础和临床研究

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董国华，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=1Liatvxrotg2+byzcAM6Rg==, magXml=IQay1tonCtwQ1sFvGfKyqg==, pdfUrl=null, pdf=uxH03ztZ7WXr8ZYglhN1ZA==, pdfFileSize=635679, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=v+YJzgyBAymTU/JYvehc8Q==, mapNumber=null, fund=null)}, authors=[Author(id=1322608099987403196, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322608097449849269, orderNo=0, firstName=null, middleName=null, lastName=null, nameCn=null, orcid=null, stid=null, country=null, authorPic=null, dead=0, email=null, emailSecond=null, emailThird=null, correspondingAuthor=0, authorType=1, ext={EN=AuthorExt(id=1322608100071289278, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322608097449849269, authorId=1322608099987403196, language=EN, stringName=De-zhi WANG, firstName=De-zhi, middleName=null, lastName=WANG, prefix=null, suffix=null, authorComment=null, nameInitials=null, affiliation=null, department=null, xref=null, address=Rizhao Hospital of Traditional Chinese Medicine, Rizhao, Shandong 276800, China, bio=null, bioImg=null, bioContent=null, aboutCorrespAuthor=null), CN=AuthorExt(id=1322608100142592447, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322608097449849269, authorId=1322608099987403196, language=CN, stringName=王德志, firstName=null, middleName=null, lastName=null, prefix=null, suffix=null, authorComment=null, nameInitials=null, affiliation=null, department=null, xref=null, address=日照市中医医院，山东　日照　276800, bio={"content":"

王德志（1988—），男，硕士，主治医师，研究方向：骨关节疾病的基础和临床研究

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王德志（1988—），男，硕士，主治医师，研究方向：骨关节疾病的基础和临床研究

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IL-6、TNF-α、IL-10在类风湿关节炎合并抑郁中的临床意义 [D]. 石河子：石河子大学, 2021., articleTitle=IL-6、TNF-α、IL-10在类风湿关节炎合并抑郁中的临床意义, refAbstract=null), Reference(id=1322608109038711313, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322608097449849269, doi=null, pmid=null, pmcid=null, year=2021, volume=null, issue=null, pageStart=null, pageEnd=null, url=null, language=null, rfNumber=[24], rfOrder=35, authorNames=Wang JQ, journalName=null, refType=null, unstructuredReference=Wang JQ. Clinical significance of IL-6TNF-a and IL-10 in rheumatoid arthritis complicated with depression [D]. Shihezi: Shihezi University, 2021. 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Neuron, 2020, 107 (2): 234-256., articleTitle=The bidirectional relationship of depression and inflammation: double trouble, refAbstract=null), Reference(id=1322608109361672723, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322608097449849269, doi=null, pmid=null, pmcid=null, year=2022, volume=23, issue=1, pageStart=7, pageEnd=12, url=null, language=null, rfNumber=[26], rfOrder=37, authorNames=韩欣慰, 马迪, 杜金, journalName=中国预防医学杂志, refType=null, unstructuredReference=韩欣慰，马迪，杜金, 等. 中老年人关节炎与抑郁症状的关联效应探讨 [J]. 中国预防医学杂志, 2022, 23 (1): 7-12., articleTitle=中老年人关节炎与抑郁症状的关联效应探讨, refAbstract=null), Reference(id=1322608109449753108, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322608097449849269, doi=null, pmid=null, pmcid=null, year=2022, volume=23, issue=1, pageStart=7, pageEnd=12, url=null, language=null, rfNumber=[26], rfOrder=38, authorNames=Han XW, Ma D, Du J, journalName=China Preventive Medicine, refType=null, unstructuredReference=Han XW, Ma D, Du J, et al. The association between arthritis and depressive symptoms in the middle-aged and the elderly [J]. China Preventive Medicine, 2022, 23 (1): 7-12. (In Chinese), articleTitle=The association between arthritis and depressive symptoms in the middle-aged and the elderly, refAbstract=null)], funds=[Fund(id=1322608104219455977, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322608097449849269, awardId=ZR2023LZY018, language=CN, fundingSource=山东省自然科学基金(ZR2023LZY018), fundOrder=null, country=null), Fund(id=1322608104290759146, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322608097449849269, awardId=Q-2023143, language=CN, fundingSource=山东省中医药科技项目(Q-2023143), fundOrder=null, country=null), Fund(id=1322608104366256619, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322608097449849269, awardId=M-2023231, language=CN, fundingSource=山东省中医药科技项目(M-2023231), fundOrder=null, country=null), Fund(id=1322608104437559788, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322608097449849269, awardId=202304071439, language=CN, fundingSource=山东省医药卫生科技项目(202304071439), fundOrder=null, country=null), Fund(id=1322608104504668653, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322608097449849269, awardId=RZY2023C06, language=CN, fundingSource=日照市中医药科技项目(RZY2023C06), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1322608099895128504, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322608097449849269, xref=null, ext=[AuthorCompanyExt(id=1322608099903517113, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322608097449849269, companyId=1322608099895128504, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Rizhao Hospital of Traditional Chinese Medicine, Rizhao, Shandong 276800, China), AuthorCompanyExt(id=1322608099916100026, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322608097449849269, companyId=1322608099895128504, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=日照市中医医院，山东　日照　276800)])], figs=[ArticleFig(id=1322608102231355875, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322608097449849269, language=EN, label=Table 1, caption=

Basic characteristics of the subjects［n（%）］

, figureFileSmall=null, figureFileBig=null, tableContent=
变量总数(n=7 875)失能(n=586)非失能(n=7 289)t/χ2值P值
性别男4 004(50.8)236(40.3)3 768(51.7)28.309<0.001
女3 871(49.2)350(59.7)3 521(48.3)
年龄（岁）67.8±6.070.4±6.967.6±5.810.935<0.001
婚姻状况已婚6 290(79.9)420(71.7)5 870(80.5)26.485<0.001
未婚/离异/丧偶1 585(20.1)166(28.3)1 419(19.5)
教育水平小学及以下5 590(71.0)471(80.4)5 119(70.2)27.223<0.001
中学2 146(27.3)107(18.3)2 039(28.0)
大专及以上139(1.80)8(1.40)131(1.80)
居住地城市2 791(35.4)179(30.5)2 612(35.8)6.6310.010
农村5 084(64.6)407(69.5)4 677(64.2)
吸烟情况不吸烟5 815(73.8)475(81.1)5 340(73.3)17.071<0.001
吸烟2 060(26.2)111(18.9)1 949(26.7)
饮酒情况不饮酒5 111(64.9)438(74.7)4 673(64.1)26.924<0.001
饮酒2 764(35.1)148(25.3)2 616(35.9)
慢性病无其他慢性病1 583(20.1)47(8.0)1 536(21.1)57.534<0.001
有其他慢性病6 292(79.9)539(92.0)5 753(78.9)
关节炎无5 069(64.4)271(46.2)4 798(65.8)90.659<0.001
有2 806(35.6)315(53.8)2 491(34.2)
抑郁无4 747(60.3)201(34.3)4 546(62.4)178.46<0.001
有3 128(39.7)385(65.7)2 743(37.6)
), ArticleFig(id=1322608103820997092, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322608097449849269, language=CN, label=表1, caption=

研究对象基本特征［n（%）］

, figureFileSmall=null, figureFileBig=null, tableContent=
变量总数(n=7 875)失能(n=586)非失能(n=7 289)t/χ2值P值
性别男4 004(50.8)236(40.3)3 768(51.7)28.309<0.001
女3 871(49.2)350(59.7)3 521(48.3)
年龄（岁）67.8±6.070.4±6.967.6±5.810.935<0.001
婚姻状况已婚6 290(79.9)420(71.7)5 870(80.5)26.485<0.001
未婚/离异/丧偶1 585(20.1)166(28.3)1 419(19.5)
教育水平小学及以下5 590(71.0)471(80.4)5 119(70.2)27.223<0.001
中学2 146(27.3)107(18.3)2 039(28.0)
大专及以上139(1.80)8(1.40)131(1.80)
居住地城市2 791(35.4)179(30.5)2 612(35.8)6.6310.010
农村5 084(64.6)407(69.5)4 677(64.2)
吸烟情况不吸烟5 815(73.8)475(81.1)5 340(73.3)17.071<0.001
吸烟2 060(26.2)111(18.9)1 949(26.7)
饮酒情况不饮酒5 111(64.9)438(74.7)4 673(64.1)26.924<0.001
饮酒2 764(35.1)148(25.3)2 616(35.9)
慢性病无其他慢性病1 583(20.1)47(8.0)1 536(21.1)57.534<0.001
有其他慢性病6 292(79.9)539(92.0)5 753(78.9)
关节炎无5 069(64.4)271(46.2)4 798(65.8)90.659<0.001
有2 806(35.6)315(53.8)2 491(34.2)
抑郁无4 747(60.3)201(34.3)4 546(62.4)178.46<0.001
有3 128(39.7)385(65.7)2 743(37.6)
), ArticleFig(id=1322608103883911653, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322608097449849269, language=EN, label=Table 2, caption=

Association of arthritis and depression with disability risk

, figureFileSmall=null, figureFileBig=null, tableContent=
变量总人数失能人数（%）模型1模型2模型3
HR值 (95% CI)P值HR值(95% CI)P值HR值(95% CI)P值
非关节炎5 069271(5.3)1(Ref)1(Ref)1(Ref)
关节炎2 806315(11.2)2.18(1.85～2.56)<0.0012.06(1.75～2.43)<0.0011.92(1.63～2.26)<0.001
非抑郁4 747201(4.2)1(Ref)1(Ref)1(Ref)
抑郁3 128385(12.3)3.04(2.56～3.6)<0.0012.83(2.38～3.38)<0.0012.65(2.22～3.16)<0.001
), ArticleFig(id=1322608103942631910, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322608097449849269, language=CN, label=表2, caption=

关节炎和抑郁与失能风险的关联

, figureFileSmall=null, figureFileBig=null, tableContent=
变量总人数失能人数（%）模型1模型2模型3
HR值 (95% CI)P值HR值(95% CI)P值HR值(95% CI)P值
非关节炎5 069271(5.3)1(Ref)1(Ref)1(Ref)
关节炎2 806315(11.2)2.18(1.85～2.56)<0.0012.06(1.75～2.43)<0.0011.92(1.63～2.26)<0.001
非抑郁4 747201(4.2)1(Ref)1(Ref)1(Ref)
抑郁3 128385(12.3)3.04(2.56～3.6)<0.0012.83(2.38～3.38)<0.0012.65(2.22～3.16)<0.001
), ArticleFig(id=1322608104034906599, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322608097449849269, language=EN, label=Table 3, caption=

Analysis of interaction of arthritis and depression on disability risk

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变量总人数失能人数（%）模型1模型2模型3
HR值(95% CI)P值HR值(95% CI)P值HR值(95% CI)P值
非关节炎/非抑郁3 392116(3.4)1(Ref)1(Ref)1(Ref)
非关节炎/抑郁1 677155(9.2)2.78(2.19～3.54)<0.0012.60(2.03～3.32)<0.0012.44(1.91～3.12)<0.001
关节炎/非抑郁1 35585(6.3)1.87(1.41～2.47)<0.0011.81(1.36～2.39)<0.0011.69(1.27～2.24)<0.001
关节炎/抑郁1 451230(15.9)4.99(3.99～6.23)<0.0014.72(3.74～5.94)<0.0014.22(3.34～5.32)<0.001
相乘交互作用0.96(0.68～1.36)0.8251.00(0.71～1.42)0.9821.02(0.72～1.45)0.901
相加交互作用
RERI1.34(0.47～2.22)0.0011.31(0.47～2.15)0.0011.08(0.32～1.85)0.003
AP0.27(0.11～0.42)<0.0010.28(0.12～0.43)<0.0010.26(0.09～0.42)0.001
SI1.51(1.13～2.02)<0.0011.54(1.14～2.09)<0.0011.51(1.09～2.08)<0.001
), ArticleFig(id=1322608104110404072, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1322608097449849269, language=CN, label=表3, caption=

关节炎和抑郁对失能风险的交互作用分析

, figureFileSmall=null, figureFileBig=null, tableContent=
变量总人数失能人数（%）模型1模型2模型3
HR值(95% CI)P值HR值(95% CI)P值HR值(95% CI)P值
非关节炎/非抑郁3 392116(3.4)1(Ref)1(Ref)1(Ref)
非关节炎/抑郁1 677155(9.2)2.78(2.19～3.54)<0.0012.60(2.03～3.32)<0.0012.44(1.91～3.12)<0.001
关节炎/非抑郁1 35585(6.3)1.87(1.41～2.47)<0.0011.81(1.36～2.39)<0.0011.69(1.27～2.24)<0.001
关节炎/抑郁1 451230(15.9)4.99(3.99～6.23)<0.0014.72(3.74～5.94)<0.0014.22(3.34～5.32)<0.001
相乘交互作用0.96(0.68～1.36)0.8251.00(0.71～1.42)0.9821.02(0.72～1.45)0.901
相加交互作用
RERI1.34(0.47～2.22)0.0011.31(0.47～2.15)0.0011.08(0.32～1.85)0.003
AP0.27(0.11～0.42)<0.0010.28(0.12～0.43)<0.0010.26(0.09～0.42)0.001
SI1.51(1.13～2.02)<0.0011.54(1.14～2.09)<0.0011.51(1.09～2.08)<0.001
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关节炎和抑郁及其交互作用对中国老年人失能风险的影响
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王德志 , 蒲文荣 , 朱明 , 辛全超 , 刘玉龙 , 董国华
现代预防医学 | 流行病与统计方法 2025,52(21): 3866-3871
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现代预防医学 |流行病与统计方法 2025 , 52 (21) : 3866 -3871
关节炎和抑郁及其交互作用对中国老年人失能风险的影响
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王德志, 蒲文荣, 朱明, 辛全超, 刘玉龙, 董国华
作者信息
  • 日照市中医医院，山东　日照　276800
通讯作者:
董国华，E-mail：
作者简介:

王德志（1988—），男，硕士，主治医师，研究方向：骨关节疾病的基础和临床研究

The impact of arthritis and depression and their interaction on disability risk in Chinese elderly
De-zhi WANG, Wen-rong PU, Ming ZHU, Quan-chao XIN, Yu-long LIU, Guo-hua DONG
Affiliations
  • Rizhao Hospital of Traditional Chinese Medicine, Rizhao, Shandong 276800, China
出版时间: 2025-11-10 doi: 10.20043/j.cnki.MPM.202505220
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摘要
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目的

探究关节炎和抑郁及其交互作用对中国老年人失能风险的影响。

方法

基于中国健康与养老追踪调查（China health and retirement longitudinal study，CHARLS），纳入符合标准的研究对象，收集2015年基线数据，五年随访期间统计失能发生情况。建立多因素Cox回归模型分析关节炎和抑郁与中国老年人失能风险的关联效应，并运用相乘模型和相加模型分析关节炎和抑郁的交互作用对中国老年人失能风险的影响。

结果

共纳入7 875例研究对象，在五年随访期间，新发生失能586例，发生率7.4%。多因素Cox回归分析结果显示，关节炎（HR=1.92，95% CI：1.63～2.26）和抑郁（HR=2.65，95% CI：2.22～3.16）均是失能的危险因素。交互作用分析显示，关节炎和抑郁对中国老年人失能风险不存在相乘交互作用（P>0.05），但存在相加交互作用（P<0.05），超额相对危险度（RERI）为1.08(95% CI：0.32～1.85)，交互作用归因百分比为0.26(95% CI：0.09～0.42)，协同指数为1.51(95% CI：1.09～2.08)。

结论

关节炎和抑郁均是中国老年人失能的危险因素，且二者存在相加交互作用。我们应对关节炎抑郁共病老年人群加强关注，采取积极措施降低中国老年人失能风险。

中国老年人  /  关节炎  /  抑郁  /  失能  /  中国健康与养老追踪调查
Objective

To explore the impact of arthritis, depression and their interaction on the disability risk in Chinese elderly.

Methods

Using data from the China Health and Retirement Longitudinal Study (CHARLS), eligible participants were enrolled, and 2015 baseline data and incident disability during the 5-year follow-up were collected. Multivariable cox regression models were established to analyze the effects of arthritis and depression on disability risk among Chinese elderly and to assess, on the multiplicative and additive scales, the impact of their interaction on disability risk.

Results

A total of 7 875 participants were included, and 586 new cases of disability occurred during the 5-year follow-up period, with an incidence rate of 7.4%.The multivariable cox regression analysis showed that arthritis (HR=1.92, 95% CI: 1.63-2.26) and depression (HR=2.65, 95% CI: 2.22-3.16) were both risk factors for disability. The interaction analysis showed that there was no multiplicative interaction between arthritis and depression on the disability risk (P>0.05), but there was an additive interaction effect (P<0.05), with the relative excess risk due to interaction (RERI) of 1.08 (95% CI: 0.32-1.85), the attributable proportion of interaction (AP) of 0.26 (95% CI: 0.09-0.42), and the synergy index (SI) of 1.51 (95% CI: 1.09-2.08).

Conclusion

Both arthritis and depression are risk factors for disability in Chinese elderly, and there is an additive interaction between them. We should pay more attention to elderly people with comorbid arthritis and depression and take active measures to reduce the disability risk in Chinese elderly.

Chinese elderly  /  Arthritis  /  Depression  /  Disability  /  China Health and Retirement Longitudinal Study
王德志, 蒲文荣, 朱明, 辛全超, 刘玉龙, 董国华. 关节炎和抑郁及其交互作用对中国老年人失能风险的影响. 现代预防医学, 2025 , 52 (21) : 3866 -3871 . DOI: 10.20043/j.cnki.MPM.202505220
De-zhi WANG, Wen-rong PU, Ming ZHU, Quan-chao XIN, Yu-long LIU, Guo-hua DONG. The impact of arthritis and depression and their interaction on disability risk in Chinese elderly[J]. Modern Preventive Medicine, 2025 , 52 (21) : 3866 -3871 . DOI: 10.20043/j.cnki.MPM.202505220
正文
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失能是指在年龄、疾病等多因素作用下机体功能受损的状态，以老年人为主要受累人群，其核心表现为日常生活活动能力的显著下降，无法独立完成如穿衣、进食、洗澡等基本生活自理任务，失能不仅降低老年人生活质量，还可能致残、致死，加重家庭和社会负担[1]。随着我国人口老龄化的不断加剧，老年人口数量持续攀升，失能老年人口的规模也日益庞大，据相关研究预测，到2050年，中国失能老年人口将达到5 205万，占比呈现不断上升的趋势[2]，这一数据凸显了老年失能问题的严峻性和紧迫性。在这样的背景下，老年人失能问题成为日益紧迫的公共卫生挑战，亟待更深入的研究并出台有效的应对策略。
关节炎是一种常见的慢性肌肉骨骼疾病，多以关节疼痛和功能障碍为主要临床表现，不同程度影响老年人的日常活动能力[3]，抑郁症则是一种常见的心理健康问题，其症状包括情绪低落、兴趣丧失和精力减退等，同样对老年人的生活能力产生负面影响[4]。既往研究表明[5]，关节炎和抑郁在老年人群中联系紧密，具有较高的共病率，进一步梳理文献发现，虽然已有研究证实关节炎和抑郁均是老年人失能的危险因素[6-7]，但目前的研究多集中于探讨关节炎或抑郁与失能的单独关联，对于二者的交互作用对老年人失能风险影响的研究尚无报道。鉴于此，本研究采用中国健康与养老追踪调查（China Health and Retirement Longitudinal Study，CHARLS）数据，首次在整个中国人口层面上探讨关节炎和抑郁及其交互作用与老年人失能风险的关联效应，以明确关节炎抑郁共病模式对中国老年人失能风险的影响，以期为我国老年人健康管理和失能预防的相关公共卫生政策制定提供参考。
1　资料与方法
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1.1　研究对象
本研究数据来源于CHARLS 2015、2018和2020年的数据，以CHARLS 2015为基线调查，以CHARLS 2018和2020年为随访调查，CHARLS 2015年基线调查时共纳入21 095名参与者，依次排除关节炎数据缺失者（n=2 328）、抑郁诊断数据缺失者（n=2 602）、失能诊断数据缺失者（n=128）、协变量数据缺失者（n=150）、年龄<60岁者（n=7 579）、基线调查时已发生失能者（n=433）、最终纳入7 875例数据完整的研究对象。CHARLS已获北京大学伦理审查委员会审查通过（伦理审批号：IRB0000105211015），所有研究对象签署知情同意书，所有数据对外开放并允许规范使用。
1.2　自变量
本研究中的自变量为关节炎与抑郁。
1.2.1　关节炎
参考既往研究[8]，依据CHARLS问卷“健康状况与功能”条目，由经医生诊断的关节炎进行判定，医生诊断作为临床金标准，能够有效排除其他类似症状的疾病干扰，确保关节炎的判定具有较高的特异性和敏感性。
1.2.2　抑郁
参考既往研究[9]，依据CHARLS问卷“认知和抑郁”条目，采用流调中心抑郁水平评定量表（CESD-10）进行抑郁筛查，CESD-10量表是用于老年人群抑郁筛查的简明工具，在中国老年人群中具有良好的信度和效度，适用于大规模流行病学调查，共包括10项问题，每项问题分4级评分，分别赋值0～3，其中第5项和第8项反向计分，将10项问题评分汇总相加，总分0～30分，得分≥10分判定为抑郁。
1.3　因变量
本研究中的因变量为失能。
参考既往研究[10]，依据CHARLS问卷“健康状况与功能”条目，采用日常生活活动能力（activitie of daily living，ADL）量表作为失能评估工具，ADL量表是评估失能的经典工具，具有良好的信效度，测量指标共包括穿衣等6项行为，每项指标根据完成情况分为4个等级：没有困难,有困难但仍可以完成，有困难、需要帮助，无法完成；有任何一项回答“有困难，需要帮助”或“无法完成”，即视为失能。
1.4　协变量
参考既往研究[11]，并基于社会人口学特征、健康行为及共病状况对失能影响的广泛共识，本研究纳入的协变量包括性别、年龄、婚姻状况、教育水平、居住地、吸烟情况、饮酒情况、是否合并其他慢性病。本研究中的其他慢性病包括高血压、血脂异常、糖尿病、恶性肿瘤、慢性肺部疾病、肝脏疾病、心脏病、中风、肾脏疾病、消化系统疾病、情感及精神方面问题、与记忆相关的疾病、帕金森症、哮喘等14种慢性病，本研究中，当研究对象患有上述14种慢性病中的至少1种，即定义为合并其他慢性病。
1.5　统计学方法
统计分析采用Free Statisticsversion 1.9.2软件和R（http：//www.R-project.org，R基金会）统计软件包完成，检验水准α=0.05。我们采用Shapiro-Wilk检验对计量资料进行了正态性检验，结果显示符合正态分布（P>0.05）。计量资料以（均数±标准差）描述，比较采用t检验，计数资料以频数和构成比描述，比较采用χ2检验。建立多因素Cox回归模型分别分析关节炎和抑郁与失能的关联效应，将关节炎和抑郁两项作为交互项纳入多因素Cox回归模型，运用相乘模型和相加模型分析关节炎和抑郁的交互作用对失能风险的影响。相乘交互作用结果的95% CI不包括1表示存在相乘交互作用；当HR值>1且其95% CI值不包括1时，相乘交互作用为协同作用；HR值<1且其95% CI值不包括1时，相乘交互作用为拮抗作用。相加交互作用包括超额相对危险度（relative excess risk due to interaction，RERI）、归因百分比（the attributable proportion of interaction，AP）、协同作用指数（the synergy index，SI），指标的计算公式：RERI=HRA1B1-HRA1B0-HRA0B1+1，AP=RERI/HRA1B1，SI=（HRA1B1-1）/[（HRA1B0-1）+（HRA0B1-1）]。若RERI与AP的95% CI不包含0且SI的95% CI不包含1，表示存在相加交互作用；RERI以及AP均<0且SI<1为拮抗作用；RERI以及AP均>0且SI>1为协同作用。本研究共拟合3个模型，模型1不调整任何协变量，模型2调整性别、年龄、婚姻状况、教育水平和居住地，模型3在模型2基础上调整吸烟情况、饮酒情况和慢性病情况。
2　结果
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2.1　纳入人群一般资料
本研究共纳入7 875例研究对象，男性4 004例，女性3 871例，平均年龄67.8岁；关节炎2 806例，患病率35.6%；抑郁3 128例，患病率39.7%；五年随访时间中,新发生失能586例，发生率7.4%；对失能组和非失能组的性别、年龄、婚姻状况、教育水平、居住地、吸烟情况、饮酒情况、慢性病情况等一般资料进行比较，结果显示均有统计学差异。见表1。
2.2　关节炎和抑郁与失能风险的关联分析
建立多因素Cox回归模型分析关节炎和抑郁与失能的相关性，调整不同协变量，各模型均显示关节炎和抑郁是老年人失能的危险因素（HR>1，P<0.001）。完全调整模型（模型3）显示，关节炎人群的失能风险是非关节炎人群的1.92（95% CI：1.63～2.26，P<0.001）倍，抑郁人群的失能风险是非抑郁人群的2.65（95% CI：2.22～3.16，P<0.001）倍。见表2。
2.3　关节炎和抑郁对失能风险的交互作用分析
将关节炎和抑郁两项作为交互项纳入多因素Cox回归模型，运用相乘模型和相加模型分析关节炎和抑郁的交互作用对失能风险的影响，调整不同协变量，各模型均显示关节炎和抑郁对失能风险无相乘交互作用，但存在相加交互作用。完全调整模型（模型3）相加交互作用分析显示，RERI为1.08(95% CI：0.32～1.85，P=0.003)，交互作用AP为0.26(95% CI：0.09～0.42，P=0.001)，SI为1.51(95% CI：1.09～2.08，P<0.001)。见表3。
3　讨论
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本研究基于CHARLS数据以中国老年人为研究对象，探讨了关节炎和抑郁及其交互作用对中国老年人失能风险的影响。研究结果表明，关节炎和抑郁均是中国老年人失能的独立危险因素，且关节炎和抑郁对中国老年人失能风险的影响存在相加交互作用，提示关节炎抑郁共病老年人群面临更高的失能风险。
作为一种常见的慢性炎症性疾病，关节炎好发于老年人群，随着老龄化形势的不断加剧，我国关节炎发病率逐年升高，基于本研究纳入人群的关节炎患病率高达35.6%，与另一项2011—2015年CHARLS 45岁以上人群研究报道的32.2%患病率接近[12]。关节炎不仅给患者带来疼痛和功能障碍，更与老年人失能的发生密切相关[7]，一项针对墨西哥裔美国人的研究发现罹患关节炎人群更易发生失能[13]，本研究显示关节炎人群失能风险是非关节炎人群的1.92倍（95% CI：1.63～2.26）,基于我国全国性样本也印证了关节炎是失能的危险因素。关节炎引起的疼痛和关节功能障碍会降低老年人的日常生活能力，如行走、家务、洗澡、进食等[13-14]，可能是关节炎患病导致软骨损伤、关节囊和支持韧带的松动，进一步导致关节进行性功能丧失，从而损害老年人日常活动能力。另外，关节炎患者多见于老年人群，往往伴随有其他慢性疾病，如心血管疾病、糖尿病等，这些疾病也会损害老年人日常活动能力，加剧老年人的失能风险。
抑郁不仅会严重损害老年人的心理健康，还会对他们的身体机能产生负面影响，甚至诱发失能，本研究显示抑郁人群失能风险是非抑郁人群的2.65倍（95% CI：2.22～3.16），证实抑郁是老年人失能的危险因素，与现有文献报道相吻合[15-16]。高会莹等人[17]研究显示抑郁是老年人失能的直接影响因素，陈玲等人[18]指出抑郁状况和失能症状之间存在指向失能的有向弧连接，阮韵晨等人[19]的研究进一步表明不同程度的抑郁状况对老年人失能风险存在着梯度作用，这些都提示我们需关注老年患者的抑郁风险，强化评估与干预，以减轻抑郁对老年人生活能力的损害并降低失能风险。与心理健康老年人群相比，合并抑郁的老年人发生失能的风险更高，首先，抑郁情绪可能导致老年人认知功能下降[20]，进而影响其日常生活能力；其次，抑郁情绪会影响老年人的行为和生活方式，如减少体育锻炼、社交活动等[21]，这些行为和生活方式的改变可能进一步加剧失能；最后，抑郁影响老年人的心理状态，使其对生活失去信心，这种心理状态导致老年人忽视自己的健康状况，从而忽视对失能的预防和干预。
本研究发现，关节炎与抑郁对老年人失能风险存在相加交互作用，合并关节炎与抑郁时，老年人的失能风险是两者均不存在的4.22倍，协同效应为两者单独存在效应之和的1.51倍（SI=1.51，95% CI：1.09～2.08），老年人失能风险有26%可归因于二者的交互作用（AP=0.26，95% CI：0.09～0.42），这也是首次基于我国全国性人口数据发现关节炎和抑郁与老年人失能风险存在相加交互作用，提示关节炎和抑郁与老年人失能的发生密切相关，且两者相互影响、互为促进。Rathbun等人[22]发现,抑郁对关节炎患者的身体功能影响呈非线性关系,持续的抑郁状态可造成关节疼痛的累积效应，导致肌肉和关节功能更加恶化，产生运动恐惧、焦虑等负性情绪，从而诱发或加重抑郁症状，形成恶性循环，进而增加了失能的发生风险。从生物学角度，关节炎和抑郁都可能引起神经递质和免疫系统的异常变化，这些变化可能相互作用，进一步加剧患者的病情，进而损害患者的日常生活能力，最终增加失能风险。关节炎患者体内慢性炎症因子（如IL-6、TNF-α）的过度释放诱发中枢神经系统神经递质（如5-羟色胺和多巴胺）失调，导致兴奋性神经递质水平增加有关[23-24]，患者表现为弥漫性疼痛过敏，且常规疗法对此类疼痛效果不佳，从而诱发或加重抑郁症状，而抑郁相关的下丘脑-垂体-肾上腺轴功能紊乱可进一步促进炎症反应，形成“炎症-抑郁”双向增强环路[25]。从心理学角度，关节炎和抑郁共同影响患者的心理状态和行为模式[26]，关节炎患者因疼痛和活动受限而感到沮丧和无助，抑郁则会强化患者对疾病影响的认识，削弱患者的应对能力和生活信心，同时，抑郁患者的执行功能损害（如注意力分散、决策能力下降）可能削弱疾病管理能力，导致治疗依从性降低，影响关节炎的规范治疗和康复进程等，这些都会最终导致失能风险的增加。
综上所述，我国老年人失能现状不容乐观，亟待采取相应的措施加以防治，应作为重要的公共卫生课题进行深入探讨。基于本研究，我们认为在老年人健康管理和失能预防工作中应重点关注关节炎和抑郁这两种疾病的共病情况，通过早期筛查和及时干预，以有效降低老年人失能风险。本研究还为老年人健康管理提供了新的思路，在治疗躯体疾病的同时，我们也应关注患者的心理健康状况，提供必要的心理支持和干预措施，以促进患者的全面康复。本研究的优势是基于CHARLS全国性人口数据，纳入样本量大，可信度高，同时中国数据符合我国实际国情，实用性强。本研究同样存在一定局限性，受CHARLS数据本身限制，无法调整所有潜在混杂因素的影响，我们在未来的研究中将进一步探讨关节炎与抑郁的交互作用机制，为老年人健康管理和失能预防提供更加全面和科学的依据。
基金
收起
  • 山东省自然科学基金(ZR2023LZY018)
  • 山东省中医药科技项目(Q-2023143)
  • 山东省中医药科技项目(M-2023231)
  • 山东省医药卫生科技项目(202304071439)
  • 日照市中医药科技项目(RZY2023C06)
文献
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2025年第52卷第21期
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doi: 10.20043/j.cnki.MPM.202505220
  • 接收时间：2025-05-13
  • 首发时间：2026-10-29
  • 出版时间：2025-11-10
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  • 收稿日期：2025-05-13
基金
山东省自然科学基金(ZR2023LZY018)
山东省中医药科技项目(Q-2023143)
山东省中医药科技项目(M-2023231)
山东省医药卫生科技项目(202304071439)
日照市中医药科技项目(RZY2023C06)
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    日照市中医医院，山东　日照　276800

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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
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
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